the important role public payers can play in the delivery of prevention services within the care setting.47

These policy issues are often heightened in the context of the HIV/AIDS epidemic due to shifting demographics and rapidly changing clinical standards of care. People with HIV/AIDS are increasingly likely to be members of already disadvantaged groups who are more likely to rely on the public sector for financing their care and face historical barriers to access. African Americans and Latinos, for example, represent the majority of new HIV infections and women now comprise almost a third (30%) of new HIV infections in the United States; most women newly infected are minority women.37

In addition, HIV care has grown increasingly complex, requiring rapid dissemination of new standards to diverse groups of providers. Moreover, to support receipt of and adherence to complex treatment and help them navigate the financing and health care delivery systems, people with HIV/AIDS need access to a comprehensive continuum of care and experienced providers. Yet some needed services, such as case management or prevention, are not always financed through the same mechanism as medical care or may not be financed at all. Together, these aspects of the epidemic mean that policymakers will be faced with continued challenges to financing HIV-related care in the future, particularly as the number of people with HIV/AIDS continues to grow, as do health care costs. These challenges may be exacerbated during tough economic times.


Despite the existence of multiple sources of financing, many people with HIV/AIDS are not in regular care and a significant proportion does not know they are infected. Even among those who are in care, numerous barriers may impede their access to needed treatments. The high cost of care poses challenges for individuals and caregivers, as well as state and federal governments. Eligibility rules create barriers to coverage and care. Existing programs vary significantly across the states and are often poorly coordinated. As the HIV epidemic continues to shift towards those who have always had a more difficult task gaining access to and paying for care, these policy challenges are certain to grow.



This paper is an update of: Kates, J. and Sorian, R., Financing HIV/AIDS Care: A Quilt with Many Holes, prepared for the Kaiser Family Foundation, October 2000.


Institute of Medicine, No Time to Lose: Getting More for HIV Prevention, 2000.


Presidential Advisory Council on HIV/AIDS, AIDS: No Time to Spare: The Final Report to the President of the United States, 2000.

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