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 graph below depicts the HIV/AIDS epidemic in Rhode Island according to the latest data from the CDC. Note that the following HIV/AIDS statistics only represent a portion of the epidemic in the U.S. -- those cases that have been both confirmed through testing and reported.

Reported AIDS Casesⁱ

Demographic Trendsⁱⁱ

The HIV/AIDS epidemic disproportionately affects those at risk from social factors such as disparity and discrimination. The following demographic numbers are from the State of Rhode Island Department of Health through 2008.

Fiscal Year 2010 Funding for HIV/AIDS in Rhode Island

At-a-Glance

Prevention

The Centers for Disease Control and Prevention provided Rhode Island with $2,032,934 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.^iv

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 state received $0 Part A funding.^v

• 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 state received $3,794,189 in CARE Act Part B funds.^vi

• 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 state received $1,169,743 in Part C funds.^vii
• 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 state received $578,941 in Part D funds.^viii
• 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 (the AETC National Resource Center, the National HIV/AIDS Clinicians' Consultation Center, the National Evaluation AETC, the AETC National Center for HIV Care in Minority Communities, and the AETC National Multicultural Center); 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.

  Total Statewide AETC Funding^ix: $0

  AETCs^x

  Regional:

  New England AIDS Education and Training Center
  23 Miner Street
  Ground Level
  Boston, MA, 02215-3319
  Email: aidsed@neaetc.org
  Web Site: www.neaetc.org
  Serves: CT, ME, MA, NH, RI, VT

  Local:

  Brown University AIDS Program (BRUNAP)
  172 Cushing Street
  Providence, RI, 02912
  Email: brunap@brown.edu
  Phone: 401-383-3004
  Web Site: www.brown.edu/BRUNAP

  The Miriam Hospital of Rhode Island
  164 Summit Avenue
  Providence, RI, 02906

  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 state's dental program was $0.^xi

  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 Funding^xii: $399,991

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.

The Department of Housing and Urban Development (HUD) provided the state a total of $2,856,164 HOPWA funding in FY 2010.^xiii

State Issues

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.^xiv There are currently exchange programs operating in Providence.^xv

Policy and Law

Rhode Island does not have any HIV-specific statues that allow for criminal prosecution, and there are no known arrests or prosecutions for HIV transmission in the state. The state has a communicable disease control statue, but has not targeted HIV. Criminalization of HIV, which is often dependent on known status, creates barriers to testing, along with discouraging disclosure and fostering stigma.^xvi

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. There are no current grants in Rhode Island.

State AIDS Director

AIDS Director
Paul Loberti, MPH
Chief Administrator
Office of HIV/AIDS and Viral Hepatitis
Division of Disease Prevention and Control
Rhode Island Department Health
3 Capitol Hill, Room 106
Providence, Rhode Island, 02908
Phone: 401-222-2320
Fax: 401-222-2488
paul.loberti@health.ri.gov^xvii

References

1. HIV/AIDS Surveillance Report, 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. 2008 Rhode Island HIV/AIDS Epidemiological Profile with Surrogate Data, Division of Community Family Health and Equity, Rhode Island Department of Health, available from: www.health.ri.gov/publications/epidemiologicalprofiles/HIVAIDSWithSurrogateData.pdf.
3. State & County QuickFacts, US Census Bureau, available from: http://quickfacts.census.gov/qfd/index.html.
4. DHAP HIV Prevention Funding Allocations by State and Dependent Area (Fiscal Year 2010), Centers for Disease Control & Prevention, available from: www.cdc.gov/hiv/topics/funding/state-awards/index.htm.
5. Ryan White Part A Awards to Eligible Metropolitan Areas (EMAs) and Transitional Grant Areas (TGAs) for FY 2010, HRSA, US Department of Health and Human Services, available from: http://hab.hrsa.gov/data/reports/partaemastgas.html
6. Find Grant Awards: Rhode Island, HRSA, US Department of Health and Human Services, available from: http://granteefind.hrsa.gov/; Breakouts provided by NASTAD: Part B totals include Base, ADAP, MAI, and EC; Base includes supplemental funds; ADAP includes supplemental and emergency funds.
7. Find Grant Awards: Rhode Island, HRSA, US Department of Health and Human Services, available from: http://granteefind.hrsa.gov/.
8. Find Grant Awards: Rhode Island, HRSA, US Department of Health and Human Services, available from: http://granteefind.hrsa.gov/.
9. Find Grant Awards: Rhode Island, HRSA, US Department of Health and Human Services, available from: http://granteefind.hrsa.gov/.
10. About the AIDS Education & Training Centers, AETC National Resource Center, available from: www.aids-ed.org/aidsetc?page=ab-00-00.
11. The HIV/AIDS Program: Caring for the Underserved; Part F: Dental Reimbursement Programs 2010 Award Amounts, HRSA, US Department of Health and Human Services, available from: http://hab.hrsa.gov/treatmentmodernization/dentalrosters2010.htm.
12. Find Grant Awards: Rhode Island, HRSA, US Department of Health and Human Services, available from: http://granteefind.hrsa.gov/.
13. HOPWA Report, US Department of Housing and Urban Development, available from: www.hudhre.info/hopwa/index.cfm?do=viewHopwaRptsSelect&opt=Awards#tab.
14. 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.
15. Syringe Exchange Programs in the United States 2011, amfAR, available from: www.amfar.org/uploadedFiles/On_The_Hill/SEPS.pdf?n=3826%29.
16. 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.
17. State HIV/AIDS Program Directory, National Alliance of State and Territorial AIDS Directors, available from: http://nastaddemo.dedicated.advansiv.com/About/res_state_Directory.aspx.