Recent estimates of new HIV infections, or HIV incidence, suggest that HIV continues to be a severe problem in the United States. In a study by the Centers for Disease Control and Prevention, or CDC, approximately 47,500 people in the United States contracted HIV in 2010. Compared to 2008, HIV incidence stayed relatively stable in most groups, even decreasing by 21 percent (from 7,700 infections to 6,100 infections) among black women. The statistics among men who have sex with men, or MSM,* and transgender women, however, did not improve to the same degree. There was even a significant increase in HIV incidence among black MSM and transgender women.
For all individuals living with HIV, and especially those populations with increased infection rates, reauthorization of the Ryan White Comprehensive AIDS Resources Emergency Act, also known simply as the Ryan White program, is crucial. Ryan White is the largest federal program that provides treatment specifically for people living with HIV/AIDS. If the Ryan White program is not reauthorized, many people living with HIV will face serious and possibly life-threatening consequences, such as gaps in care not met by other payers and decreased access to medical treatment and services from health care providers.
This column details the Ryan White program and why it is particularly helpful to the LGBT community, specifically MSM and transgender women.
HIV incidence among MSM and transgender women continues to increase
MSM remain the population most affected by HIV infection. The CDC estimates that, “MSM represent approximately 4% of the male population in the United States” but comprised 63 percent of all new HIV infections in 2010. Young black MSM accounted for more new infections in 2010 than any other subgroup by race/ethnicity, age, and sex.
In the United States, transgender communities are also at the highest risk of HIV prevalence. Many socioeconomic and health-related factors contribute to the HIV epidemic in the transgender community, including homelessness, unemployment, attempted suicide, violence, stigma, and limited access to health care, among others. According to the National Transgender Discrimination Survey, transgender women reportedly have “over four times the national average of HIV infection, with rates much higher among transgender women of color.” Specifically, the infection rate of transgender women was 2.6 percent in 2009, compared to 0.6 percent for the general population.
Providing assistance for care, treatment, and support services to people living with HIV would be nearly impossible without Ryan White funding. In light of the increasing incidence rates among MSM and transgender women, supporting the reauthorization of the Ryan White program should be a priority for the LGBT community, as the program is an essential step in reducing LGBT health disparities.
The Ryan White program has served more than 500,000 people living with HIV/AIDS in the United States
Enacted in 1990, the Ryan White program has become an increasingly critical part of the health care system in the United States, playing a vital role in providing funding to people living with HIV/AIDS for health care and support services. The program provides these funds by functioning as the “payer of last resort,” filling in coverage gaps for more than half a million people who may have no other sources of coverage such as Medicaid, Medicare, or a private health care provider.
Although the Ryan White program has provided medical, health, or other support services to many people living with HIV/AIDS, it has not kept pace with the number of individuals in need. Ryan White funding has not increased since the program’s initial authorization, although the number of people living with HIV has increased by 33 percent over the same time period. Congress should neither reduce nor eliminate Ryan White funding but should instead consider increasing it in the next reauthorization.
Since the Ryan White program’s inception in 1990, it has been amended and reauthorized by Congress four times—in 1996, 2000, 2006, and 2009. The Ryan White program’s current authorization is set to expire on September 30, 2013. Some discussions imply, however, that in light of the Affordable Care Act, the Ryan White program may not be reauthorized, which could have devastating consequences for people living with HIV/AIDS.
The Ryan White program provides specific funds to help people living with HIV/AIDS
The Ryan White program provides funding to state health departments that would benefit marginalized groups, including MSM and transgender people, low-income individuals, and the uninsured or underinsured. This funding goes directly to core medical and support services, including:
- Outpatient medical care
- Oral health care
- Home and community-based services
- Continuation of health insurance coverage
- Prescription-drug assistance
- Medical transportation services
- Viral-load testing
- Mental-health services
- Viral-resistance monitoring
This list is not exhaustive, but it summarizes the critical support services and treatment that the Ryan White program provides to people living with HIV. Although the Affordable Care Act is beneficial to the LGBT community, the Ryan White program must be reauthorized in 2013 to complement the existing changes in the health care system and continue these critical supports for people living with HIV/AIDS.
The Ryan White program is an essential complement to the Affordable Care Act
Since the passage of the Affordable Care Act, which substantially increases access to health insurance coverage for people living with HIV, many wonder if the Ryan White program will still be necessary. In short, the answer is yes.
The full implementation of the Affordable Care Act will provide the LGBT community many benefits. The new fairness standards for health insurance premiums, for example, will open access to affordable coverage for LGBT individuals and their families. In addition, nondiscrimination principles will help prevent insurance discrimination against transgender people. Moreover, under the Affordable Care Act, Medicaid expansion would provide earlier treatment to people living with HIV and reduce the costs of treating individuals with AIDS.
Despite these improvements in coverage, however, losing Ryan White funding will lead to critical problems for people living with HIV, many of whom are MSM or transgender. Currently, 70 percent of Ryan White program recipients also have insurance coverage elsewhere. They rely on program funds to supplement what their insurance cannot pay for, which indicates that insurance coverage is not enough on its own to pay for the high costs of HIV medical and nonmedical services. The Affordable Care Act simply cannot replace all Ryan White services; as such, the Ryan White program must continue to assist people living with HIV who are uninsured or underinsured. Thus, the Ryan White program will continue to provide treatment and support services essential to many members of the LGBT community, even in a post-Affordable Care Act America.
Conclusion
Thousands of people living with HIV/AIDS need Ryan White program funding for medical treatment and services. Considering the increasing number of HIV-positive MSM and transgender women, Congress should reauthorize the Ryan White program. It provides an essential supplement to the Affordable Care Act and will continue to provide support to vulnerable and marginalized populations. The realities of living with HIV may be difficult, but funding from the Ryan White program may, at a minimum, help alleviate some concern over reducing the costs for treatment and services. For HIV-positive MSM and transgender women, the loss of these services may be a matter of life or death.
Because of the increased HIV incidence rates, congressional reauthorization of the Ryan White program should be an LGBT priority.
Preston Mitchum is a Policy Analyst for the LGBT Research and Communications Project at the Center for American Progress.
* In this column, MSM is not a substitution for “gay” or “bisexual.” MSM is an epidemiological grouping, regardless of self-identification.