The Kansas Department of Health and Environment used to provide free HIV testing kits and specimen analysis to 40 counties — but this year, it’s scaling back its services to cover just the 10 most populous counties, a move that health advocates warn could end up restricting care for some of the state’s most vulnerable residents living in rural areas.

State and federal agencies are attempting to allocate their prevention funds strategically. Since Kansas is considered a “low incidence” state for HIV, cutting back on free testing in some counties is an attempt to concentrate resources where they are most needed. But health officials warn that the strategy may backfire, particularly because the state’s poorest residents may not seek out preventative care and get themselves tested:

“What we’re really talking about is potentially decreased access to services,” said Michelle Ponce, executive director of the Kansas Association of Local Health Departments. “If there’s not an entity in a community able to provide HIV testing on a basis which clients can afford, it’s not going to be done.” [...]

In Kansas, Medicaid pays for HIV testing if a physician orders it, Wilmoth said.

Donna Sweet, University of Kansas director of internal medicine education at Via Christi Regional Medical Center in Wichita, cautioned that people who live in rural communities where everyone knows everyone may be unwilling to discuss their concerns with a primary care physician. They might not recognize the signs or understand the risks, she said.

“Certainly it’s going to make an impact. People who are poor generally don’t have the money to pay for anything that is not free,” said Sweet, who has been the principal investigator for the Mountain Plains AIDS Education and Training Center since 1988.

State officials note that, since Obamacare seeks to expand the Medicaid program to cover additional low-income people, the health reform law will help improve access to free testing in Kansas because Medicaid picks up the tab for HIV tests. But that’s only true if Kansas agrees to accept the optional expansion and add an estimated 240,000 low-income people to its Medicaid rolls. A Democratic lawmaker in the state recently introduced a bill to expand Medicaid, but Gov. Sam Brownback (R) — a staunch Obamacare opponent — hasn’t yet indicated whether he will cooperate with that provision of the health law.

Obamacare does take big strides to improve access to HIV testing and treatment. But, since the Centers for Disease Control estimates that about 20 percent of all HIV-positive Americans don’t realize they have the virus — which includes half of the HIV-positive people between the ages of 13 and 24 — a widespread emphasis on preventative testing is critical to reach that population.

Anthem Blue Cross, California’s largest for-profit health insurance company, is under fire for potentially targeting HIV-positive patients with its new prescription drug policy. Blue Cross is no longer allowing patients to pick up their HIV medications at a pharmacy, requiring them to instead go through a mail-order system — even though the policy hasn’t changed for people with other chronic conditions, like diabetes.

A consumer advocacy group has filed suit against the insurance company on behalf of an HIV-positive San Diego man, going by the pseudonym Jon Jones, who says he has incurred hundreds of dollars in out-of-pocket expenses now that he is no longer able to get his medications from his regular pharmacy. Jones asked Anthem Blue Cross for an exception to their new policy, but they refused — and now his lawyers are asking for an injunction to block the change:

Consumer Watchdog claims the change in programs is discriminatory under state civil rights law and potentially devastating for HIV/AIDS patients, many of whom rely on their local pharmacist to monitor potentially life-threatening adverse drug reactions.

According to the lawsuit, Blue Cross’ change will also cause consumers to lose access to drug discounts available only at retail pharmacies.

In addition to the serious health consequences of the program, patients’ fundamental right to privacy is also threatened because HIV/AIDS medications will be delivered to homes and businesses, according to the complaint.

Blue Cross says that any patients who feel the new requirement is causing them hardship may request an exception, although it’s unclear why Jones didn’t qualify for that.

Fortunately, Obamacare could help ensure that HIV positive individuals receive the best possible care from insurance companies. When the health reform law is fully implemented in 2014, insurers will no longer be able to treat HIV like a pre-existing condition and deny Americans coverage simply for having the virus. The health law will also eliminate lifetime caps on coverage, so HIV-positive individuals will be able to afford the care they need without reaching an arbitrary cut-off set by their insurance companies.

A new government report finds that one in five safety-net health centers — federally funded clinics that serve low-income Americans — aren’t routinely testing patients for HIV, even though the Centers for Disease Control began encouraging regular HIV tests back in 2005.

