Despite awareness, care for youth with HIV/AIDS faces uncertain future

In 2014, more than 1 in 5 new HIV diagnoses in the United States were among young people aged 13-24 years, according to the CDC. However, even with the disproportionate number of new HIV infections occurring among youth, only 10% of sexually-experienced high school students report having ever been tested for HIV.

April 10, 2017 marks the fifth annual observance of National Youth HIV & AIDS Awareness Day, intended to raise awareness about the impact of the HIV/AIDS epidemic among young people, as well as ongoing efforts to link youth with appropriate health care services. Since many of these services are currently funded under the Affordable Care Act, however, renewed attempts at health care reform could further compromise care for this vulnerable population.

On March 22, just two days before the U.S. House of Representatives eventually withdrew H.R. 1628 – the proposed American Health Care Act (AHCA) – 100 HIV/AIDS organizations signed a letter to Congress urging its members to oppose the bill due to an estimated 24 million Americans who would likely lose health insurance coverage, including thousands of patients with HIV, if it was enacted.

Sponsored by the Federal AIDS Policy Partnership’s HIV Health Care Access Working Group, the letter warned that the AHCA weakens the federal commitment to Medicaid, threatens access to health care for low-income Americans, and undermines “key elements” in the ACA.

“We had hoped to see a plan that maintained the progress that was made under the ACA for patient access to health coverage,” James Friedman, executive director of American Academy of HIV Medicine, said in a press release. “But given the proposed changes to Medicaid and tax credits for insurance purchasing, this plan makes it even harder for low-income patients to access the coverage they need, including the 40% of HIV patients that depend on Medicaid for coverage.”

The AHCA also intended to end the Medicaid expansion; defund Planned Parenthood, which is the sole source of HIV and hepatitis C testing in some areas of the U.S; and eliminate the Prevention and Public Health Fund, which is “critical” to detecting and responding to infectious disease outbreaks and other public health threats.

In addition, the joint letter noted that refundable tax credits offered in the AHCA would not be adjusted for income or geographic variation in premiums, putting health insurance coverage “out of reach” for many people living with HIV. It would also allow insurers to financially penalize consumers not receiving health care coverage for 2 months or longer, charging up to 30% higher premiums for a year.

“[The AHCA] would reduce the availability of tax credits to purchase insurance for some of the poorest, while it expanding it to wealthier households who need it less,” Margaret Hoffman-Terry, MD, chair of the board of directors at the American Academy of HIV Medicine, said in the release. “Under this plan, young HIV patients with high health costs and low incomes could be left with less financial assistance than older healthier individuals. A plan for subsidizing insurance costs should be based on financial and medical need, not arbitrary number games.”

To mark the occasion of National Youth HIV/AIDS Awareness Day, Infectious Diseases in Children presents the latest news coverage regarding HIV/AIDS in younger populations as well as ongoing research that could impact children with HIV in the future.

HIV over 3 decades: From fatal disease to chronic condition

On June 5, 1981, the CDC published an MMWR on five cases of Pneumocystis pneumonia among previously healthy young men who have sex with men in Los Angeles. Approximately 1 year later, another MMWR documented a cluster of Kaposi’s sarcoma and Pneumocystis pneumonia among men who have sex with men in California.

As of 2015, the most recent year for which statistics were available, approximately 35 million people have died of the disease worldwide. In that time — more than 30 years later — advances in detection, treatment and prevention have led to a shift in which HIV is now considered a chronic, manageable disease in regions where ART is readily accessible. The next stage of progress focuses on a long-awaited vaccine and a cure. Read More

Incidence of perinatal HIV infections remain 1.75 times higher than CDC goal

Although perinatal HIV infections among infants born in the United States have significantly declined since 2002, occurrence remains 1.75 times greater than the goal set in place by the CDC to eliminate mother-to-child transmission. Read More

Q&A: Lifting stigma, increasing knowledge of HIV

In the earliest days of the HIV/AIDS epidemic, HIV was characterized as “the gay man’s disease,” a misrepresentation that resulted in the exclusion of thousands of women from HIV/AIDS clinical trials and an increase in mortality among women who contracted the virus.

Unfortunately, the reverberations of this misunderstanding persist today, in the sense that many women — as well as many clinicians — may not be aware that women represent approximately 50% of the 37 million people living with HIV worldwide. Read More

Black teens with mental illnesses at increased risk for HIV, STIs

For black teenagers, who account for 63% of new adolescent HIV cases in the United States, education on proper coping mechanisms targeting depression, emotion regulation and sexual risk behaviors may reduce their risk for sexually transmitted infections. Read More

Q&A: What malaria and TB can teach us about HIV

Tuberculosis and malaria are diseases that have existed in the human population for thousands of years. Although effective treatments for both conditions are now available, new cases of these diseases continue to be seen each year. Infectious Disease News spoke with Alana R. Sharp, policy associate at amfAR, the Foundation for AIDS Research, about the lessons learned from TB and malaria, and how this knowledge can be used to improve treatment of HIV/AIDS. Read More