New HIV/AIDS Bureau Emerges from a Shared Mission

Many advocates and people living with HIV/AIDS (PLWHA) who pressed so tirelessly for Federal action in the first decade of the AIDS epidemic did not live long enough to see the second. Had they done so, they would have witnessed a government that some people thought slow to respond making an unprecedented effort to treat the disease.

Creation of HRSA’s HIV/AIDS Bureau (HAB) in 1997 “pulled together some of the country’s leading HIV/AIDS care experts into an organized team able to continue an aggressive and coordinated response to the evolving epidemic,” said Claude Earl Fox, acting administrator of HRSA at the time.

Joseph O’Neill, head of HAB and HRSA’s associate administrator for AIDS, described the work of the new bureau as a “partnership with hard-pressed communities and States to develop an organized infrastructure responsive to the needs of people affected by HIV disease.”

Between 1990 and 1997, the components of the Ryan White HIV/AIDS Program were administered by four independent bureaus within HRSA.

  • Title I (Part A) and Title II (Part B) programs and the Special Projects of National Significance Program were housed under the Bureau of Health Resources Development along with the AIDS Program Office, a HRSA-created administrative body:
  • Title III (Part C) and the Dental Reimbursement Program were managed by the Bureau of Primary Health Care.
  • Title IV (Part D) programs were managed by the Bureau of Maternal and Child Health.
  • The AIDS Education and Training Centers (AETCs) were part of the Bureau of Health Professions.

Consolidating the Ryan White HIV/AIDS Program under a single management umbrella allowed the new Bureau to capitalize on synergies among programs. And after the development of HAART, as programs became more medically oriented, consolidation helped create much-needed clinical expertise to advise the direction of programs and encourage further medical developments. Consolidation also brought the following benefits:

  • Improved grantee and provider access to clinical care training and technical assistance
  • A more concentrated attack on health disparities among PLWHA
  • Development of a single common data system for measuring effectiveness
  • A reduction in administrative costs for organizations receiving funding through more than one Ryan White HIV/AIDS Program.

In short, bringing programs together under one roof created an effective means to combat the epidemic in hard-hit, resource-poor communities; it fostered greater professional collaboration; and it underscored the shared mission of State and Federal governments, communities, and PLWHA to combat HIV/AIDS. The result has been a Ryan White HIV/AIDS Program client base that is reflective of the epidemic as well as a dramatically decreased AIDS morbidity and mortality rate among populations who, without the Ryan White HIV/AIDS Program, would have had little access to care.