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Despite all these efforts, the AIDS rate among African-Americans and Latinos remained extraordinarily high. Even after HAART was introduced, AIDS mortality rates for minorities did not fall as significantly as they did for Whites. As the end of the Ryan White HIV/AIDS Program’s first decade approached, the scope of the epidemic among minorities called for greater resources, more public attention, and further action.

African-American man with arm around caucasion woman health-care provider.

When providers are culturally competent, patients are more likely to be retained in care.

The Minority AIDS Initiative

The Ryan White HIV/AIDS Program was working on its own to reposition resources toward minority needs and in 1999, Congress created the Minority AIDS Initiative (MAI). The new initiative provided a framework for a more comprehensive, coordinated, and strategic response to AIDS in communities of color. The multitude of Federal agencies involved included HRSA’s HIV/AIDS Bureau, the CDC, the National Institutes of Health (NIH), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Office of Minority Health, and the Office of Women’s Health.

“Activists from cultural associations and national organizations had an impact on this work and HRSA valiantly strived to deal with a lot of issues related to HIV including culture,” explains Lucy Bradley-Springer, Ryan White grantee and AETC faculty member. “What happened in the early days, is people stood up and said this is what’s important to my community and myself… and HRSA and Federal legislators paid attention. They listened and incorporated these concerns into various funding streams.”

The MAI has brought significant financial resources to the challenge of addressing AIDS in communities of color. It has also helped to focus much-needed public attention on the social determinants and resulting health disparities fueling HIV incidence among persons of color in the United States. The MAI, through HRSA’s leadership, has worked to improve care in minority communities, better training for providers, more targeted prevention messaging, and approaches designed to meet the unique needs of people of color. MAI grew Exit Disclaimer from $156 million in 1999 to $398.7 million in 2005 before being codified into the law in 2006; today its funds are distributed via Ryan White HIV/AIDS Program Parts.

Education & Training

Since 1987, clinical care providers that predominantly serve minorities have taken advantage of extensive training provided by the HIV/AIDS Bureau’s AETCs. In 1999, the AETC program’s role in addressing the training needs of clinical providers in minority communities was enhanced by creation of The National Minority AETC. The role of the National Minority AETC is to work with the schools of medicine of historically Black colleges and universities to provide clinical consultation. The National Minority AETC builds networks among clinicians and expands educational resources to increase the number of minority clinicians providing quality HIV care.

In September 2010, two new AETCs were launched to specifically address access to quality care among minorities and replaced the one National Minority AETC. They include the National Multicultural Center, Exit Disclaimer which is committed to improving cultural competency among HIV care providers across the country, and the National Center for HIV Care in Minority Communities, Exit Disclaimer which is implementing exciting new programs that increase HIV care capacity in health centers and should be adding new resources on gay men of color shortly.

There is, of course, a national AETC Exit Disclaimer as well as regional AETCs to increase training and clinical and cultural competency among providers. As Bradley-Springer explains,

The AETCs are one of the best ways for providers to address cultural issues and offer services to everyone. HRSA, through the Ryan White HIV/AIDS Program, says you are a valuable person and you deserve services…and [it tells providers] your patients are unique, valuable individuals and it doesn’t matter what community they come from. AETCs work with providers to develop the skills they need to treat the populations they propose to reach and serve.

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