In the early 1980’s a new disease known as human immunodeficiency virus (HIV) was introduced into the medical field. The disease was something new to study and had no cure at the time. Society began to speculate were this disease came from. For approximately twenty years the disease was thought of as the gay mans disease. Not until the early nineties did society begin to see that the disease was not a gay mans disease but women and young infants were getting the HIV virus. As more people come out that they have this disease the speculation has stopped on who can get it and now everyone knows it is not just one group of society but a disease that everyone can get.
In 1990 the Ryan White CARE Act was implemented to provide care for people with HIV. Money is given to states and metropolitan areas with large numbers of citizens with AIDS. The act also provides grants for prevention of the virus and grants to research the virus in hopes to find a cure (Anonymous, 2000b).
II. Description of Social Problem
Human immunodeficiency virus (HIV) leads to the disease acquired immune deficiency syndrome (AIDS). The disease AIDS kills white blood cells that make up the immune system. A person with AIDS is unable to fight any sickness that enters the body. Many people with the disease will often die of the common cold or the flu. Their body is unable to fight the bacteria in their body. Signs of the disease are often unfelt or seen and can only be known through testing the blood. People can get AIDS through using dirty hyperemic needles, through sexual contact with someone with the virus, blood trafusions, or pregnant woman can spread it to their unborn child (Radcliffe,J., 1998).
In 1998 there were a reported six million people infected with the HIV virus. Approximately one person gets the virus every eleven minutes. That is eight thousand five hundred new cases a day that are reported. These numbers are not completely accurate because so many people do not know they have the virus or don’t have means to go to hospitals or doctors to be checked for the virus. In 1998 over three million people under the age of twenty five were reported to have the AIDS virus HIV (American Association for World Health, 1999).
Populations affected by the virus are men, women, children, white , black , brown, American, or Non-American all these labels and definitions of who a person is does not keep them away from getting the HIV virus. Anyone and everyone has the ability to be infected if they come in contact with the virus. It is not one group or one country it is a world wide virus. Even though knowledge of how the virus is contracted the cases of people infected is increasing. The American Association for World Health reported “ if the spread of HIV is not contained, AIDS may increase infant mortality by as much as 75% and mortality in children under 5 by more than 100% by the year 2010 in regions most affected by the disease (1999).” People concerned about the virus include a wide range of organizations.
There are 33.4 million cases of HIV/AIDS worldwide. Every continent on the earth is faced with the fact that people in their countries are dying from the virus. Approximately twenty two million sub-Saharan Africans are know to have HIV/AIDS. In the United States there are organizations to help people cope with the disease. Organizations include the American Foundation for AIDS Research, Centers for Disease Control and Prevention, CDC National AIDS Clearinghouse, Gay Men’s Health
Crisis, National AIDS Fund, National Native American AIDS Prevention Center, and the list goes on ( HIV/AIDS Support Groups, 1998).
Groups who minimize the problem include people who care for the patients with the disease. Law makers who wrote the policy and people who implement the programs all minimize the problem. Educators and healthcare providers all help in some part to either information people of the disease or research it in search for a cure or medicine to help with the disease. Pharmaceutical companies benefit from not finding a cure because they make and distribute the medicines needed for the patients. If a cure was found then all the medicines and research projects would not be needed and people could lose their jobs. Early intervention programs would also be shut down if the problem was found.
Factors in the spread of HIV/AIDS is a wide range of problems. “Poverty, discrimination, sexual inequality, inadequate health or social services, rapid urbanization, and a migrant labor force” are factors in the spread of HIV/AIDS ( American Association for World Health , 1999). Other factors are peoples ignorance or the thinking “It can’t happen to me” or that it only happens to the “poor people” and the it is a “gay man’s disease”.
The policy being analyzed is the Ryan White CARE Act (Public Law 101-381).
“The Ryan White CARE Act was created in 1990 to help states, communities and families cope with the growing impact of the AIDS epidemic, …and to provide support systems of care for people with AIDS who do not have adequate health insurance or other resources”( Ryan White CARE Act, pg. 1). “It is the purpose of this Act to provide emergency assistance to localities that are disproportionately affected by HIV epidemic and to make financial assistance available to states and other public or private nonprofit entities to provide for the development, organization, coordination and operation of more effective and cost efficient systems for the delivery of essential services to individuals and families with HIV disease” (Public Law 101-381 , pg.) Title I of the Ryan White CARE Act gives grants to communities that report more than two thousand cases of the HIV/AIDS virus.
