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HIV/AIDS in the United States: 2008-2010

August 5, 2011

While the Federal government's investment in treatment and research is helping people with HIV/AIDS live longer and more productive lives, HIV continues to spread at a staggering national rate. The latest incidence data from the Centers for Disease Control and Prevention (CDC) estimates nationally there were 48,100 new HIV infections in 2009. The following HIV/AIDS statistics only represent a portion of the epidemic in the U.S. -- those cases in states and dependent areas with confidential name-based reporting that have been both confirmed through testing and reported. The CDC estimates that 21% of all persons living with HIV are unaware of their status.

Reported AIDS Casesi

Reported AIDS Cases

Demographic Trendsii

The HIV/AIDS epidemic disproportionately affects those at risk from social factors such as disparity and discrimination. The following demographic numbers are 2008 year end estimates from the 2009 CDC Surveillance Report of forty-five states and dependent areas with confidential name-based reporting.

Demographic Trends


Fiscal Year 2010 Funding for HIV/AIDS in the U.S.

At-a-Glance

Fiscal Year 2010 Funding for HIV/AIDS in the U.S. at a Glance

Prevention

The Centers for Disease Control and Prevention was provided $799,300,000 for HIV prevention programs in 2010. These funds were allocated to state and local health departments and community-based organizations to finance counseling, testing programs, health education/risk reduction activities, and surveillance/monitoring programs.iii

Ryan White CARE Act

The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, enacted in 1990 and reauthorized in 1996, 2000, 2006, and 2009 is the centerpiece of the federal government's efforts to improve the quality and availability of care for medically underserved individuals and families affected by HIV/AIDS. The CARE Act, administered by the HIV/AIDS Bureau of the Health Resources and Services Administration, provides funding to states, territories, and other public and private nonprofit entities to develop, organize, coordinate, and operate more effective and cost-efficient systems for the delivery of essential health care and support services to people living with HIV/AIDS and their families.

  • Part A -- Eligible Metropolitan Areas (EMAs) and Transitional Grant Areas (TGAS): Part A provides funding to Eligible Metropolitan Areas (EMAs) and Transitional Grant Areas (TGAs), areas that are disproportionately affected by the HIV epidemic. To be considered EMAs, metropolitan areas must have more than 2,000 cumulative AIDS cases over the last five-years and a population of 50,000 or more. Cities are considered TGAs if they have at least 1,000, but not more than 1,999, cumulative AIDS cases in the last five years, and a population of 50,000 or more.

    In FY 2010, the United States allocated $678,100,000 in Part A funding.iv

    • EMAs: Atlanta, Baltimore, Boston, Chicago, Dallas, Detroit, Ft. Lauderdale, Houston, Los Angeles, Miami, Nassau-Suffolk, New Orleans, New York, Newark, New Haven, Orlando, Philadelphia, Phoenix, San Diego, San Francisco, San Juan, Tampa-St. Petersburg, Washington D.C., and West Palm Beach.
    • TGAs: Baton Rouge, Bergen-Passaic, Caugus, Charlotte-Gastonia, Cleveland, Denver, Dutchess County, Ft. Worth, Hartford, Indianapolis, Jacksonville, Jersey City, Kansas City, Las Vegas, Memphis, Middlesex-Somerset-Hunterdon, Minneapolis-St. Paul, Nashville, Norfolk, Oakland, Orange County, Ponce, Portland, Riverside-San Bernardino, Sacramento, St. Louis, San Antonio, San Jose, Santa Rosa, Seattle, St. Louis, Vineland-Millville-Bridgeton.
  • Part B -- States and Territories: Part B helps state health departments improve the quality, availability, and organization of HIV health care and support services. In additional to base grant, Part B funds support the AIDS Drug Assistance Program (ADAP) which provides medications to individuals with low income, the Minority AIDS Initiative (MAI), and Supplemental Grants for Emerging Communities (EC), cities reporting between 500 and 1,999 cumulative AIDS cases in the past five years.

    In FY 2010, the U.S. allocated $1,276,800,000 in Part B funds, which included $418,800,000 for CARE and $858,000,000 for ADAP.v

  • Part C -- Early Intervention Services: Part C supports competitive grants to provide medical treatment and medical support services for people living with HIV including HIV testing, early intervention services, risk reduction counseling, case management, outreach, oral health, nutrition, and mental health services. Part C supports Early Intervention Services (EIS) grants that provide services for HIV positive individuals with low income who are uninsured or underinsured as well as grants for planning and capacity building to help rural or underserved communities develop high-quality HIV primary care. In FY 2010, the U.S. provided $206,400,000 in Part C funds.vi
  • Part D -- Capacity Building and Women, Infants, Children, Youth and Their Families: Part D focuses on the operation and development of primary care systems and social services for women and youth, who represent a growing share of the epidemic. In FY 2010, the U.S. provided $77,600,000 in Part D funds.vii
  • Other CARE Act Funding Programs:

    AIDS Education and Training Centers (AETC) Program: AETCs provide training, consultation, and information to HIV health care providers through a network of 1 international center; 5 national centers; 11 regional centers, each of which serves between two and ten states and/or territories; and over 130 local performance sites across all 50 states, the District of Columbia, and the U.S. territories. Funding is allocated to each of the 17 national and regional centers, which then distribute resources to local performance sites in each state. Note that international, national, and local AETC programs may receive funding from HRSA through non-Ryan White grants.