As the global community has continued to make strides to combat the HIV/AIDS epidemic over the past several years, health experts have gradually expanded their guidelines on HIV testing, pointing out that the best defense against the spread of the virus is educating all Americans about their HIV status. The U.S. Preventative Task Force, a government-backed panel that determines what preventative health care will be covered under Obamacare, updated their recommendations last year to make HIV testing as routine as regular blood pressure screenings in annual check-ups.

Nevertheless, the health centers that provide care for the country’s poorest residents don’t have enough funding to make sure they can screen everyone for the virus:

The health centers, all of which received money from the federal Health Resources and Services Administration (HRSA), reported a lack of financial resources from patients and sites as one factor that limited their HIV testing.

“Respondents from one health center site reported that patients who were not eligible for free HIV tests were unlikely to pay for tests, and respondents from another health center site reported that patients had difficulty paying even the small office visit fee, let alone an additional testing fee,” the report said. [...]

HRSA funds grantees that administer clinics for community health, migrant health, homeless health, and public housing primary care. In 2011, such sites provided care to more than 17 million patients, and, with the CDC estimating one in five people in the U.S. living with HIV doesn’t know his status, HRSA centers can play a critical role in reducing the transmission of the virus, the [Department of Health and Human Services Office of Inspector General] said.

The health clinics that are currently forced to prioritize their resources for HIV testing often can’t focus on regular screenings because they only test patients who categorized at “high-risk” for contracting the virus. But it’s important to do regular screening even for patients who don’t exhibit symptoms, or don’t appear to be at a high risk for contracting HIV, since an estimated 220,000 HIV-positive Americans don’t know their HIV status. In fact, half of the HIV-positive individuals between those ages of 13 and 24 aren’t aware they have the virus because they don’t get tested regularly — which is partly why that age group contributes to more than a quarter of the country’s new HIV infections each year.

Fortunately, Obamacare prioritizes funding for the community health centers that are often on the front lines of providing care for the nation’s most vulnerable populations. Under the health reform law, more than $125 million in grant money will be awarded to about 200 safety-net clinics across the country. If fully implemented, that increased funding will allow community clinics to serve more than twice as many people by 2019 — and potentially better adhere to the CDC’s guidelines on HIV testing.

Over 700 veterans may have been exposed to the HIV, hepatitis B, and hepatitis C viruses after a medical oversight allowed insulin pens to be shared between multiple patients at a Buffalo, NY hospital. According to hospital officials, the insulin pens — which are each supposed to be designated for a single patient, to help prevent the spread of diseases — were used incorrectly over a two-year period.

In November, pharmacy inspection rounds revealed that the hospital was storing insulin pens in supply drawers without any patient labels on them — despite the fact that the federal government has been warning against the practice of sharing insulin needles for years. In 2009, after a similar incident at a Texas hospital put more than 2,000 patients at risk, the Food and Drug Administration issued an alert about the issue.

“What has happened can only be described as the grossest of irresponsible and dangerous behavior,” Sen. Charles Schumer (D-NY) said of the incident. And representatives from the Buffalo area, including Rep. Brian Higgins (D) and Rep. Chris Collins (R), are now seeking an investigation into the hospital’s practices:

“Beyond the fact that the error occurred at all, most concerning was the length of time it took the Buffalo VA to catch the error — over two years, as well as the three-month delay in informing patients who may have been exposed,” Higgins, whose district includes the city of Buffalo, wrote in a letter to the VA on Monday. “Also detail why affected patients weren’t notified immediately.” [...]

“Unfortunately, since the day that new technology was introduced at the VA, they did not have a protocol in place that let the nurses know they were not supposed to use the cartridge on more than one patient,” Republican U.S. Rep. Chris Collins told CNN affiliate WGRZ. Collins also called the situation in Buffalo “unacceptable.” [...]

Higgins has also requested a detailed response outlining what steps will be taken to prevent any similar issues in the future.

