As AIDS experts press for most teen and adult Americans to be tested for HIV, they also worry about where the money and talent will come from to treat potentially hundreds of thousands of new patients.
During a two-day summit, 300 of the nation’s leading medical, government and community experts on HIV/AIDS were here this week in advance of World AIDS Day. There was much discussion about a new Centers for Disease Control and Prevention recommendation that screening for HIV become a routine part of medical care for all Americans aged 13 to 64.
The CDC estimates that a million people in the United States are infected with the virus that causes AIDS, but at least 250,000 don’t know they’re HIV-positive.
Research shows that people who are unaware they’re infected with HIV are responsible for 50-to-70 percent of the roughly 40,000 new infections that occur each year in the United States.
And that pace of new infection, while far less than the 25 percent rate observed when HIV emerged in the early 1980s, hasn’t changed in 16 years, despite many other advances in understanding and treating the disease.
"We seem to have reached a stone wall in the spread of this disease, beneath which we cannot go," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.
Studies show that HIV testing is cost-effective even in populations where as few as 2 in 1,000 people are undiagnosed.
But once new patients are identified, they also need to be counseled and treated.
David Holtgrave, a senior professor in public health at Johns Hopkins University and one of the summit organizers, noted that if wider screening identifies even 60,000 new HIV-positive individuals, it would add about $1 billion a year in treatment costs.
"This is not a barrier to testing, but we need a plan to deal with this additional need," he said.
Yet funding for HIV care is scarce. A bill reauthorizing federal support for treatment and support has been stalled in Congress for much of this year because of disputes over a funding formula that would shift money from urban centers to the rural South, and a compromise that would add $200 million or more to the fund remains uncertain.
"It’s a struggle to get resources," said Dr. John Bartlett, also of Hopkins. "Sixty percent of AIDS patients are unemployed, 45 percent are uninsured. There’s not another disease that targets the disadvantaged like this one does."
Money is a problem, but so too are people. Central to the concept of universal, voluntary HIV screening is that all primary caregivers in family practices, clinics and hospitals will help in getting people tested, but also be prepared to advise and help those who test positive.
"There are fewer young people being drawn into HIV care as doctors and nurses, because they’re aware of the long hours and relatively low pay in the clinics, among other things," said Dr. Michael Saaq, director of the Center for AIDS Research at the University of Alabama at Birmingham.
Marsha Martin, senior deputy director of the HIV/AIDS administration in the District of Columbia’s health department, said her agency is not just seeking to expand testing, "we’re seeking to expand programs that deliver care, and we’re reaching out to more primary caregivers to deliver some of that care."
Since June, D.C. has screened more than 15,000 people in all health settings across the nations’ capital, which has the highest per person AIDS rate in the country. And 580 of those tested positive.
Saaq noted that while the screening will add more patients, getting HIV patients into treatment earlier, when their infection and damage to their immune systems are less advanced, can save money by requiring fewer drugs and less intensive care.
Fauci also pointed to extensive research that shows patients whose viral loads have been reduced by therapy are less likely to spread the infection, even if they don’t adhere to safe-sex practices.
"There’s no doubt," he said, "adequate treatment is also a form of prevention."
On the Net: www.cdc.gov