Ryan White HIV/AIDS Treatment Modernization Act: Does It Synchronize With Needs of Urban America
Ryan White, a 13 year-old, Caucasian boy, died of AIDS in 1990 (1). He contracted HIV via blood transfusion in 1984. From 1984-1990, Ryan and his family experienced a series of life-changing events that would ultimately bring necessary attention to the epidemic through legislative action. During the infancy of the AIDS epidemic in 1983 (CDC reported 1,025 cases) and Ronald Reagan’s leadership during this crisis, propelled an environment of homophobia, fear and hostility (2). Ryan’s profile did not fit the scope of the population that Reagan appeared to turn a deaf ear on. Primarily, those who were Caucasian, male and gay. Hence, Ryan White became a national story.
In 1990, Congress enacted the Ryan White Comprehensive AIDS Resource Emergency Act to improve the quality and access to care for low-income and those who were disenfranchised from the health care system.
The cumulative estimated number of deaths of persons with AIDS in the United States and dependent areas, through 2005, was 550,394. In the 50 states and District of Columbia, this included 525,442 adults and adolescents, and 4,865 children under age 13 (3). In addition, the estimated number of HIV/AIDS cases in 2005 for black, not Hispanic was 18,121 compared with White at 11, 559. Consequently, according to the 2000 census data, blacks (not Hispanic) made up 13% of the US population in 2005. The CDC estimated that 49% or 18,121 of 37,331 newly diagnosed cases in 2005 were Black (4). This unique trend among Blacks is truly alarming.
HIV longevity has been primarily been attributed to advances in medication therapy (primarily, protease inhibitors) and increased targeted marketing campaigns. As researchers grapple with the nuances of this unique trend, the newly enacted Ryan White HIV/AIDS Treatment Modernization Act of 2006 provides the Federal HIV/AIDS programs in the Public Health Service (PHS) Act under Title XXVI flexibility to respond effectively to the changing epidemic. Changes in the law were primarily economic in scope. Whereas, funding initiatives appear to be motivated by HIV epidemiology as represented by the designated area. For example, the formularies for urban areas like New York City reflect the number of individuals living with HIV/AIDS (138,000) (10). Funding formularies now called Part A (formerly, Title I) attempts to give priority to the hardest hit urban areas. What is interesting about this “evidence-based” approach is how and who determines the final numbers. Initially (Title I) grants were designated to Eligible Metropolitan Areas (EMA) and Transitional Grant Areas (TGA) that were disapproportianely affected by HIV/AIDS (5).
The funding scheme addressed core medical necessity and outreach. The complexity on how Department of Health and Human Services divided $611.6 million in 2006 appeared to test the infrastructure of the Ryan White Program.
FY 2007 Part A – Formula Grants
Eligible Metropolitan Areas
Atlanta, GA $12,223,780
Baltimore, MD $13,101,233
Boston, MA $9,091,554
Chicago, IL $16,477,405
Dallas, TX $9,137,396
Detroit, MI $5,648,743
Ft. Lauderdale, FL $9,444,098
Houston, TX $12,780,890
Los Angeles, CA $23,182,654
Miami, FL $16,014,327
New Orleans, LA $4,944,054
New York, NY $74,867,223
Newark, NJ $9,089,812
Orlando, FL $5,503,524
Philadelphia, PA $14,920,594
Phoenix, AZ $4,970,250
San Diego, CA $6,769,231
San Francisco, CA $14,672,553
San Juan, PR $9,415,282
Tampa-St. Petersburg, FL $6,330,047
Washington, DC $18,759,719
West Palm Beach, FL $5,769,416
Total FY 2007 Part A Formula Funds to EMAs $303,113,785
Bold denotes highest incidence rates of HIV in US cities.
Most Ryan White clients are of low-income, underinsured and of ethnic backgrounds. But as trends become more complex in Blacks, particularly those in prison, on probation and others who fall through the cracks…efforts to capture these cohorts appear to be lost in translation in comparison to the new Part A formularies. This is evidenced by the scope of funding parameters for the EMA’s and validation of Community Resource Guides (6, 7, and 8) from five cities. There appears to be no evidence or acknowledgement of Blacks in prison or probation, as it relates to HIV epidemiology and the correlation to Part A funding.
According to an unpublished Department of Justice report (The Health Status of Soon-to-be-Released Inmates)(8) seems to suggest that out of 11.5 million prisoners that cycle through prison each year; 18% are carriers of hepatitis C (HCV), 8% Human Immunodeficiency Virus (HIV) and tuberculosis(TB) respectively. Prison health experts believe that for these diseases, the infection rates (the number of cases per 100,000 cases) among prisoners are upward of ten times those found in the general population. In addition, a body of evidence has grown concerning the incidence of HIV rate among Black women in urban settings to down-low Black men.
The Minority AIDS Initiative (MAI) was created in 1998 in response to growing concern about the impact of HIV/AIDS on racial and ethnic minorities in the US. The core driver of the initiative is to improve HIV-related health outcomes for racial and ethnic communities disproportionately affected by HIV/AIDS. To accomplish this recurring goal, MAI has reached out to community-based providers. Within this daunting portfolio, there still appears to be minimum effort to acknowledge the prison population as it relates to HIV/AIDS in Urban America. Until this fete is acknowledge and accomplished, MAI’s portfolio will yield less than a satisfactory outcome.
1. www.ryanwhite.com [Online]. Ryan’s Story. Retrieved from www.ryanwhite.com on October 4, 2007.
2. White, R. (June 8, 2004). Reagan’s AIDS Legacy. San Francisco Chronicle.
3.Centers for Disease Control and Prevention. [Online]. Deaths of Persons with AIDS. Retrieved from http://www.cdc.gov/hiv/topics/surveillance/basic.htm#ddaids on October 4, 2007.
4. Centers for Disease Control and Prevention. [Online]. HIV/AIDS in 2005. Retrieved from http://www.cdc.gov/hiv/topics/aa/resources/factsheets/aa.htm on October 4, 2007.
5. Health Resources Services Administration. [Online]. Ryan White Care Act. Retrieved from http://hab.hrsa.gov/programs/CareActOverview/ on October 4, 2007.
6. Ohio Board of County Commissioners. [Online]. Community Resource Guide: To Medical and Social Services Available To Persons Living With HIV/AIDS in Northeast Ohio. Retrieved from http://ryanwhite.cuyahogacounty.us/services.htm on October 4, 2007.
7. www.miamidade.gov [Online]. Miami Dade County-Ryan White. Retrieved from http://www.google.com/search?sourceid=navclient&aq=t&ie=UTF-8&rls=GGLF,GGLF:1969-53,GGLF:en&q=Ryan+White+Part+A on October 4, 2007.
8. Boston Public Health Department. [Online]. Boston Public Health Commission AIDS Program. Retrieved from http://www.bphc.org/bphc/pdfs/aids_provider-manual.pdf on October 4, 2007.
9. Abramsky, S. (July 12, 2002). The Shame of Prison Health. Retrieved from http://www.thenation.com/doc/20020701/abramsky on October 4, 2007.
10. New York State Department of Health. (2005). New York State HIV/AIDS Surveillance Semiannual Report: For Cases Diagnosed through December 2005. Bureau of HIV/AIDS Epidemiology. Pp 3-40.