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HIV Testing Policy: A Joint Position Paper of the HIV Medicine Association of the Infectious Diseases Society of America and the American College of Physicians

Editorial Backgrounder

April 15, 2009

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Federal policies regarding the prevention, diagnosis and treatment of AIDS have not kept pace with changes that have transformed the disease from a fatal illness to a chronic disease for patients with ongoing access to HIV care and treatment. The American College of Physicians (ACP), the leading professional organization of internal medicine, and the HIV Medicine Association of the Infectious Diseases Society of America (HIVMA), the nation's foremost organization of physicians and scientists

Audio provided courtesy of the HIV Medicine Association.
specializing in HIV and infectious diseases, have collaborated in this third update of a joint policy paper first published in 1986.

The revised paper examines the current state of HIV/AIDS and its global impact, highlighting the remarkable scientific advances in HIV treatment and current barriers to realizing the full potential of these achievements in combatting the HIV pandemic.

Despite medical and scientific advances, here in the U.S., 56,300 new HIV cases occur every year; 36 percent of people with HIV are diagnosed so late that they have already progressed to full-blown AIDS; and 20 percent of people living with HIV are undiagnosed. What's more, it is estimated that 1 in 16 black men will be diagnosed with HIV during their lifetime and 1 in 30 black women.

HIVMA and ACP are calling on federal policymakers to bring HIV public policy up to speed with science as they address health care reform and set federal HIV program funding levels for 2010. Specifically, the medical societies urge:

  • Coverage of routine HIV testing by Medicare, Medicaid and private payers [Click here to read HIVMA's letter to the Centers for Medicare and Medicaid Services supporting coverage for HIV testing.]
  • Federal support for evidence-based comprehensive sex education, including condoms and syringe exchange programs rather than abstinence-only prevention programs
  • Increased funding for HIV prevention at the Centers for Disease Control and Prevention
  • Access to care for all people living with HIV/AIDS in the U.S. through enactment of a federal entitlement program for low-income people with HIV, as recommended by the Institute of Medicine
  • Continued support by the U.S. government for research into the causes, prevention and treatment of HIV/AIDS and co-morbidities
  • Sustained leadership by the U.S. in responding to the global HIV pandemic, particularly in sub-Saharan Africa
  • Removal of HIV disease from the list of communicable diseases preventing visitors and immigrants who are otherwise qualified to enter the U.S.

Key Facts About HIV/AIDS

Human Immunodeficiency Virus (HIV)

Human immunodeficiency virus (HIV) is a retrovirus that infects and attacks T-cells, also known as CD4+ cells or T-helper cells, which turn the immune system on to fight disease. Once inside these cells, HIV uses the energy and nutrients they provide to grow and reproduce, eventually killing them and moving on to other cells. HIV is transmitted only through blood and other body fluids that contain blood or white blood cells; it is not transmitted through casual contact.

Acquired Immunodeficiency Syndrome (AIDS)

Acquired immunodeficiency syndrome (AIDS) is a condition caused by HIV in which the body's immune system breaks down and is unable to fight off serious, often deadly infections and cancers, known as "opportunistic infections," that take advantage of a weakened immune system.

HIV/AIDS Treatment

HIV treatment is one of the most effective medical interventions available today. Currently, there are 32 FDA-approved HIV/AIDS drugs in five major drug classes. Most patients take these in some combination -- a regimen known as highly active antiretroviral therapy (HAART). Effective treatment reduces the amount of HIV in the bloodstream to very low levels and enables the body's immune cells to rebound to normal levels. It has been estimated that combination antiretroviral therapy has saved 3 million years of life.

HIV/AIDS in the U.S.

Since the first AIDS cases were reported in 1981, there are approximately 1.7 million HIV-infected people in the U.S. 415,000 of those people are estimated to be living with AIDS and 417,000 with HIV infection. An additional estimated 252,000 to 312,000 people are unaware of their HIV infection. Regionally, the South has the greatest number of people living with AIDS, AIDS deaths and new diagnoses, followed by the Northeast, West and Midwest. HIV/AIDS continues to disproportionately impact racial and ethnic minorities who now account for 65 percent of new AIDS cases in the U.S.

HIV/AIDS Internationally

While the U.S. has seen a drastic decline in the number of AIDS deaths since the early 1990s, AIDS remains a global epidemic, affecting an estimated 33 million people worldwide. Sub-Saharan Africa continues to be the region most affected by the AIDS pandemic, accounting for 67 percent of all people living with HIV infection and 75 percent of AIDS deaths in 2007.

Access to combination antiretroviral therapy is still a challenge, and when the drugs are available, most individuals only have access to one drug regimen due to the prohibitive cost of second-line therapies and common diagnostic tools. Opportunistic infections in HIV-infected patients are common in developing countries, with tuberculosis leading the way as the number one cause of death for patients with HIV infection in Sub-Saharan Africa and much of the developing world.

Access to Care and HIV Medical Workforce Shortages

Early and reliable access to care is critical to successful treatment of HIV disease. As treatment has evolved, it has become more complex. Today, treating people with HIV requires a commitment to staying abreast of the latest treatment developments and a unique blend of HIV and primary care expertise. Experienced HIV medical professionals provide more cost-effective and higher quality treatment to HIV patients. There is a growing concern that we face a serious shortage of HIV medical providers similar to the crisis that we face in primary care providers. Recruitment of minority physicians is critical because of the disproportionate impact on African American and Hispanic populations.

Prevention Is Critical

The best way to fight HIV is to prevent it -- and that means paying for strategies that have proven effective, such as comprehensive sex education programs that include sound information about contraception and condoms, and syringe and needle exchange programs and drug treatment strategies.

Stigma Persists

For too many in the US, an HIV diagnosis still carries with it significant stigma and discrimination that impedes access to health insurance and health care providers; jeopardizes employment; and contributes to the high rates of clinical depression among people with HIV/AIDS. As a result of stigma, people with HIV often do not see an HIV provider until they are sick and it is too late for them to fully benefit from treatment.

Click here to read the full position paper, from the journal Clinical Infectious Diseases.

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This article was provided by HIV Medicine Association. Visit HIVMA's website to find out more about their activities, publications and services.
See Also
Quiz: Are You at Risk for HIV?
10 Common Fears About HIV Transmission
More Viewpoints on U.S. HIV Testing Policy

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