Monthly Archives: December 2016

Federal program cuts disparities in HIV/AIDS care

When Gina Brown was diagnosed with HIV in 1994, she considered it a death sentence, but nearly 23 years later, she’s living a full life in New Orleans, thanks largely to the federally funded Ryan White HIV/AIDS Program.

In 2014, the safety-net program provided drugs, medical care and support services to more than 268,000 people in the U.S. living with human immunodeficiency virus (HIV) infections. Now a study shows that in 82 percent of them, including Brown, HIV is no longer detectable in their blood – a state known as “viral suppression.”

Those who are virally suppressed take antiretroviral medications that allow them to expect to live a nearly average lifespan. In addition, the drugs can virtually eliminate the possibility of transmitting the virus to others.

The number of Ryan White program participants who achieved viral suppression rose 12 percent from 2010 until 2014, researchers found. The study considered only those who used the program for medical care and were at least 13 years old.

Senior author Dr. Laura Cheever hailed the increase as a “huge improvement.” She is the associate administrator of the federal Health Resource and Service Administration’s HIV/AIDS Bureau in Rockville, Maryland.

Named for a boy who was expelled from school at age 13 following a 1984 diagnosis with HIV, the Ryan White program has offered healthcare and other services – from drugs to temporary housing to counseling, substance-abuse treatment and rides to medical appointments – to HIV-positive people since 1990.

The program cost $2.3 billion this fiscal year and is expected to serve more than 500,000 people, about half the number of Americans diagnosed with HIV, Cheever said.

The viral suppression rate rose even higher for program participants who received medical care in 2015 – to more than 83 percent, Cheever said in a phone interview. Some participants receive just support services, not medical care, and were not included in the viral suppression number.

From 2010 to 2014, disparities between suppression rates for those in vulnerable groups shrank, the report in Health Affairs found.

The gap in viral suppression rates for blacks narrowed in comparison to whites; the gap for adolescents and youth adults narrowed in comparison to those for older adults; and the gap for HIV-positive people living in the South narrowed in comparison to people in other regions of the U.S.

Disparities persisted, but were significantly reduced for every group except homeless and transgender people, Cheever said.

Brown, 51, a black woman living in the South, has been a beneficiary of the program’s equal access, and she sees it as her salvation.

“The Ryan White program allows us to live,” she said in a phone interview.

The program enabled Brown to earn a master’s degree in social work, and she now works in the HIV testing and prevention program at the Institute of Women and Ethnic Studies in New Orleans.

Most importantly, Brown said, the program has introduced her to other HIV-positive people. “You can hang out with women just like you and not feel stigmatized and not feel so alone,” she said.

The Ryan White program reduces disparities for vulnerable groups that persist for other diseases throughout the U.S., Cheever said.

“The paper demonstrates that by taking a public health approach to a complicated medical condition, we can really serve the people in this country who have limited access to care,” she said.

Dr. Michael Saag directs the University of Alabama at Birmingham AIDS Center and was not involved in the new research. The study’s findings mirror what he’s seen in his clinic and present “evidence that when you give people ready and equal access to care, healthcare disparities disappear,” Saag said in a phone interview.

“Why is it that health disparities are substantially less with HIV? The answer is it’s because of the Ryan White Care Act,” he said. “These are the healthcare disparities we’re so used to, that we expect. And that’s a tragedy.”

Under the Ryan White program, financial status no longer limits access to care because the program fills whatever holes people with HIV have in their healthcare coverage and in their related needs.

“You could almost think of it as an experiment in single payer because it creates relatively equal access to all people, regardless of their station in life,” Saag said. Because people who are virally suppressed don’t transmit HIV, he said, the program benefits not only individuals but the general public.

Before the Affordable Care Act was enacted, only about 13 percent of HIV-positive people in the U.S. had private health insurance, and 24 percent had no coverage at all, according to the Department of Health and Human Services.

Ryan White died at age 18, just months before Congress passed the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act.

Why You Need a Health Emergency Fund

Even with good health insurance, a health emergency or a prolonged illness can be a financial disaster. Health insurance deductibles, co-payments, emergency room costs, and other costs of illness can add up in a hurry.

A health savings account (HSA) is one way you can put aside tax-free money for a health emergency. HSAs were established in 2003. If you are covered by a type of insurance known as a high-deductible insurance plan, you can make tax-deductible contributions to an HSA. Your employer may also make tax-deductible contributions.

“An HSA account is very different from having a general emergency fund account,” says Joseph J. Porco, managing member of the Financial Security Group, LLC, in Newtown, Conn. “An emergency fund is about more than just out-of-pocket medical expenses. If possible, it’s a good idea to have both.”

How Much of an Emergency Fund Do You Need?

For an older adult, a health emergency might result in the need for long-term care, possibly for the rest of the senior’s life. For a young adult supporting a family, a medical emergency might be much more than just the cost of illness. Your health emergency could cause a disability that results in loss of income over an extended period. That means you should save enough to cover all your expenses.

“Most advisers would say you should have enough emergency funds saved to cover your family expenses for three to six months. I would recommend trying to put enough aside to cover all your expenses, not just health expenses, for 6 to 12 months,” says Porco.

