According to the Centers for Disease Control and Prevention (CDC), over 56,000 Americans become infected with HIV each year. A lot needs to be done to halt the HIV epidemic in the U.S. and, thankfully, we have effective tools at our disposal.
Chief among these tools is HIV testing. CDC estimates that 21% of people living with HIV are unaware of their HIV status. You might ask how this is related to stopping the HIV epidemic. Well, many studies have found that HIV-positive individuals who know that they are HIV-positive change their behavior to reduce the chance of transmitting the virus to their HIV-negative partners. People who are infected with HIV but don’t know it are at high risk of unintentionally placing HIV-negative partners at risk for HIV infection. The result is that a greater number of new HIV transmissions in the U.S. each year stem from people who do not know that they are HIV-positive. If we scale up HIV testing, then we can reduce the number of individuals who are unaware of their HIV infection and possibly also reduce the number of annual HIV transmissions.
We can also do more to help people who are diagnosed with HIV to get connected to appropriate health care services. Besides prolonging the life of people living with HIV, HIV-positive individuals on antiretroviral therapy (ART) are less likely to transmit HIV to an HIV-negative partner. Increasing the number of people with HIV who receive regular care will help extend their lives, reduce the likelihood of late stage diagnoses (which is especially common among racial/ethnic minorities), and possibly reduce the number of new HIV transmissions.
So, why aren’t people getting tested regularly for HIV or accessing services once diagnosed? There are many complicated personal, financial, and other reasons that affect a person’s decision to get tested for HIV or to access HIV services after diagnosis. Federal, state and private health insurance policies can also deter people from seeking HIV-related preventive or treatment services.
The White House Office of National AIDS Policy (ONAP) has commissioned the Institute of Medicine -- the independent health arm of the National Academy of Sciences that provides unbiased and authoritative advice to decision makers and the public -- to examine federal, state, and private health insurance policies that 1) serve as barriers to HIV testing or 2) inhibit entry into clinical care or continuous and sustained care. We know that providing clinical care for HIV-positive persons is complicated by the fact that fewer providers are choosing to specialize in HIV care. Even if we get more people tested for HIV or into health care services, it is a problem if there are fewer health care providers available to provide these services for the long-term. We have also asked the Institute of Medicine to examine policies that may help increase the number of health professionals providing HIV care.
To get the process started, the IOM will select a panel of 15 subject matter experts who will plan a series of workshops that will address questions in each of the following 3 areas:
- HIV testing and federal, state, and private health insurance policies: Relevant questions include: What current federal and state laws or private health coverage policies impede HIV testing? What has been the impact of opt-out HIV testing? What effective HIV testing methods can be used to reach at-risk populations?
- Health care system capacity to administer a greater number of HIV tests and to accommodate new HIV diagnoses: Relevant questions include: Where do HIV-positive patients currently get care? What is the training of most HIV care providers? What capacity is there to absorb newly diagnosed HIV-positives as a result of expanded HIV testing services? What are the impediments for professionals entering into AIDS care and being retained? Are there ways to incentivize HIV/AIDS as a specialty among the health care professions?
- Federal and state policies that influence entry into clinical care and the provision of sustained care: Relevant questions include: How can federal and state agencies provide more integrated HIV care services? What policies promote clinical care services among agencies at the federal level, state level or between state and federal agencies? What are federal and state agency policies in funding HIV medication adherence programs?
A summary report from the each of the workshops on these three topics will be released in March 2010, May 2010 and September 2010, respectively. Information from the reports will help inform the implementation of the National HIV/AIDS Strategy and will complement ONAP’s other activities. Stay tuned...
Greg Millett is Senior Policy Advisor in the Office of National AIDS Policy