The Next Wave in AIDS Care: Reauthorization of the Ryan White CARE Act 2005-2010

The AIDS Institute (TAI) is a national nonprofit public policy research, advocacy, and education organization based in Washington, DC, and Florida. Since 1992, TAI has sought to improve HIV/AIDS research, prevention, healthcare, social support services, and housing programs through public policy and education. In recent years the organization has expanded this role to the areas of Hepatitis, Sexually Transmitted Infections, and Tuberculosis. While an independently incorporated agency, TAI is associated with the Division of Infectious Diseases and Tropical Medicine at the University of South Florida College of Medicine.

The reauthorization of the CARE Act provides an opportunity to improve HIV/AIDS services for a large group of persons living with HIV/AIDS. For that reason, and since there has been a dramatic shift in the domestic epidemic since the 1990s, TAI has participated in previous reauthorizations and is actively participating in this year's reauthorization. Since the last reauthorization we have seen rapid advances in medical care and treatment, as well as a corresponding reduction in mortality and morbidity.

TAI began preparing for this reauthorization two years ago by conducting public policy research about the relationship between CARE Act and Medicaid services; analyzing cost containment in CARE Act ADAP services; and researching the growing co-infection of HIV/AIDS with hepatitis B and C. These and other research papers may be found on the TAI website at: www.theaidsinstitute.org.

In addition, a TAI staff working group on reauthorization, including participation by the TAI Board of Directors, was established. That work group has reviewed data and internal and external recommendations, met with various interested parties and experts, and deliberated on important issues. Moreover, the agency has actively participated in a national coalition on reauthorization and serves as the co-chair of that body. This national coalition has deliberated about reauthorization issues and met with elected officials regarding the importance of the HIV/AIDS care system and, in particular, the CARE Act.

This paper describes The AIDS Institute's basic views about long-term HIV/AIDS care in the United States for those individuals who must rely on the public health system, as well as the more short-term issues associated with the 2005 CARE Act reauthorization. It is intended to stimulate further discussion in the AIDS community, the Congress and the Administration. Furthermore, it will be used by the agency as a framework to discuss reauthorization with elected officials and others involved in the process of reauthorizing the CARE Act.