HIV medical providers unite to advocate for patient care

January 24, 2007

Medical providers facing a crisis in HIV care are forming a coalition that will stand up for the needs of community health centers, university and hospital clinics, city and county health departments, private clinics, and others providing medical care for low-income people with HIV with nowhere else to turn.

Clinics and other programs funded through the Ryan White CARE Act provide care and services to more than half a million people with HIV nationwide. The Title III Coalition represents medical providers funded through Title III of the CARE Act, who are struggling after years of stagnant funding as their patient loads have steadily increased.

Forty thousand people are newly infected with HIV every year in the United States alone. Advances in medical care and lifesaving medications have changed HIV/AIDS from a fatal illness to a manageable, chronic condition. But Congress has not supplied the funding to Title III providers to keep pace with the epidemic and bring these advances within reach of the soaring numbers of low-income, uninsured, and underinsured people with HIV/AIDS.

Merceditas Villanueva MD, project director of the Title III Program at the Waterbury Hospital ID Clinic in Waterbury, CT, said the number of patients at her clinic has more than doubled in two-and-a-half years. "We have risen to the challenge with limited resources, and we offer our patients some of the best care available in medicine," she said. "For this," she added with frustration, "we were asked to take an $8,000 cut in our Title III base funding levels."

The Title III Coalition will advocate for funding for medical providers to respond to the full scope of the HIV/AIDS epidemic. People with HIV very often have complex medical and other needs that can make treating their HIV disease more difficult. More than half of Dr. Villanueva's patients are infected with hepatitis C. One in five has hypertension or diabetes or both. More than half have depression. Patients often need transportation, housing, or food assistance.

The HIV Medicine Association (HIVMA) and the American Academy of HIV Medicine--together representing nearly every HIV care provider in the country--have joined forces to help assemble the Title III Coalition. Leadership of the Coalition includes providers from a wide range of settings, from Oakland, Calif., to the rural South.

"We are squeezing out everything we can from our available resources, but we can't provide all the services our patients need," said Aimee Wilkin, MD, MPH, Ryan White program director at Wake Forest University Health Sciences in Winston-Salem, NC, and member of the AAHIVM Board of Directors. "Many have substance abuse or mental health problems that would keep them from sticking to their treatment, but we don't have the funds or personnel to provide psychiatric or substance abuse treatment. We end up sending fragile patients into a complex and collapsing public mental health system." She says one such patient has seen four different psychiatrists in the last year.

"Congress's neglect of Title III providers is indefensible," said Michael S. Saag, director of the 1917 Clinic at the University of Alabama at Birmingham, and member of the HIVMA Board of Directors. "And the burden will be even greater when the Centers for Disease Control and Prevention's new routine testing recommendations go into effect. We hope to start making progress identifying the 25 percent of people who don't know they are infected with HIV--but who will care for all those new patients? That's why the Title III Coalition is forming: to deliver the message to Congress that more funding is urgently needed."

In addition, the Title III Coalition will give providers a seat at the table when the Health Resources and Services Administration (HRSA), the office that oversees CARE Act programs, implements the newly reauthorized Act.

"It's time HRSA heard from those who are seeing firsthand the effects of this growing epidemic," Dr. Wilkin said. "We're in danger of sliding backward in the level of care we can provide our patients. Congress needs to fund Title III and the rest of the Ryan White CARE Act, and HRSA needs to implement it, to meet the needs of those it was intended to help: those people living with HIV with nowhere else to turn for care."

Quick Facts

• The Title III Coalition represents medical providers funded through Title III of the Ryan White CARE Act.

• Title III providers are struggling after years of stagnant funding as their patient loads have steadily increased.

• The Coalition will advocate for funding to provide the patients with the complex medical care they need, as well as support services to make care possible.

• It also will give providers a seat at the table in implementing the newly reauthorized Act.
Contact: Rob Banaszak: (202) 659-0699,

The Ryan White Title III Coalition was created by the American Academy of HIV Medicine and the HIV Medicine Association for HIV clinicians working on the frontlines of the AIDS epidemic across the country in Ryan White-funded clinics to ensure that they have a voice in programmatic and funding decisions that affect the lives of their patients and the quality and breadth of their HIV clinical programs.

Infectious Diseases Society of America

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