HIV, with both CARE Act dollars and community health center grant funding.4 They can also directly bill Medicaid for eligible beneficiaries. In 2000, community health centers provided almost 250,000 HIV-related encounters to more than 48,000 people. In addition, they provided more than 270,000 HIV tests to approximately 231,000 people.94
Most of these safety net programs are funded through discretionary grants, and are dependent upon annual appropriations for funding. As such, funding does not necessarily match the need for or cost of care. In addition, people with HIV/AIDS may not always have access to experienced HIV providers through these mechanisms.
While there are several other mechanisms available for coverage and care, they provide access to only limited numbers of people with HIV/AIDS. These include high-risk pools, designed for people with significant health risks who have been denied coverage in the private market85,86,95,96,97 and pharmacy assistance programs offered by states98,99,100 and pharmaceutical manufacturers101 to low-income individuals (with varying other eligibility requirements). Twenty-nine states currently operate high-risk pools95 and 14 states have state pharmacy assistance programs available to non-seniors, either through subsidies or discounts.99,100 Finally, the Department of Defense provides care to a small number of active duty service personnel69 and the federal government, as an employer, provides care to federal employees with HIV/AIDS through the Federal Employee Health Benefits program.24,51
The patchwork of financing for HIV/AIDS care presents barriers to accessing care. As policymakers search for ways to improve access, they face several important challenges, many of which cut across the multiple sources of financing and care, including
A significant proportion (42% to 59%) of people living with HIV/AIDS are not in regular care. While some may not know their HIV status, many face financial and other barriers to access. More research is needed to identify the barriers to care. Outreach is also needed both to help bring people who know their HIV status into care early and to encourage others to get tested and learn their status. This will require better linkages between HIV testing and treatment facilities and services.