The current financing and delivery system for publicly financed HIV care is complex and undermines the significant advances made in the development of new technologies to treat HIV/AIDS, such as highly active antiretroviral therapy (HAART). Many individuals experience delays in treatment access or are provided only limited options for specific drugs or important laboratory monitoring. As a result, each year there are missed opportunities to reduce mortality, morbidity, and disability among individuals with HIV infection. It is not uncommon for patients to receive care for the first time only at advanced disease stages. The fact that about 40,000 new AIDS diagnoses and 16,000 deaths occur each year further indicates that our current system is failing to ensure adequate health care for persons living with HIV infection. A similar number of new HIV infections each year indicates that the threat to the public’s health from HIV continues.

The current system is not without success, most notably the development of HAART, its adoption as the standard of care, and its wide use. As a result of this new therapy, the number of deaths from AIDS dropped by 43 percent over a two-year period (1995–1997). But new and difficult challenges have emerged, including the central role of adherence to the therapeutic regimen and the attendant risk of drug resistance to HAART, the changing demographics of the epidemic and the challenges presented by those changes, and the increasing incidence of both medical and social