The AIDS Education and Training Centers (AETCs) were also launched in 1987. Beginning with four AETC sites and initially housed within the Bureau of Health Resources Development, the program rapidly expanded to 11 sites by the end of 1988. These centers were instrumental for training clinicians in HIV/AIDS care. Given the lack of meaningful treatment options, the centers initially focused on providing support services for dying patients and their families.13 Over the years, however, they have played an increasingly important role in educating medical professionals about the new advancements that would eventually make HIV/AIDS more treatable.
The AETCs have been a lifeline for rural communities. By providing onsite training for medical professionals in some of the most remote parts of the country, AETCs are able to reduce barriers to care. According to one report, 38 percent of HIV-positive individuals in rural areas receive care from physicians who have treated fewer than 10 HIV/AIDS patients.14 Thus, added capacity—especially in States with small populations and vast geographic areas, such as Wyoming, Montana, and Alaska—is critically important for making HIV care so much more accessible for PLWHA. Over the years, these HRSA-funded AETCs created local performance sites in rural communities as a means of offering more localized support.
“All the staff members that I hire are required to go to AETC training,” says Tonya Green, director of social services at the Southeast Mississippi Rural Health Initiative in Hattiesburg, MS. “The AETCs are essential to making sure that health care professionals who are treating HIV patients know enough so they can adequately care for patients.”
In fiscal year 1989, HRSA awarded a total of $3.9 million in Low Prevalence Planning Grants to 22 recipients. Among the first resources available for States and mid-sized cities, the grants set the stage for building a care continuum outside the large urban epicenters where HIV/AIDS first emerged. Though the grants were relatively small, in many rural locations these funds represented the first AIDS-specific resources received.15 These grants—along with the Home and Community-Based Care programs which provided funding for rural PLWHA to stay in their homes if their families had difficulty providing care for them—provided a foundation for much of what was to become Title II (now Part B) of the Ryan White HIV/AIDS Program.
Ryan White HIV/AIDS Program to the Rescue
On August 18, 1990, the U.S. Congress passed the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act—a piece of landmark legislation that would help PLWHA for decades to come. The boy for whom the law was named was a hemophiliac who was diagnosed with AIDS at just 13 years of age, and lost his battle with the disease 5 years later. As a young teen from small-town Indiana, Ryan White came to symbolize the reality that the HIV virus could infect people of all ages, living in all locations.
Support under the legislation was divided into several program Parts, each designed to help PLWHA in unique ways. The Ryan White CARE Act grew out of the 1986 AIDS Service Demonstration Grants and provided increased support primarily to States with urban areas. A particularly hard-hit city might receive funding through Part A; because of the emphasis on cumulative cases, that same city might receive additional funding through Part B.
In an effort to create innovative HIV service delivery models in rural areas and remove barriers to care, the HRSA Special Projects of National Significance (SPNS) Program under Part F funded the HIV Service Delivery Models Cooperative Agreements. This funding ran from 1994 to 1999 and involved 24 organizations across the country. Findings from the initaitive’s rural grantees were summarized in the HRSA publication HIV/AIDS in Rural Areas: Lessons for Successful Service Delivery.
Despite these efforts, rural areas continued to have many unmet needs, particularly because of their high levels of stigma and less advanced medical infrastructure. Over the years following the law’s passage, Congress would make changes to the Ryan White CARE Act to address changing needs in the epidemic and offer increased support to rural regions.