Pediatric AIDS Service Demonstration Grants, first awarded in 1988 and later incorporated into the Ryan White HIV/AIDS Program as Part D, have supported HIV treatment, care, and support services for African-American women and their families. This holistic approach to care has proven to be a lifeline for so many HIV-positive Black women. Part D also helped disseminate guidance developed during the AIDS Clinical Trial Group Study 076 (ACTG-076) in 1994, which demonstrated AZT’s efficacy in reducing mother-to-child transmission of HIV during pregnancy and nursing.45 This approach dramatically reduces perinatal transmission, particularly in Black communities, in which most mother-to-child HIV infections occurred.46
HRSA, along with Ryan White HIV/AIDS Program providers and grantees, understands that much remains to be done to end HIV/AIDS and ensure that those living with the disease are engaged in treatment and care. The CDC estimates that 20 percent of PLWHA remain unaware of their status. There are also PLWHA who are aware of their status but not engaged in care, or have fallen out of it. A disproportionate number of PLWHA in all of these groups are African-American, which has serious implications for the health outcomes of Black communities overall. As of 2012, Blacks accounted for approximately one-half of the nearly 600,000 HIV/AIDS deaths that have occurred in the United States since the epidemic began.47
Fortunately, Ryan White HIV/AIDS Program providers are well-equipped to address the needs of African-American clients. Those that wish to ramp up their service delivery to Black PLWHA have access to a wide-range of programs and tools that support and foster innovation, and help fill in any gaps in care. For instance, Part C supports a variety of HIV service providers in delivering a tightly woven continuum of Early Intervention Services (EIS) that help identify PLWHA and engage them in care earlier. Newly-diagnosed PLWHA are provided intensive case management as well, which often proves essential to African-American PLWHA in learning how to navigate health care systems and in developing the skills to manage their HIV.48 Providers targeting African-American PLWHA also benefit from Part C’s Planning and Capacity Development Grants Program, which supports providers attempting to engage and retain underserved populations in care.
Most Ryan White capacity-building assistance programs, however, are in Part F. These include the Minority AIDS Initiative (MAI), established in 1998 during a meeting between Federal officials and African-American service providers and community leaders about the continued disproportionate impact of HIV in Black communities. During the meeting, those in attendance declared a “state of emergency” in the Black community, and demanded the government take further action to bolster the response to AIDS among African-Americans, and heavily impacted minorities overall.49 HRSA and its Federal partners listened. The MAI supports the expansion of HIV services within minority and minority-serving providers and community-based organizations managing and treating HIV at the grassroots level. Melanie Wieland, who serves as special assistant to the director in HRSA’s Division of Service Systems, notes that MAI funding was never meant to be the sole source of programmatic funding, but rather to “close the gap between PLWHA in communities of color” and ultimately reduce HIV incidence and prevalence among ethnic and racial minorities.