    Total Ryan White AETC Fundingviii: $34,700,000

    AETCsix

    International:

    International Training and Education Center for Health (I-TECH)
    901 Boren Avenue, Suite 1100
    Seattle, WA, 98104-3508
    Email: info@go2itech.org
    Phone: 206-221-4944
    Fax: 206-221-4945
    Web Site: www.go2itech.org

    National:

    AETC National Evaluation Center
    University of California, San Francisco
    AIDS Policy Research Center, Center for AIDS Prevention Studies
    50 Beale Street, Suite 1300
    San Francisco, CA, 94105
    Email: aetcnec@ucsf.edu
    Phone: 415-597-9186
    Fax: 415-597-9213
    Web Site: aetcnec.ucsf.edu

    National HIV/AIDS Clinicians' Consultation Center
    University of California, San Francisco
    Department of Family and Community Medicine
    San Francisco General Hospital
    1001 Potrero Avenue
    Building 20, Ward 2203
    San Francisco, CA, 94110
    Web Site: www.nccc.ucsf.edu

    AETC National Center for HIV Care in Minority Communities
    HealthHIV
    2000 S St., NW
    Washington, DC, 20009
    Phone: 202-232-6749
    Fax: 202-232-6750
    Web Site: www.NCHCMC.org

    AETC National Multicultural Center
    Howard University College of Medicine
    1840 7th Street, NW, 2nd Floor
    Washington, DC, 20001
    Phone: 202-865-8146
    Fax: 202-667-1382
    Web Site: www.aetcnmc.org

    AETC National Resource Center
    François-Xavier Bagnoud Center
    School of Nursing, University of Medicine and Dentistry of New Jersey
    65 Bergen Street, 8th floor
    Newark, NJ, 07101
    Email: info@aidsetc.org
    Web Site: www.aidsetc.org

    Regional:

    Delta Region AETC
    Louisiana State University Health Sciences Center
    School of Public Health
    136 South Roman Street, 2nd Floor
    New Orleans, LA, 70112
    Phone: 504-903-0788
    Fax: 504-903-7186
    Web Site: www.deltaaetc.org

    Florida/Caribbean AETC
    University of South Florida, Center for HIV Education and Research
    13301 Bruce B. Downs Boulevard, MHC 1715
    Tampa, FL, 33612
    Email: Contact@FCAETC.org
    Phone: 813-974-4430
    Fax: 813-974-8451
    Web Site: www.FCAETC.org

    Midwest AETC
    University of Illinois at Chicago, Jane Addams College of Social Work
    1640 W. Roosevelt Road, Suite 511 (M/C 779)
    Chicago, IL, 60608-1316
    Email: matec@uic.edu
    Phone: 312-996-1373
    Fax: 312-413-4184
    Web Site: www.matec.info

    Mountain Plains AETC
    University of Colorado Denver
    Department of Medicine, Division of Infectious Diseases
    12631 East 17th Avenue, MS 8204
    Aurora, CO, 80045
    Phone: 303-724-0867
    Fax: 303-724-0875
    Web Site: www.mpaetc.org

    New England AETC
    23 Miner Street
    Ground Level
    Boston, MA, 02215-3319
    Email: aidsed@neaetc.org
    Web Site: www.neaetc.org

    New York/New Jersey AETC
    Columbia University, Department of Psychiatry
    HIV Center
    100 Haven Avenue #31G
    New York, NY, 10032
    Email: nynjaetc@columbia.edu
    Phone: 212-304-5530
    Fax: 212-304-5555
    Web Site: www.nynjaetc.org

    Northwest AETC
    Harborview Medical Center
    Mail Stop: 359932
    325 Ninth Avenue
    Seattle, WA, 98104
    Web Site: www.nwaetc.org

    Pacific AETC (PAETC)
    Department of Family and Community Medicine
    University of California, San Francisco
    50 Beale Street, Suite 1300
    San Francisco, CA, 94105
    Phone: 415-597-8198
    Fax: 415-597-9386
    Web Site: www.paetc.org

