Despite significant medical and scientific advances in HIV/AIDS during the past decade, federal public policy continues to lag behind, according to a joint position paper by the HIV Medicine Association (HIVMA) and the American College of Physicians (ACP). The new paper, published in the May 15 issue of Clinical Infectious Diseases, outlines several strategies for bringing public policy up to speed with the science, to help ensure that HIV/AIDS is effectively controlled in the United States and abroad.

Specifically, the two groups are calling for enhanced federal support of prevention, screening, and treatment programs, and funding to maintain a competent HIV workforce.

“Today, people with HIV can live to near-normal life-spans,” said Michael Saag, MD, FIDSA, chair-elect of HIMVA. “This progress was unimaginable when most of us entered the field in the early 1980s. But most federal public policies on HIV/AIDS were established in the 1990s and haven’t been revisited since that time.”

Too many people in the United States have no access to care or unreliable access to care, Dr. Saag said, and the problem is only getting worse due to the growing shortage of HIV medical providers. As the first generation of HIV clinicians retires, the health care system faces a shortage of qualified successors. In a 2008 survey of Ryan White-funded clinics , 69 percent reported difficulty recruiting HIV clinicians, and reimbursement and lack of providers were the leading factors.

About 20 percent of people living with HIV are undiagnosed, and about 36 percent of people with HIV are diagnosed so late that they already have progressed to full-blown AIDS. For that reason, HIVMA and ACP are calling for coverage of routine HIV testing by Medicare, Medicaid, other government agencies, and private payers.

Although the Centers for Medicare and Medicaid Services (CMS) is considering covering HIV testing, the proposed policy would only apply to high-risk patients. ACP and HIMVA want all populations to have access to screening, regardless of risk factors or type of insurance.

“Routine HIV testing is critical to identifying people with HIV and connecting them with care,” said Jeffrey Harris, MD, FACP, president of ACP. Screening also helps with prevention because patients who are in treatment with suppressed viral loads are less likely to transmit the virus.

“Our public policy has particularly lagged behind the science in the area of prevention,” said Kathleen Squires, MD, HIVMA vice chair. “We are still providing federal funding for abstinence-only education despite study after study showing that abstinence-only education is not effective. The federal government doesn’t support needle exchange programs, despite evidence that such programs work and don’t promote drug use.” Prevention efforts in the United States and abroad must take a more well-rounded approach that is grounded in science, the two groups say.

Treatment for HIV disease is one of the most effective medical interventions available today, and yet 50 percent of people with HIV in the United States do not have a reliable source of HIV care. HIVMA and ACP are calling for access to care through enactment of a federal entitlement program for low-income people with HIV, as recommended by the Institute of Medicine.

“With health care reform on the agenda for policymakers, the release of this paper comes at a pivotal time,” said Fred Ralston, MD, FACP, chair of ACP’s Health and Public Policy Committee. “We urge policymakers to incorporate our recommendations into health care reform and in making federal funding decisions for the coming fiscal year.”

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