An official from the Centers for Disease Control, Dr. Melissa Schaefer, told the Associated Press the CDC believes these incidents still go underreported despite previous warnings from federal public health officials. Part of the problem may be that some medical professionals, like the staff at the Buffalo-area hospital, may believe it’s safe to reuse insulin pens if they simply change the needle within the pen.

But Scaefer explained that’s not the case. “Reuse of insulin pens for more than one patient essentially is akin to syringe reuse,” she said. “You can get back flow of blood into that syringe or cartridge that contains the insulin and then you potentially expose others patients. And changing the needle wouldn’t make it safe for multi-patient use.”

A team of Spanish researchers say they have made an important breakthrough in HIV research, developing a new vaccine against the virus that is significantly more effective than earlier attempts. Advancing vaccine research could eventually eliminate the need for the expensive methods currently used to treat HIV-positive individuals.

Researchers tested the vaccine on randomly selected HIV-positive individuals who were already taking highly active antiretroviral therapy (HAART) medications, the most scientifically advanced form of treatment currently available to combat the virus. They wanted to see if, rather than simply suppressing the effects of the virus with outside treatment, their vaccine could lead the human immune system to coordinate its own defense against HIV — and they succeeded, seeing some subjects’ HIV viral loads drop more than 90 percent after 12 weeks of the trial:

“What we did was give instructions to the immune system so it could learn to destroy the virus, which it does not do naturally,” said Felipe Garcia, one of the scientists in the team at Barcelona University’s Hospital Clinic.

The therapeutic vaccine, a shot that treats an existing disease rather than preventing it, was safe and led to a dramatic drop in the amount of HIV virus detected in some patients, said the study, published Wednesday in Science Translation Medicine. [...]

The vaccine allowed patients temporarily to live without taking multiple medicines on a daily basis, which created hardship for patients, could have toxic side-effects over the long term and had a high financial price, the team said.

“This investigation opens the path to additional studies with the final goal of achieving a functional cure — the control of HIV replication for long periods or an entire life without anti-retroviral treatment,” the researchers said in a statement.

The researchers did find that the effectiveness of the vaccination declined after the first year, when patients had to return to their previous HAART treatment. Still, though, they noted this breakthrough is the culmination of seven years of research — and they will spend the next several years working to improve the vaccine even further.

Over the past year, the global community has made significant strides forward in its mission to eradicate the HIV/AIDS epidemic. This latest scientific progress builds upon previous research and policy advances that have contributed to better tests and treatments for HIV, better health care for HIV-positive individuals, and ever-increasing life expectancy rates for those living with the virus.

About a third of Philadelphia’s public high schools are welcoming students back to class this week with free condom dispensers. The initiative to increase sexual health resources in 22 of the city’s 51 high schools is part of an effort to address high rates of STDs among adolescents.

Reuters reports that more than 400 public schools across the country currently make condoms available to students through a nurse, guidance counselor, or other school personnel. Less than ten percent of schools make condoms directly available to teens without an adult intermediary — in a basket, bowl, or vending machine — as Philadelphia’s schools have started to do.

The 22 schools that have added the dispensers to their nurses’ offices were identified by the city’s Health Department as having the most serious rates of STDs, including HIV:

It’s a pilot designed to address “an epidemic of sexually transmitted disease in adolescents in Philadelphia,” said Donald F. Schwarz, the deputy mayor for health and opportunity. Since April 2011, the city has given away about four million condoms, and now, STD rates are falling.

But, Schwarz pointed out, 25 percent of new HIV infections in Philadelphia are teens, and that’s a major worry.

Some city high schools — the dozen that have “health resource centers” — already dispense free condoms. And the Health Department also provides them at city high schools when they go in to test teens for STDs, as they do every year voluntarily with a parent’s consent.

The pilot is the next logical step, Schwarz said.

Unfortunately, the troubling trend of high numbers of adolescents contracting the HIV virus isn’t specific to Philadelphia. The Centers for Disease Control warns that young Americans between the ages of 13 and 24 contribute to a quarter of the U.S.’s new HIV infections each year, partly because they aren’t getting regularly tested and are unaware they have the virus.

