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Public Financing and Delivery of Hiv/Aids Care: Securing the Legacy of Ryan White
Despite remarkable advances in the treatment of HIV, the epidemic remains a threat to public health.
Access to HAART is the cornerstone of HIV care. Without it, individuals face increased illness, disability, and death.
HAART presents its own challenges, as well. To receive optimal benefit, individuals must achieve 90 percent or higher rates of adherence to the treatment regimen, which can involve multiple pills taken at multiple times throughout the day (Paterson et al., 2000; Bangsberg et al., 2001; McNabb et al., 2001; Garcia de Olalla et al., 2002; Harrigan et al., 2003). Poor adherence also carries with it the risk of the development of drug resistant strains of the virus, dangerous not only because drug resistant strains contribute to treatment failure in the individual, but also because they can be transmitted to others. Emerging evidence indicates that the number of newly infected individuals who exhibit drug resistance is growing and that this resistance decreases treatment response, making the epidemic ever more difficult to control (Grant et al., 2002; Little et al., 2002).
Finding: Nearly complete adherence to the prescribed HAART regimen is crucial for both optimal treatment benefit and the prevention of drug resistance.
Persons newly infected with HIV are more likely to be poor, members of a racial/ethnic minority, and uninsured or publicly insured than in the past (Levi and Hidalgo, 2001). Whereas HIV was once considered a disease of white men who have sex with men, people of racial and ethnic minority groups now represent the majority of Americans in the categories of new AIDS cases, new HIV cases, people living with AIDS, and AIDS-related deaths (CDC, 2002). Although blacks and Hispanics together accounted for 70 percent of all new AIDS cases in 2001, these groups comprised only an estimated 26 percent of the total United States population (CDC, 2002; U.S. Census Bureau, 2000). For the age group 25–44, AIDS is the leading cause of death for blacks, the third leading cause of death for Hispanics, and the fifth leading cause of death for whites (NCHS, 2001).
The disease also increasingly affects women. The proportion of annual new AIDS cases represented by adult/adolescent women rose from 16 percent in 1993 to one quarter in 2001 (CDC, 1994; CDC, 2002). That same year women also accounted for 32 percent of new HIV cases. The growing