-- AIDS advocates are hailing as a victory the U.S. House of Representative's vote last night to reauthorize the Ryan White CARE Act, a program which provides emergency financial relief to cities, states and local community-based programs affected by the AIDS epidemic. Originally enacted in 1990, the Ryan White CARE Act expired in September 1995. Aside from reauthorizing this vital program through 2000, the reauthorization bill passed yesterday makes a number of significant changes intended to better reflect the effects of AIDS on contemporary America. The Senate is expected to approve the same bill some time this week.
"Passage of this vital piece of AIDS care legislation is definitely cause for celebration. AIDS Action and our other national partners have labored for more than two years to reauthorize a Ryan White CARE Act that meets the critical needs of all Americans living with HIV disease at this stage of the epidemic," said Fred Miller, interim executive director of AIDS Action Council. "The legislation overwhelmingly approved last night is a testament to our efforts, and represents bipartisan support for the concept of caring fairly and comprehensively for the hundreds of thousands of people who are HIV-infected in this country."
The Ryan White CARE Act of 1990 was made up four titles which both worked independently of each other and complemented each other in a number of ways to provide a wide range of comprehensive services. These original four titles include:
- Title I.
This title provides emergency formula and supplemental grants to those eligible metropolitan areas (EMAs) disproportionately affected by the HIV/AIDS epidemic to develop and deliver comprehensive HIV/AIDS health care services. There are currently 49 EMAs, among them New York City, San Francisco, Los Angeles and Miami.
- Title II.
This title provides formula grants to states to improve the quality, availability and organization of health care and support services, to fund health insurance continuation, home-based care services, and the AIDS Drug Assistance Program (ADAP), which provides life-sustaining drugs to low income individuals who would otherwise go without.
- Title III(b).
This title provides grants to existing community-based clinics and public health providers serving traditionally underserved populations to deliver early and ongoing comprehensive HIV/AIDS primary health care services.
- Title IV.
This title provides grants for pediatric AIDS research with family-centered health and support services to meet the HIV/AIDS care needs of adolescents, children and their mothers.
While the reauthorization bill passed yesterday maintains the fundamental structure of the Ryan White CARE Act, it does make several significant changes, among these changes are:
The establishment of a fifth title to the Ryan White CARE Act. Title V includes the AIDS Dental Reimbursement Program, the Special Projects of National Significance (SPNS), and the AIDS Education and Training Centers (AETC) program. The SPNS program addresses the needs of underserved populations and model programs of national significance. The AETC program, transferred from federal health professions education legislation, provides critical up-to-date HIV clinical training for physicians, nurses, social workers and other allied health professionals across the country.
The modification of Title I and Title II funding formulas so that the distribution of these funds more accurately reflects the service needs of people living with AIDS in states and cities. The Title II formula, specifically, is modified to better distribute funds to states that do not contain Title I EMAs.
The requirement that Title I and II grantees prioritize a portion of their funds for the provision of services for women, infants, and children. These services may include but are not limited to the provision of treatments to prevent the perinatal transmission of HIV.
A modification to the way that supplemental grants to Title I EMAs are awarded. Supplemental grants will now be awarded based on, among other current criteria, the degree of severe need in a given EMA as demonstrated by rates of co-morbidity factors. These factors include homelessness, poverty, substance abuse, severe mental illness and tuberculosis. These factors are an indication of the complexity and costs facing EMAs in providing services to their HIV-infected population.
AIDS advocates are expressing concern about other more troubling provisions included in the reauthorization bill, including ones dealing with spousal notification of HIV infection and mandatory HIV testing.
The reauthorization bill includes Sen. Jesse Helms's (R-N.C.) original spousal notification amendment with minor revisions. This provision prohibits the Secretary of Health and Human Services from making Title II grants to any state that does not make a good faith effort to notify the spouse of a known HIV-infected person that he or she may have been exposed to HIV and should seek testing. The definition of "spouse" in this provision is any current marriage partner or former marriage partner at any time within the 10 years prior to the diagnosis of HIV infection.
The reauthorization bill also includes provisions regarding counseling and testing of pregnant women and newborns that AIDS advocates fear may lead to state legislators implementing mandatory testing programs. This provision differs from the one originally championed by Reps. Tom Coburn (R-Okla.) and Gary Ackerman (D-N.Y.) in that it does not mandate HIV testing of newborns or pregnant women but instead emphasizes the importance of voluntary counseling and testing. However, because the language is confusing and does imply a threat to states's Title II funding unless a series of measures are met, AIDS advocates fear state legislatures will implement mandatory testing programs to protect themselves against the loss of critical Title II funds.
For more information, contact
AIDS Action Council
1875 Connecticut Avenue NW #700
Washington DC 20009
202-986-1300 exension 3042