How Pharmacists Can Help Address HIV Infection

The extreme public fear of human immunodeficiency virus (HIV) has diminished since the 1980s crisis, and now many health care professionals are seeing less urgency surrounding HIV prevention and treatment.

In an effort to improve HIV outcomes, The Foundation for AIDS Research (amfAR) and the National HIV/AIDS Initiative at the O'Neill Institute for National and Global Health Law at Georgetown Law have published a report detailing more effective HIV strategies at the state level.

Lead author Jeffrey S. Crowley, MPH, program director for Georgetown’s National HIV/AIDS Initiative, exclusively told Pharmacy Times how pharmacists in particular can provide support to HIV-infected patients.

“Pharmacists have an important role to play in educating policymakers about the importance of [pre-exposure prophylaxis (PrEP)] and its potential role in averting substantial numbers of new HIV infections, as well as ensuring that people with HIV can access the medications and services they need,” Crowley said. “This means that they can encourage states to expand Medicaid and work to ensure that both Medicaid and marketplace health plans adopt pharmacy access policies that make it easy for people to get HIV medications and other services consistent with federal guidelines, in an affordable manner.”

Crowley, who served as President Barack Obama’s HIV/AIDS advisor in 2010, said pharmacists can also be influential in helping patients understand complex insurance systems, troubleshooting insurance access issues, and steering patients in the right direction to assistance programs if their insurance does not cover treatment.

In the “Bolstering State Efforts to Implement the National HIV/AIDS Strategy” report, Crowley and his co-authors emphasized that the most important action a state can take is to implement the Affordable Care Act’s Medicaid expansion to low-income Americans.

Some other ways in which states can address the HIV epidemic include:

· Developing state-based prevention and care plans in line with the National HIV/AIDS strategy.

· Keeping track of state progress in meeting HIV prevention and care targets, and then distributing results to the public.

· Promoting HIV testing and encourage individuals to seek out their serostatus.

· Targeting HIV services to appropriate demographics.

· Increasing access to sexual education.

· Expanding access to insurance.

· Encouraging PrEP and non-occupational post-exposure prophylaxis (nPEP).

· Striving to stop “criminalizing” those with HIV through updates to state laws.

The researchers found that 34 states mandate HIV education, while 17 do not. Fewer states had mandates for sexual education in general; 23 states mandated sexual education, and 28 did not.

Forty states had “scientifically accurate/plausible” HIV laws, while 11 did not. In addition, 18 states did not have specific laws that criminalized HIV transmission or exposure, while 33 did.

Nearly all states (49) had HIV testing laws that aligned with the US Centers for Disease Control and Prevention testing recommendations.

Some barriers to HIV care include a lack of housing, mental health/substance abuse treatment, and social support, according to the researchers.

There may also be a stigma or lack of understanding of PrEP, so pharmacists can provide patient education and encourage state leadership to ensure PrEP is easily accessible and affordable, Crowley said.

“[P]harmacists can continue to be that knowledgeable, trusted resource to answer questions about PrEP or HIV treatment,” Crowley said. “President Obama has always said that the federal government cannot implement the National HIV/AIDS Strategy alone. Pharmacists have an undeniably valuable role.”

The amfAR report follows the first US National HIV/AIDS Strategy, which was released in 2010. It was also published simultaneously with an update to the first strategy from the White House.