The Ryan White HIV/AIDS Program is a federal program that provides medical care, prescription drugs, and support services to more than a half a million uninsured and underinsured people living with HIV/AIDS in the US. Although most Ryan White clients (80% in 2015) have some form of insurance coverage, the Ryan White Program affords them access to critical and important services that are not covered by their insurance. The program provides models for integrated care that brings together physical and mental health services. It also provides mechanisms to monitor health outcomes and ensures capacity to provide HIV medical care across the country through both technical assistance and funding.
The Ryan White Program operates as a safety net to ensure patients with HIV get access to the medical care and services they need in a cost effective and coordinated manner.
What has the Ryan White HIV/AIDS Program done?
The Ryan White HIV/AIDS Program began in 1990 and was initially an emergency response to the growing HIV epidemic in the US. Since its inception, the Ryan White Program has continued to receive bipartisan support and has been reauthorized by Congress four times. With each reauthorisation, the program has evolved to better respond to the changing HIV epidemic. Although the Program’s authorization has now lapsed, it has continued functioning under its prior authority and has been funded through annual Congressional appropriations. Since the last reauthorization in 2009, there have been meaningful scientific developments. The Affordable Care Act has also expanded insurance coverage to many people with HIV, which has prompted many states to shift the focus of their programs to focus on other issues, including mental health and substance abuse treatment as well as cost-sharing assistance. The role of the Ryan White Program will likely become even more critical as the health system changes.
The Ryan White Program has led to tangible improvements in health outcomes including increasing rates of viral suppression and reducing health disparities. These outcomes have the further benefit of reducing new HIV infections. This is because when people with HIV are virally suppressed – i.e. the amount of HIV virus within their blood is undetectable – they do not transmit the disease to other people. In fact, The Partners of People on ART–A New Evaluation of the Risks (PARTNER) Study, a European observational study of serodiscordant partners (one partner was HIV positive and one was HIV negative), recently found that no transmissions resulted from virally suppressed individuals.
Given evidence regarding the importance of viral suppression in prevention efforts, consideration should be given to how the Ryan White Program could increase population-level HIV viral suppression by leveraging program data to address populations and communities with the most urgent needs. Promoting and expanding access to pre-exposure prophylaxis (PrEP) for HIV prevention is another potential role the Ryan White Program could fulfill in the future. Policy makers could also consider whether there could be a role for the Ryan White Program to be expanded to address other health issues such as Hepatitis C.
The views reflected in this expert column are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.