World AIDS Day 2024: Progress but plenty of room to improve (by Meg Bracht, MPH)

December 11, 2024

Summary: Infections and deaths from AIDS have declined substantially since the peak in the early 1990s, but the goal of eliminating new infections is elusive.

Source: HIV.gov

World AIDS Day was Sunday, December 1^st. It is a day of remembrance of lives lost and a celebration of the tremendous global progress in the prevention, detection and treatment of HIV/AIDS. World AIDS Day is also a reminder that we are not close to the goal of eliminating new cases of HIV.

Antiretroviral therapy (ART) suppresses the viral level in those who are infected, reducing the risk of HIV transmission and extending and improving quality of life. Educational campaigns increased awareness of HIV/AIDS among the general population and underscored the importance of prevention measures such as practicing safe sex and testing to determine HIV status. New HIV infections decreased 12% from 2018 to 2022 and maternal to child transmission is now a rare event.

Source: HIV.gov Black and White are non-Hispanic in this graphic

Despite this progress, there is still work to be done. An estimated 1.2 million Americans are living with HIV. Certain demographic groups, including Black and Hispanic people and men who have sex with men (MSM), are disproportionately affected. In 2022, Black and Latino people accounted for 37% and 33% of new HIV diagnoses, respectively, while two-thirds of new HIV diagnoses occurred in MSM. Seven percent of new infections were among injectable drug users and approximately 50% of new cases are concentrated in the southern U.S.

There are effective approaches to prevent HIV infection, including pre-exposure prophylaxis (PrEP), where people at high risk take a daily medicine (or a periodic injection) of an anti-HIV medication. The Affordable Care Act mandates insurers cover PrEP without cost-sharing, although recent reports show that many on PrEP do not have all cost sharing waived. PrEP uptake has lagged among certain demographics, including black women. HIV testing is also covered without cost sharing as a preventive service, yet one in eight Americans living with HIV are not aware of their status and could unknowingly transmit HIV to others.

Stigma surrounding HIV, racism, and homophobia continue to hinder uptake of prevention and treatment measures.

Implications for employers:

• Employers can periodically check with their PBMs and medical carriers to ensure HIV-related preventive care, including HIV testing, medications, and office visits are covered without cost-sharing to eliminate financial barriers.

• Employers can increase awareness of HIV/AIDS and reduce stigma through member-facing education and communications about the risks of contracting the disease as well as prevention and treatment options available.

• Telehealth can allow members to access healthcare more discreetly to combat stigma. Employers can facilitate access to care by offering a telehealth option with diverse providers to meet the various needs of their population. Some telehealth providers may be able to order lab tests and prescribe PrEP, as appropriate.

• The telehealth “safe harbor” that allows high deductible health plans to waive pre-deductible cost sharing expires at the end of 2024 (or at the end of the employers’ 2024 plan year) unless it is renewed by Congress. Employers can check with counsel about implications of this if Congress does not extend the safe harbor.

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