The uncertainty hovering over low-income people living with HIV or AIDS ended this week with the announcement that in California they are now eligible for Medicaid, even in advance of the national implementation of the Affordable Act Care reforms.

That means uninsured, low-income HIV patients statewide for the first time do not have to wait until they are diagnosed with AIDS to qualify for the publicly-funded health care program, called Medical in California.

"We have a long way to go," said Rep. Barbara Lee, D-Oakland.

But the change is a major shift in the front lines in the battle to one day see "an AIDS-free generation," Lee said Monday, just days after the U.S. Supreme Court upheld the Affordable Care Act.

Lee spoke at Cal-Pep, an HIV/AIDS advocacy organization in Oakland.

"This is a new era," Cal-Pep Deputy Director Carla Dillard Smith said Monday.

California, she added, is the first state to roll out the reform, which doesn't fully go into effect until 2014.

Alameda County, in turn, is the launching ground within California.

There are 7,500 cases of HIV and AIDS in the county, "that we know of," Supervisor Keith Carson said. "The number might be higher."

The annual rate of new HIV infections in Alameda County has not fallen in two decades.

Today, however, African-Americans are overwhelmingly at the highest risk in Alameda County: the rate of new infections -- a rate closely related to education and income -- is two to three times higher than other groups.

The hardest hit populations are gay men and African-American women, especially between the ages of 20 and 40. AIDS is now a leading cause of death among African-American women between the ages of 20 and 40 in Alameda County, according to county figures.

The Affordable Care Act expands coverage without cutting what has been the largest source of federal dollars for people living with HIV or AIDS -- the Ryan White Care Act program. The program is the last resort for low-income, uninsured and underinsured victims of AIDS and their families.

They would have been ineligible for the program under the health care reform as it was originally written. That would have left Alameda County scrambling to find the $7.5 million needed to help subsidize medication for 600 needy HIV and AIDS patients.

"The Affordable Care Act keeps body and soul together," said Kathleen Clanon, an AIDS specialist who is the interim chief medical officer of the Alameda County Medical Center.

The Ryan White program, in contrast, she added, can stop the advance of the epidemic.

The tools exist to make HIV and AIDS rare within 15 years if the support continues, Clanon said. If the country wants to see an AIDS-free generation, she said, "We have to make the investment."