Almost Half of American Adults with HIV don't take Meds

[Ptrk3]

A surprising study shows there may be much more work to do:

http://hivaidstribe.e-healthsource.com/index.php?p=news&id=703510

[AusShep]

Been the same since 2011.  There are better charts, but this figure from the CDC MMWR shows how step by step you lose patients resulting in less than 30% in care and UD.  I think there was an update earlier this year, but percentages seem about the same so it could have used much of the same data. 

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6047a4.htm?s_cid=mm6047a4_w#fig3

From your link:
"Based on what we know nowadays, everyone who's HIV-positive should be on therapy," said Dr. Carlos del Rio, co-director of the Center for AIDS Research at Emory University, in Atlanta. "This highlights the challenges we have ahead because we have such an unequal epidemic."

Even on this site, the out of date when to start treatment thread is still a sticky, and otherwise smart people decide to ignore the very clear research...  If one on one factual consulting can't get people to start, I don't know what can...

[mecch]

Universal health care that everyone expects and experiences as routine, responsive, reliable, and their human right.

[leatherman]

Not so surprising. The HIV Continuum of Care has been showing that things have been worse than this survey for quite some time

In 2013, the Office of the National AIDS Policy (ONAP) established the HIV Care Continuum Initiative to direct Federal departments to prioritize addressing the HIV care continuum as they implement the updated 2015-2020 National HIV/AIDS Strategy.


http://www.cdc.gov/nchhstp/newsroom/2012/Continuum-of-Care-Graphics.html
this older graphic from the CDC shows what the data looked like from 2011. And the data shows things are a lot worse than the report on that survey!


the updated graphics at aids.gov (I have no clue why the marketing dpt choose to turn the graph sideways. LOL) shows some improvements, in part thanks to the ACA, have been made; but the data still shows things are worse than this report!

Ryan White programs have been putting a lot of effort into transitioning people into ACA insurance programs. By subsidizing the premium, and copays, RW is able to get clients even more services through insurance than RW could have provided (legally or financially). RW paying less now to ensure clients have meds means RW dollars can pay for other healthcare procedures

https://www.aids.gov/federal-resources/policies/care-continuum/

I would point out that there is a difference in these graphs, and others graphs can be even more different. For starters, "linked to care" and "retained in care" versus "engaged in care". Each of these statuses is defined through US Dpt of Health and Human Resources HRSA (Health Resources and Services Administration) HAB (HIV/AIDS Bureau) HIV Performance Measures. For example "retained in care" and "engaged in care" can be determined through "HIV Medical Visit Frequency" ¹ (which should be noted has a very different 24-month time period than many other measures) and "Gap in HIV Medical Visits" ². ASOs and states report this data as part of their quality improvements and performance.

Another difference that can be seen in some graphs is to start the chart with "Diagnosed" as the first column. States coordinate prevention interventions, so they track the population starting with those who might be infected. An ASO is more concerned with it's client population so their graphs start with "diagnosed" or "all HIV positive patients". A Ryan White agency might start their continuum off with "HIV positive people who receive RW services" (which wouldn't include HIV+ people accessing care through work or personal insurance)

TL;DR
Real data over the last 5ish years shows that only around 25% of people are virally suppressed. "not virally suppressed" is not quite representative of those who "Don't Take Meds" but it's pretty close, so 75% is even worse then this survey's 50%

1 HIV Medical Visit Frequency
Percentage of patients, regardless of age, with a diagnosis of HIV who had at least one medical visit in each 6-month period of the 24-month measurement period with a minimum of 60 days between medical visits
Numerator:
Number of patients in the denominator who had at least one medical visit in each 6-month period of the 24-month measurement period with a minimum of 60 days between first medical visit in the prior 6-month period and the last medical visit in the subsequent 6-month period
Denominator: Number of patients, regardless of age, with a diagnosis of HIV with at least one medical visit in the first 6 months of the 24-month measurement period
Patient Exclusions: Patients who died at any time during the 24-month measurement period

2 Gap in HIV Medical Visits
Percentage of patients, regardless of age, with a diagnosis of HIV who did not have a medical visit in the last 6 months of the measurement year
Numerator: Number of patients in the denominator who did not have a medical visit in the last 6 months of the measurement year
Denominator: Number of patients, regardless of age, with a diagnosis of HIV who had at least one medical visit in the first 6 months of the measurement year
Patient Exclusions: Patients who died at any time during the measurement year

http://hab.hrsa.gov/deliverhivaidscare/coremeasures.pdf
http://hab.hrsa.gov/deliverhivaidscare/habperformmeasures.html

[AusShep]

The W.H.O. has jumped on the everyone needs treatment immediately bandwagon, as well as greatly increased PrEP according to this NY Times article. 

Since many countries follow their guidelines, hopefully more slow to implement care areas will update their policies.

It's interesting that they point out BC Canada as a success.  They offer full prescription coverage for all HIV+, unlike eastern Canada where it can be very expensive/difficult to get a Rx plan that covers HIV and no coverage is offered by the state for Rx if you're working.

http://www.nytimes.com/2015/10/01/health/millions-more-need-hiv-treatment-who-says.html?smid=fb-nytimes&smtyp=cur&_r=1

Here's the WHO press release
http://www.who.int/mediacentre/news/releases/2015/hiv-treat-all-recommendation/en/