It is important to understand the basic steps that people with HIV go through in their treatment, from diagnosis to suppression through medication. HIV.gov (2017) outlines the following stages:
- HIV testing and diagnosis —The HIV care continuum begins with a diagnosis of HIV infection. The only way to know for sure that you are infected with the HIV virus is to get an HIV test. People who don’t know they are infected are not accessing the care and treatment they need to stay healthy. They can also unknowingly pass the virus onto others. CDC recommends that all adolescents and adults be tested for HIV infection at least once, and that persons at increased risk for HIV infection be tested at least annually.
- Getting and staying in medical care—Once you know you are infected with the HIV virus, it is important to be connected to an HIV healthcare provider who can offer you treatment and prevention counseling to help you stay as healthy as possible and prevent passing HIV on to others. Because there is no cure for HIV at this time, treatment is a lifelong process. To stay healthy, you need to receive regular HIV medical care.
- Getting on antiretroviral therapy— Antiretrovirals are drugs that are used to prevent a retrovirus, such as HIV, from making more copies of itself. Antiretroviral therapy (ART)is the recommended treatment for HIV infection. It involves using a combination of three or more antiretroviral drugs from at least two different HIV drug classes every day to control the virus. U.S. clinical guidelines recommend that everyone diagnosed with HIV receive treatment, regardless of their CD4 cell count or viral load. Treatment with ART can help people with HIV live longer, healthier lives, and has been shown to reduce sexual transmission of HIV by 96 percent.
- Achieving viral suppression—By taking ART regularly, you can achieve viral suppression, meaning a very low level of HIV in your blood. You aren’t cured. There is still some HIV in your body. But lowering the amount of virus in your body with medicines can help you stay healthy, live longer, and greatly reduce your chances of passing HIV on to others.
Access to Healthcare
The Affordable Care Act has been helpful in securing quality care and coverage for those living with HIV. Thanks to the ACA, no American can be dropped because they are HIV positive or have another chronic health condition. Furthermore, there is broader Medicaid eligibility, which is important because Medicaid is the largest payer for HIV care in the United States. The ACA also provides financial assistance for some people to lower out of pocket costs for health insurance. As a sum, here are coverages that are guaranteed under the ACA (HIV.gov, 2017):
- Preventive services. Under the ACA, most new health insurance plans must cover certain recommended preventive services—including HIV testing for everyone ages 15 to 65, and for people of other ages at increased risk—without additional cost-sharing, such as copays or deductibles. Since one in eight people living with HIV in the U.S. are unaware of their infection, improving access to HIV testing will help more people learn their status so they can be connected to care and treatment.
- Comprehensive coverage. The law establishes a minimum set of benefits (called “essential health benefits”) that must be covered under health plans offered in the individual and small group markets, both inside and outside of the Health Insurance Marketplace. These include many health services that are important for people living with HIV/AIDS, including prescription drug services, hospital inpatient care, lab tests, services and devices to help you manage a chronic disease, and mental health and substance use disorder services.
- Coordinated care for those with chronic health conditions. The law recognizes the value of patient-centered medical homes as an effective way to strengthen the quality of care, especially for people with complex chronic conditions such as HIV/AIDS. The patient-centered medical home model of care can foster greater patient retention and higher quality HIV care because of its focus on treating the many needs of the patient at once and better coordination across medical specialties and support services. The Ryan White HIV/AIDS Program has been a pioneer in the development of this model in the HIV health care system. The ACA also authorized an optional Medicaid State Plan benefit for states to establish Health Homes to coordinate care for Medicaid beneficiaries with certain chronic health conditions. HIV/AIDS is one of the chronic health conditions that states may request approval to cover.
