The numbers of AIDS and HIV cases in Texas have been static for a while.
“We have not stopped HIV transmission since it started. We’ve made really good gains, but for a long period, we stalled out,” said Christopher Hamilton, CEO of Texas Health Action, which runs the Kind Clinic locations in Austin. The Kind Clinic offers HIV testing, care and prevention free or at reduced costs.
Hamilton said Texas has seen a slight declines in cases — from a rate of 17.76 per 100,000 people in Texas in 2010 to 14.50 per 100,000 in 2019. Newer medications offer the possibility of reducing HIV transmission even more. To make that happen, more people need to get tested and know their HIV status, Hamilton said, to know which medication is right for them.
Two bills filed in the Texas House would require insurance companies to cover HIV testing and some additonal treatment options.
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What types of HIV medications are available?
People who are at risk of contracting HIV can take pre-exposure prophylaxis medication, which is a daily pill made by several manufacturers. That type of medication is often referred to as PrEP. A bimonthly injection of the drug has also been approved by the Food and Drug Administration.
People who might have been exposed to HIV can take a post-exposure prophylaxis medication known as PEP within three days.
For those who have already contracted HIV, new antiviral medications can help them become “undetectable,” meaning the virus is not detectable in them, which makes them unable to transmit it to another person.
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Bills address testing and medication
House Bill 526, filed by Rep. Gene Wu, D-Houston, would require insurance companies to provide coverage of HIV testing. It also would allow blood taken for medical screenings to be tested for HIV unless a person opts out of that testing. The person must be informed that the blood will be tested for HIV to opt out.
People taking PrEP need to have an HIV test before starting it and then every three months. People who have taken PEP should test afterward to make sure it worked. And people taking antivirals need to test regularly to make sure they remain undetectable.
Tests in a doctor’s office can range from $80 to $150, Hamilton estimated, and even more in an urgent care center or some lab settings.
“We’re not great at preventative health care, especially when we have to pay for it,” Hamilton said.
HB 839, filed by Rep. Jessica González, D-Dallas, aims to prevent insurance companies and Medicaid from requiring prior authorization for prescriptions to prevent infectious diseases. This would include PrEP, PEP and antivirals.
“This bill would help by removing speed bumps and barriers,” Hamilton said. “If you’re ready to start PrEP, let’s not get in the way of that.”
It’s unclear whether the bills, both filed by Democrats, will advance in the Republican-controlled Legislature. The bills were filed after a federal judge in Texas ruled in September that the government cannot require a company to provide insurance that covers PrEP, based on a company’s religious rights. That ruling is expected to be appealed.
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Challenges for preventive measures
Hamilton said HIV preventive measures still face a number of challenges.
The stereotype that HIV affects only white gay men is problematic. Not every man who has sex with other men considers himself gay. It also doesn’t account for the women who are HIV-positive, especially Black women, who have HIV rates 14 times higher than white women. Black men are four times as likely as white men to have HIV and twice as likely as Latino men.
“This has been a challenge of public health messaging from the start,” Hamilton said.
Not enough primary care doctors are asking about sexual health, sexual activity and risk factors or offering testing to their patients, Hamilton said.
“If you want to get access to PrEP, sometimes it’s difficult,” Hamilton said.
People are told, “That’s not for you” or “you don’t need that,” he said.
“There are biases or misunderstandings of sexual activity and risks and the broader and bigger idea of sexual health. If someone is interested in their sexual health, they should be able to take care of it in a nonjudgmental way,” he said.
Clinton Mora is a reporter for Trending Insurance News. He has previously worked for the Forbes. As a contributor to Trending Insurance News, Clinton covers emerging a wide range of property and casualty insurance related stories.