Although these were the only AIDS programs to which funds were appropriated through the CARE Act in FY 1991, they were not the only AIDS programs at HRSA. In 1991, Title IV (Part D) was administered through the Bureau of Maternal and Child Health, and the AIDS Education and Training Centers program was administered by the Bureau of Health Professions. All of these programs have been funded through the Ryan White HIV/AIDS Program budget since 1997.
On the surface, it might appear that having so many unique authorities manage the Government’s AIDS programs was solely an administrative issue. In fact, the existence of the different administrative bodies inhibited collaboration across programs, created redundancies, and hampered shared learning. For these and many other reasons, the HIV/AIDS Bureau (HAB) was created in 1997. Since then, all of HRSA’s HIV/AIDS programs have been administered by HAB, thereby reducing administrative costs and ensuring a concentrated, united front in the fight against HIV/AIDS.
Part A planning bodies were required to consist of at least 25 percent consumers when the CARE Act was first enacted in 1990. That requirement has since increased to 33 percent. Planning bodies are also required to reflect the demographics of the local HIV/AIDS population.
State and Local Government Roles
Part A grant recipients are large and small cities that meet the criteria for designation as Eligible Metropolitan Areas (EMAs) or Transitional Grant Areas (TGA). For legal purposes, the grantee is the chief elected official of the largest political jurisdiction in that area. For example, the Philadelphia EMA actually covers nine counties, and the Philadelphia EMA grantee is the chief elected official (the mayor) of Philadelphia, the largest political jurisdiction within that area.
Part B grantees are State and territorial governments. State, territorial, and city governments bear enormous responsibility for implementing Part A and Part B grants. For example, Part A grantees are required to create Planning Councils, which consist of advocates, service providers, government officials, community leaders and, crucially, people living with HIV/AIDS (PLWHA), who work together to set funding priorities. PLWHA are also active in implementing Part B of the Ryan White HIV/AIDS Program through their work on HIV/AIDS consortia. Part A planning bodies were required to consist of at least 25 percent consumers when the CARE Act was first enacted in 1990. That requirement has since increased to 33 percent.
Part A and Part B grantees are responsible for collaborating with planning bodies and the community at large to build systems of care. They must lead the community in identifying unmet needs, evaluating the capacity of local providers to meet those needs, and deciding how to use grant funds. As part of this process, Part A and Part B grantees administer a request for proposal and proposal review process and create contracts with local providers.
Unlike grantees for Parts A and B, grantees for Parts C, D, and F of the Ryan White HIV/AIDS Program are nongovernmental organizations, such as community-based organizations, outpatient health clinics, AIDS services organizations, social services organizations, and institutions of higher learner. The Federal Government bears the sole responsibility for administration of Ryan White HIV/AIDS Program Parts C through F.