In meetings with key congressional and Bush administration officials this week, the HIV Medicine Association (HIVMA) and the American Academy of HIV Medicine (AAHIVM) are telling policymakers to make access to medical care for low-income people with HIV/AIDS the top priority when reauthorizing the Ryan White CARE Act, the nation's primary federal program dedicated to providing care and support for people living with HIV/AIDS.
Ryan White includes a constellation of programs designed to fill in gaps in health coverage for uninsured or underinsured people with HIV/AIDS. Ryan White programs provide aid ranging from social and support services like legal services, child care, and housing assistance to access to antiretroviral medications through the AIDS Drug Assistance Program.
"However, Ryan White does not currently give medical care and basic medical services the priority they should receive in the era of highly active antiretroviral therapy (HAART)," says Paul Volberding, MD, chair of the HIVMA Board of Directors. "Two million years of life have been saved since the introduction of HAART. Access to these revolutionary medicines and the medical services required to deliver and manage their use should be given precedence when Congress renews Ryan White this year."
"Lack of funding has, furthermore, forced some states to start waiting lists for anti-AIDS drugs," notes AAHIVM Board of Directors chairman John Stansell, MD. "This is completely unacceptable. Patients need those medications to live. The federal government should guarantee access to these essential medicines for low-income people living with HIV/AIDS."
The two leading HIV medical associations collectively represent nearly all of the medical providers delivering HIV care in the United States in a wide range of practice settings. They have joined together for the first time since Ryan White was created to make recommendations to modernize the program. The recommendations are online on the HIVMA website, www.hivma.org, under "New at HIVMA."
"Without Ryan White, many of our patients would have to go without lifesaving medical treatments and care," says HIVMA Vice President Daniel Kuritzkes, MD. "When Ryan White was created in 1990, HIV infection was a death sentence for nearly everyone. Antiretroviral therapy has changed that, allowing many to live longer, productive lives. While there are patients who are still dying, most don't need help with end-of-life support. What they need are primary care and medicines."
Howard Grossman, MD, executive director for the Academy, adds, "Managing HIV infection is extremely complex. Many of our HIV patients also have health needs ranging from substance abuse and mental health conditions to HIV treatment complications and additional conditions like hepatitis C infection. This complexity is the reality of treating HIV infection today, and it's what Ryan White needs to address."
HIVMA and AAHIVM are calling for groups receiving Ryan White grants to devote at least 25 percent of the funding to primary medical care services like physician visits, medically necessary medications, and laboratory tests. An additional 25 percent should be earmarked for basic medical services like mental health, substance abuse, and prevention counseling.
To end wide state-to-state variations in access to anti-AIDS drugs, HIVMA and AAHIVM are also strongly recommending that the federal government establish a minimum formulary of essential drugs for people with HIV with incomes below 300 percent of the federal poverty level.
The two organizations additionally recommend expansion of the AIDS Education and Training Center program to help train the next generation of HIV medical providers. Access to medical providers with appropriate expertise is essential to managing this complex disease.
Furthermore, Dr. Volberding adds, "Ryan White needs to finally get the funding it deserves. Forty thousand people are newly infected with HIV every year in the United States, but Ryan White has seen virtually no increase in funding for several years in a row."
"Ryan White has been an extremely valuable program for people living with HIV/AIDS," says Dr. Stansell. "Now, it needs to be updated to deal with the transformation of HIV into a chronic disease, and funded appropriately to serve its function filling the void for low-income people living with HIV/AIDS."
HIVMA is the professional home for more than 2,700 physicians, scientists and other health care professionals dedicated to the field of HIV/AIDS. Nested within the Infectious Diseases Society of America (IDSA), HIVMA promotes quality in HIV care and advocates policies that ensure a comprehensive and humane response to the AIDS pandemic informed by science and social justice. IDSA is a professional society representing about 8,000 physicians and scientists who specialize in infectious diseases.
The American Academy of HIV Medicine is an independent organization of 2,000 AAHIVM HIV SpecialistsTM and others dedicated to promoting excellence in HIV/AIDS care. Through advocacy and education, the Academy is committed to supporting health care providers in HIV medicine and to ensuring better care for those living with AIDS and HIV disease.