individuals with HIV; it specifically refers to those who are low-income, uninsured, or underinsured. Third, the authorizing language and direction from HRSA do not place limits on the range of financing and delivery options the Committee could consider, nor do they place limits on the amount of new public expenditures or the time frame that the Committee should keep in mind in developing its recommendations.

It might be appropriate for readers of this report to ask why those with HIV/AIDS should be provided public financing for care and services when those with other chronic conditions are not? This is a fair question. The IOM, in its recent report, Insuring America’s Health: Principles and Recommendations, recommended moving toward some form of universal health insurance. Under such a model, it would not be necessary to link an HIV/AIDS diagnosis to an entitlement to services; all citizens would share in the same entitlement. Until a model of universal insurance is adopted, however, the Committee believes that the combination of factors mentioned above results in the potential for a far more catastrophic epidemic and public health threat, which in turn justifies a special program for those who are infected.

In this report, the Committee recommends the establishment of a new federally-funded program for low-income, HIV-infected persons that provides early access, continuous coverage, and uniform benefits to best meet the needs of those with HIV/AIDS. The HIV Comprehensive Care Program is designed with a strong focus on comprehensive and continuous primary care, substance abuse treatment, and mental health services to support adherence to HAART. The Committee took a holistic approach when considering the delivery of services to its targeted group because HIV/AIDS is a complex, multi-system illness that is heavily influenced by other aspects of the individual—general health, behaviors, and state of mind. In particular, the co-occurrence of HIV, substance abuse, and mental illness poses unique challenges for the management and treatment of the disease. When considering the types of services that should be delivered to people with HIV, therefore, the Committee acknowledged the large body of literature demonstrating that substance abuse and mental health are treatable conditions as well as the federal efforts in treating these diseases. The Committee agrees with the Substance Abuse and Mental Health Administration that individuals with and without HIV who have substance abuse problems or mental illness should be treated for those conditions. That such services may also help stabilize a patient and contribute to better adherence to HAART is an added benefit. In the Committee’s view, not including such services in the benefit package would lower the standard of care for individuals with HIV.

Much of the Committee’s recommended program is not entirely new. In many ways, this Committee’s work is a logical application of the pertinent findings of other IOM Committees to the relatively narrow subject the



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement