Shortage of AIDS Workers to Care for New U.S. HIV Cases

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Plans to find the 250,000 Americans who don't know they have HIV will bump up against a shortage of funds and care workers to treat them, leading U.S. AIDS experts said today.

Experts almost universally praise the CDC's recent recommendation to make the HIV test part of routine annual health care.

The change is part of a major effort to identify the more than 250,000 Americans who have HIV but don't know it.

But there's a big problem. All of these newly diagnosed people would need immediate treatment. Yet AIDS clinics already have too many patients, too few doctors, too few nurses, and far too little money.

"It is unacceptable that we go about the business of finding more people with HIV with lack of a plan of how to treat them," said Phill Wilson, CEO of the Black AIDS Institute, at a news conference.

In an effort to address this and other issues, U.S. AIDS experts this week are holding an "HIV summit meeting" in Washington, D.C. The experts are discussing how the U.S. can improve HIV diagnosis, HIV prevention, and access to HIV care.

The conference comes on the eve of the annual Dec. 1 World AIDS Day.

AIDS a 'Black Disease'

John S. Bartlett, MD, chief of infectious diseases at Johns Hopkins University, strongly supports universal, routine HIV testing.

"The question is: Can the U.S. health care system manage this?" Bartlett asked at the news conference. "Most newly diagnosed patients are on public resource. Most are unemployed. And the number of slots in existing clinics may be limited, where we can't handle the number of new cases."

Bartlett notes that in his Baltimore AIDS clinic, 60 percent of patients are unemployed, and 45 percent are uninsured.

"No other disease attacks the disenfranchised population like this one does," Bartlett said. "It is hitting the underserved."

In the 1980s, successful AIDS prevention efforts were targeted to the group that bore the brunt of the epidemic -- gay white men. That was yesterday's AIDS epidemic.

"The face of the epidemic is changing," CDC AIDS chief Kevin Fenton, MD, PhD, said at the news conference. "AIDS is increasingly becoming a black disease in the U.S."

Wilson put the issue more forcefully.

"U.S. AIDS today is a black disease, plain and simple," Wilson said. "Of the 40,000 Americans newly infected with HIV every year, 20,000 are black.

“We have to get black folks and black institutions to take ownership of this disease,” Wilson said.

“But that has to be part of a much larger strategy,” he added. “We have to demand that we have the tools to make sure people know what the test means, and that we have access to treatment."

Caretakers Struggling to Keep Up

The problem is evident in the Birmingham AIDS clinic run by University of Alabama researcher Michael S. Saag, MD.

Saag notes that most of his clinic's patients don't show up for HIV tests until they already have AIDS.

Such patients' treatment costs are vastly higher than those of patients diagnosed earlier in the disease. Yet their drug costs -- the costs most likely to be reimbursed by government AIDS funds -- are only a fraction of their health care costs.

"The reimbursement to providers is extremely low," Saag said at the news conference. "We collect $360 per patient per year. Clinics like ours have been flat-funded for years, despite a 60 percent to 70 percent increase in patients."

That means Saag's clinic loses a staggering $1.1 million a year -- before the effects of routine HIV tests are felt.

Saag said routine testing -- followed by effective treatment -- will cut long-term costs. But treatment, he insisted, has to be part of the equation.

Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, agreed.

"It is not what we are doing that is wrong; it is what we are not doing," Fauci said.

"As we expose this societal lesion -- having more people infected than in care -- I would not slow the momentum of testing,” said Fauci. “I hope that is the engine that ignites more activity in getting more people into care."

By Daniel J. DeNoon, reviewed By Louise Chang, MD

SOURCES: News conference, "Opportunities for Improving HIV Diagnosis, Prevention & Access to Care in the U.S.," Nov. 29-30, 2006; participants: Anthony S. Fauci, MD, director, National Institute of Allergy and Infectious Diseases; Kevin Fenton, MD, PhD, director, CDC's National Center for HIV, STD, and TB Prevention; David R. Holtgrave, PhD, professor and department chairman, Johns Hopkins Bloomberg School of Public Health; Michael S. Saag, MD, professor of medicine and director, Center for AIDS Research, University of Alabama at Birmingham; Marsha Martin, DSW, senior deputy director, HIV/AIDS Administration, Department of Health, Washington, D.C; John S. Bartlett, MD, professor of medicine and chief, infectious disease division, Johns Hopkins University School of Medicine; Kenneth H. Mayer, MD, professor of medicine, Brown University; and Phill Wilson, CEO, Black AIDS Institute.