    Pennsylvania/MidAtlantic AETC
    University of Pittsburgh Graduate School of Public Health
    130 DeSoto Street
    A427 Crabtree Hall
    Pittsburgh, PA, 15261
    Phone: 412-624-1895
    Fax: 412-624-4767
    Web Site: www.pamaaetc.org

    Southeast AETC
    Emory University School of Medicine
    1256 Briarcliff Road, NE
    Building A, Suite 238
    Atlanta, GA, 30322
    Email: seatec@emory.edu
    Phone: 404-727-2929
    Fax: 404-727-4562
    Web Site: www.seatec.emory.edu

    Texas/Oklahoma AETC
    Parkland Health and Hospital Systems
    Chase Bank Building
    6300 Harry Hines Boulevard, Suite 250
    Dallas, TX, 75235
    Phone: 214-590-2181
    Fax: 214-590-2184
    Web Site: www.aidseducation.org

    Dental Program: The Ryan White Care Act Dental program provides funding to the Community Based Dental Program, which aims to increase HIV-positive individuals' access to oral health care services while providing education and clinical training for dental care providers. The Dental program also provides funding for a Dental Reimbursement Program which reimburses dental schools, postdoctoral dental education programs, and dental hygiene programs for oral health care of individuals living with HIV.

    In FY 2010, the total funding allocated to the dental programs was $13,600,000.x

    Minority AIDS Initiative (MAI): The Minority AIDS Initiative (MAI) was created by the United States Department of Health and Human Services (HHS) and the Congressional Black Caucus (CBC) in 1998 in response to the HIV/AIDS health crisis facing racial and ethnic minorities in the United States. The program funding is channeled through several Federal agencies and utilized across all Parts of the Ryan White CARE Act. MAI funds are targeted at HIV/AIDS programs that directly benefit racial and ethnic minority communities.

    Total MAI Fundingxi: $420,000,000

    Special Projects of National Significance (SPNS): SPNS is the research and development aspect of the Ryan White CARE Act. SPNS is responsible for assessing the effectiveness of certain care models, providing support for innovative models of HIV/AIDS service delivery and for assisting the replication of effective models across the nation.

    Total SPNS Fundingxii: $25,000,000

Housing Opportunities for Persons With AIDS

The Housing Opportunities for Persons with AIDS program (HOPWA) provides housing assistance and related supportive services for HIV positive persons with low income and their families. Funding is provided in the form of formula grants, which are awarded to eligible states and cities on behalf of their metropolitan areas, and competitive grants, which are awarded to model projects or programs.

In FY 2010, the HOPWA program awarded $335,000,000 in grants to states.xiii

National Issues

ADAP -- AIDS Drug Assistance Programs save lives by providing HIV-related medications to uninsured and under insured individuals. ADAPs are primarily funded through Ryan White Part B but also receive state and private pharmaceutical funding. Over 2010, the economic recession put increased pressure on states budgets, at the same time clients seeking to enroll in ADAPs drastically increased. As a result, State ADAPs face a crisis in which 9,039 individuals in thirteen states are currently on wait lists for ADAP as of August 4, 2011 according to the National Alliance of State and Territorial AIDS Directors (NASTAD). Furthermore, cost cutting measures such as reduced formularies and restricted eligibility levels have been taken in eighteen states and Puerto Rico. Greater federal funding for ADAPs is needed so that individuals to receive the life-saving medications that ADAPs provide.xiv

Enhanced Comprehensive HIV Prevention Plan (ECHPP) -- In 2010, the Centers for Disease Control and Prevention (CDC) released a plan for prevention targeting twelve cities (Miami, New York City, Chicago, Los Angeles, Washington D.C., Atlanta, Philadelphia, Houston, San Francisco, Baltimore, Dallas, San Juan) that compromise 44% of all infections in the United States. In accordance with the National HIV/AIDS Strategy, the Department of Health and Human Services (HHS) built upon the program with what is known as the "twelve cities" project by coordinating cross-departmental collaboration with the Centers for Medicare and Medicaid Services (CMS), Health Resources and Services Administration (HRSA), Indian Health Service (IHS), National Institutes of Health (NIH), and Substance Abuse and Mental Health Services Administration (SAMHSA).

