HIV Program May Put Strain on System in Texas

In 2007, Houston was one of two dozen metropolitan areas to receive CDC grants to begin routine HIV testing on a voluntary, opt-out basis. But an increase in the volume of patients needing treatment, retiring HIV specialists, and few new practitioners in the wings could overburden capacity to care for those newly diagnosed, several local physicians say.

From June 2008 through March 2010, the region's six testing locations - including four emergency departments - diagnosed nearly 900 people with HIV who were unaware of their infections. About 1 percent of all those screened were HIV-positive. In 2009, the six opt-out sites accounted for almost half of the 1,228 new Houston-Harris County HIV diagnoses.

"There is no one coming behind me to take the burden of HIV treatment," said Dr. Joseph Gathe, a long-time area HIV specialist. "I've been looking for 10 years for someone to come to work with me. They don't want to do this - even to see what it's like."

In April, a Health Resources and Services Administration report noted "severe workforce capacity challenges to effectively treat people with HIV/AIDS" nationally. Reasons cited include more demand for HIV services, a declining supply of experienced clinicians, and flat or falling insurance reimbursement rates.
At the University of Texas Medical School in Houston, just 15 people have completed the HIV medicine training program in 10 years, a spokesperson said. In a 2009 American Academy of HIV Medicine survey of 1,783 HIV specialists, 20 percent said they intend to stop practicing in the next decade. Only one in three students interested in HIV medicine plan a career in the field.

To foster a clinician pipeline, the academy suggested loan forgiveness programs, more exposure of medical students to HIV care, and increasing Medicaid and other insurance reimbursements. In addition, primary care physicians, nurse practitioners, and physician assistants could be trained in HIV care.

"Can primary care physicians do this? Yes, because HIV is becoming more of a primary care disease," said Dr. Shannon Schrader, a Houston family physician and HIV specialist. "But if you don't keep up with this, you may actually do harm to a patient."

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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