U.S. Fight Against HIV/AIDS Requires Attention to Care Access as Much as Medical Advances
July 29, 2012
Global Health Research Fellow
Achieving an AIDS-free generation is a chief rallying cry at AIDS 2012 this week in Washington, DC. In the U.S., reaching the goal is not a question of resources, but resolve, according to experts speaking at sessions focused on AIDS in America. Unlike many affected countries, the U.S. can provide treatment to all who need it and fund outreach and education for those vulnerable to infection. But attention to the disease has waned in recent years and the new infection rate has been stubbornly stuck at roughly 50,000 annually for most of the last decade. Many are hoping the conference will provide the jolt needed to drive transmission levels to as close to zero as possible.
The Obama Administration has started the process. It developed a National HIV/AIDS Strategy two years ago, providing a more unified vision of how to address the disease. It has increased the federal budget for HIV, including providing an additional $80 million this month for treatment. Health and Human Services Secretary Kathleen Sebelius announced several new initiatives at the opening session of the conference: a three year trial with Walgreens to explore how pharmacies can aid medication adherence; additional training programs for clinicians, and; a mobile texting pilot to provide reminders and tips to patients. And in a move many have said is long overdue, she announced a joint project with the President’s Emergency Plan for AIDS Relief (PEPFAR) to convene international leaders to explore lessons learned through the global program that could be applied to the U.S.
Gregorio Millett, senior policy advisor for the White House Office of National AIDS Policy, had several suggestions at the Washington Post’s July 24 event, AIDS in America. First, the U.S. should test serodiscordant couples, something he says is not done here but is key component of PEPFAR. Secondly, he called for the use of rapid CD4 count tests to determine a patient’s status and an immediate link to care. He also said the U.S. needs to ramp up social media surrounding the disease.
But it will take more. HIV care in the U.S., like that for many diseases, runs up against the inherent inequities and weaknesses of the nation’s health system--it is fragmented, complex and frequently inaccessible to lower income populations.
Remedies aimed at the health system generally will greatly enhance access to care for those with HIV, according to advocates at the Post event. These include development of medical homes that provide team based comprehensive care and training of patient navigators to help patients steer through the system. Another critical improvement is the Patient Protection and Affordable Care Act. The Obama Administration estimates that only 17 percent of those with HIV have private insurance and almost 30 percent have no coverage at all. The new health care law will ensure that people with pre-existing conditions, including HIV, cannot be denied insurance. It also will include HIV testing as part of a comprehensive prevention benefits provided without patient co-payments. Perhaps most importantly, advocates say, Medicaid expansions included in the law will ensure coverage for millions of currently uninsured Americans, thus enhancing access to HIV treatment. Full implementation of the health law “is the single most important thing we need to do to end HIV in this country,” Phill Wilson founder and executive director of the Black AIDS Institute said at AIDS in America.
While biomedical advances are now available to drastically reduce the number of new HIV infections in the U.S., additional efforts are needed to address social and financial factors impeding access to prevention and care. In addition to federal actions, affected communities need to take the issue head on, advocates say, addressing complicating factors such as housing, transportation, child care, nutrition and stigma. “All the tools in the world, they don’t mean anything if people don’t use them and people don’t have access to them,” Wilson said.
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