Ryan White CARE Act Heads to Congress for Renewal

In 1990, after almost a decade of inaction, the federal government responded to the HIV/AIDS epidemic by passing the Comprehensive AIDS Resources Emergency (CARE) Act, which was designed to fund comprehensive, community-based medical care and supportive services for people living with HIV/AIDS. By that time, AIDS had already ravaged gay and bisexual communities and substance users in urban centers across America.

San Francisco was one of the most devastated of these communities and had been forced to respond without federal assistance to the medical and supportive care needs of people living with HIV/AIDS. This "San Francisco Model" of community-based health care formed the basis for the CARE Act, which was named for Ryan White, an Indiana teenage hemophiliac who had faced severe discrimination in his hometown and died of AIDS-related complications while the bill was being considered by Congress.

The Ryan White CARE Act, now funded at $2.1 billion annually, is the largest federal discretionary response to the domestic HIV/AIDS epidemic. Since its inception in 1990, the CARE Act has been renewed (or "reauthorized") every five years and needs to be reauthorized again before it expires on September 30, 2005. In general, this legislation has enjoyed broad bipartisan congressional support and as the AIDS epidemic has spread to suburban and rural areas of the country, the CARE Act has responded by targeting resources and tested models of care to these areas.

In his State of the Union speech in January, the President urged Congress to reauthorize the Ryan White CARE Act and to focus efforts specifically on African Americans, who have been hardest hit by the disease. While AIDS advocates welcomed the President's statements, they were deeply disappointed when the President released his Fiscal Year 2006 budget proposal in early February, which virtually flat-funded this critical program, despite rising numbers of people living with HIV/AIDS throughout the country.

Instead of allocating the increased resources that are needed to provide appropriate care to the thousands of Americans living with HIV disease, the Bush Administration and some members of Congress are looking to use the reauthorization process to redirect scarce CARE Act service funding exclusively toward primary medical care, prescription drugs and laboratory testing, thereby eliminating or severely reducing other services, including housing, food/nutritional counseling, child care and transportation. This approach would ignore the comprehensive nature of the CARE Act and the critical role supportive services play in enhancing a person's ability to access medical care and adhere to HIV/AIDS treatment plans.

The rapid spread of HIV/AIDS in the Southern United States is also driving Congress to find ways to address the disproportionate growth of AIDS cases in those areas. The Senate Health, Labor, Education, and Pensions (HELP) Committee and House Energy and Commerce Committee that control the reauthorization of the CARE Act are both controlled by members from rural States and localities. AIDS advocates, Congress and the Bush Administration will be challenged to continue to respond to areas of the country with serious, ongoing HIV/AIDS epidemics--like the San Francisco Bay Area--while finding innovative ways to respond to the needs in emerging communities. Additional resources must be provided by Congress to meet these growing needs.

The San Francisco AIDS Foundation will continue to advocate for the interests of San Francisco Bay Area residents living with HIV/AIDS to ensure that the CARE Act is reauthorized and funded at the highest possible levels. For updates on this process or to get involved in these efforts, join the HIV Advocacy Network (HAN) by visiting www.sfaf.org/policy/han or by calling 415-487-3099.