The Washington PostDemocracy Dies in Darkness

AIDS activists cite a milestone, but the most vulnerable patients are left behind

The White House's North Portico decorated with a red ribbon last year to commemorate World AIDS Day. (AP Photo/Manuel Balce Ceneta)

On World AIDS Day today, activists are celebrating what they see as a pretty major milestone in efforts to combat the deadly virus —for the first time in the past year, the number of HIV patients who started receiving medication was greater than those newly infected with the virus, according to the ONE Campaign.

That marks a "tipping point" in global efforts to fight a disease that's killed about 40 million people worldwide since it was first reported a little more than 30 years ago, the campaign declared Monday morning. As a "tipping point" indicates, that also means more progress is still needed.

Though global funding for HIV/AIDS hit an all-time high of $19.1 billion in 2013, that's still at least $3 billion less than what UNAIDS says is needed each year to control the virus. And HIV is increasingly concentrated among harder-to-reach populations, including men who have sex with men, female sex workers, injection drug users and adolescent girls, according to the report.

Here in the United States, the progress fighting the virus has been mixed recently. The HIV diagnosis rate dropped about 33 percent over a decade, from 24.1 per 100,000 population in 2002 to 16.1 per 100,000 in 2011. That's according to a recent analysis from the Centers for Disease Control and Prevention, which found significant decreases in diagnosis rates for most demographics, with the largest seen among women, people ages 35-44 and people of multiple races. However, diagnoses attributable to male-to-male sexual contact saw increases for nearly every group, with those 13-24 years old recording the largest increase (133 percent) of any group.

And even newer statistics from the CDC present further concern. Of the 1.2 million Americans who had HIV in 2011, just 40 percent said they were seeing a medical professional for the virus and 37 percent had a prescription, the CDC revealed last week. Just 30 percent of those infected had the virus under control.

The coverage expansion under the Affordable Care Act that took effect this year will provide new opportunities for people with HIV to receive care. Before the ACA, the system of coverage for HIV patients was "a complex patchwork that leaves some outside the system and presents others with barriers to needed access," according the Kaiser Family Foundation.

Some of that patchwork will still remain, of course. Twenty-three states haven't expanded Medicaid to all low-income adults earning below 138 percent of the federal poverty level, or $16,105 for an individual. And in the first year of the ACA's health insurance marketplaces, patient groups complained that some health insurers discriminated against HIV patients by requiring them to pay 40 percent to 50 percent of the cost for HIV medications, including generics.

In response, two insurers last month agreed to cut the amount HIV patients have to pay for those drugs, and advocates say new federal rules will soon require better coverage options in the insurance marketplaces.

"On the whole, it is clear that increased overall resources to fight the disease, applied and targeted more effectively, have helped to accelerate progress at the global level," the ONE Campaign concludes. "But equally clear is the fragility of this progress."


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