Since 1996 there has been a significant decline in deaths from AIDS. A primary factor contributing to this decline is the services thousands of low-to-moderate HIV-positive individuals receive from the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act. As of June 1998, more than 660,000 men, women and children have been diagnosed with AIDS in the United States. Of that number over 400,000 have died of the disease. Current trends indicate that between 650,000 to 900,000 people in the U.S. are living with HIV, but do not yet have AIDS, and 40,000 new HIV infections occur each year. The Ryan White CARE Act, originally enacted in 1990 and reauthorized in 1996, is probably the single most important piece of federal legislation enacted affecting the healthcare needs and concerns of people living with HIV. It will expire on September 30, 2000.
The CARE Act supports a crucial spectrum of services for persons living with HIV who have little or no access to some basic healthcare necessities. These services include -- but are not limited to -- AIDS medications (AIDS Drug Assistance Programs, or ADAP), primary medical care, viral load testing, and food and nutritional services. As it presently operates, the CARE Act is a collaborative effort that brings federal, state and local governments to the same table with persons living with and impacted by HIV and AIDS, healthcare providers and not-for-profit community based organizations. These groups and individuals work together to ensure that specific local health related needs and concerns are being addressed. While the current structure of the CARE Act has successfully improved the quality and quantity of life for HIV-positive individuals, there is still much to accomplish.
Statistics released in the January 14th issue of the CDC's Morbidity and Mortality Weekly Report show that men of color now represent the majority of HIV/AIDS cases among gay and bisexual men, exceeding the number of cases among white gay and bisexual men for the first time. The CDC report shows that AIDS cases among men of color increased from 31% in 1989 to 52% of the AIDS cases in 1998. "The face of AIDS among gay and bisexual men is changing," said Helene Gayle, M.D., director of the CDC's National Center for HIV, STD and TB Prevention. "African-American and Hispanic men must recognize that this is not a disease that only affects white, gay men -- gay and bisexual men of all races are affected."
Researchers now recognize that this epidemic has grown disproportionately among communities of color and difficult to reach populations, including African-Americans, Latinos, women and youth. The CDC report also cites several possible economic factors contributing to the disproportionate growth of HIV and AIDS in communities of color, such as high rates of poverty, unemployment and a lack of access to adequate healthcare. In 1998, 60% of the 500,000 individuals who received primary medical care and support services provided by the CARE Act were people of color.
Significant inroads have occurred to reduce inpatient care costs and increase healthcare access for underserved populations through provisions established by the Ryan White CARE Act. However, much work remains to be done. The CARE Act must be reauthorized in 2000 for many reasons. HIV/AIDS care continues to grow more complex as people live longer. As a result the cost of HIV care, drug therapy assistance and case management threatens to cripple local and state healthcare systems. To ensure that healthcare and support services as established by the CARE Act can continue to meet the growing needs of individuals living with HIV/AIDS and communities disproportionately impacted by the disease, funding must be increased for every part of the Ryan White CARE Act.
As programs and services established under the Ryan White CARE Act take center stage in Washington during this election year, this piece of federal legislation in all likelihood will be one of the most important debates on Capitol Hill affecting the lives of HIV-positive people. Early indications show reauthorization will not be an easy process. Some members of Congress are in favor of radically reducing the delivery of services under the CARE Act. Additional information on the CARE Act, the reauthorization process and congressional opposition can be obtained from the following web sites:
AIDS Action and
However there is something you can do now. Please take time to write a short, handwritten personal letter. You can write something along the lines of the one below. Urge your Senators and U.S. Representatives to support swift reauthorization of the Ryan White CARE Act.
The services provided under the Ryan White CARE Act continue to make it possible for thousands of Americans with HIV and AIDS to access appropriate care and treatment services, resulting in more productive lives. This access is threatened if reauthorization is blocked in Congress. It is imperative that your representative is made aware that you understand how important these services are for HIV-positive people and that you appreciate his/her continued support for the Ryan White CARE Act.
(Thank you to David Ernesto Munar, Director of Public Policy, AIDS Foundation of Chicago, for information and suggestions used in this update.)
Charles Clifton is the director of the MOCHA 2000 project for Test Positive Aware Network, the publisher of Positively Aware. The MOCHA (Men of Color HIV/AIDS) 2000 project is a collaborative effort among several Chicago HIV service organizations and the Chicago Department of Public Health seeking to identify and provide prevention efforts in communities of color.
Dear Senator Fitzgerald:
In the spring of 1987, my partner Antonio was
diagnosed with AIDS. In October of 1987, Antonio died after being hospitalized with pneumonia. Prior to his first illness in April we had no idea that Antonio had HIV or AIDS. Still suffering from denial and out of fear of rejection Antonio and I kept his illness a secret from all of our friends and family. He died in isolation.
In 1987, Antonio and I did not have access to and knowledge of agencies that provided health and support services. Today these agencies provide a crucial service to people infected and affected by HIV and AIDS.
I urge you and Congress to support AIDS care,
prevention, housing and research programs. Despite the great progress that has been made, as a black gay man I know first hand that AIDS is not over in my communities, and much work remains to be done.