MAI funds have played an integral role in expanding HIV service delivery in African-American communities, enabling providers already serving hard-to-reach African-American PLWHA an opportunity to address issues around infrastructure and HIV/AIDS stigma that have prevented them from addressing HIV disease. Evanson explains, “MAI funds help Ryan White providers already doing good work to provide a greater level of care and treatment than they otherwise would be able to, particularly for African-Americans and other minority groups.”
In addition to the MAI, Part F also includes the Special Projects of National Significance, which supports the development and testing of innovative and cutting-edge models of HIV care that otherwise would not be funded or evaluated. Numerous initiatives have addressed how to engage various vulnerable subpopulations of African-Americans into HIV care, including Black gay youth; PLWHA in jail settings; adolescents; women of color; and Caribbean PLWHA. The best practices generated from these projects are disseminated to Ryan White HIV/AIDS Program providers nationwide to facilitate their replication, which has helped mitigate HIV/AIDS and improve health outcomes within African-American communities.
Providers engaging Black PLWHA also have access to technical assistance through Part F’s AIDS Education and Training Centers (AETCs), which provide resources geared to building capacity to deliver comprehensive, culturally and linguistically competent care to patients. Two AETCs in particular address the needs of providers delivering HIV treatment and care services in Black communities with high rates of HIV/AIDS. These are the National Multicultural Center, which addresses the training needs of providers and clinicians delivering care to ethnic and racial minorities, and the AETC National Center for the Expansion of HIV Care in Minority Communities: Building Capacity in Community Health Centers, which enhances the capacity of non-Ryan White-funded CHCs to provide primary medical care and treatment to racial and ethnic minorities living with or affected by HIV/AIDS. Many of these resources include interactive trainings and guidance, factsheets, training manuals, and presentations, including BE SAFE: A Cultural Competency Model for African Americans; The Impact of Stigma on HIV Care Access in the African American Community; and Developing a Peer-Based Early Intervention Services Program. Like SPNS, they also address the unique needs of different African-American groups, such as Black PLWHA not in care and women over 50.50,51,52
The Future of the Ryan White Response to HIV in Black Communities
In the 30 years since the HIV/AIDS epidemic began, there have been many lessons learned. Activists, PLWHA, families, health care workers, and others have demonstrated the power of the community-based response in creating innovative and powerful continuums of care that successfully engage HIV-positive African-Americans.
With support from the Ryan White HIV/AIDS Program, providers have extended the lives of countless African-American PLWHA, preventing new infections and ultimately reducing HIV prevalence and mortality. Access to lifesaving drugs has improved the health outcomes of Black communities overall, including that of HIV-positive African-American mothers, who no longer have to worry about transmitting the virus to their unborn children. This tightly woven network of care will be further enhanced with the full implementation of the Patient Protection and Affordable Care Act (Pub.L. 111–148) in 2014, which will ensure greater access to health care among African-Americans living with and affected by HIV/AIDS. It will also bolster the reach of the providers who serve them.
Perhaps most essential to the success of the Ryan White HIV/AIDS Program in serving Black PLWHA is the continued high quality of care delivered by providers and renewed emphasis on outreach and linkage to care and retention efforts. These have only improved since the rollout of the National HIV/AIDS Strategy (NHAS), begun in 2010. Providers will benefit from the collaboration at the Federal, State, and local levels strengthened by the launch of the NHAS but built upon the groundwork already set forth by the Ryan White HIV/AIDS Program. Ultimately, it will result in more integrated approaches to supporting providers delivering care to vulnerable communities, and will benefit medical personnel delivering services to Black PLWHA. Evanson, who represents HRSA in its interagency activities to advance the NHAS, says, “The Strategy has contributed to a greater sense of vision and purpose that we have welcomed. It adds an additional mantle of responsibility within the work of the Ryan White HIV/AIDS Program.”
Within the African-American community itself, there is a sense that stigma may one day be a thing of the past. Wilson says, “Several Black churches are creating AIDS ministries, and organizations, like the National Association for the Advancement of Colored People (NAACP) and the Urban League, have gotten AIDS coordinators.” He says that the community realized it was up to them to solve the problem of AIDS—to be a voice in the process and in supporting the Ryan White HIV/AIDS Program. “Nobody can come in and fix that for us.”