Nearly 47,000 people with HIV who are in care and an additional 124,000 who are not have the potential to gain insurance coverage thanks to the Affordable Care Act (ACA, or “Obamacare”), according to Kaiser Family Foundation. The nonprofit health research organization analyzed data from the Centers for Disease Control and Prevention’s (CDC) Medical Monitoring Project to provide this first-of-its-kind analysis of how the 2010 health care law likely affects the HIV population. The study does not take into account any actual enrollment into ACA-related health care plans that may have taken place since open enrollment began in October 2013.
Out of an estimated 1.2 million Americans who are living with the virus, nearly 407,000 are in care. Eighty-seven percent of those in care have incomes below 400 percent of the federal poverty level (FPL), which is the cutoff for receiving federal subsidies to pay for the new insurance marketplace plans. About 40 percent of Americans with HIV who are in care are currently covered by Medicaid.
Matt Sharphad high hopes for the nation’s health law. The self-employed health consultant is HIV positive and has been denied insurance in the past because of his illness, so he was relieved to learn that the law wouldn’t allow that to happen again.
But now, the 57-year-old San Francisco Bay Area resident is less sure that Obamacare will live up to his expectations.
He plans to enroll in coverage through the state’s insurance marketplace — but he still doesn’t know if his doctors will be included. And although he will get help with premiums and medications through an existing program for HIV patients, Sharp worries he won’t be able to afford co-payments and other out-of-pocket expenses.
“I am apprehensive,” said Sharp, a former classical dancer. “There is a lot of unease with the whole rollout. But when you are talking about a person in my situation, there is even more unease.”
Computerised counselling can achieve reductions in viral load and HIV transmission risk behaviour, investigators from the United States report in the online edition of the Journal of Acquired Immune Deficiency Syndromes. The counselling programme was associated with significant reductions in viral load, improvements in adherence to HIV therapy and reductions in risky sexual behaviour.
“The adherence effect was most pronounced among those whose plasma HIV-1 load was not suppressed at baseline,” comment the investigators. “This reduced viral load and fewer sexual transmission risk behaviors seen among those undergoing the intervention both may contribute to decreasing HIV transmission to sexual partners.”
Thanks to antiretroviral therapy, many people with HIV now have a normal life expectancy. The best outcomes are seen in individuals who adhere to their treatment. Good adherence also has a secondary benefit, as suppression of viral load is associated with a reduced risk of HIV transmission to sexual partners.
However, some people living with HIV have difficulty achieving and sustaining the levels of adherence associated with the best treatment outcomes, and a significant proportion of patients with HIV have sexual behaviour that involves a risk of HIV transmission.
Investigators in Seattle wanted to see if a computer-delivered intervention called Computer Assessment and Rx Education for HIV-positive people (CARE+) improved treatment adherence and reduced transmission risk behaviours.
Strong association between regular clinic attendance and achieving undetectable viral load
People taking HIV treatment who have a low CD4 cell count are especially likely to achieve an undetectable viral if they attend their routine clinic appointments, research published in the online edition of the Journal of Acquired Immune Deficiency Syndromes suggests.
The US study showed that retention in HIV care had a stronger association with viral suppression for people with a low CD4 cell count than people with stronger immune systems.
Overall, people with higher CD4 cell counts were more likely to achieve an undetectable viral load. However, the effect of regular clinic attendance on the chances of viral suppression was greater for people with immune suppression.
“While it is well established that retention in care is important for all HIV-infected patients”, write the authors, “our data suggest that retention in care may be even more central to achieving optimal virologic outcomes for persons with advanced HIV disease.”
HIV, at least in some parts of the world, may be developing a lower replicative capacity as it adapts to variations in the human immune system, studies in southern Africa and elsewhere suggest.
Philip Goulder of the University of Oxford told the AIDS Vaccine conference last month that competition between HIV and certain varieties of human HLA (human leukocyte antigen) genes may be contributing to a diminution in HIV virulence, a lower community viral load, and an increased proportion of ‘elite controllers’ in the population.
Goulder remarked that these changes seemed to be happening surprisingly fast, and that in some populations the introduction of antiretroviral therapy would also tend to reduce the fitness of the HIV that was still circulating.
Sunday, January 19th at 8-9 pm EST / 5-6 pm PST Streaming on VH1.com and GreaterThanAIDS.org
Live Chat #WeAreEmpowered
Fourteen time Grammy Award-winning artist and HIV advocate, Alicia Keys, is joining with Greater Than AIDS to host a National Watch Partyand Twitter Chat about women and HIV/AIDS in America Sunday, January 19th.
Ms. Keys is urging women and their loved ones to come together on Sunday, January 19th between 8-9 pm ET (5-6 pm PT) and log on to VH1.com to watch “We Are Empowered,” an intimate and inspiring half-hour conversation that she had about friendship, love and strength with five women living with HIV in the U.S. Ms. Keys will be live tweeting throughout the hour at #WeAreEmpowered.
Clear Channel Radio will make available an audio version of the program for broadcast across its stations nationwide (check local stations for airtime). And Walgreens is helping to amplify the message through social media efforts by engaging popular bloggers to encourage their followers to take part and host their own watch parties.
More information on the broadcast can be found here.
“According to the latest CDC data, only 25 percent of people living with HIV in the U.S. have achieved viral suppression. In other words, three out of four people living with HIV in the United States have not been successfully supported in navigating the entire HIV care continuum.”
The HIV care continuum—sometimes also referred to as the HIV treatment cascade—is a model that is used by Federal, state and local agencies to identify issues and opportunities related to improving the delivery of services to people living with HIV across the entire continuum of care.
This continuum has five main “steps” or stages:
HIV Diagnosis —The HIV care continuum begins with a diagnosis of HIV infection. The only way to know for sure that you are infected with the HIV virus is to get an HIV test. People who don’t know they are infected are not accessing the care and treatment they need to stay healthy. They can also unknowingly pass the virus on to others.
Getting linked to care—Once you know you are infected with the HIV virus, it is important to be connected to an HIV healthcare provider who can offer you treatment and counseling to help you stay as healthy as possible and prevent passing HIV on to others.
Staying in care—Because there is no cure for HIV at this time, treatment is a lifelong process. To stay healthy, you need to receive regular HIV medical care.
Getting antiretroviral therapy—Antiretrovirals are drugs that are used to prevent a retrovirus, such as HIV, from making more copies of itself. Antiretroviral therapy (ART) is the recommended treatment for HIV infection. It involves uses using a combination of three or more antiretroviral drugs from at least two different HIV drug classes every day to control the virus.
Achieving a low amount of HIV virus in your body—By taking ART regularly, you can achieve viral suppression, meaning a very low level of HIV in your blood. You aren’t cured. There is still some HIV in your body. But lowering the amount of virus in your body with medicines can keep you healthy, help you live longer, and greatly reduce your chances of passing HIV on to others.