New Studies Highlight Racial Disparity, Treatment Access Among HIV Patients

At the 2002 Ryan White Comprehensive AIDS Resources Emergency conference, some of the latest research into the differences between minority and white HIV patients and access to HIV treatment indicated that there were not huge disparities within HIV programs. However, "When you sum it up across states and programs, you get disparities," says Stephen F. Morin, Ph.D., professor of medicine at the University of California-San Francisco, AIDS Research Institute.

"So it's a complicated picture, and there's a huge difference in how people receive care through Medicaid and the AIDS Drug Assistance Program," Morin said. "African-Americans are far more likely to receive access to antiretrovirals through Medicaid, and people on Medicaid are less likely to be on optimum therapy than people in ADAP."

Research at the conference, which was sponsored by the Health Resources Services Administration of Rockville, Md., indicated that differences in household income and disability status led to proportionately more African-Americans in Medicaid programs than whites and Latinos. Studies also showed a greater proportion of Latinos in ADAP programs than in Medicaid, a difference that investigators attributed partly to the fact that Medicaid programs require a residency test for enrollees and ADAPs do not.

Perhaps the biggest problem with the current Medicaid/ADAP safety net for uninsured and poverty-level people infected with HIV is that their access to care is largely dependent upon their state of residence and whether they were tested for HIV soon after becoming infected, research shows. Some states have stringent Medicaid requirements in which enrollees must have an AIDS-defining illness or a disability before they qualify for HIV medications and services. And in some states and communities, minorities are less likely to learn of their HIV status until after they begin to experience symptoms, said T. Anne Richards, MA, a research specialist with the UCSF Department of Medicine.

US Rep. Nancy Pelosi (D-Calif.) and others in Congress have sponsored a bill called the Early Treatment for HIV Act of 2001, which would enable more HIV-infected poor people to receive antiretrovirals and HIV treatment before their disease progressed to illness, said Scott Brawley, MSW, director of public policy for AIDS Action, an advocacy group in Washington, D.C. However, the bill has been stalled in the House subcommittee on health since shortly after it was introduced in June 2001. Also, 2002 has not been a good year for a bill that would cost states more money, he noted.

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