Friday, January 09, 2009

Ryan White CARE Act

I'm Utsha Khatri.

The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, was the first piece of comprehensive AIDS legislation created to provide funding for people living with AIDS (PWAs) to access care and treatment. Ryan White was a young, Caucasian hemophiliac who contracted HIV through a blood transfusion. He was diagnosed with AIDS at age thirteen and died six years later. Prior to the media’s coverage of the Ryan White story, it was widely held that HIV/AIDS only affected marginalized sectors of society namely homosexuals, intravenous drug users, and racial minorities. However, because of the widespread media attention given to the Ryan White story, the American people soon realized that this was not the case and that it could potentially infect anyone. When Ryan White’s story was put on the media agenda in 1985, it changed the meaning of HIV/AIDS for the media, the public and policymakers.

Political scientist Mark Donavan explains that this shift in public consciousness allowed policy-makers to formulate an AIDS policy that would deliver benefits to what were considered “deserving” target populations. When people with AIDS were considered to be social deviants and dependents, policy-makers could not defend the use of tax dollars to provide care and treatment to these populations. However, when Americans realized that the HIV/AIDS epidemic started affecting “innocent victims” (whose infection was not caused by their behavior), policy-makers were able to create programs to provide benefits to a “deserving” population. For this reason, Ryan White CARE Act bills passed both houses with overwhelming bipartisan support in 1990.

Donavan emphasizes that during the drafting of the legislation, lawmakers attempted to, “downplay the receipt of benefits of gays while emphasizing the benefits granted to positively constructed populations, most notably children,” During floor debates lawmakers told moving stories of people with AIDS to win over support for the bill. Of the 19 stories told on the Senate floor, only one story was that of a homosexual. Lawmakers needed to justify the act by ensuring each other and the public that the recipients of the benefits did in fact deserve it. Donavan describes the final version of the bill emphasized women and children as the “victims” of the epidemic and deemphasized the extent to which benefits would be delivered to negatively constructed groups. The bill did nonetheless provide benefits to populations with negative social constructions as well; however, to the public, the policy was directed towards helping populations with positive social constructions.

The Ryan White CARE Act was first passed in 1990 as Congress’ attempt to financially assist many urban public hospitals that had not been compensated for care they provided to AIDS patients. It was reauthorized in 1996, 2000 and most recently in 2006. The reauthorization in 2006 changed the acceptable use of Ryan White funds. The amendments emphasized providing funding to urban areas with the highest prevalence of AIDS, encouraged outreach and testing and required that 75% of funding be spent on “core medical services.” Core medical services include services such medications, outpatient and ambulatory medical services, mental health services, substance abuse services, hospice care, early intervention services and home health care. Ryan White funds are also used for support services, including transportation, respite care, outreach and language services.

The Ryan White program presents the third largest source of federal funding for HIV/AIDS care, after Medicaid and Medicare. Currently, it provides about $2.2 billion a year to fund over 2,500 organizations and provides some level of care to about 500,000 people living with HIV/AIDS. Unlike Medicaid and Medicare, it is not a health insurance program. It is a series of flexible grants given to cities, states, and other public and private nonprofit organizations to develop and operate systems that deliver health and support services to uninsured or underinsured individuals affected by HIV/AIDS. Though the CARE Act was originally designed to fill the gaps in financing care, it has now grown into a major source of funding essential to the operation of HIV/AIDS programs across the country. The reauthorization in 2006 extended the program for an additional three years. After September 30, 2009 further legislative action will be needed to provide continued federal funding.

It is important to recognize that the program by itself is not capable of improving access to HIV/AIDS care and treatment for the majority of the infected population. The CARE Act is a discretionary grant program that receives annual appropriations from Congress. Services are provided only as long as the finite funds last. Therefore, it is not able to meet the rising demands in services due to the growing number of people living with HIV/AIDS. Furthermore, CARE Act programs vary from region to region due to the flexibility given to organizations in formulating programs and services. The programs therefore do not provide a single, unified policy solution to a national problem. Rebecca Haag, Executive Director of the AIDS Action Council, while expressing appreciation for the 2006 reauthorization, stressed the need of more funding. As Haag described, “…this bill alone is not sufficient to ensure that life saving drugs and medical treatment is available to all who are infected. Appropriations have fallen far short over the last several years while the epidemic is growing with 40,000 new infections every year.”


Anonymous said...

