AIDS In 2012: Senior policy advisor in the Office of National AIDS Policy tells Joanne Silberner the president’s National HIV/AIDS Strategy has improved coordination among federal agencies and that the 2010 health law will improve access to care for those living with HIV/AIDS. A transcript follows.
JOANNE SILBERNER: You work on the president’s AIDS policy. Two years ago, he released a pretty ambitious blueprint. The idea was to reduce HIV incidence and health disparities, and also to increase access to care and to optimize health outcomes. Is it happening?
GREG MILLETT: It’s not only happening, it’s actually going well. It has been about 30 years that we have had the HIV/AIDS pandemic across the world, and over that 30-year period, there are quite a few things that we did that were terrific and that are actually reducing the number of new infections each year. After all, at the height of the epidemic in the United States, we had about 120,000 new infections each year. And now we’re down to about 50,000 each year.
However, for us to get it further below the 50,000, there’s much more that needs to be done. That’s part of the reason why the president crafted the National HIV/AIDS Strategy with three primary goals. The first goal was to reduce the number of new infections. The second goal was to increase access to care for people living with HIV. And the third goal was to reduce HIV/AIDS-related disparities.
When the president released the strategy, he also released a presidential memorandum, basically giving marching orders to several agencies, letting them know that he expects these agencies to work in a coordinated response to address HIV/AIDS in the United States. That part of the strategy really is one of the most innovative parts, because, heretofore we’ve really had a lot of responses that were somewhat siloed across the federal government, and now you have federal agencies that are linked with one another to address HIV/AIDS and the epidemic — and working with one another to address HIV/AIDS in specific populations, specific geographic areas, and making sure that we’re not duplicating our response, but also reinforcing our responses and working on those interventions that would have the biggest impact.
The Office of the Assistant Secretary has been tasked with implementing the National HIV/AIDS Strategy in the Department of Health and Human Services under Dr. Howard Koh, and they have really been doing an incredible job marshaling the resources across the Department of Health and Human Services and across many of those agencies to really address HIV per the president’s strategy.
The other important thing about the strategy is that we realize it’s not just a health issue. HIV/AIDS is bigger than health. HIV/AIDS deals with issues such as the Department of Justice, and making sure that there’s not discrimination for people living with HIV. Dealing with issues in terms of income: We know that people who are lower income are more likely to be HIV positive. So we brought in the Department of Labor to see what type of income supports and training that they can do for employers who hire people living with HIV and AIDS.
HIV/AIDS, of course, is something that we see in our prisons. There are quite a few people in our prisons who are living with HIV and AIDS who might not have access to care. So working with Bureau of Prisons and others to make sure that we have adequate care for people living with HIV/AIDS — that not only extends while they are in prison, but once they are released from prison, making sure there is an adequate bridge to make sure that they have access to care, as well.
All of these different parts are working in concert with one another to make sure that we have the most robust response as possible in the U.S.
JOANNE SILBERNER: What’s going to happen with the Affordable Care Act? Is that going to make any kind of a difference?
GREG MILLETT: The Affordable Care Act is going to make a huge difference. As a matter of fact, in many ways, the National HIV/AIDS Strategy was predicated upon the Affordable Care Act. We knew from a lot of the research that was taking place that treatment is prevention. Over the past two years, there have been some incredible studies that have found that people who are living with HIV or are taking antiretroviral therapy, and if they’re virally suppressed, not only are they more likely to have better health outcomes for themselves, but they are also 96 percent less likely to transmit HIV to their sexual partners.
So in many ways, the goal right now is to make sure that we diagnose as many people as possible in the United States and to make sure they have adequate access to health care. And that is where the health care law really is the perfect nexus to making sure that we can address the HIV/AIDS response in the United States by increasing the number of people living with HIV who have access to health care — and making sure they are virally suppressed.
Another part of the health care law that is extremely important to people living with HIV is making sure that individuals who are positive have access to health care. There are many people who are living with HIV — when we were doing our community discussions several years ago, trying to get input on the National HIV/AIDS Strategy — who were telling us they just didn’t have access to health care. Whenever they tried to apply for health care services, they were denied because of their HIV status.
A huge part of the president’s Affordable Care Act is the fact that those preexisting condition denials are no longer in play. That is something that helps people living with HIV/AIDS enormously in this country. So just one act has been able to bring health care for many low-income individuals living with HIV/AIDS and has really helped our response in incredible fashion.
JOANNE SILBERNER: Another part of the Affordable Care Act — the one that was struck down by the Supreme Court — is going to allow some states to move away from Medicaid. Will that make a difference?
GREG MILLETT: We’re not confident that it’s going to make a difference. When you take a look at the average Medicaid reimbursement among states, it’s about 57 percent. What we have under the Affordable Care Act for reimbursement is 100 percent for three years, and then it drops down to 90 percent.
Many believe that there is such an incentive to have that type of reimbursement in each one of these states that it’s going to make it very difficult for most states to turn way from that 90 percent reimbursement for Medicaid expansion.
We’re going to make sure that people who are living with HIV/AIDS will still remain covered under ACA, even among those states who think that, perhaps, it’s not going to be able to go ahead and move forward with it.
JOANNE SILBERNER: How can you do that if the states have walked away from it?
GREG MILLETT: I’m not sure how much of it is going to be the part of the states, or is going to be the part of even the health insurance and health lobbyists who are part of those states, who really would benefit from this, as well.
There are many different actors and players on the state level in terms of the provision of health care, and it’s not just the federal government and federal agencies — not the least, of course, are consumers of health care. And all of them will be brought to the table in those states who don’t wish to comply with that component of the law — and will certainly have their voices heard.
JOANNE SILBERNER: Should be interesting. Thank you very much.
GREG MILLETT: Thank you.
