Although the Patient Protection and Affordable Care Act will improve access to HIV care in some respects (e.g., Medicaid will become available without categorical restrictions), it may aggravate the situation in other ways (e.g., funding for the Ryan White program, the primary source of funding for flexible services and safety-net providers, may be reduced or cut). Policies in the areas of housing, corrections, immigration, mental health services, and substance abuse all affect the care of HIV-infected persons and would benefit from increased coordination among and transitions between various programs and funding mechanisms. Many of these policy concerns pertain to care for other chronic health conditions as well (e.g., diabetes, hypertension, kidney disease, etc.). But HIV’s communicable nature and the very high personal and financial costs associated with each new infection add significant public health and economic components to the considerations of social justice that necessarily accompany policies that affect the provision of HIV care.



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