The RWCA is composed of four major program titles and several other components:
Title I provides grants to Eligible Metropolitan Areas (EMAs—currently 51) that have been disproportionately affected by the HIV/AIDS epidemic. Title I funds a variety of medical care and support services for people living with HIV disease. To qualify as an EMA, a metropolitan area must have a population of 500,000 or more and more than 2,000 reported AIDS cases within the past five years. Half of Title I funding is distributed by a formula, while the other half is awarded through a competitive supplemental application process, based on severity of need and other criteria (HRSA, 2002a).
Title II provides grants to states, the District of Columbia, Puerto Rico, and U.S. territories to improve the quality, availability, and delivery of health care and support services for individuals with HIV disease. Title II provides states with funds to provide access to HIV medications through the AIDS Drug Assistance Program (ADAP). In addition, Title II also provides funding for “Emerging Communities” that do not qualify as EMAs and are ineligible for Title I grants (HRSA, 2002b,c).
Title III provides direct grants to nonprofit entities for primary care and early intervention services (such as testing, counseling, referrals, and case management), capacity-building, and planning (HRSA, 2002d).
Title IV provides grants for family-centered care for infants, children, youth, women living with HIV disease, and their families. Title IV provides primary and specialty medical care, psychosocial services, and outreach and prevention services. Title IV also provides clients with increased access to HIV/AIDS clinical trials and research (HRSA, 2002e).
In addition, the RWCA supports AIDS Educational Training Centers, which provide clinical HIV training and education for providers, and the Dental Reimbursement Program, which covers uncompensated oral health care for individuals with HIV/AIDS (HRSA, 2002f,g). RWCA also funds the Special Projects of National Significance (SPNS) program, which establishes demonstration projects that address the challenge of providing care to underserved and vulnerable populations (HRSA, 2002h).
Issues of equity have been at the heart of legislative and public debate over RWCA. That debate has often centered on the adequacy of the formulas and supporting data used to distribute Title I and II funds. A significant proportion of RWCA funds are allocated to EMAs and states