Category: HIV

Trump Pledged to End H.I.V. But His Policies Veer the Other Way.

WASHINGTON — In his State of the Union address, President Trump announced a bold plan to end the scourge of H.I.V. by 2030, a promise that seemed to fly in the face of two years of policies and proposals that go in the opposite direction and could undermine progress against the virus that causes AIDS.

In November, the Trump administration proposed a rule change that would make it more difficult for Medicare beneficiaries to get the medicines that treat H.I.V. infection and prevent the virus from spreading.

Mr. Trump has repeatedly urged Congress to repeal the expansion of Medicaid under the Affordable Care Act, even though Medicaid is the largest source of coverage for people with H.I.V. And he has promoted the sale of short-term health plans that skirt the Affordable Care Act, even though such plans usually exclude people with H.I.V.

To end the spread of the virus, federal health officials say they must reduce the stigma attached to gay men and transgender people who are at high risk so they will seek testing and treatment. But for two years the administration has tried to roll back legal protections for people in those groups.

Those opposing moves by the administration have AIDS activists baffled.

“The president’s announcement comes as a surprise, albeit a welcome surprise,” said Jennifer C. Pizer, the law and policy director at Lambda Legal, a gay rights group. “It represents an about-face on H.I.V. policy.”

The administration describes the plan to end the spread of H.I.V. as one of the most important public health initiatives in history. But the record shows a rather large gap between the administration’s words and deeds.

Since Medicare’s outpatient drug benefit began in 2006, the government has required prescription drug plans to cover “all or substantially all drugs” in six therapeutic classes, including antiretroviral medicines to treat H.I.V.

In November, the Trump administration proposed a new policy to cut costs for Medicare by reducing the number of drugs that must be made available to people with H.I.V.

The proposal would allow certain exceptions to the requirement for Medicare drug plans to cover all drugs in the six “protected classes.”

Insurers could require Medicare beneficiaries to get advance approval, or “prior authorization,” for H.I.V. drugs and could require them to try less expensive medications before using more costly ones, a practice known as step therapy.

People with H.I.V. and doctors have condemned the proposals.

Bruce Packett, the executive director of the American Academy of H.I.V. Medicine, representing doctors who care for H.I.V. patients, said the administration’s proposals “could be catastrophic” for Medicare patients with the virus, as well as for the president’s campaign to end the epidemic.

“At least 25 percent of all people living with H.I.V. who are in care in the United States rely on Medicare as their insurer,” Mr. Packett said.

Those patients are 65 or older or have disabilities and often have other chronic diseases or conditions, so doctors need access to the “full arsenal” of medicines to treat H.I.V., Mr. Packett said.

Many of the Medicare patients with H.I.V. are taking medicines for their other conditions, so doctors have to worry about drug interactions, Mr. Packett said. In addition, he said, some have drug-resistant strains of H.I.V., and different patients often respond to the same drug in different ways.

“It’s important that providers have access to all the available options” among drugs to treat H.I.V., he said.

Requirements for prior authorization and similar restrictions can delay the start of treatment. Studies show that a rapid start to therapy, within a week or even a day of diagnosis, produces better results for patients and reduces the likelihood that they will infect others while waiting for treatment.

READ MORE: https://www.nytimes.com/2019/02/12/us/politics/trump-hiv-plan.html


The State of HIV/AIDS in Black America

ImageThere is some good news and not-so-good news to report on National Black HIV/AIDS Awareness Day. The good news: The number of new infections has finally stabilized at about 50,000 new cases per year in the USA since the mid-1990s.The bad news: The epicenter of the epidemic is Black America. African-Americans and other Black communities represent only 12% of the nation’s population but account for nearly half—some 44%—of all new HIV infections, report the Centers for Disease Control and Prevention. Black gay and bisexual men suffer the highest new infection rates in the country. “African-Americans account for about half of the more than one million people living with HIV/AIDS in the United States,” Donna Hubbard McCree, PhD told EBONY.com. Dr. McCree is the Associate Director for Health Equity of the CDC’s Division of HIV/AIDS Prevention. “And about half of those who die from AIDS every year.” “African-Americans tend to have sex with other African-Americans. So even with less risky behavior their chances are much higher of meeting are partner who is infected,” adds Dr. McCree. But there is some good news on Black women. Recent data show that new infections—these are called seroconversions—among Black women are declining for the first time in over a decade. “New HIV infections among Black women [decreased by] 21 percent between 2008 and 2010,” CDC reported in December 2012. “We are cautiously optimistic about that,” said Dr. McCree. “But Black women continue to account for more HIV infections among women than any other race or ethnicity. African-American women account for more than 60 percent of all infections among women.” Infection rates among Black women are nearly 15 times higher than those among White women. Seroconversions among Black women are rising the fastest in the South and rural states. Those states also are predominately poorer than the rest of the country—and the state governments are overwhelmingly conservative and against expanding health care access, the Black AIDS Institute reported in November.

Meanwhile: The number of new infections have been particularly “alarming” among young Black gay and bisexual men aged 13 to 19, according to CDC. New seroconversions have increased by almost half between 2006 and 2009.  The crisis is so severe in some American cities that “one in two Black men who have sex with other men is HIV positive,” according to a report released by the Black AIDS Institute last July at AIDS 2012 in Washington.