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Issues

Women and AIDS

Women living with HIV/AIDS often place the needs of their families ahead of their own, including health care. Ryan White outreach and primary care programs empower these women to live longer, healthier lives and HRSA works to better educate providers to address the unique needs of this population.

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Gay Men

Gay men have been heavily impacted by HIV/AIDS since the beginning of the epidemic. Gay men have helped lead the way towards creating high standards of culturally competent care and integral to the creation and direction of the Ryan White HIV/AIDS Program.

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Cultural Competency

Culturally competent service providers are crucial to recruiting and retaining people living with HIV/AIDS into primary care, particularly when they are members of historically disenfranchised communities and populations such as people of color, gay men, women, and substance users.

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Confidentiality

Ryan White confidentiality guidelines have helped allay the fears that many people living with HIV have around unwanted disclosure and HIV discrimination.

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Treatment Advances

The Ryan White HIV/AIDS Program ensures people living with HIV/AIDS have access to the latest treatments, including life-saving AIDS medications. Advances in vaccine and pharmaceutical research promise new ways to treat, and perhaps halt, HIV infection in the future.

African-Americans

African-Americans are the racial and ethnic group most disproportionately affected by the HIV/AIDS epidemic. By providing culturally competent, comprehensive care the Ryan White HIV/AIDS Program is committed to turning this tide.

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Aging

Wonderful advances in treatment have brought with them the promise of longer life for people living with HIV. The Ryan White HIV/AIDS Program has been there, growing with the people it serves and ensuring that the program’s aging patients have many years of good health and happiness to look forward to, every step of the way.

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HIV/AIDS Stigma

Stigma represents one of the most complex and pervasive barriers to health care for people living with HIV/AIDS. From the beginning, the Ryan White HIV/AIDS Program has fought against the discrimination and isolation that stigma creates, a commitment that helps more people engage and remain in care.

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Rural Challenges

In rural America, unique challenges add to the complexity of providing care for people living with HIV/AIDS. The Ryan White HIV/AIDS Program is, thus, a critical source of support in remote areas, helping patients overcome barriers to care as well as providing technical assistance for providers.

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Young People

Youth represent the only age group in the United States still experiencing increases in HIV diagnoses. The Ryan White HIV/AIDS Program is working tirelessly to find ways of reaching more of these at-risk young people and providing the kind of comprehensive, responsive care that can change lives.

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Snapshot: Demographics of the HIV Epidemic in the United States

According to the U.S. Centers for Disease Control and Prevention, there are more than 1 million HIV-positive people in the United States. People of color and the poor are hardest hit: HIV is 7.6 times more prevalent among Blacks, and 2.6 times more prevalent among Hispanics than Whites. It is twice as common among people living below the poverty line than among those above it.1,2

HRSA’s Response to HIV Treatment Advances*

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For more than two decades, Ryan White HIV/AIDS Program grantees have rapidly implemented life-saving advances in HIV care and treatment in their clinics, under the guidance of the U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB). The Ryan White HIV/AIDS Program is the payor of last resort for poor, uninsured, or underinsured HIV-positive people in the United States. But grantees are far more than gap-fillers: They are extraordinary for both the range and quality of services they offer. Years of dedication and hard work have built a medical home for people living with HIV/AIDS (PLWHA) who have nowhere else to turn.

PLWHA often face multiple hardships, such as poverty, unstable housing, incarceration, and stigma as well as addiction and other medical and psychiatric comorbidities. From the beginning, HRSA recognized and developed the capacity to address the medical and psychosocial needs of PLWHA. Ryan White–funded programs provide patient-centered HIV primary care, medications, mental health care, addiction treatment, case management, transportation, and other ancillary services proven to be essential for keeping people in care.4,5 As Brian Feit, public health analyst in HAB’s Technical Assistance Branch, notes, “We built a system that would hold people as they got sicker. Lo and behold, it was the system we needed to keep people alive.”

Although the program itself is administered by HAB, the Federal Government has always made community involvement a cornerstone of its implementation at the State and local levels. Planning Councils and Consortia, for example, are comprised in part by consumers who reflect the demographics of the local epidemic. Participation of PLWHA is essential for identifying and prioritizing community needs; making decisions to allocate funds; and creating short- and long-term plans for service coordination, delivery, and oversight.

HIV Treatment Timeline

“At the beginning of the epidemic, there was no treatment. We didn’t talk much about the future,” recalls Linda Frank, a public health professor and HRSA AIDS Education and Training Center (AETC) faculty member. “We were just watching people die.” Both the prognosis and the standard of care for HIV infection have changed since those early years. Antiretroviral therapy (ART) has dramatically lowered HIV-related morbidity and mortality in the United States.6,7,8

By 2006, highly active ART (HAART) had increased life expectancy among PLWHA in the United States by so much that the combined total is equivalent to 3 million years of life.9 But when the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act (also called the Ryan White HIV/AIDS Program) was enacted in 1990, the only approved treatment for HIV/AIDS infection was a single antiretroviral drug, AZT (zidovudine). Clinicians fought to stave off opportunistic infections and administered palliative care. “When I started working as a nurse in 1984, all you could do for people with AIDS was to help them die as comfortably as possible,” says Diana Travieso Palow, chief of HAB’s HIV Education Branch in the Division of Training and Technical Assistance. “People have forgotten,” she says.

Research efforts had yet to lead to better treatments or a cure for HIV/AIDS, but basic science began to bear fruit. Researchers were learning more about HIV and AIDS. They discovered that instead of remaining dormant for approximately a decade, HIV was actively replicating in infected lymph nodes and gradually depleting the immune system through several different mechanisms.10

 

* This essay is not meant to be an exhaustive summary of all HIV medications but rather a discussion about the Health Resources and Services Administration’s HIV/AIDS Bureau in the context of major HIV/AIDS treatment advances.

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