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Program Origins

PART A

Eligible Metropolitan Areas/ Transitional Grant Areas

The first HRSA-funded AIDS Service Demonstration Grants, in 1986, brought care to four urban centers. By 1991, when Title I (now Part A) programs began, the number of cities receiving funds had increased fourfold, to 16.

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PART B

States and Territories

Part B grew into the largest component of the Ryan White HIVAIDS Program primarily as a result of increases in funds to support access to drug therapies. More than 175,000 people received medications through the AIDS Drug Assistance Programs in 2008.

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PART C

Early Intervention Services

Direct grants to primary care providers have been funded from the time Ryan White CARE Act legislation first passed. The number of sites has grown significantly, from 114 in 1991 to 357 in 2008.

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PART D

Services for Women, Infants, Youth, Children, and Families

Title IV (now Part D) played a leading role in reducing mother-to-child transmission of HIV—from as many as 2,000 babies born HIV positive in 1990 to roughly 200 cases in 2005.

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PART F

SPNS, AETCs, Dental, and MAI

In 2008, more than 70 percent of Ryan White HIV/AIDS Program clients self-identified as racial or ethnic minorities. Through Part F, the Minority AIDS Initiative has played a major role in eliminating disparities in HIV/AIDS care for these populations.

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Part F: A Diverse Portfolio for an Evolving Epidemic

When incorporated into the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act in 1996, Part F included the AIDS Education and Training Center (AETCs), the Special Projects of National Significance (SPNS) program, and the Dental Reimbursement Program. The Minority AIDS Initiative was added during the 2006 reauthorization. Although Part F did not enter the legislation until 1996, 3 of its 4 programs were up and running long before that date: one in another section of the Act and two others at HRSA but not within the domain of the legislation.

Evolution of AIDS Education and Training Centers

AETCs, dedicated to training health care providers in HIV treatment and prevention, were the first component of Part F to launch. Inaugurated in 1987 as HRSA’s other HIV care initiatives were starting, the AETCs initially included four sites and were housed in the Bureau of Health Resources Development. The network of sites quickly expanded to 11 in 1988. At that time, given the lack of meaningful treatment options, their focus was primarily on support services and death and dying, according to Linda Frank, who has directed a Pennsylvania AETC since 1988.1

As treatment options became available, AETCs evolved to provide relevant training. In the early days, that meant training on the prevention and treatment of opportunistic infections and, later, on the use of AZT monotherapy. “At that point, the assumption was that anyone could treat, and we were training providers to give people one pill,” says Frank.1

When the AIDS Clinical Trials Group study 076 (ACTG 076) protocol showed dramatic results reducing perinatal transmission in 1994, the AETCs played a critical role by training a broad swath of providers, including many at Community and Migrant Health Centers, on how to prevent mother-to-child transmission. In 1996, with the advent of combination therapy and greater understanding of the importance of viral load, the AETCs began to focus more intently on clinical training and clinical management for providers treating larger volumes of patients. Included was the service of one-on-one consultations. As treatment became more complicated, the AETCs added trainings on important topics, such as viral resistance, complex comorbidities, and adherence.

The number of AETC sites has evolved over the years (see timeline below), as has its home at HRSA. In 1991, the AETC Program moved to the Bureau of Health Professions.

View as a table
    TIMELINE of AETCs2
  • 1987: 4 sites
  • 1988: 11 sites
  • 1989: 13 sites
  • 1990: 15 sites
  • 1991: 17 sites
  • 1995: 15 sites
  • 1999: 14 sites + 4 national centers
  • 2002: 12 sites + 4 national centers
  • 2005: 11 sites + 4 national centers
  • 2010: 11 sites + 5 national centers

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