The demonstration grants also laid the foundation for the Ryan White HIV/AIDS Program, established with the passage of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990. The Program is not an entitlement, but the payer of last resort for PLWHA who otherwise would not be able to afford treatment, care, and support services for themselves or their families.40 Almost 500,000 PLWHA access Ryan White services annually, most of whom mirror the populations heavily impacted by HIV/AIDS: injection drug users, racial and ethnic minorities, women, and children. Almost one-half of all Ryan White HIV/AIDS Program clients were African-American in 2007 and 2008.41
The Ryan White HIV/AIDS Program has responded to the needs of Black PLWHA by providing comprehensive, culturally competent care. Many provider sites are medical homes, which offer patients a continuum of care that includes HIV primary care as well as support and specialty services all under one roof, or within proximity.42 These multifaceted care structures ensure clients can access the full array of HIV services they need, regardless of the “door” they use to enter care.
Many community-based health centers offer a bright, friendly, and welcoming environment complete with art and other personalized touches to make patients feel at home.
To ensure that Black PLWHA remain in care, providers often create a welcoming atmosphere complete with comfortable waiting areas that look more like living rooms than hospital hallways. Medical personnel and support workers are trained to understand the unique health concerns, cultural norms, and psychosocial and economic realities of Black PLWHA. In addition, many staff members are African-American themselves and, in the case of clinics serving Black immigrant populations, share their clients’ cultural backgrounds. They often speak their clients’ language(s), or have access to appropriate translation services.
HRSA and its providers have also taken measures to help allay their clients’ fears around confidentiality. In addition, sites often offer same-day appointments, as well as support services, such as transportation, childcare, health education, and housing assistance, to facilitate continued access to care. One provider, who has participated in several HRSA Special Projects of National Significance (SPNS) initiatives concerned with increasing linkages to care for at-risk PLWHA, recalls, “We had an African-American mother who had to bring her four children, all under age 5, with her to the clinic in order to make an appointment. The kids ran everywhere…[but] we were happy to have her there and in care.”
The quality of care provided by Ryan White HIV/AIDS Program providers and grantees often rivals, if not exceeds, that delivered by private hospitals and clinics.43 For many African-American PLWHA, enrolling in the Ryan White HIV/AIDS Program marks their first encounter with systematic, regular care. Much of this is delivered through Part A of the Program, which covers a majority of Ryan White clients.44 U.S. States and Territories receive Part B funding based on their proportion of living HIV/AIDS cases. These funds have helped States in the rural South and in urban areas, like Washington, D.C., where the epidemic has continued to grow relative to other parts of the country, particularly in Black communities.
Part B also includes the AIDS Drug Assistance Program (ADAP), which evolved from HRSA’s AIDS Drug Reimbursement Program, established in 1987, which enabled providers to offer African-Americans and other patients access to zidovudine (AZT), the first drug approved by the U.S. Food and Drug Administration (FDA) to treat HIV. Today, ADAP not only provides PLWHA access to life-saving medications, it supports education programs geared to recruiting African-Americans and other vulnerable PLWHA into highly active antiretroviral therapy—the gold standard of HIV care.