Syringe Exchange -- In 2009, the nationwide ban on a state's use of federal funds for Syringe Exchange Programs (SEPs) was removed through appropriations legislation and signed by President Barack Obama. Numerous studies have indicated that SEPs offer vital care and services to intravenous drug users and reduce risk behavior. Yet, despite long held support from the CDC, NIH, and the majority of the medical and scientific community, syringe exchange programs remain politically targeted.xv There are currently 221 exchange programs operating one or more exchange sites in 32 states, D.C., Puerto Rico, and the Indian Nations.xvi

Policy and Law

Criminalization, which is often dependent on known HIV status, creates barriers to testing along with discouraging disclosure and fostering stigma. U.S. Federal law has one statue specific to HIV criminalization under which no prosecutions have been made. A few cases have used HIV-related enhancements, though no official guidelines on HIV-related enhancements exist. Under the Uniform Code of Military Justice which applies to members of the U.S. Armed Forces, there exists no provision specific to HIV. However, military service members have been prosecuted through general criminal assault provisions, failure to follow (safe-sex or disclosure) orders, and conduct prejudicial to good order. Certain state and local jurisdictions have HIV-specific criminal laws and many have made prosecutions and arrests based on HIV status.xvii

AIDS United Partners and Grantees

AIDS United promotes collaborative local planning and provides strategic grants and technical support to more than 400 direct service organizations annually through our Community Partnerships, Public Policy Committee, and targeted initiatives such as AmeriCorps, Access to Care (A2C), GENERATIONS/Women's Initiative, Southern REACH, Puerto Rico grantmaking, and the Syringe Access Fund.

U.S. State Level AIDS Leadership

Julie Scofield
National Alliance of State and Territorial AIDS Directors, Executive Director
444 North Capitol Street, NW, Suite 339
Washington, D.C. 20001
Phone: (202) 434-8090
E-mail: jscofield@nastad.orgxviii


References

  1. HIV/AIDS Surveillance Report, 17 (2005), 18 (2006), 19 (2007), 20 (2008), 21 (2009), Division of HIV/AIDS Prevention, Centers for Disease Control & Prevention, available from: www.cdc.gov/hiv/topics/surveillance/resources/reports/.
  2. HIV/AIDS Surveillance Report, 21 (2009), Division of HIV/AIDS Prevention, Centers for Disease Control & Prevention, available from: www.cdc.gov/hiv/topics/surveillance/resources/reports/.
  3. 2012 Appropriations for Federal HIV/AIDS Programs, AIDS Budget and Appropriations Coalition, available from: http://sites.google.com/site/abacfy12/.
  4. 2012 Appropriations for Federal HIV/AIDS Programs, AIDS Budget and Appropriations Coalition, available from: http://sites.google.com/site/abacfy12/.
  5. 2012 Appropriations for Federal HIV/AIDS Programs, AIDS Budget and Appropriations Coalition, available from: http://sites.google.com/site/abacfy12/.
  6. 2012 Appropriations for Federal HIV/AIDS Programs, AIDS Budget and Appropriations Coalition, available from: http://sites.google.com/site/abacfy12/.
  7. 2012 Appropriations for Federal HIV/AIDS Programs, AIDS Budget and Appropriations Coalition, available from: http://sites.google.com/site/abacfy12/.
  8. 2012 Appropriations for Federal HIV/AIDS Programs, AIDS Budget and Appropriations Coalition, available from: http://sites.google.com/site/abacfy12/.
  9. About the AIDS Education & Training Centers, AETC National Resource Center, available from: www.aids-ed.org/aidsetc?page=ab-00-00.
  10. 2012 Appropriations for Federal HIV/AIDS Programs, AIDS Budget and Appropriations Coalition, available from: http://sites.google.com/site/abacfy12/.
  11. 2012 Appropriations for Federal HIV/AIDS Programs, AIDS Budget and Appropriations Coalition, available from: http://sites.google.com/site/abacfy12/.
  12. 2012 Appropriations for Federal HIV/AIDS Programs, AIDS Budget and Appropriations Coalition, available from: http://sites.google.com/site/abacfy12/.
  13. 2012 Appropriations for Federal HIV/AIDS Programs, AIDS Budget and Appropriations Coalition, available from: http://sites.google.com/site/abacfy12/.
  14. ADAP Watch Update -- August 5, 2011, NASTAD, available from: http://nastad.org/Files/020843_ADAP%20Watch%20update%20-%208.5.11.pdf.
  15. Syringe Exchange and HIV/AIDS, AIDS United (published under formerly AIDS Action), available from: www.aidsunited.org/uploads/docs/Learn-Syringe_Exchange_and_HIV.pdf.
  16. Syringe Exchange Programs in the United States 2011, amfAR, available from: www.amfar.org/uploadedFiles/On_The_Hill/SEPS.pdf?n=3826%29.
  17. Ending and Defending Against HIV Criminalization: A Manual for Advocates, Volume 1, State and Federal Laws and Prosecutions, The Center for HIV Law and Policy, Fall 2010, available from: www.hivlawandpolicy.org/resources/view/564.
  18. NASTAD Staff, National Alliance of State and Territorial AIDS Directors, available from: www.nastad.org/contact_us.aspx.



  
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This article was provided by AIDS United. Visit AIDS United's website to find out more about their activities and publications.
 

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