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Updating the Ryan White HIV/AIDS Program for a New Era: Examining critical issues facing this major program in the domestic HIV response

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UntitledThis post was written by Jeffrey S. Crowley, Distinguished Scholar and Program Director, NationalHIV/AIDS Initiative at the O’Neill Institute.  Questions may be directed to

This is an exciting and dynamic time in responding to the HIV epidemic.  The United States continues to face a very serious epidemic, with 1.1 million Americans living with HIV and roughly 50,000 people who become newly inflected each year, yet recent developments have led many to conclude that we now have the tools to greatly reduce the scope of the epidemic.  Leading policymakers have even begun talking about working toward an AIDS-free generation.

The Ryan White HIV/AIDS Program is the largest HIV-specific grant program for providing HIV care and services in the United States and it is the third largest source of federal funding for HIV care after Medicaid and Medicare.   It exists to compliment and supplement the rest of the health system by providing HIV health services to uninsured and underinsured people living with HIV.  Three specific developments have taken place that alter the environment in which the program operates and that create new opportunities for increasing access to and retention in quality HIV care in order to achieve broader population-level suppression of HIV:

  1. New scientific evidence demonstrating that antiretroviral treatment (ART) not only provides tremendous clinical benefit, it can also significantly reduce the risk of HIV transmission;
  2. The passage of the Affordable Care Act (ACA), which will significantly increase access to health insurance coverage for millions of people, including people with HIV; and,
  3. The release of the first-ever comprehensive National HIV/AIDS Strategy for the United States, with the goals of reducing HIV incidence, increasing access to care, and reducing HIV-related health disparities.

With the program’s current authorization set to expire on September 30, 2013, discussions about how best to structure the program in this new environment, including the timing of any changes, have already begun.  Earlier this week, the Henry J. Kaiser Family Foundation released a policy brief that I co-authored with Jen Kates, Vice President and Director, Global Health & HIV Policy for the Foundation entitled, Updating the Ryan White HIV/AIDS Program for a New Era: Key Issues and Questions for the FutureThe brief may be accessed here.

Given Ryan White’s unique role in the HIV response, the program is likely to act as the fulcrum of efforts to help turn the vision of an AIDS-free generation into a reality in this country.

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