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Show seven percent of the newly reported HIV/AIDS patients in 1998 were between the ages of 20-49. Patients who were older than 49 years of age accounted for 11% of those reported in 1998. This mirrors the national epidemic and remains relatively constant. HIV Positive Women and Pregnancy A study reported by the Centers for Disease Control (CDC) (1994) concerned the use of zidovudine (ZDV) during pregnancy, labor, and delivery of HIV-infected women. The study, a multicenter trial, included 43 women who delivered an infant from 1981 through 1989 and from 1990 through March 1998. Fourteen women delivered during 1981-1989. None of the 14 was antibody tested for HIV during pregnancy. Thirteen of 14 of these infants subsequently tested HIV positive; one was lost to follow-up. Five of these infants were born in Utah. Of the 29 women who delivered from 1990-1998, 16 (55%) were known to be HIV positive during pregnancy, 9 (31%) were not known to have been HIV antibody tested, and 4 (14%) were lost to follow-up. Ten (77%) of the infants born were not HIV infected; 3 were lost to follow-up. Three of the women who were known to be HIV positive did not receive ZDV during pregnancy. Two of the 3 infants tested HIV positive; one was lost to follow-up. Five (56%) of the infants born to the 9 women whose HIV status was not known at pregnancy tested HIV positive. Although there has been improvement in the offering of HIV testing and antiretroviral therapy during pregnancy, or preferably before pregnancy, it is still not the standard of care in Utah. HIV/AIDS Care at the University of Utah Hospital and Clinics The Infectious Diseases Clinic at the University of Utah Hospital is the leading provider of care for the adult with HIV/AIDS. In 1998 the Division of Infectious Diseases provided services for approximately 700 patients. The majority of the HIV/AIDS patients in the Infectious Disease clinic caseload are eligible for private insurance, Medicaid or Medicare. The remainder is assisted to access either Ryan White Title III B funding (a federal grant), or the Utah Medical Assistance Program (UMAP). With the improvement of therapies and therefore the improved health of persons with HIV/AIDS, there are fewer patients who are eligible for Medicaid. The care and the costs of care have simply shifted from hospital care and the treatment of opportunistic infections to outpatient HAART therapies. This has impacted the way the care is funded for the patients who are increasingly uninsured or underinsured. In 1998 the pattern of coverage has changed remarkably. Provision of care relies more heavily on federal grant monies and less upon Medicaid and private insurance. In 1995, Medicaid covered 24% of the patients in the clinic; in 1998 only 12.95% were covered by Medicaid (Table 3). The percent of patients who were covered by the Ryan White Title 1MB federal grant increased from 16% to 26.4%. This is especially worrisome as the coverage is for HIV/AIDS care only; there is thus a shift for the patients to be underinsured. The HIV/AIDS data continue to point out the erosion of the health care system. Summary Since the last report in Utah's Health there have been remarkable technological advances which have resulted in new therapies and increased survival for patients with HIV/AIDS in the developed world. The Utah epidemic mirrors the U.S. epidemic with only minor differences. With HAART therapy, the death rates are markedly decreased. It is unknown if this decrease in death and progression to AIDS will continue or if it is simply a delay of the epidemic brought about by HAART. The changes have made the therapies much more complex and the health care coverage unsure in an already complex health care system. Despite the Federal and State funding for care, there are still many patients with HIV/AIDS who in reality are still unable to access care due to high insurance co-payments or rules which require prepayment for prescriptions which usually cost in excess of $1000 per month. Some patients can not pay these costs up front and rules prevent the use of other Federal or State funds for this purpose(Practice Division of Infectious Diseases, personal communication). These patients are not receiving adequate care. 37 |
