HIV Strategy

A drug designed to stop HIV before it infects a person is being described as a key part of the new White House plan to fight the deadly virus.

The White House recently updated its national HIV/AIDS strategy, which is designed to better manage the spread of the virus.

The report updates the White House’s original 2010 plan. It details 37 recommendations for management and treatment of the disease.

One of the most controversial aspects of the plan is to make pre-exposure prophylaxis (PrEP) accessible through access to drugs like Truvada. The daily pill can be taken by HIV-negative people who may be at high risk for the disease. Truvada was approved in 2012.

The U.S. Centers for Disease Control and Prevention (CDC) reports that young gay and bisexual men accounted for 72 percent of new HIV infections in 2010.

White House

Dr. Judith A. Aberg, who serves as the HIV Medicine Association’s liaison to the Infectious Diseases Society of America board of directors, said that statistic means “we cannot afford not to increase access to PrEP.” 

She also noted that the lifetime cost of treating HIV is $379,668. Providing PrEP not only prevents infection, it eliminates that expense.

“PrEP should be covered by insurers like other effective prevention interventions in addition to being supported with federal resources for those who need it with no other source of coverage,” Aberg added.

Lindsey Dawson, a senior policy analyst with the HIV policy team at Kaiser Family Foundation, said the inclusion of PrEP and other scientific advances in the plan is “important given PrEP’s ability to potentially reduce new infections when taken as directed.”

Another goal of the plan is to suppress the virus in those who already have it. PrEP is also seen as a key to that part of the strategy.

According to the Human Rights Campaign (HRC), about 50,000 cases of HIV arise each year. About two-thirds of them are in gay and bisexual men. HRC reports that transgender women are also highly susceptible to contracting HIV.

Tari Hanneman, deputy director of the Health and Aging Program at HRC, said her organization has endorsed PrEP. She said HRC has urged insurers, policy makers, and drug manufacturers to make PrEP available to all people who qualify regardless of their socioeconomic standing.

Her group has been working to promote the use of PrEP through the #DailyBlue social media campaign.

Read More: Educating Doctors About HIV and PrEP »

A Timely Update

A few things have changed since the White House plan first came out in 2010 that could have big impacts on HIV and AIDS treatment and prevention efforts in the United States.

In the United States, at least 1.2 million people have HIV. Of those, it’s estimated 1 in 8 do not know they have the disease. Of the people with HIV, about 30 percent have the virus suppressed so it cannot be transmitted. 

The White House would like to see new diagnosis numbers fall by at least 25 percent and the death rate fall by at least 33 percent.

PrEP should be covered by insurers like other effective prevention interventions in addition to being supported with federal resources.
Dr. Judith A. Aberg, HIV Medicine Association

Since the original plan was released, the Affordable Care Act (ACA) has also come into play. The updated version takes into account the changing landscape of healthcare in America.

Aberg said that more people with HIV and more people at risk for HIV will have access to insurance coverage for the first time since the ACA has gone into effect.

“Not too long ago, nearly 25 percent of people with HIV were unaware of their status. With a focused effort to screen people for HIV, the percentage of people with HIV unaware of their status has dropped to around 13 percent,” she told Healthline. 

The Foundation for AIDS Research (amfAR) released a report on how to implement the federal plan. In it, they called for expanded access to Medicaid.

The program is the primary source of healthcare coverage for most uninsured people living with HIV under the ACA. According to the report, 21 states have not expanded Medicaid. This includes 10 states in the South, which is a region disproportionately affected by HIV/AIDS. The report details efforts by individual states.

“As we look to implement the next five years of the National HIV/AIDS Strategy, we hope that state officials and community stakeholders see this as a useful tool to help strengthen their HIV programs and make further progress toward ending the AIDS epidemic in America,” Brian Honermann, senior policy adviser of amfAR and co-author of the report, said in a statement.

Read More: Researchers Closer Now to HIV Vaccine Than Ever Before »

What’s Next in Fighting the Disease?

Overall, Hanneman said she is on board with the updates to the strategy.

“I believe the strategy is realistic, however, it will take widespread community engagement and support in addition to federal efforts to implement it effectively,” Hanneman said.

Dr. David Holtgrave, a professor at Johns Hopkins University’s Bloomberg School of Public Health who also is the vice chair of the Presidential Advisory Council on HIV/AIDS, said he hopes the CDC will provide a timely update on the number of new HIV infections in the United States.

Those updates are “critical for gauging the success of HIV prevention efforts and for making mid-course adjustments in programs as necessary,” he said.

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