AIDS: Dark in Life

-Mohammad Khairul Alam-
-Executive Director-
-Rainbow Nari O Shishu Kallyan Foundation-
-24/3 M. C. Roy Lane-
-Dhaka-1211, Bangladesh-
-Tell: 880-2-8628908-
-Mobile: 88-01711344997-

The Asian HIV/AIDS epidemic is highly dynamic. Though, in the early 1980s when the HIV/AIDS epidemic was becoming significant in the Western Hemisphere and Africa, only a few cases of HIV infection were reported in Asia. The risky behaviour and vulnerability, which promote, fuel and facilitate the rapid transmission of HIV, are present in virtually all countries of the Asian region. Thus, the potential for its further spread is significant. Based on evidence from various causes, behaviours that produce the highest risk of infection in this region are unprotected sex (both heterosexual and homosexual) and needle sharing among intravenous drug users (IDUs). However, the HIV/AIDS pandemic in Asia took a new turn in the 1990s. It is spreading faster in parts of Asia than in other regions of the world. Some have predicted that the magnitude of the HIV/AIDS epidemic in this region in the twenty-first century could be much worse.

Trafficking in young girls, children and women is a matter of great concern all over the world. In South Asia, cross-border trafficking, sourcing, transit to destination is a big problem. Even more prevalent is the movement of persons within the countries for exploitation in various forms. There are no definite figures about the number of victims.

Trafficking for commercial sexual exploitation is the most virulent form in South Asia. Internal displacement due to conflict in some of these countries, poverty and lack of employment opportunities, increase the vulnerabilities to being trafficked.

AIDS researcher Mr. Anirudha Alam said, "Trafficking & HIV/AIDS is interrelated, especially women and girls are trafficking for use of sexual industry. Most of trafficking girls would face several physical & sexual abuses. When a girl or women newly enrolls a sex industry, she tries to safe herself heard & soul, but most of the time they couldn't free her."

Though this data is not enough to certify the fact, still South Asia is home to one of the largest concentrations of people living with HIV. Female sex workers (FSWs) - as a group - are an important driver of the epidemic. As has been shown in a very recent research involving repatriated FSWs in Nepal, many of the FSWs who have been trafficked are at a significantly higher risk than "average" women of contracting HIV. The Rainbow Nari O Shishu Kallyan Foundation conducted a survey that focuses on the attitude, behavior and practice of FSWs in Goalondo Brothel, this study points out that almost 53% of sex workers enter the profession before the age of 20 years, and 30% enter between 20 to 25 years of age, and some of them have been entangled through instigation of the traffickers.

The spread of HIV/AIDS in Asia is expected to accelerate if Governments fail to act with a sense of urgency, and if preventive action is taken too little or too late. In this regard, the Monitoring the AIDS Pandemic Study has warned that the recent increase in HIV prevalence in specific locations in Asia should be regarded as a serious warning of more widespread epidemics. It is also significant to recognize that HIV/AIDS cases are often underreported. Asia is lacking in providing a comprehensive system of complete range of voluntary counseling with testing (VCT) services. However, governments and some NGOs have developed some VCT centers in several regoin in their countries. Though insufficient in number, the initiative is praiseworthy.

The risk factors for HIV/AIDS infection is at an upsetting level in Bangladesh. Being a low prevalence country, containing the epidemic in the early stage is very essential. The Voluntary Counseling and Testing (VCT) services for HIV is now acknowledged within the international arena as an efficacious and pivotal strategy for both HIV/AIDS prevention and care. The need for VCT is increasingly compelling as HIV infection rates continue to rise, and many countries recognised the need for their populations to know their sero-status as an important prevention and intervention tool. However, access to VCT services in Bangladesh like many developing countries is limited. Many people are still very reluctant to be tested for HIV. This reluctance is the result of barriers to VCT, which are: stigma, gender inequalities and lack of perceived benefit.

The consequences of HIV/AIDS can be far-reaching for young people. Not only does HIV disease have terrible consequences for the individual, causing serious illness and eventual death, it has the potential to trigger negative social reactions. Across the world, people with HIV/AIDS routinely experience discrimination, stigmatization and ostracization.

References: CARE, World Bank, UNAIDS.

AIDS said... together account for one in every two deaths. This year, the report says, “a mil­lion women will die from HIV/AIDS

Marshall said...

We are not dying of AIDS. We have this stupid nonspecific test that looks for a reaction between proteins thought to make up HIV and antibodies. This test is so nonspecific that there are more than 60 other ways that can cause a person to test positive. And hemophelia is one of them. Why do you think we have to use PCR to even claim we have found HIV in the blood of an AIDS patient? We have never found enough to do anything. Also there is no such thing to date as a retrovirus able to kill any cell. Ask the scientist who isolated the genetic structure of a retrovirus, Peter Duesberg. Why did they finally have to take the credit of finding HIV away from Gallo? Something is wrong. Wake up. Are you afraid to read about Maria Papagiannidou? She cured herself of AIDS by simply quiting the antiretrovirual drugs. Read her book, "Goodbye AIDS! Did it ever exist?" Open your mind. We have been duped.
Go to and begin a study of your own. Peace,
Marshall Sandefur