Progress toward ending HIV epidemic is challenged by threats to ACA

On World AIDS Day, we honor lives cut short by HIV and celebrate tremendous progress toward ending the epidemic. As research continues toward a vaccine and a cure, we already have the tools to bend the epidemic curve toward zero new infections and zero AIDS deaths in America.

Effective HIV treatment allows people with HIV to live near-normal lifespans without transmitting the virus to others, including newborns. Antiretroviral medicine taken as preexposure prophylaxis (PrEP) is highly effective at preventing new infections. The Affordable Care Act is playing an important role in extending lifesaving services to tens of thousands of people with HIV, as well as those at highest risk for new HIV infections.

{mosads}Yet today, with the ACA once again under fire with a tax reform proposal to abolish the individual mandate, a move the Congressional Budget Office estimates will add 13 million people to the rolls of the uninsured, we stand at a tipping point that threatens to reignite the epidemic.

This threat comes following a year in which health care professionals, hospitals, insurers, and consumers raised voices in unison to protect the ACA and legislators listened. Today ACA enrollment has outpaced previous years. In addition, just a few weeks ago, voters in Maine moved forward with the decision to take up Medicaid expansion in their state, and other states, including some in the deep South — now the epicenter of America’s HIV epidemic — are discussing expansion options.

The Senate proposal represents a giant step backward, and a direct threat to people living with HIV. Many people living with the virus were among the 20 million Americans who gained health insurance since the ACA was passed.

The ACA made it possible for them, along with millions of other Americans with pre-existing conditions, to partake of the medical care, including preventative services, essential for good individual and public health. Likewise, expansion of Medicaid is particularly important to people with HIV, more than 40 percent of whom now benefit from the Medicaid program. Thousands of Americans also access HIV screening and PrEP through Medicaid and private ACA insurance plans.

For people living with HIV, the outcomes of political maneuvers surrounding the ACA are literally a matter of life and death. Research has proven that interruption in HIV therapy results in illness and increased death rates, and growth of virus that is resistant to medications and harder to treat. But the effect of successful HIV treatment goes far beyond its benefits to individual health.

When HIV is suppressed to undetectable levels by medications, the virus is not transmitted to others. Ninety percent of new infections come from people with HIV who are not actively in care. Continuous access to HIV medication and care is essential to individual and public health.

In Georgia, where I provide care to people with HIV and have served on the Fulton County Task Force on HIV/AIDS, we have emphasized the importance of access to health care in our Strategy to End AIDS in Fulton County. We stress the critical importance of early diagnosis and rapid and continuous access to treatment and care. Treatment for addiction and mental health conditions is essential for maintaining lifelong continuous adherence to HIV treatment regimens, and these services are made much more available by the ACA.

We stress the need to expand PrEP to prevent new infections, as access is currently limited for the uninsured. It is no coincidence that Georgia has the second highest rate of new HIV diagnoses among states, and one of the nation’s highest rates of uninsured persons. For these reasons, the Task Force strongly recommends strengthening the ACA in Georgia by expanding Medicaid.

The aims of all Americans who would like to live healthy and productive lives are reflected in the Task Force strategy.

Still, in 2017, silence equals death. People with HIV, as well as those with other health conditions must be prepared to continue to tell their stories, and health providers and advocates must continue to amplify them.

During this week when the HIV community reflects on our progress and challenges, we urge legislators once again to listen and to join with us to create an America in which this preventable, treatable virus is defeated once and for all.

Melanie Thompson, MD is chair of the HIV Medicine Association and principal investigator of AIDS Research at the Consortium of Atlanta.