The Ryan White HIV/AIDS Program is a major success. For many, it is the first name they hear in regards to treatment options. But its scope can leave those newer to HIV health confused.
Ryan White, then 13, was diagnosed with HIV in 1984. After being barred from his school over fears he might infect other students, the resulting lawsuit and media coverage transformed White into a national spokesperson for HIV awareness. He died in 1990 at 18 years old.
White’s influence in educating the public about the disease prompted Congress to pass the Ryan White CARE Act that same year. Since then, it has remained the largest federally funded program serving people living with HIV. The program was signed into law by George H.W. Bush and has been reauthorized four times, the last being in 2009 by President Barack Obama.
The Ryan White HIV/AIDS Program addresses immediate and long-term care and treatment for those living with HIV, especially for those who are underinsured or uninsured. Those who receive an HIV diagnosis and fall into this economic category can, through Ryan White, receive treatment. This means consistency in medications and preventative care, resulting in healthier communities where HIV is far less prevalent. Half the clients are gay and bisexual men, and men who have sex with men.
Within the United States, the majority of HIV diagnoses come from people experiencing poverty or earning low incomes, especially from people of color. People who are economically disadvantaged (such as in the South) are at a higher risk for HIV and are less likely to have access to preexposure prophylaxis, or PrEP, a medication that prevents HIV. Much of the Ryan White Program is aimed at this population: 73% of Ryan White patients are from racial and ethnic minority groups, and 59% have incomes 100% less than the federal poverty level.
To tackle HIV, America’s economic and racial realities must be a focal point for treatment. The Ryan White Program addresses these social determinants of health. Social determinants of health are described by the Centers for Disease Control and Prevention as “the nonmedical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies, racism, climate change, and political systems.”
It is also designed for flexibility, noting different community needs. As of 2023, Ryan White now has five distinct sections:
- Part A — Grants provided to “eligible metropolitan areas,” areas with 2,000+ reported AIDS cases over the past five years and “transitional grant areas,” areas with 1,000-1,999 reported AIDS cases in the past five years. Both described areas must have a population of at least 50,000 — this is intended for higher-density areas where outbreaks are recorded.
- Part B — Grants for care to the entire United States and all territories, specifically covering medications, core medical and support services.
- Part C — Provides grants to local community-based organizations, such as rural hospitals, Indian health services, nonprofit organizations and others. Grants are aimed toward capacity building and early intervention services.
- Part D — Grants aimed at family-centered HIV primary medical care and support services in an outpatient setting for women, infants, children and youth living with HIV and their family members.
- Part F — Funding for the following programs:
- The Special Projects of National Significance Program, supporting emerging interventions for HIV care and effective service delivery systems for people with HIV.
- The AIDS Education and Training Center Program, which works to increase the number of health care providers who are competent and willing to counsel, diagnose, treat and medically manage individuals with HIV by providing education, training, consultation and clinical decision support to health care professionals at the local and regional levels.
- The Dental Programs provide funding for oral health care for people living with HIV and support training dental and dental hygiene providers.
- The Minority AIDS Initiative provides funding to evaluate and address the disproportionate impact of HIV on Black people and other minority populations.
By the numbers, The Ryan White Program is a major policy success. In 2021 alone, Ryan White programs served roughly 576,000 people. Of those people, nearly 90% are at viral suppression, meaning the virus can’t ravage their body and they can no longer transmit the virus. Compared with the national average of 65% viral suppression, the Ryan White Program is clearly reaching its goals and helping in ending the HIV epidemic by 2030 (the goal set by the United States government in the Ending the HIV Epidemic initiative).
Patients with coverage under Ryan White have higher levels of viral suppression compared to those who don’t get any assistance from the program.
Given its massive success, major expansions are warranted to help end the epidemic. Yet funding for the program is dependent on congressional allocation, meaning Congress must authorize payment for the program to continue. Without a permanent fund, hundreds of thousands of people are at risk of shifting political winds or congressional inaction. It has continuously expanded since its inception, with its original budget allocation being $220 million. Today it is over $2 billion.
Data shows the effectiveness of the Ryan White HIV/AIDS Program and the need for its continuation and expansion. While there are new challenges the program faces in addition to funding (such as an aging patient base), the program has proven a smart allocation of resources and addressing social determinants of health can be a formula for success.
You can read more about the program here.