HRSA Welcomes HIV/AIDS Health Care Providers to Biennial Conference;
Studies Find That While Patients in Federal Programs Are Mostly Minorities,
Those Groups Still Face Barriers to Accessing HIV/AIDS Care

The Health Resources and Services Administration (HRSA) today welcomed HIV/AIDS health care providers from around the country to its 2002 Ryan White Comprehensive AIDS Resources Emergency (CARE) Act Grantee Conference in Washington, D.C. Federal CARE Act programs fund primary care and support services for individuals living with HIV who lack health insurance and financial resources for their care.

Attendees to the biennial conference learned in just-released reports that while CARE Act programs serve predominantly minority populations – almost seven in 10 of the more than 530,000 served annually are racial or ethnic minorities – those same groups continue to face policy and social barriers to obtaining HIV/AIDS care and services.

As an agency of the Department of Health and Human Services, HRSA administers CARE Act programs, whose fiscal year 2002 appropriation was $1.91 billion.  Information on the CARE Act’s impact on AIDS in the United States is contained in HRSA’s annual report, "The AIDS Epidemic and the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act--Progress Report, 2002."

Meanwhile, four new studies funded by HRSA and conducted mainly by University of California-San Francisco (UC-SF) researchers found continuing disparities among racial and ethnic groups’ access to HIV care and HIV drugs.  The studies, which will appear in the September edition of the journal Public Health Reports, identified these key barriers to minorities’ access of HIV health care services: restrictive eligibility criteria for public insurance; income and benefit limits in State programs; lack of information; distrust of government; and HIV-related stigma.

“Our CARE Act programs provide more than half a million poor or uninsured Americans living with HIV/AIDS access to the best available clinical treatment,” said HRSA Administrator Elizabeth M. Duke. “We recognize that some problems remain in accessing HIV treatment and services, but we know, too, that CARE Act grantees do an exceptional job in breaking down barriers and reaching out to those who need care most.”

In 2000, CARE Act programs funded more than 4 million patient visits through its two largest programs: Title I grants to Eligible Metropolitan Areas and Title II grants to States and Territories. That year, 69 percent of all CARE Act clients were minority, up from 66 percent in 1997. A third of all CARE Act clients in 2000 were women, up from 29 percent in 1997.

Summaries of the four Public Health Reports UC-SF studies follow:

• “Responding to Racial and Ethnic Disparities in Use of HIV Drugs: Analysis of State Policies,” by Stephen F. Morin, Sohini Sengupta, Myrna Cozen, T. Anne Richards, Michael D. Shriver, Herminia Palacio, and James G. Kahn, UCSF, used state surveillance and claims data to assess trends by race/ethnicity in AIDS cases and mortality as well as participation rates in Medicaid and the CARE Act’s AIDS Drug Assistance Program (ADAP) in California, New York, Florida and Texas.  They found that, in most cases, the reduction of death rates among African Americans and Latinos between 1996 and 1998 was not as dramatic as the drop in death rates among non-Latino whites in New York, Florida and Texas. Researchers said policy barriers that prevented greater participation by minority Americans living with HIV/AIDS in Medicaid and ADAP programs included Medicaid requirements for legal immigration status and residency; limits on Medicaid eligibility based on disability requirements; and state-imposed income and benefit limits on ADAP.  Social barriers to accessing AIDS medications included lack of information, distrust of government, and HIV-related stigma. The study concluded that state policies play a significant role in determining access to HIV drugs, and that revisions to state policies can reduce racial/ethnic disparities in pharmaceutical access.

• “Access to and Use of HIV Antiretroviral Therapy: Variation by Race/Ethnicity in Two Public Insurance Programs in the U.S.,” by James G. Kahn, UCSF; Xiulan Zhang, UCSF; Lanny T. Cross, New York AIDS Institute; Herminia Palacio, San Francisco Department of Public Health; Guthrie S. Birkhead, New York AIDS Institute; and Stephen F. Morin, UCSF, examined reimbursement claims and AIDS surveillance data in New York, California, Florida, and Texas to determine access to and use of highly active antiretroviral therapy (HAART).  HAART is highly effective in slowing the progression of HIV disease to full-blown AIDS and is available through Medicaid and ADAP.  The researchers concluded that African Americans were more likely to access HIV drugs through Medicaid than ADAP since Medicaid participation is limited to those with poverty-level incomes and African Americans have higher poverty rates.  In addition, because Medicare usually requires the individual to be disabled to obtain coverage, African Americans typically seek care later in HIV-disease.  Differences in the use of HAART by race/ethnicity within state programs were small.

• “Differences by Race and/or Ethnicity on Use of Antiretrovirals and Prophylaxis for Opportunistic Infection: A Review of the Literature,” by Herminia Palacio, James G. Kahn, T. Anne Richards, and Stephen F. Morin, UCSF, assessed published articles that analyzed race/ethnicity as a predictor of antiretroviral or HIV-related medication use. Their review concluded that there is substantial evidence of pervasive racial disparities in antiretroviral use, which is known to be strongly associated with positive HIV health outcomes.

• “The HIV Care Continuum in Publicly Funded Clinics,” by T. Anne Richards, Herminia Palacio, James G. Kahn, and Stephen F. Morin, UCSF, assessed data from HIV specialty clinics serving racial/ethnic minorities in New York, California, Texas and Florida. Researchers found that all of the sites tested for HIV relatively late in the disease after infection, that treatment for HIV did not take priority over basic family needs for people living in poverty, and that comprehensive support services were critical in order to treat HIV. In three clinics, the restriction of Medicaid eligibility to persons with an AIDS diagnosis or other medically defined disability was a barrier to accessing care.

HRSA is sponsoring the four-day conference to improve systems of care for people living with HIV/AIDS, facilitate grantee compliance with changes in the reauthorized CARE Act, increase grantees’ knowledge of administrative requirements, and enable them to share best practices.

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