U.S. Surgeon General C. Everett Koop applauded HRSA’s AIDS Demonstration Grants:
These projects emphasize case management and a coordinated approach to caregiving, by bringing together local, State, and Federal resources.... What we learn from these demonstration projects will be very helpful to us in assisting other States and localities to understand their needs and to respond to their problems.1
At the start of 1986, AIDS will have been reported in 51 countries. By year end, nearly 25,000 deaths will have occurred in the United States.2
HRSA FUNDS FIRST AIDS PROGRAM AT $15.3 MILLION
The AIDS Service Demonstration Grants marked HRSA’s first AIDS-specific health initiative. It made funds available to four of the country’s hardest-hit cities in its first year: New York, San Francisco, Los Angeles, and Miami.
“Those of us working in public health at the time,” says Richard Schulman, “realized that communities didn’t have the resources to respond. With the AIDS Service Demonstration Grants, we were finally able to jump into the fray.” Schulman, retired from the U.S. Public Health Service, and Shelia McCarthy, Director of Policy and Branch Chief of the policy branch for the Division of Science and Policy, helped launch the new program.
A Community Based Response
The AIDS Service Demonstration Grants were informed by work going on outside the government. Activists and organizations in San Francisco had developed what became known as the San Francisco Model, a community based rather than an inpatient approach, centered around case management. This model was used by demonstration program grantees to build their own community based responses to the epidemic.
HRSA’s AIDS Service Demonstration Grants were also affected by the groundbreaking work of the Robert Woods Johnson Foundation (RWJF). Through its AIDS Health Services Program, RWJF distributed a total of $17.2 million in grants to 11 communities between 1986 and 1990. The goal was to replicate and evaluate the San Francisco Model Nationwide.
“The work that RWJF was doing,” says McCarthy, “helped HRSA grantees shorten the learning curve and use their funds more efficiently.”
Grantees Grow in Number
The number of AIDS Service Demonstration grantees grew significantly over the five-year period in which the program was funded, from four in 1986, to 24 in 1990. The increase in the level of funding, however, grew an insignificant seven percent.
Yet when the initiative ended with passage of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act in 1990, the groundwork for Title I (Part A) had been laid. HRSA had a relationship with what would become the first eight Title I Eligible Metropolitan Areas. And the local response to AIDS in cities across the country was already well underway.
