CARE Act: Committed to Action
The Ryan White CARE Act
Training and Technical Assistance Grantee Meeting 2006
Aug. 28-31, 2006

Contributed by:
Rachel L. Matillano
Director of HIV Care Services

The 2006 Grantee Meeting held on Aug. 28-31 in Washington, D.C. marked the 15th year of the Ryan White CARE Act (Comprehensive AIDS Resources Emergency Act), the congressional legislation that authorizes funding for HIV care and treatment services and programs nationwide. It was first authorized by congress in 1990 and named after Ryan White, an Indiana teen who contracted HIV through blood transfusion and later died of AIDS that same year.

The Grantee meeting is held biennially to facilitate learning and exchange between local, state, regional, and national programs and jurisdictions receiving CARE funds from the Health Resources Services Administration (HRSA). Focusing on the theme CARE Act: Committed to Action, this year’s meeting had close to 3, 000 attendees who packed sessions halls to catch the four plenary sessions, 184 workshops and 130 poster presentations grouped into six tracks:

• Access to Care
• Administration and Fiscal Management
• Coordination and Linkages
• Data Evaluation and Outcomes
• Program Development
• Quality

With so many interesting and stimulating workshops and presentations to choose from, it was understandably hard to narrow down what to catch and what not to miss. Whenever our workshops finished early, many attendees like myself would run into other interesting sessions that were still going on to catch the tail end. Whenever we could, other colleagues from the San Francisco Bay Area and I would divide what sessions to go to so we could cover more ground. On some occasions, we’d call each other by cell and make a decision to junk a boring workshop and move to another one based on colleagues’ recommendations.

I mostly I prioritize the opportunity to interact face-to-face with other programs and providers around their experiences in implementing engaging and innovative services. I decided I could take advantage of the administrative, fiscal management and data evaluation and outcomes workshops through their handouts and post-conference once the technical assistance materials were made available online. The most interesting workshops for me were mostly in the Access to Care and Coordination and Linkages tracks such as:

“The Options Project: Rapid Replication of Prevention with Positives”
“Prevention with Positives in a Clinical Setting”
“Linking HIV Testing to Care Services”
“Using Motivational Interviewing to Promote Behavior Change”
“Peer Advocates as Essential Members of Multi-disciplinary Healthcare Teams”
“Outreach, Engagement and Retention Models”
“Client Retention Strategies: the First Four Months”
“Best Practices in HIV Care for Homeless Patients”
“Innovative Use of Incentives to Improve Treatment Adherence”
“Training a New Generation of HIV/AIDS Leaders”
“Considering Work Benefits Planning and Work Incentive Programs for People Receiving Cash Benefits and Public Health Care Coverage”

Looking at the whole list of workshops offered, I realized that while there were several innovative models that offered new learning for myself, however for the most part it was very validating to see that our model of integrated multi-disciplinary HIV care services is truly considered at the Best Practices level nationwide. What and how we have been doing services for many years, are still “new and innovative” for many parts of the country.

I can credit that to external and internal factors. Externally, we have benefited from the development of cutting edge models of HIV care services throughout the San Francisco EMA (Eligible Metropolitan Area encompassing the counties of San Francisco, San Mateo and Marin) and a certain extent even in the other neighboring EMAs such as Alameda/Contra Costa Counties and Santa Clara. More importantly, similar to other people of color communities, the culturally competent HIV care services for Asians and Pacific Islanders that we have developed and nurtured in internally within the agency in the last 20 years are proving to be the model programs that federal bodies such as HRSA recognize and recommend to be replicated throughout the country.

There were two international focused workshops that I found to be very interesting:
“The Role of HRSA HIV/AIDS Bureau in Promoting PEPFAR (Presidential Emergency Plan for AIDS Relief” and “International Opportunities for RWCA Grantees through the TwinningCenter.” PEPFAR is the multi-billion dollar five year effort to provide prevention, care and treatment in Sub-Saharan Africa, the Caribbean and Southeast Asia. HRSA and other federal agencies presented how they are contributing to PEPFAR by sharing expertise in the RWCA and the provision of anti-retroviral treatment as well as providing capacity building assistance.

The presentation on Twinning Center showed how a capacity building program can strengthen indigenous organizations in countries funded by PEPFAR through partnerships between US and overseas agencies to exchange personnel, resources, , and best practices. They shared on various ongoing twinning opportunities something that A&PI Wellness Center is very keen in pursuing in the near future.

The plenary session presentations were well chosen and thought-provoking. One plenary speaker who focused on the clinical realm posited that in the future HIV medication/treatment adherence (meaning adherence to HAART or Highly Active Anti-Retroviral Therapies) may be equated to an effective prevention intervention. The thinking around this is science-based fact that HIV positive people with lower viral loads are less virulent and thus are at less at risk of infecting other people through sexual or intravenous transmission.

This got a number of San Francisco-based colleagues wondering whether the government is starting to think of making HAART mandatory for HIV positive people and possibly instituting directly observed therapy (DOT) mechanisms to ensure HIV treatment adherence. An obvious parallel is tuberculosis control where the full extent of law enforcement can be used to oblige people to adhere to TB treatment and prevention.

Another plenary session was dedicated to honoring seven leaders from across the country who had accomplished exceptional work along HIV care and treatment service delivery. One of them who really impressed the conference attendees was Dr. Michael Kaiser from the Louisiana State University Public Hospital system in New Orleans who with the aftermath of hurricanes Katrina and Rita, “worked tirelessly to coordinate the clinical response and recovery efforts of the fourth largest public hospital system in the nation”. Dr. Kaiser presented the grave impact on treatment and care for HIV-positive people in the areas devastated by the hurricanes and how even at the time of the conference, the public health system still had to account for a high percentage of their HIV positive patients. They still didn’t know 100% who had died or migrated to other parts of the country and certainly were very concerned that those who survived may still not be linked to HIV care services wherever they had moved.

He received a rousing standing ovation when he without mincing words highlighted the hard lessons on the state of our public health system and criticized the fallacy  of the federal government for continuing to fund the anti-terrorist war at the level it has at the expense of the lives of HIV-positive and poor people, especially people of color of this country. Dr. Kaiser was also one of the leading proponents to a particular track of presentation entitled Voices from the Storm Institute: Impact of Hurricanes Katrina and Rita on HIV Care in Louisiana, one of the most consistently well-attended series of workshops.

At the time of the conference, the reauthorization of RWCA was still pending after a year of delay (it was slated to be reauthorized a full year earlier in the fall of 2005). The long delay did not seem to daunt HRSA administrators’ confidence that it would be reauthorized by Congress later in the year. (Note: RWCA was indeed reauthorized in December 2006 with San Francisco EMA receiving less cuts than it initially anticipated).

It was memorable to meet and hear Jeanne White Ginder, Ryan White’s mother, speak and wholeheartedly honor everyone in the conference for the amazing work that people do day in and day out in whatever capacity as medical providers, social service providers, volunteers, and administrators. She also honored those who had passed away and those living with HIV, their families and loved ones for continuing with the challenges and the good work. It was a good charge to ground us back to the basics of why we do what we do for and in partnership with our HIV positive community.

For more information on the conference visit www.rwca2006.com.

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