The Ryan White Patient Equity and Choice Act (H.R. 4260), a bill to overhaul and re-prioritize the Ryan White CARE Act, the nation’s premier AIDS program that has been the principle source of funding for AIDS care and services in the US since 1990, was introduced in Congress in mid-March.
Since then, over 100 organizations including HIV/AIDS medical providers, social service organizations, municipalities and local representatives as well as community churches, have signed on to a letter to House Committee on Energy and Commerce urging swift congressional passage of the bill.
WASHINGTON (May 2, 2014) Advocates from AIDS Healthcare Foundation (AHF), the largest global AIDS organization, and over 100 other organizations including HIV/AIDS medical providers, social service organizations, municipalities and local representatives as well as community churches, have signed on to a letter to the United States House of Representatives’ Committee on Energy & Commerce urging Congress to swiftly pass a bill that would overhaul and re-prioritize the landmark lifesaving U.S. AIDS program.
In mid-March, the Ryan White Patient Equity and Choice Act (H.R. 4260), a bill to overhaul and re-prioritize the Ryan White CARE Act, the nation’s premier AIDS program that has been the principle source of funding for AIDS care and services in the US since 1990, was introduced in Congress. The new bill was authored and sponsored by Renee Ellmers, (R, NC, 2nd District); and co-sponsored by Bennie Johnson, (D, MS, 2nd District); Jeff Duncan (R, SC, 3rd District) and David McKinley (R, WV, 1st District).
“The Ryan White Care Act has been a tremendously successful program with broad bipartisan support for many years,” said Michael Weinstein, President of AIDS Healthcare Foundation. “By reprioritizing this lifesaving program, we will seize a critical an opportunity to make sure that funds are being spent efficiently to end the HIV/AIDS epidemic. Eliminating the gaps illustrated by HIV care continuum is possible if we take what we know and spend smarter.”
Since November, advocates from AHF have helped set the stage for Congressional re-prioritization of the lifesaving US AIDS program by spearheading a bipartisan effort to educate legislators and congressional staff on suggested re-prioritizations in the new bill. In the week prior to the bill’s introduction in March, AHF mobilized stakeholders and constituents from 16 states for meetings with over 40 congressional offices, during which stakeholders urged swift action on the bill. Since then, over 100 groups have signed on to a letter supporting passage of the legislation.
The letter was sent to Congressman Fred Upton (R, MI), Chairman, and Congressman Henry Waxman (D, CA), Ranking Member, of the House Committee on Energy and Commerce.
The letter (in part) states:
We, the undersigned HIV medical providers and community advocates, write to support the swift passage of the Ryan White Patient Equity and Choice Act (H.R. 4260).
If we are going to finally turn the tide against HIV in America, we need to align Ryan White with new knowledge on the best approaches to control the epidemic. Most critically, we must ensure the program is focused on eliminating gaps in the number of people with HIV who are knowledgeable of their status, linked to and retained in care, and adherent to their prescribed medications – as illustrated by the “HIV care continuum.” As stated in the July 2013 presidential executive order establishing a new HIV Care Continuum Initiative, federal agencies must work to “prioritize addressing the continuum of HIV care, including by accelerating efforts to increase HIV testing, services, and treatment along the continuum.”
Eliminating these gaps in care has become even more important as we have learned more about the impact of treatment on preventing the spread of the HIV. New studies have shown that the less of the virus a person has in him, the harder it is to transmit that virus and infect others. In fact, people with HIV on successful treatment are 100% non-infectious. Because HIV can only be transmitted by someone with the disease, this means we can drastically drive down the number of new infections by getting people with HIV into care keeping them adherent to treatment.
Unfortunately, the vast majority of Americans with HIV are not linked to or retained in care, as illustrated by the care continuum. Of the 1.2 million Americans with HIV, 20 percent are still unidentified, only 40 percent are retained in care, and less than 30 percent have the HIV virus under control (and thus rendered noninfectious to others). Our goal has to be to eliminate these gaps, so that virtually everyone who has HIV is adherent to treatment. This will result not only in healthier people, but also in a virtual elimination of new infections.
Addressing these gaps also means ensuring that funding is following the epidemic. Surveillance data from the Centers for Disease Control and Prevention indicates a significant and disproportionate impact of HIV in the South. In addition, many states in the Midwest are now seeing a disproportionate increase in new HIV infections. Despite this trend, these states receive less Ryan White funding per person with HIV compared to other regions.
Finally, we cannot successfully address gaps in the care continuum if Ryan White does not enable patients more choice in how and where they seek care. Too often individuals who utilize Ryan White services are forced to use service providers that may not meet their individual health needs. This not only leads to inefficiencies and wasted funding, but also it inhibits patients from adhering to their treatment, which means they have worse health outcomes and will potentially become more infectious to others.
“This work has become even more important because other providers in our health care system, such as Medicaid and private insurance, do not cover most HIV continuum services and do not have the HIV expertise of Ryan White,” said Tom Myers, General Counsel and Chief of Public Affairs for AHF. “We know this because 70% of Ryan White patients already have some form of health insurance that does not provide these services. The implementation of health care reform does not dramatically change this situation. In fact, it creates even greater need for Ryan White – particularly in states that have chosen not to expand eligibility in their Medicaid program.”
In the four years since the last reauthorization of the Ryan White CARE Act, stakeholders have learned that the key to reversing the HIV epidemic in the United States is to eliminate gaps in the HIV care continuum. The continuum consists of the stages of HIV care ranging from knowledge of HIV status, to linkage and retention in care, and ultimately to rendering patients noninfectious by keeping them adherent to HIV treatment.
 http://www.whitehouse.gov/the-press-office/2013/07/15/executive-order-hiv-care-continuum-initiative  No-one with an undetectable viral load, gay or heterosexual, transmits HIV in first two years of PARTNER study, NAM AIDSMap, March 4, 2014. http://www.aidsmap.com/No-one-with-an-undetectable-viral-load-gay-or-heterosexual-transmits-HIV-in-first-two-years-of-PARTNER-study/page/2832748
“ HIV/AIDS Epidemic in the South Reaches Crisis Proportions in Last Decade.” Duke Center for Health Policy and Inequalities Research. December 2011. http://southernaids.files.wordpress.com/2011/10/research-report-final-revised10-26-121.pdf  No-one with an undetectable viral load, gay or heterosexual, transmits HIV in first two years of PARTNER study, NAM AIDSMap, March 4, 2014. http://www.aidsmap.com/No-one-with-an-undetectable-viral-load-gay-or-heterosexual-transmits-HIV-in-first-two-years-of-PARTNER-study/page/2832748