Sustainability Strategies

There are several different strategies for sustaining HIV/AIDS prevention and treatment programs.

Federal Funding
Many HIV/AIDS programs in rural communities receive federal funding. The categories for domestic funding are healthcare services and treatment for people living with HIV/AIDS, cash and housing assistance for individuals with disabilities living with HIV, prevention, and research (primarily carried out by the National Institutes of Health).

Funding is distributed across multiple federal agencies, each with its own purpose. These include the U.S. Department of Health and Human Services, U.S. Department of Housing and Urban Development, U.S. Department of Justice, U.S. Department of Veterans Affairs, and U.S. Department of Defense. A summary of mandatory and discretionary funding for HIV/AIDS is available by agency between FY 2018 and the FY 2019.

The Ryan White HIV/AIDS Program is a critical federal program that funds healthcare and support services for people living with HIV/AIDS. For more information about this program, please see the Ryan White HIV/AIDS Program in Module 1.

Medicare and Medicaid are large payers of HIV care in the United States. Most people with HIV/AIDS who qualify for Medicaid have low incomes and a permanent disability. Medicare is also an important payer for people living with HIV/AIDS – including people living with HIV/AIDS who are 65 years of age and older and people under age 65 who have a permanent disability and receive Social Security Disability Insurance. Social Security disability insurance and Supplemental Security Income are two programs available for people who are unable to work because of HIV/AIDS. The Patient Protection and Affordable Care Act of 2010 has expanded access to care for people at risk for and living with HIV/AIDS. See Implementation Considerations: Medicaid Expansion for more information.

Reimbursement
Rural HIV/AIDS programs may be able to seek reimbursement from insurance providers for services such as telehealth. Telehealth can facilitate access to HIV care specialists in rural areas. Laws on reimbursement for telehealth services vary by state.

Foundations
Funding from philanthropic organizations can also be used to sustain rural HIV/AIDS programs. Grants for HIV/AIDS prevention and treatment generally last only a few years, which can make it difficult to continue a successful program after the end of the grant period. Foundations funding domestic HIV/AIDS programs or rural health programs include:

Partnerships
Rural HIV/AIDS programs are leveraging their funding and increasing sustainability of their services by collaborating with local partners like health departments and community-based organizations. Partner organizations can contribute funding, time, staff/volunteers, or space for meetings and classes.

Organizations that Fund Rural HIV/AIDS Programs
Specific examples of organizations that have funded HIV/AIDS programs and services are listed below.

Funding from private corporations or their philanthropic arm:
- Kaiser Permanente
Funding from HIV/AIDS-focused organizations:
Funding from federal agencies:
- The Centers for Disease Control and Prevention maintains a list of funding opportunities available for organizations supporting HIV/AIDS-related work.
- The U.S. Department of Housing and Urban Development offers funding to communities and nonprofit organizations in support of housing opportunities for people living with HIV/AIDS.
- The National Library of Medicine has funding opportunities for organizations improving access to information about HIV/AIDS prevention and treatment.
- The Health Resource & Services Administration administers the Ryan White CARE Act, which provides HIV/AIDS care and support for those who are low-income or have insufficient health insurance coverage.
Funding from state agencies:
- The Texas Department of State Health Services maintains a list of available funding opportunities, including guidance on how to apply.
- State departments of human services and departments of health may offer funding for all or part of the program once its value has been demonstrated during the initial grant.
Private insurance may also cover HIV screenings for people at an increased risk of contracting the virus.

The Rural Community Health Toolkit also provides information about general Sustainability Strategies and Sustainability Strategies for Specific Issues. In addition, the Rural Health Information Hub provides a list of active and inactive funding opportunities related to HIV/AIDS.

Resources to Learn More

HIV InSite Funding Resources
Website
Lists funding sources for HIV/AIDS programs. Includes organizations interested in funding both domestic and international programs.
Organization(s): University of California, San Francisco

NNED Funding Opportunities
Website
A regularly updated listing of grants and funding opportunities for behavioral health programs, including many HIV/AIDS programs, categorized by the funding source (e.g. foundation, government) and the deadline to apply. Although some funding sources are focused on eliminating disparities in health, many HIV/AIDS programs may qualify.
Organization(s): National Network to Eliminate Disparities in Behavioral Health