Trump’s call to end HIV epi­demic hin­dered by his ad­min­is­tra­tion’s poli­cies

Modern Healthcare - - News - By Steven Ross Johnson

PRES­I­DENT DON­ALD TRUMP’S CALL for end­ing the HIV epi­demic in the U.S. in 10 years dur­ing his State of the Union ad­dress last week was lauded by HIV clin­i­cal ex­perts who cred­ited his will­ing­ness to call at­ten­tion to an epi­demic that still in­fects nearly 40,000 peo­ple a year.

But while most stake­hold­ers say the ad­min­is­tra­tion’s goal can be re­al­ized with the progress that has been made in treat­ments and pre­ven­tion in the past two decades, they re­main mostly skep­ti­cal of the White House’s com­mit­ment to the ef­fort. They said re­duc­ing new HIV in­fec­tions would re­quire ad­dress­ing prob­lems that hin­der ac­cess to health­care for those with HIV, such as in­creas­ing health in­sur­ance cov­er­age, re­duc­ing the im­pact of so­cio-eco­nomic health de­ter­mi­nants, and elim­i­nat­ing ex­ist­ing stig­mas of those liv­ing with the virus.

“In so far as the ad­min­is­tra­tion is will­ing to ad­dress those is­sues, which they seem to in­di­cate that they are, then this is def­i­nitely an ob­tain­able goal,” said Bruce Pack­ett, ex­ec­u­tive di­rec­tor of the Amer­i­can Academy of HIV Medicine.

Ad­vo­cates said the Trump ad­min­is­tra­tion could take a huge step to­ward achiev­ing its HIV strat­egy by re­vers­ing sev­eral of its own poli­cies, such as sup­port­ing re­peal of the Af­ford­able Care Act and rolling back pro­tec­tions for LGBTQ in­di­vid­u­als.

“One of the things that con­cern us is that the Trump ad­min­is­tra­tion has done ev­ery­thing that it can to limit health­care through try­ing to dis­man­tle the ACA,” said Dr. David Hardy, board chair­man for the HIV Medicine As­so­ci­a­tion.

Nei­ther Trump nor fed­eral health of­fi­cials have spec­i­fied how much fund­ing the gov­ern­ment should dedi- cate to­ward re­duc­ing HIV in­fec­tions. Dur­ing a me­dia call, HHS Sec­re­tary Alex Azar said the fund­ing amount would be re­flected in the pres­i­dent’s an­nual bud­get re­quest. At dead­line, HHS of­fi­cials had not re­sponded to re­quests for com­ment.

Health of­fi­cials have in­di­cated many of the plan’s ini­tia­tives could be im­ple­mented by ex­pand­ing fund­ing to the Ryan White HIV/AIDS pro­gram, which pro­vided clin­i­cal and sup­port ser­vices to more than 530,000 unin­sured and un­der­served in­di­vid­u­als liv­ing with the virus in 2017.

Yet that pro­gram has lim­i­ta­tions. It’s con­sid­ered a re­source of last re­sort for those liv­ing with HIV who are un­able to ob­tain in­sur­ance. But the pro­gram doesn’t cover preven­tive ser­vices, such as pre-ex­po­sure pro­phy­laxis, or PrEP. Health of­fi­cials, in­clud­ing HHS, say ex­pand­ing ac­cess to PrEP is a key com­po­nent of strate­gies seek­ing to re­duce new HIV in­fec­tions.

Many ad­vo­cates con­tend ex­pand­ing the Ryan White pro­gram should oc­cur along­side in­creas­ing ac­cess to Med­i­caid, which they say would have an even greater im­pact for the HIV pop­u­la­tion. Med­i­caid is the sin­gle-largest source of in­sur­ance for HIV care ser­vices, cov­er­ing more than 40% of peo­ple with HIV, ac­cord­ing to the Kaiser Fam-

Ad­vo­cates said the ad­min­is­tra­tion could take a huge step to­ward achiev­ing its HIV strat­egy by re­vers­ing sev­eral of its own poli­cies and po­si­tions, such as sup­port­ing re­peal of the ACA and rolling back pro­tec­tions for LGBTQ in­di­vid­u­als.

ily Foun­da­tion.

In­deed, most of the seven states that HHS will tar­get with re­sources to re­duce their high rate of HIV in­fec­tions haven’t ex­panded Med­i­caid, ac­cord­ing to Jesse Mi­lan Jr., CEO of the ad­vo­cacy or­ga­ni­za­tion AIDS United. The Trump ad­min­is­tra­tion has sought to roll back Med­i­caid ex­pan­sion for the last two years, and has sup­ported pro­pos­als to turn Med­i­caid into a block grant pro­gram that could cut off thou­sands of ben­e­fi­cia­ries.

Pack­ett ac­knowl­edged the ad­min­is­tra­tion’s past and cur­rent ac­tions send mixed mes­sages. Among his con­cerns is a pro­posed rule change the CMS is­sued in Jan­uary that would ef­fec­tively end cov­er­age pro­tec­tions for HIV med­i­ca­tions ob­tained via Medi­care Part D. Un­der the rule, insurers would be allowed to im­pose re­stric­tions such as prior au­tho­riza­tion and step ther­apy. A quar­ter of U.S. HIV pa­tients re­ceive their an­tiretro­vi­ral ther­a­pies through Part D, ac­cord­ing to the Kaiser Fam­ily Foun­da­tion.

Hardy said any mean­ing­ful pol­icy to lower HIV in­fec­tions would have to tar­get in­ter­ven­tions that ex­pand care for LGBTQ in­di­vid­u­als since gay and bi­sex­ual men ac­count for nearly 70% of new HIV in­fec­tions, ac­cord­ing to the Cen­ters for Dis­ease Con­trol and Pre­ven­tion. Yet the ad­min­is­tra­tion has taken a num­ber of ac­tions to ei­ther take away or not rec­og­nize civil rights pro­tec­tions for LGBTQ in­di­vid­u­als.

Such con­tra­dic­tions give stake­hold­ers doubts about Trump’s com­mit­ment. “I think it was a lot of grand-sweep­ing prom­ises of what he (Trump) thinks peo­ple want to hear with very lit­tle specifics,” said Dr. Mar­garet Hoff­man-Terry, board chair of the Amer­i­can Academy of HIV Medicine. “Ac­tions speak louder than words and his ac­tions never match his words when it comes to these very im­por­tant so­cial is­sues.” ●

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.