Federal program cuts disparities in HIV/AIDS care

(Reuters Health) - When Gina Brown was diagnosed with HIV in 1994, she considered it a death sentence, but nearly 23 years later, she’s living a full life in New Orleans, thanks largely to the federally funded Ryan White HIV/AIDS Program.

In 2014, the safety-net program provided drugs, medical care and support services to more than 268,000 people in the U.S. living with human immunodeficiency virus (HIV) infections. Now a study shows that in 82 percent of them, including Brown, HIV is no longer detectable in their blood – a state known as “viral suppression.”

Those who are virally suppressed take antiretroviral medications that allow them to expect to live a nearly average lifespan. In addition, the drugs can virtually eliminate the possibility of transmitting the virus to others.

The number of Ryan White program participants who achieved viral suppression rose 12 percent from 2010 until 2014, researchers found. The study considered only those who used the program for medical care and were at least 13 years old.

Senior author Dr. Laura Cheever hailed the increase as a “huge improvement.” She is the associate administrator of the federal Health Resource and Service Administration’s HIV/AIDS Bureau in Rockville, Maryland.

Named for a boy who was expelled from school at age 13 following a 1984 diagnosis with HIV, the Ryan White program has offered healthcare and other services – from drugs to temporary housing to counseling, substance-abuse treatment and rides to medical appointments – to HIV-positive people since 1990.

The program cost $2.3 billion this fiscal year and is expected to serve more than 500,000 people, about half the number of Americans diagnosed with HIV, Cheever said.

The viral suppression rate rose even higher for program participants who received medical care in 2015 – to more than 83 percent, Cheever said in a phone interview. Some participants receive just support services, not medical care, and were not included in the viral suppression number.

From 2010 to 2014, disparities between suppression rates for those in vulnerable groups shrank, the report in Health Affairs found.

The gap in viral suppression rates for blacks narrowed in comparison to whites; the gap for adolescents and youth adults narrowed in comparison to those for older adults; and the gap for HIV-positive people living in the South narrowed in comparison to people in other regions of the U.S.

Disparities persisted, but were significantly reduced for every group except homeless and transgender people, Cheever said.

Brown, 51, a black woman living in the South, has been a beneficiary of the program’s equal access, and she sees it as her salvation.

“The Ryan White program allows us to live,” she said in a phone interview.

The program enabled Brown to earn a master’s degree in social work, and she now works in the HIV testing and prevention program at the Institute of Women and Ethnic Studies in New Orleans.

Most importantly, Brown said, the program has introduced her to other HIV-positive people. “You can hang out with women just like you and not feel stigmatized and not feel so alone,” she said.

The Ryan White program reduces disparities for vulnerable groups that persist for other diseases throughout the U.S., Cheever said.

“The paper demonstrates that by taking a public health approach to a complicated medical condition, we can really serve the people in this country who have limited access to care,” she said.

Dr. Michael Saag directs the University of Alabama at Birmingham AIDS Center and was not involved in the new research. The study’s findings mirror what he’s seen in his clinic and present “evidence that when you give people ready and equal access to care, healthcare disparities disappear,” Saag said in a phone interview.

“Why is it that health disparities are substantially less with HIV? The answer is it’s because of the Ryan White Care Act,” he said. “These are the healthcare disparities we’re so used to, that we expect. And that’s a tragedy.”

Under the Ryan White program, financial status no longer limits access to care because the program fills whatever holes people with HIV have in their healthcare coverage and in their related needs.

“You could almost think of it as an experiment in single payer because it creates relatively equal access to all people, regardless of their station in life,” Saag said. Because people who are virally suppressed don’t transmit HIV, he said, the program benefits not only individuals but the general public.

Before the Affordable Care Act was enacted, only about 13 percent of HIV-positive people in the U.S. had private health insurance, and 24 percent had no coverage at all, according to the Department of Health and Human Services.

Ryan White died at age 18, just months before Congress passed the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act.

SOURCE: Health Affairs, online January 9, 2017.