CDC to research coverage gaps for gay people of color

The Centers for Disease Control and Prevention wants to research whether gay and transgender people of color could receive better access to care and experience reduced HIV infection rates if they discuss insurance coverage with their providers earlier.

Gay men accounted for 81% of new HIV infections among males and 65% of all new HIV infections, according to the CDC. Researchers have also found HIV rates among black and Hispanic transgender women to be 56% and 16%, respectively.

The CDC wants to evaluate whether these individuals will experience better health outcomes if providers talk with them about coverage options during sexually transmitted disease testing. Currently, these conversations tend to take place after patients receive their test results.

The agency wants to determine whether the change will lead to more participants obtaining health insurance, experiencing better health by achieving viral suppression or remaining HIV-free and improve retention rates for HIV care including using medications known as pre-exposure prophylaxis, or PrEP, and other HIV-associated health services like mental health counseling and substance use treatment.

Research has shown that individuals who start antiretroviral therapy on the same day that they are diagnosed with HIV are more likely to be engaged in their care over the long term, according to Jeffrey Crowley, who served under President Barack Obama as director of the Office of National AIDS policy and now oversees infectious disease initiatives at Georgetown University.

However, there are too many barriers to same-day starts to treatment, Crowley said. A primary hurdle is lack of health insurance.

"If this study is able to demonstrate that getting people who test for HIV enrolled in coverage when they test, it could improve their health generally no matter their HIV test result," Crowley said.

Others agreed the study could be an important step to making sure marginalized individuals are getting the coverage they need.

"People who are HIV-negative are great candidates for PrEP, and we have seen very low uptake among populations most vulnerable to HIV in Chicago and nationally," said John Peller, CEO of the AIDS Foundation of Chicago. "The opportunity to sign these most vulnerable populations up for health insurance and connect them to primary care could address a major gap in the system."

A third of gay young men who take PrEP medication discontinue it within six months, according to a May 2018 study published in the AIDS and Behavior Journal.

Common reasons for stopping included being unable to get an doctor appointment and problems with insurance coverage.

The CDC's proposed study could affect the practice of medicine by engaging individuals in care earlier and thus improving the support these populations receive, according to Ethan Morgan, a research fellow at Northwestern University who co-authored the May 2018 study.

In addition to improving access to coverage, there is hope that promising findings from the CDC study will lead to an increase in federal funding for coverage navigators, according to Erin Loubier, senior director for health and legal integration and payment innovation at Whitman-Walker Health, a community health center in Washington, D.C., that specializes in caring for LGBTQ patients.

Federal funding for navigators that help people search the individual market or Medicaid programs for coverage dropped 41% or by $62.5 million between 2016 and 2017.

"If the CDC finds it makes a difference to have these conversations it begs the question if it will help drive more funding for insurance enrollment assistance," Loubier said.