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As World AIDS Day approaches, Congress may adjourn without renewing the largest set of programs for HIV/AIDS care and services in the United States. The HIV Medicine Association (HIVMA) is calling on Congress to pass a stalled bill reauthorizing the Ryan White CARE Act, and to back its programs with enough resources to fulfill their mission to provide care and services to the more than half a million low-income, uninsured and under-insured Americans who depend on them.
"Congress must not fail HIV/AIDS patients in this country," says HIVMA chair Daniel R. Kuritzkes, MD. "The nation is very near a crisis in HIV care. Programs funded through the Ryan White CARE Act are overburdened and nearing their breaking point. The CARE Act needs to be reauthorized and properly funded now, before the situation deteriorates any further."
CARE Act funding has stagnated for years, while the epidemic continues to grow by an estimated 40,000 infections a year, according to the HIVMA. Overworked and underpaid clinic staffs are burning out under the growing caseload. Many states have more low-income patients needing medications than money to pay for them, leaving hundreds on waiting lists and relying on charity programs. The situation is particularly serious in the Southeast, where the fast-growing epidemic is far outstripping the resources to respond to it.
That's largely because the CARE Act is allocating funding based on yesterday's epidemic, according to HIVMA Vice Chair Arlene Bardeguez, MD, MPH. "With powerful antiretroviral therapy, more patients today are living with HIV rather than dying of AIDS like they used to. But states still get CARE Act funding based on AIDS cases, not HIV infections. That favors states and cities with older epidemics at the expense of those with growing caseloads."
A compromise bill in Congress would change how the funding pie is sliced among states and cities. It would also put the focus on the medical care and servicesincluding antiretroviralsthat are saving the lives of people with HIV and AIDS. The bill makes concessions to minimize the impact of the funding shifts. This compromise is the last best chance to reauthorize the CARE Act this year, but those who would end up with smaller slices of the pie are blocking the bill.
"Congress should not be pitting people with HIV/AIDS in different parts of the country against each other," Kuritzkes says. "The epidemic is shifting, growing in rural areas that don't get much funding under the current CARE Act, and the renewed Act has to address this. But we believe the real problem is not the size of the slices, but the size of the pie," Kuritzkes adds.
Bardeguez concludes, "The CARE Act should be reauthorized and funded to respond to the evolution of the HIV/AIDS epidemic in our country, addressing the needs of those affected and in need of treatment, regardless of where they live. Failing to reauthorize the CARE Act leaves millions of low-income people living with HIV/AIDS in this country in jeopardy. It's the wrong message to send on World AIDS Day."