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1990: The CARE Act – Increasing Resources, Increasing Responsibilities

At a time when the early community-based response to AIDS, built largely by the gay and lesbian community, was stretched to its limits, HRSA provided a critical influx of resources and support. It was 1990, the year Ryan died, that Congress passed the Ryan White HIV/AIDS Comprehensive AIDS Resources Emergency (CARE) Act and President George H.W. Bush signed it into law. Today it is known as the Ryan White HIV/AIDS Treatment Extension Act or, more simply, the Ryan White HIV/AIDS Program.

Also in 1990, the CDC reported 94,125 cumulative AIDS cases among gay men in the U.S, including 10,557 gay men who were also injection drug users.13

Cities were under siege and States and rural communities desperately needed the resources and structure the Ryan White CARE Act brought. Gay men became involved in its implementation or, in the case of the HRSA AIDS Services Demonstration Grants, involved in program expansion. In short, gay men were working at every level and every way imaginable, and continue to do so today.

HRSA gives grants to organizations, many of which employ gay men to help implement their Ryan White programs. They fill leadership and administrative roles at the Federal, State, and local levels – and inside public and private agencies. HRSA created ways to ensure programs were reflective of the people they serve. This can be seen in the creation of Planning Councils (commissions delegated to identify service needs and gaps, develop plans for HIV delivery, and establish priorities for funding allocation), and consumer advisory boards (organizational boards comprised of HIV-positive individuals who help advise clinics on HIV care delivery), many of which include gay men.

Gay men work as case managers and outreach coordinators, as doctors and nurses, as advocates and planners, as developers of evermore effective programs and in many other ways that were completely unfathomable at the onset of this strange new disease. And it should always be remembered that they have often made their professional contributions at significant cost: the field of HIV/AIDS was never a “safe” place to work, often being perceived as a stigmatizing dead-end career choice. More personally for gay men, working in the field of HIV/AIDS frequently resulted that they had to come out from the safety of the closet, exposing them to the risks faced by their HIV-positive clients: being ostracized, abandoned, and scorned.

As the Ryan White CARE Act came into being, it immediately became “a lifeline for communities across the country,” says Phill Wilson, AIDS coordinator for the City of Los Angeles at the time. Wilson, a gay man, who today is Chief Executive Officer of the Black AIDS Institute, was the first co-chair of the Los Angeles Eligible Metropolitan Area (EMA) Title I Ryan White Planning Council.

Wilson recalls how the new CARE Act opened doors to medical care for those who did not meet Medicaid eligibility criteria. He reminds us that the new legislation provided critical wraparound support programs that Medicaid and other public programs did not cover. These support services, according to Wilson, “facilitated some people hanging in until the advent of HAART [highly active antiretroviral therapy].”

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