How much you need for a health emergency and how much you can actually put into an emergency fund will depend on your family size, your income, your health status, and your age. But your first step is to understand your health insurance situation.

“The best way to start is to sit down with a financial adviser and figure out what your insurance actually covers and what it doesn’t cover. What are your insurance limits? What kind of medical bills might arise that you would be responsible for? Get some expert advice on how best to cover your actual needs,” advises Porco.

What Insurance May Not Cover

How much insurance companies actually pay for accidents, cancer treatment, or surgery depends on what kind of insurance you have, but there are usually limits. Here are some facts to consider:

  • Cost of illness. Most insurance companies have a cap on how much they will pay for a long-term illness. A recent survey found that 10 percent of people with cancer have hit their lifetime cap and are no longer covered by insurance. Looking forward, however, the new health care reform law will eliminate caps on lifetime insurance by 2014.
  • Emergency room cost. If you have an accident that requires emergency treatment and you end up in an emergency room outside your insurance network, you may not be covered. One study found that HMOs in California denied one out of every six claims for emergency room costs.
  • Surgical coverage. You may be surprised at what your insurance company considers non-covered surgery. There can be a big gray area between covered “reconstructive” surgery and uncovered “cosmetic” surgery. Even when surgery is covered, your deductible may be $500 or more, and you may still be responsible for up to 25 percent or more of surgical costs, depending on the specifics of your plan.

How to Save for a Health Emergency

Once you know what your insurance actually covers and how much you need to put away for an emergency, the next question is where to put it. “Money that you put aside for a health emergency needs to be liquid and secure,” says Porco. “That means you need to be able to get it when you need it.”

And your money needs to remain liquid. “Those who fail to set up an emergency fund may find themselves running up credit card debts to cover their expenses. The last thing you need is to be paying interest on your emergency,” warns Porco.

Examples of places to put your emergency fund include an interest-bearing checking or savings account, money market fund, or bond fund. Don’t tie your money up in anything that would penalize you for early withdrawals or any investment or account that has the potential for loss.

Practical Ways to Save

There are many different ways to approach starting — and adding to — your health emergency savings. “You can take advantage of a health savings account if this is offered at your job, but start a general emergency fund also,” suggests Porco.

Here are more health savings tips:

  • Put any money you get from a tax refund or earned income credit into your health savings fund.
  • Ask your bank or credit union to automatically transfer funds into your emergency account.
  • Explain the importance of an emergency fund to your family and get everyone involved in cutting back on unnecessary expenditures.

Human rotavirus manipulates immune

This and other human viruses of the digestive system have been difficult to study because they do not grow well in experimental animals or in cell cultures in the laboratory,” said Dr. Mary Estes, Cullen Endowed Professor of human and molecular virology and microbiology at Baylor and emeritus founding director of the Texas Medical Center Digestive Diseases Center. “This has changed since the development of the human intestinal enteroids (HIEs), a laboratory model of the human gut that recapitulates many of the biological and physiological properties of the human small intestine.”

Using a laboratory model of the human gut, Estes and colleagues have revealed a strategy human rotavirus uses to evade the attempts of the human body to eradicate it. They found that although the virus does not succeed at preventing initial steps of the defense response, it is able to minimize subsequent steps that could stop its growth. Using a model of the live human gut, the scientists also showed cellular strategies to counter the viral response.

Studying anti-viral defenses in a living model of the human gut

“In this study we used the HIE model of the gut, which included epithelial cells, to study what happens when these cells encounter the virus and how the virus responds to IFNs,” said Estes.

The researchers developed HIEs from a number of patients to compare the responses of different individuals. Their results show that each culture from an individual patient exhibits diversity in basal gene expression, yet after viral infection, all the cultures responded in a very similar manner.

When the researchers added human rotavirus to the HIE cultures in the laboratory, the epithelial cells activated type III IFN genes, which in turn activated other genes involved in the anti-viral response. However, this activation did not reduce viral reproduction. Unexpectedly, almost no type I IFN was activated.

The scientists then looked at whether activation of IFN genes had produced the desired IFN proteins, which are the molecules that ultimately carry out the job of inhibiting the virus. They found that when they added live rotavirus to the cultures, type III IFN genes were active but did not go through the process of efficiently translating their instructions into IFN proteins. On the other hand, when the scientists added inactivated rotavirus, which can enter the cells but not replicate, the epithelial cells responded by both activating the type III IFN genes and producing IFN proteins.

“These experiments showed us that in the HIE cultures, the active rotavirus is able to suppress the production of most of the IFN proteins aimed at controlling virus reproduction,” Estes said. “Adding type I IFN to the HIE cultures with live rotavirus reduced viral replication more efficiently than adding type III IFN. This suggests that type I IFN may be more critical to limiting the growth of the virus and this IFN may be made from a source different from epithelial cells.” The HIE model system of the human gut is a valuable tool to assess how people respond to viruses and other microorganisms that cause intestinal diseases and how those microorganisms counter bodily defenses. This is the first step toward designing treatments to prevent or control these deadly diseases.