Federal and state HIV/AIDS policies in the U.S.: Are they working for minority families?

Background. African American and Latino families and communities are currently disproportionately affected by HIV/AIDS. These groups comprise approximately 70% of AIDS cases, but represent only 26% of the US population. HIV rates and AIDS-related mortality rates for these groups are also estimated to be higher than for the general population. These disparities exist despite Federal and State policies to assist persons living with HIV/AIDS. Methods. A policy analysis was conducted on Federal policies such as Ryan White, Medicaid, and Medicare and State policies on testing, needle exchange, and Medicaid expansion. The analysis was designed to examine: the availability of programs/services resulting from policies and the cultural competency of policies (i.e., their effectiveness in addressing HIV/AIDS among African Americans and Latinos). After compiling an inventory of the policies and resulting programs/services, researchers rated each policy on cultural competency criteria identified using a literature review and consensus process. Results. Access to and availability of HIV/AIDS services are no longer primary issues for minorities; policies have largely addressed these issues. However, social and institutional barriers continue to hinder progress in reducing HIV/AIDS rates among minorities, especially immigrants. Moreover, existing policies inadequately address co-occurring problems such as substance abuse, homelessness, and mental disorders. Inventories of the policies and their cultural competency ratings are presented. Conclusions. Policy visions include: systems-level changes to remove structural barriers to prevention, treatment and care; support for evidence-based public health strategies to address HIV/AIDS and co-occurring problems; and expanded training to ensure a culturally competent public health workforce.