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H H S Department of Health and Human Services
Health Resources and Services Administration
HIV/AIDS Programs

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HRSA, History, HIV

HRSA’s earliest global HIV/AIDS activities began in 1998.  The HRSA Global HIV/AIDS Program was officially established in 2001 and vastly expanded in 2004 under PEPFAR, with a charge to fund and oversee multiple care and treatment programs and mechanisms of technical support, training, and assistance.  

Many of HRSA's Global HIV/AIDS Program activities are informed by the experience gained under the domestic Ryan White HIV/AIDS Program.  See highlights in the sidebar. 

Learn about the Living History of the Ryan White HIV/AIDS Program.

Early Years: Responding to HIV/AIDS in the U.S.

Image of Ryan White smiling.Prior to the founding of the President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003, HRSA had nearly two decades of experience grappling with an earlier HIV/AIDS epidemic—the one faced by the United States.  Like PEPFAR, those efforts began rapidly, largely under a program that also had the word “emergency” in its name: the Ryan White CARE (Comprehensive AIDS Resources Emergency) Act, which was enacted in 1990.

The first HRSA HIV/AIDS program actually began even earlier, in 1986, when cases were measured in the thousands, not millions.  These first steps generated momentum and were eventually brought together by CARE Act legislation and HRSA efforts as today’s renamed Ryan White HIV/AIDS Program—now the largest program in the U.S. focused solely on HIV/AIDS care for underserved populations.  

HRSA’s domestic HIV/AIDS activities under the Ryan White HIV/AIDS Program foreshadowed the approach adopted years later under PEPFAR.  For example, HRSA responded rapidly to the need for HIV services, drawing on the agency’s long-standing experience as the lead domestic agency charged with developing safety-net health care programs for low-income populations in under-resourced and isolated areas in the U.S. HRSA also invested in training health care providers, planning service systems and building their capacity, and providing technical assistance to help agencies deliver care.

Efforts Expand

HRSA’s international HIV/AIDS work has evolved over the past decade into its current position within the PEPFAR portfolio.  

  • Pre-PEPFAR projects included the Enhancing Care Initiative, a five-year effort that started in 1998 to create continuity of care programs (and train professionals) in Brazil, Puerto Rico, Senegal, South Africa and Thailand. 
  • A year later, in 1999, HRSA assisted with planning activities for the LIFE Initiative (Leadership and Investment for Fighting an Epidemic), which was established to expand community-based palliative care for persons living with HIV/AIDS and TB. The LIFE Initiative was led by USAID, the U.S. Agency for International Development, and targeted 13 countries in Africa and India.  
  • Several years later, in 2001, the HRSA Global HIV/AIDS Program was first established.
Ryan White & PEPFAR


Training of health care workers overseas is modeled on the AIDS Education and Training Centers (AETCs)—the clinical training arm of the Ryan White HIV/AIDS Program.  

Protocols and Guides

A number of HIV/AIDS care guides developed for Ryan White agencies in the U.S. have been modified for use overseas.  

Clinic Monitoring

A Ryan White tool to monitor clinic operations has been modified.  Called ClASS, it is now being used internationally to do the same across PEPFAR countries.  

Quality Management

A methodology to build quality of care systems for HIV/AIDS ambulatory care, called HIVQUAL, was developed for Ryan White agencies in 1997. Today, HIVQUAL International is in use in multiple nations.

Data Software

The electronic health information system CAREWare was first released in 2000 for Ryan White agencies to manage clinical and service information and generate required data reports. The software has been modified to enable agencies to collect and report data based on international care and treatment needs and guidelines. 

Technical Assistance

Technical assistance to build the clinical capacity of domestic U.S. agencies was started in the early 1990s, using techniques like expert consultants, development of training curricula, and clinical consultations.  These same methods are being used to deliver assistance to PEPFAR countries.

Capacity Building for Local Agencies

Capacity of agencies is being built under PEPFAR’s Local Capacity Initiative in such areas as strategic planning, financial management, and human resources management.  This work is similar to HRSA’s HIV/AIDS capacity building grants to community agencies in the U.S., which began in the late 1990s.