IV. Description of Policy
There are four different titles that give different grant opportunities. Title I-HIV Emergency Relief Grant Program as different criteria in order for communities and states to receive the grant money. Under Title I states must provide the number of HIV/AIDS cases in each area , the severity of need, and the resources that are needed and that the state already provides.
To receive the grant the elected official must also provide information coming from the areas of health care providers, community-based and AIDS service organizations, social service providers, mental health care providers, local public health agencies, hospital planning agencies or health care planning agencies, affected communities, non-elected community leaders, State government, and the lead agency of any Health Resources and Services Administration adult and pediatric HIV-related care demonstration project operating in the area served (Public Law 101-381).
The title also outlines who should be in charge of the program once the money in given. The title outlines the qualifications of the official , the purpose, and duties. Section 2603 of Title Ioutlines how much money the state will receive and how the state must keep track of who gets the money or how it is spent. Also in this title refers to different qualification guidelines individuals must go through to be a part of the program and the application process they must go through. All in all title one provides emergency relief grants for cities that produce evidence they have a need to control the HIV/AIDS virus in their community.
It also outlines the procedures to set up the program and how to present the evidence of need for the community. Title II is know as the HIV care grants. This section outlines state support services for citizens and their families with the disease. Sections in this title explain how money provided can be used to help the people. Public Law 101-381 says that the money can be used to “ establish and operate HIV care, provide home and community services, provide assistance , and provide treatment.” Title II also explains the requirements an individual must meet to be part of the grant program provided by the state. Grant money can be used towards equipment, medicine, services, and other services needed to help a person living with the disease.
There are stipulations on the patient on what kind of care can be given and who can provide the services needed. In this section how much money can be used for different services and when it can be used is outlined. Title III is the Early Intervention Service part. The first part explains how to set up programs to help people that are considered at risk to get the disease. Title III explains how to set up early intervention programs, who can be in control and how to provide information to know a section of the population is at risk in an area. The state must set up funds that meet the grants given by the federal government.
This amount is that the state must meet changes with each fiscal year. Healthcare providers in the area of at risk citizens must agree to offer services and explain and report on the services that they do provide. Title III also gives information on how an individual must agree to the services and meet requirements to receive any services that are offered. It also explains how a doctor must talk to and how to act around someone who does come up with a positive HIV/AIDS test result and how to get at risk people to take the test to insure they are not spreading the disease.
Also , healthcare providers emergency crews that may come in contact with the disease are to be counseled on how to deal with the disease and contain it in an situation that may occur. Title IV is the General Provisions Reports and Evaluations (Public Law 101-318). The section emphasis’s the need for services for children or “pediatric patients” (Public Law 101-381).
Testing procedures and the technology used to determine patients with the disease are given. Since mothers can pass the disease onto their unborn child women are included in this section as well. Reports must be given to certain committees on the progress of programs . Research on new findings must also be given to insure every health care giver is up to date with procedures in handling the disease. Emergency employees, families, and individuals must all receive counseling under this section. Counseling must provide information about the disease and how to control the spreading of the disease.
Healthcare givers must also report cases of the outbreak if more services are needed. All in all each title explains how to find the disease, how to contact people with the disease and how to control the disease with the grant money given by the federal government. After five years of being in act the policy was resigned for another five years with some changes on eligibility and money distribution. Some critics of the program don’t like how Medicaid made getting help difficult and didn’t try to make getting help easier (Health and Human Services, 1995). Distribution of the money has also been criticized by public officials.
They believe the urban areas are receiving more money than the rural areas. Tom Coburn a Representative of Oklahoma has been known to be a critic of the policy. He believes that more funding should be put towards prevention and that money should be given on the number of people reported to have the disease AIDS instead of being calculated on the number of people with the virus HIV( American Health Line, 2000). Supporters of the program are found in many areas. Such supporters include the American Foundation for AIDS Research, Jeanne White ( Ryan White’s mother), AIDS Action Council who lobbied for the act, and gay activists.