If Philadelphia wants to take additional steps to address the epidemic, public officials also might want to consider updating the sexual health education that students receive. Pennsylvania does mandate HIV education in public schools, but doesn’t require that health curricula meet standards for medical accuracy, and doesn’t mandate that religion cannot influence sexual education materials — which means students may receive inaccurate information about how HIV is contracted and spread, like the public school students in California who were told they can get the virus from kissing and prevent STDs with “plenty of rest.”

New data from the Centers for Disease Control estimates that even though the total number of Americans living with HIV steadily increased between 1980 and 2010, the rise is partly due to the fact that treatment programs are helping HIV-positive individuals live longer and healthier lives. Overall, new HIV infections have not increased, and the CDC estimates that prevention efforts have averted more than 350,000 cases of infection to date. Unfortunately, that good news doesn’t hold true for every community once the data is broken down by specific demographics.

The HIV epidemic is still disproportionately impacting the LGBT community — particularly men who have sex with men (MSM), who accounted for nearly two-thirds of all new infections in 2010. And the CDC reported last month that young people between the ages of 13 and 24 aren’t getting the message about HIV testing and treatment, despite the recent public education campaigns on the topic, which may be why the number of new HIV infections among MSM in that age group increased 22 percent from 2008 to 2010:

And gains in HIV treatment are also racially stratified, as African-American men continue to bear the biggest burden. Although the cases of new HIV infections among African-American women did decline between 2008 and 2010, black women still accounted for nearly two-thirds of all new infections among women in 2010. Nearly 90 percent of those women contracted the virus from heterosexual sex. Altogether, the rate of HIV infection for black Americans is about eight times higher than the rate for white Americans:

Fortunately, the U.S. made big strides toward combating HIV over the past year, a time period that is not reflected in the CDC’s new report. Breakthroughs in HIV research and drugs may help ensure that HIV-positive individuals’ life expectancy is extended even further, and the health reform law will help ensure that HIV testing and treatment is affordable for Americans who may have previously gone without it. The next time the CDC runs the numbers, there may be even more good news to report, even for typically hard-hit demographic groups.

As the global health community makes significant strides toward effectively combating the HIV/AIDS epidemic, HIV-positive individuals are now living longer and healthier lives, largely thanks to advances in treatments for the virus. Research suggests that the virus itself is hardly a death sentence anymore — and, for HIV-positive people, other public health issues are beginning to surpass their HIV status as the biggest threat to their life expectancy.

According to a new study, health complications resulting from smoking — and not from HIV itself — are actually the biggest cause of death among HIV-positive individuals. Researchers tracked HIV-positive people with access to highly active antiretroviral therapies (HAART), the medications that have drastically lowered the rates of HIV-related deaths since they first became available in 1996, and found stark differences between the smokers and non-smokers who received HAART treatment:

In a large case-control study, smokers with HIV had substantially higher rates of all-cause and non-AIDS mortality than HIV-positive nonsmokers, according to Marie Helleberg, MD, of Copenhagen University Hospital, and colleagues. [...]

The bottom line, Helleberg said in a statement, is that “more than 60% of deaths among HIV patients are associated with smoking,” compared with slightly more than a quarter associated with HIV.

In the general population, Helleberg and colleagues noted, smoking is one of the major factors that reduce life expectancy.

Among those with HIV, the advent of highly active anti-retroviral therapy (HAART) has meant that lifestyle factors are increasingly affecting survival, while the mortality risk associated with the virus has diminished.

Researchers also noted that HIV-positive individuals are much more likely to smoke than the people who are not infected with the virus, potentially due to stress or socioeconomic factors. In fact, men who have sex with men — the population that remains at the greatest risk for contracting HIV — are themselves more likely to be smokers, both because of minority stress and because Big Tobacco has worked to specifically target LGBT individuals. Anti-smoking activists emphasize that the U.S. should start focusing its smoking cessation campaigns specifically on the LGBT community.

The fact that tobacco could be deadlier than HIV is yet another reason why public health resources need to be invested into anti-smoking programs. But over the past few years, states have been dedicating fewer and fewer funds to anti-tobacco programs, as budget cuts have forced those public health initiatives to be scaled back or ended altogether.