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About 900,000 people in the United States are infected with the human immunodeficiency virus (HIV) that causes AIDS. More than half of new infections occur among blacks (54 percent), 19 percent among Hispanics, and 26 percent among whites. Title I of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, enacted by Congress in 1990, provides emergency assistance to eligible metropolitan areas (EMAs) disproportionately affected by HIV/AIDS to provide health care each year for low-income, uninsured, and under-insured people infected with HIV.
A survey conducted in 2000 and 2001 of 51 Title I Planning Councils (which set priorities and allocate funds) revealed that EMAs are serving significant numbers of female patients, with blacks and Hispanics constituting a majority of people served in 33 EMAs. Difficult-to-serve populations include substance abusers, people with chronic mental illness, and the homeless.
The survey was conducted by Robert J. Buchanan, Ph.D., of Texas A&M University System Health Science Center with support from the Agency for Healthcare Research and Quality (HS09819). It showed further that Title I programs received about $604 million in CARE Act funding during FY 2001. During that year, fund allocation ranged from $807,157 in one New Jersey EMA to $119,256,891 for the New York City EMA. Priority services included primary care/medical care, case management, medications, dental care, substance abuse treatments, mental health services, and support services such as housing assistance, emergency financial assistance, home-delivered meals, and food-nutrition programs.
At least 15 EMAs used waiting lists in 1999 for some services, with numbers ranging from five to seven people and a 5-day wait in Austin, TX, up to as many as 300 people and an 18-month wait for Section 8 housing in Seattle, WA. Congress appropriated over $1.9 billion for the CARE Act programs for FY 2002 ($620 million for Title I), an increase of $11 million (or 6.1 percent) over FY 2001. Unfortunately, this increased funding is still not sufficient to allow the CARE Act programs to adequately serve people with HIV disease, conclude the researchers.
See "Ryan White CARE Act and eligible metropolitan areas," by Dr. Buchanan, in the Summer 2002 Health Care Financing Review 23(4), pp. 149-157.
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