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    Despite Huge HIV Treatment Gains, Many Left Out

    Large Disparities in HIV Treatment continued...

    Experts who were not involved in the study praised its methods, saying it sheds light on something about HIV treatment that often goes unnoticed.

    William E. Cunningham, MD, MPH, a professor of medicine and public health at UCLA, has spent his career studying health disparities in HIV.

    “I was not surprised, but I was really impressed by how stark the differences actually are,” Cunningham says.

    “It is this group of people who are black or Latino, but the differences are really the biggest for blacks, who are doing relatively poorly despite the fact that we have available much better treatment right now.”

    Solving the Problem

    Simard says he thinks much of the disparity rests on diagnosis. He thinks too many people don’t have access to HIV testing, or aren’t aware that they need it.

    According to a 2011 report from the CDC, about 1.2 million people are living with HIV in the U.S. About 240,000 people don’t know they are infected.

    Without a diagnosis, people don’t get started on the drugs, which can help a person have a near-normal life expectancy in many cases.

    “It’s sounding an alarm. We see with people who have access to drugs that their mortality rates have really declined. Now this study has identified a number of really disenfranchised groups that need to have more focused interventions,” so they can get access to the medications, he says.

    Simard says proposed programs that could improve diagnosis include those that encourage so-called opt-out testing for HIV.

    “When you go to a doctor, they don’t say, ‘Oh, I’m going to give you a test.’ They only don’t give it to you if you opt out,” he says.

    But those kinds of programs only work if people go to a doctor in the first place.

    “I think that’s why people are still falling through the cracks. There’s no health care encounter,” he says.

    Beyond a diagnosis, economic instability can make it tough for people to stay on their medications, which are expensive, even with insurance.

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