We’ve got some of the most powerful antiretroviral HIV drugs at our disposal, capable of preventing AIDS and prolonging life to near-normal expectancy, but they’re only reaching a fraction of the people who need it.
A disturbing report released Thursday by the Centers for Disease Control and Prevention finds that only about half of HIV-positive gay and bisexual men in the United States are receiving treatment. And only 42 percent had achieved viral suppression, or the point at which there are such low levels of the virus in the blood that the chance of passing it on to others is greatly reduced. Only 77.5 percent of HIV-positive gay and bisexual men were linked to some kind of HIV health care within three months of diagnosis.
“The most powerful tool for protecting the health of people living with HIV and preventing new HIV infections is really only reaching a fraction of the men who need it,” said Richard Wolitski, Ph.D., an expert on HIV among gay and bisexual men, as well as a senior advisor in the CDC’s Division of HIV/AIDS Prevention. “The goal of HIV treatment is for everyone to achieve viral suppression."
The report was compiled from 2010 data and will serve as a baseline for future surveys, explained Wolitski. So while it can’t tell us whether these rates are an improvement or a regression from years past, the number of people getting treatment is still too low -- especially considering that almost everyone with HIV who takes antiretroviral drugs can achieve suppression.
“The treatments that we have available today are so much more effective and so much easier to take than the medications that were available early in the HIV epidemic,” Wolitski told The Hufington Post. “HIV has really become a health condition that can be treated and monitored effectively if the right care is given and started early."
The rates are especially troubling for young people and for men of color. When the data is split up by race, only 37 percent of black gay and bisexual men have achieved viral suppression, as opposed to 44 percent of white and 42 percent of Latino gay and bisexual men.
Analyzed by age, 25.9 percent of gay and bisexual men ages 18 to 24 achieved viral suppression, as opposed to 42 percent of the overall population.
There are a lot of obstacles that can block men from their medicine, including lack of experience with the health care system, no family support and stigma that could make men afraid to reveal their HIV status to their support networks. All these factors make it more difficult to keep up with the demands of biannual check-ups and daily medication (usually pills). Mental health issues and substance abuse problems could also prevent men from accessing the drugs they need.
But the primary barriers are poverty and lack of insurance, despite the fact that HIV drugs are covered by Medicaid and federal funds are available through the Ryan White HIV/AIDS program, which fills in funding gaps that aren’t covered by Medicaid or private health insurance.
The Affordable Care Act could also end up making a significant dent in these numbers. In a report released last January, the Kaiser Family Foundation estimated that of the 407,000 people with HIV who are already linked to health care, 70,000 are estimated to be uninsured. But because of the health care act, 23,000 would gain coverage through the insurance marketplace, while 46,910 more would become eligible for expanded Medicaid -- provided that all states sign up for expanded Medicaid. As of September, only 27 states and the District of Columbia plan to participate.
As for the estimated 700,000 people with HIV who aren’t linked to care yet, the Kaiser Family Foundation estimates that ACA changes could mean health coverage for an additional 124,000 more people.
In Chicago, rates of HIV infection have jumped among gay and bisexual men under 30, mostly among black men. To close the HIV treatment gap and prevent more infections, advocacy groups and governmental organizations have to work together, said Simone Koehlinger, senior vice president of programming at AIDS Foundation of Chicago.
“For states like Illinois where Medicaid has expanded, you want to make sure that the Medicaid managed care plans continue to cover services that are needed, that formularies are covering the effective HIV drugs and that people who were perhaps not covered for many years ... understand [how to navigate] the health care system,” said Koehlinger in a phone interview with HuffPost.
As important as funding, though, are programs that continue to provide cross-cultural education about HIV/AIDS to decrease stigma around the disease, something that the AIDS Foundation of Chicago has done since its founding in 1985. Among its other priorities are advocating on behalf of patients to keep medications affordable, educating HIV/AIDS clients about their medication options, and training health care providers on how to bridge cultural divides about the disease.