• Create a federal block grant for HIV care

  • Create a federally funded state-administered HIV program

Each approach was considered in light of the Committee’s goals for the public HIV care financing and delivery system: to improve the quality and duration of life for those with HIV and to promote effective management of the epidemic by providing access to comprehensive care to the greatest number of low-income individuals with HIV infection. More specifically, the Committee considered whether each option provided (1) uniform access to services, (2) a benefit package that meets the standard of care for HIV/AIDS, (3) a financing structure that ensures continuity of care, (4) reduced barriers to access services, and (5) administrative structures that support program accountability and evaluation.


Each of the seven options has certain advantages for improving access to HIV care. The Committee chose the option that creates a new federal program administered by states as the one with the greatest potential to achieve the goals of a publicly financed system of HIV care. In the Committee’s view, other options continue to perpetuate major deficiencies in the current financing system and fail to provide for uniform and consistent access to care and the comprehensive set of benefits necessary to meet the standard of HIV care that will extend lives and reduce illness and disability. The Committee is aware that its recommendations mark a radical departure from the way that public financing and delivery of HIV care is currently organized. It believes, however, that in light of the dramatic developments in treatment and troubling demographic trends in the HIV epidemic this departure is warranted and necessary. In supporting its decision to recommend a new federal program, the Committee examined carefully the cost and health implications of what it is proposing. Through extensive modeling of program impact and costs, presented below, the Committee concluded that its recommended program will significantly reduce premature deaths from HIV/AIDS, will add a substantial number of quality-adjusted years of life to those individuals who gain access to HAART under the program, and is cost effective; that is, the benefits of the program warrant the level of expenditure required.

The Committee determined that the best option for improving the financing of HIV treatment would be to formulate a new program that is unencumbered by existing programs that provide coverage for HIV care. The Committee formulated its program in five recommendations; the first recommendation establishes the program, and the remaining recommendations address major features of the program, including (1) eligibility,

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