Programs that have been set up under the policy are wide ranged. Anything from commercials on TV to bring awareness of the disease to hospitals and health care providers. Programs that will be affected by the program are insurance companies, communities, any type of healthcare provider, public officials, and family’s who have member affected by the disease. Communities must explain a need for the money if they have large cases of patients with the disease. Communities and states that qualify for the grant money will have to provide services to HIV/AIDS patients affecting workers in each of these areas.
Since the start of the program more than 6.4 billion dollars has been given by the federal government. The programs offered have served more than 500,000 people living with the disease in any given year ( Anonymous, 2000a).
VI. Analysis of Policy
People affected by the program positively are people with HIV or AIDS who receive benefits from the policy. Programs that are implemented due to policy will provide jobs and benefit people working in the specified fields. Families who have members with the disease are also benefited through counseling sessions and the research provided to help find a cure for their loved ones. The early intervention programs could help everyone by bringing information to them.
Pharmaceutical companies are also affected because they are benefited by the earnings that let people who other wise could not get or receive medications needed can now receive the treatments making money for the people who make the drugs and equipment needed to give the drugs. They also may be affected negatively because the government may not subsidize as much money that a private physician could get for the drugs. People affected negatively also include the patients, city’s or states who don’t meet the requirements for getting the grant money.
The policy was made to provide care for people with HIV and research to find a cure or treatments that will help stop the spread or pain of the disease (Anonymous, 2000b). The policy was intended to inform the populations about the effects of the disease and how to not become at risk to get the disease. It also was intended to help families cope with the disease ( Anonymous, 2000a). No one can really say who did not get the virus or disease because of the intervention programs that give information about the disease. On the other hand more than 500,000 people per year have been helped based on information given by reports ( Anonymous, 2000a).
Once again the impact of the people protected can not be counted but the impact of people with the virus is increasing as funding increases each year. Funding for states for the years 1999-2000 increased eight percent and funding for education centers increase thirty three percent during these same years . Funding was divided into four different title programs. “These programs include help for cities, states, assistance programs, early intervention, and children”. With all these programs combined the percent for funding has rose a cumulative of three hundred and thirty eight percent since 1993 ( Anonymous, 2000a).
In the 1999 budget $1.4 billion dollars was set aside for programs included in the policy. Since the beginning of the policy in 1991 over 6.4 billion dollars has been given to the programs set up ( Anonymous, 2000a).
A good and bad affect of the policy is that people with HIV are living longer but the number of people getting the disease is growing ( American Association for World Health, 1999). Unintended results include people not being eligible for the programs due to not enough people in their area having the virus or disease. Also, abuse of the programs have been reported. Such allocations include urban areas receiving major amounts of money while rural areas are scraping by to provide services.
Strengths in program include the amount of money and people that benefit from the grants. Another strength is that the policy just doesn’t target on area but a wide range of people and cities. The policy has taken away the stigma that this disease is not just a “gay man’s disease”. It shows that anyone can get the disease and with education and prevention numerous people will be helped from catching this disease or live more comfortably from the affects from the disease. The policy also gives counseling benefits not only for families and patients but emergency workers. The policy doesn’t have a linear view but a holistic view on everyone who could be affected by the impact of the disease. The policy targets a variety of groups that either have the disease or help with the disease.
The policy analyzed in this paper is Public Law 101-381 the “Ryan White Comprehensive AIDS Resources Emergency Act of 1990.” Since the early 1990’s the government has given billions of dollars to help reduce the affects of the HIV/AIDS virus that is known to cause death from an infection because the immune system can not fight back the bacteria inside the body. The policy outlines ways cities, states, and people can help prevent from having the virus and ways to make sure people who have the virus or disease are taken care of through counseling, treatments, and organizations. Each aspects of the disease is outlined as a way to help not label or stigmatize one group of society.
Although the United States has put money and effort into this disease globally it is killing families, cities, and there are continents at risk of a major outbreak. Six million people are reported of having the disease 890,000 of them are on the North American continent ( American Association for World Health, 1999). The policy’s main goal is to make sure people with HIV/AIDS are given opportunities to get healthcare benefits and counseling for family members who have a loved one with the disease.