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Despite Huge HIV Treatment Gains, Many Left Out

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.

Of those who do know they are infected, only 28% are getting regular medical care, taking antiretroviral drugs, and have the virus under control, according to the CDC.

“The benefit of starting these drugs early outweighs much of the detrimental effects of being on the drugs in the first place,” Simard says. “If you adhere to the drugs as they’re prescribed for the long-term, your survival will be much higher. You can have a near-normal life expectancy.”

Other experts think the problem goes far beyond access to medication.

“It’s certainly not simply about people not taking pills they already have. It’s really all about the barriers to accessing the care that people actually need,” Cunningham says.

He said those barriers include having reliable transportation to get to the doctor, being worried about taking time off work to get care, being depressed, not trusting the health care system or doctors, or not believing that medication really could make a difference in one's health.

“It’s all these things that add up. It’s people having overall difficult lives, and HIV just doesn’t rise to the highest priority because HIV isn’t going to kill them that day,” he says.

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