The House and Senate have agreed to allow a $500 million “reserve fund” for state demonstration projects to expand early access to HIV care through Medicaid. The agreement was finalized on May 17 in a budget conference.

AIDS advocates have long sought implementation of the principles of the Early Treatment for HIV/AIDS Act (ETHA). It would allow low-income persons to receive treatment when it is medically appropriate, rather than waiting for the onset of opportunistic infections and a diagnosis of full-blown AIDS.

The agreement holds a place in the budget for funding ETHA in fiscal year 2008. But the legislation still has to be passed, and the funding must also be approved through the appropriations process. The closeness of the vote on the budget process suggests to some that full funding is not assured.

Gordon Smith, R-Ore., and Hillary Clinton, D-N.Y., have taken the lead in the Senate in pushing for enactment of ETHA. Majority Leader Nancy Pelosi, D-Calif., and Ileana Ros-Lehtinen, R-Fla., are poised to introduce the measure in the House.

“If we could get a state like South Carolina to expand its Medicaid program through ETHA, that would be huge,” said Michael Kink, legislative counsel with the New York-based group Housing Works. “The hundreds of people who can’t get HIV meds there because there is not enough money in the state’s AIDS Drug Assistance Program (ADAP) could get treatment through Medicaid.”

Abstinence education programs will not be renewed when the authorizing legislation expires at the end of June, according to John Dingell, D-Mich., chair of the House committee that must approve such a measure. Dingell said that evaluations of the program commissioned by Congress have shown that they are not effective.