The Ryan White Act in Dallas

Virtually every locality affected by the AIDS epidemic has had to confront changes in the demographics of the disease, shifts in federal priorities, and medical advances in AIDS treatment. Creating a consistent federal policy has proven difficult because the epidemic manifests itself differently in virtually every locality it invades. As a result, some local caseloads increasingly are dominated by intravenous drug users and others by gay men. In recognition of this reality, the primary federal program to fund AIDS services relies on local decisionmakers to make allocation decisions for serving the needs of their caseload. Under the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990, local Health Services Planning Councils were assigned the task of creating an effective continuum of care for persons with HIV I AIDS and were empowered with the task of allocating federal funds to accomplish that objective. In some cases creating and fostering an effective continuum of care proved to be an essentially noncontroversial managerial task, while in other localities political turmoil and rampant self‐interest served as barriers to program effectiveness. This article explores the relationship between local political culture and the development of AIDS programs in Dallas County, Texas. Specifically, we compare the provision of AIDS services in Dallas before passage of the Ryan White Act in 1990, how these services were affected by the Ryan White program, and the experiences since the reauthorization of the Ryan White Act in 1996.