It is estimated that from 1.39 to 1.85 million people are living with HIV/AIDS in the United States and that 41,000 new HIV infections occur each year.¹² Health care costs are soaring. Highly active antiretroviral therapy (HAART) is extremely expensive and HIV/AIDS now strikes hardest among the poor.

Combine these trends with others, such as increased counseling and testing among vulnerable populations and financial pressure on other public programs, and it becomes clear why CARE Act-funded providers are experiencing growing demand. For example, the Brooklyn Hospital Center Program for AIDS Treatment and Health (PATH) saw 180 new clients in 2005. At the Detroit Medical Center/ Wayne State University, the number was 327. Dr. Lawrence Crane, the Center’s medical director for HIV services, explains, “We are funded to treat 1,200 patients, but we have about 1,900. I don’t know how long the staff can hold out.”

These trends are generating waiting lists at a time when a generation of providers approaches retirement. Add a general shortage of health care professionals, and the issues coalesce to form an emergency quite different from the one that spurred passage of the 1990 CARE Act, but an emergency all the same.

Empowered Communities . . .

The CARE Act authorizes a set of diverse programs with a common mission: to ensure that underserved people living with HIV/AIDS have access to care. Everything that the CARE Act funds—from training a clinician in rural Idaho to providing mental health counseling to a homeless veteran in Miami—is tied to this purpose.

The CARE Act works primarily, but not exclusively, through grants that support delivery of outpatient medical care, medications and drug treatments, and essential support services. These grants help the 2,567 organizations that received CARE Act funding in 2004 work toward reducing health disparities related to demographic factors like race, gender, and socioeconomic status.¹¹

. . . Building Continuums of Care

Treating HIV/AIDS requires more than a prescription. It requires a “service continuum”—an interconnected set of services to address HIV/AIDS and associated problems comprehensively. It is this continuum, nurtured by the CARE Act, that clears away barriers to HIV primary care.

Consider Avis, now a patient at the Southeast Mississippi Rural Health Initiative, Inc. Avis is healthy today because of HAART, which she—like most people without a very good private health insurance policy—could never afford on her own. This is why the State AIDS Drug Assistance Program (ADAP)—the largest CARE Act program—exists.

Displaced by Hurricane Katrina, Avis moved to a new community, where she first lived in temporary housing. Without the kind of support provided through the CARE Act, how could she navigate an unfamiliar State bureaucracy and enroll in a program with enrollment criteria that might differ from those of her home State? She couldn’t. If she were beginning HAART for the first time, how could she be expected to meet adherence requirements without at least some treatment education? She couldn’t.

The CARE Act’s emphasis on providing a continuum of services reflects this reality. It also reflects the fact that serious health problems—especially those that are debilitating and stigmatizing—require a comprehensive response. CARE Act grantees have helped build this continuum, and they continue to build it in underserved communities today. The result? People with precious few resources have new access to services that can prevent suffering and an early death.