Dr. Carlos del Rio, co-director for the Clinical Science and International Research Core of the Emory Center for AIDS Research, believes the recommendations are a call to fix a known hole in the system.
“Of those with HIV 80 percent know their status, of those who know [their status] only 70 percent are linked to care, and of those who are linked to care only 60 percent are retained in care,” del Rio said. “Only slightly over a quarter are receiving what we would consider proper care.”
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Studies by the Centers for Disease Control and Prevention, as well as Dr. del Rio’s group at Emory, show that only 19 to 28 percent of Americans living with HIV actually receive a correct drug regimen and have an undetectable viral load. While the IAPAC guidelines are not binding, they do inform health care providers about the importance of testing and care.
The primary sources of HIV testing in metro Atlanta are county health departments and non- profits including Positive Impact, AID Gwinnett and AID Atlanta. As a provider of HIV medical case management in the region, AID Atlanta welcomes the call for greater testing and care.
“One of the things we’re doing is being more active in linking to care and not just referring people to a doctor, but following up and making sure they follow through,” AID Atlanta Executive Director Tracy Elliott said. “We obviously are here and ready to respond. We’re for it, equipped, and ready to go.”
Last year AID Atlanta administered 6,800 HIV tests. The group also provides a health clinic and educational services. AID Atlanta, AID Gwinnett and other nonprofit AIDS service organizations receive the bulk of their funding through grants and private donations. While the guidelines lend support to their missions, there is no new money to pay for testing, or treatment, which concerns some health care providers.
Jacqueline Muther, the HIV policy and contracts manager for Grady Health System, applauds the new guidelines but worries about the cost of drugs and treatment.
“This has been on the radar screen for quite a while,” Muther said. “It looks like it’s going to break out into one of those have or have not sort of things where the people who have insurance and have money will be able to get the drugs, but if you’re poor you might not. The worst thing in the world is to put out something which is really good science, and good health, but not be able to provide the medication.”
Dr. del Rio agrees, saying his research shows that the main reason people do not stay in treatment programs is because of lifestyle factors.
“Many of the populations that are suffering from this epidemic are poor. It disproportionately affects the poor, it’s a disease of poverty… for a lot of people with HIV in this country HIV is not their highest priority. They have other priorities and that prevents them from staying in treatment.”
Top photo: “What those guidelines are all about is trying to address people with HIV, or any chronic disease, to link them to care,” Dr. Carlos del Rio of Emory explained. (Courtesy Emory)