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    HIV Care System Is Getting Swamped

    Study Shows Increasing Gap Between the Number of AIDS Patients and Treatment Resources


    That difference reflects the U.S. HIV treatment gap.

    "We call it the triangle of misery," Saag says. "But in this day and age of budget crisis in every state across the country, asking Congress for more money is not going to cut it."

    The IOM notes that states are slashing, not increasing, their HIV/AIDS programs. In 2009, states cut $170 million from these programs:

    • 22 states cut HIV care and treatment programs
    • 17 states cut their contributions to AIDS Drug Assistance Programs
    • 25 states cut HIV prevention programs

    The cuts mean more red tape and more waiting lists for people who need HIV care. It sometimes means that people must interrupt their HIV treatment -- an extremely dangerous situation, as such interruptions mean an increase in drug-resistant HIV.

    Moreover, the old generation of health-care professionals caring for people with HIV is, well, getting older. And there's only a trickle of young doctors in the pipeline.

    One solution is "task shifting" -- allowing trained nurse practitioners, physician assistants, psychologists, dentists, and others to perform tasks previously relegated only to doctors. Saag says this strategy has worked at his clinic, allowing it to double the number of patients treated.

    But stretching current resources can only go so far. "It is worrisome. That is why the IOM report is so timely," Saag says.

    But Cleary says he and the other experts on the IOM committee are optimistic. He points to the National HIV/AIDS strategy as an important road map. And he says the committee was relieved at the passage of the Affordable Care Act, as an estimated 529,000 Americans with HIV are uninsured or underinsured.

    A big step forward, Cleary says, would be coordination of state regulations to give health care providers flexibility in treating people with HIV. Also important is to find incentives for young doctors to choose primary care as a profession.

    "We are a clever and caring nation. The amount of caring and concern on everyone's part is just amazing," he says. "HIV care providers aren't in this for the money. But we should make it less of a burden on the providers and on the system to do this kind of work."

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