Will the Affordable Care Act Help Blacks Join the AIDS-Free Generation?

There was lots of buzz at the International AIDS Conference in Washington, D.C., about the hope for an AIDS-free generation. But will the advances that place the end of the epidemic in sight benefit Black communities, which historically have been left behind? Policymakers, scientists and activists are cautiously optimistic that the Affordable Care Act (ACA), signed into law by President Obama, may help turn the tide in their favor.

Gains in the fight against HIV/AIDS haven't always made it to communities of color. According to the Centers for Disease Control and Prevention's (CDC) HIV Surveillance Report, Blacks account for more new HIV infections, AIDS diagnoses, people estimated to be living with HIV disease and HIV-related deaths than any other racial or ethnic group in the U.S. Of the approximately 50,000 new infections in the United States each year, nearly half occur among Blacks. In some zip codes of Washington, D.C., infection rates among African Americans are equal to the rates in some sections of sub-Saharan Africa, reports Greg Millett, Ph.D., senior researcher at the CDC and CDC liaison to the White House Office of National AIDS Policy.

"When it comes to an AIDS-free America, we can get there, but will we?" asks Phill Wilson, president and CEO of the Black AIDS Institute. Wilson cites many obstacles that contribute to new infections among Black MSM and heterosexual women and men, including stigma and the lack of health insurance.

Fully implemented -- including the expansion of Medicaid and rollout of essential benefits packages -- the ACA can potentially bring 30 million uninsured Americans into health care, including many who are young, poor, Black, Latino or HIV positive. Of the 1.1 million Americans living with HIV, 20 percent do not know that they have the virus, according to the CDC. The ACA will also improve providers' ability to link people to appropriate care and retain them in treatment, increasing the number of people with HIV who achieve viral-load suppression--key to driving community viral loads low enough to end the epidemic.

The ACA will also offer a variety of support services, "such as mental health, substance abuse and patient navigation, as well as services that support families, such as child care and housing," says Deborah Parham Hopson, Ph.D., the associate assistant director of the HIV/AIDS Bureau of the Health Resources and Services Administration (HRSA). In fact, the sheer number of new patients, combined with the expansion of services, is causing the HRSA to re-evaluate the Ryan White HIV/AIDS Program's role as the payer of last resort.

Support services will be critical to improving treatment retention. Health care providers have been relatively effective in suppressing the viral loads of those who receive consistent care. "We are not doing as well in linking people to care and retaining them there," says Wilson. Many Black Americans currently fall between the cracks. For example, single childless adults without disabilities -- including the low-income gay men disproportionately affected by HIV -- do not qualify for Medicaid coverage.

"Under the Affordable Care Act, everyone will have a means to pay for lifesaving treatment," Wilson says. The ACA also ends the practice of denying coverage because of a pre-existing condition, such as HIV/AIDS, and eliminates the lifetime caps that arise because of costly treatment, which can run uninsured people with HIV/AIDS some $20,000 out-of-pocket per year.

Even with their high annual cost, ARVs are cost effective, says Anthony Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases. What's more, pharmaceutical breakthroughs such as treatment as prevention and pre-exposure prophylaxis will be key to ending the epidemic--making it vital that traditionally underserved people have access to care and treatment. Dr. Fauci notes, however, that funding for access to such innovative treatments has not caught up with the exciting scientific developments.

Still, providing coverage for medications is not enough, says Surgeon General Regina Benjamin, M.D. "It is hard to take a pill," whether diabetes meds or ARVs, Dr. Benjamin says. "We have to begin to link people into medical homes through the Affordable Care Act."

Experts have long believed that medical homes -- health care centers where people are assigned not only a physician but also support services such as transportation and social services -- significantly improve health outcomes.

"We must remember that health does not occur just in the doctor's office," Dr. Benjamin adds.

Andrea King Collier is a health journalist and the lead author of The Black Woman's Guide to Black Men's Health.