The findings of a study released last Thursday by the National Institute of Allergy and Infectious Diseases (NIAID) suggest major policy implications for the fight against HIV and AIDS, indicating that United States legislators and pharmaceutical companies should ensure universal access to HIV care and treatment now.
The study found that early initiation of HIV treatment nearly eliminated HIV transmission among couples with one HIV-positive partner. The study, based on clinical trial HPTN 052, assessed 1,753 couples in Africa, India, Southeast Asia, and the United States. Researchers found that transmission was 96.3 percent less likely in those couples where the partners living with HIV began anti-retroviral therapy immediately. The study also found that early initiation of treatment significantly decreased incidence of extrapulmonary tuberculosis among HIV-infected participants.
The framework that has so often pitted prevention against treatment in the fight for scarce resources may now be a false dichotomy-- treatment can be widely embraced as a primary form of prevention. Legislators and pharmaceutical companies should ensure universal access to HIV care and treatment today.
But as always, it is those HIV-positive individuals and their partners who are most marginalized and vulnerable who are least likely to benefit from the progress that this finding should spur. The study underscores the importance of expanding programs which provide care and treatment to low-income individuals. Ending the HIV and AIDS epidemic will not be possible until HIV policy addresses the intimate link between HIV and poverty. A change in treatment protocol is powerless without the expansion of public health care and supportive services that would connect people to care, and allow them to stay in care.
Right now across the United States (though mostly in the South) nearly 8,000 people are on waiting lists for the AIDS Drug Assistance Program (ADAP). ADAP is funded by the federal and state governments, and provides treatment for low-income individuals living with HIV/AIDS. Individuals on ADAP waiting lists will be unable to access ARV therapy until their name gets to the top of the list, no matter how sick they may be. Meanwhile, every day poor people living with HIV are unable to get to the doctor or the pharmacy because they can’t afford the transportation costs, or the childcare. HIV-positive individuals on Medicaid routinely choose between medication and food, as even the costs of their co-pays are beyond their means.
As the partisan debate about how to balance the budget rages on, people in need continue to get sick, and continue to go without proper care and without medication that is known to improve health and to prevent transmission. Legislators must prioritize access to care and treatment for all individuals living with HIV/AIDS.
But money for medical care and treatment alone is not enough, especially for those who are living in poverty. Supportive services, like subsidized housing, food programs, transportation and childcare, help people access care and are known to improve adherence to medical regimens.
We now know that early treatment improves the health of individuals living with HIV/AIDS, and reduces transmission to partners. It is now up to legislators and pharmaceutical executives to commit to this fight.