AMA House of Delegates

AMA meeting: U.S. needs national HIV/AIDS strategy

■ Countries receiving U.S. funding for AIDS relief are required to have a strategic plan -- but America has no plan.

By Victoria Stagg Elliott — Posted June 29, 2009

Chicago The United States should have a national strategy to address the HIV/AIDS epidemic, and the American Medical Association should work with the White House's Office of National AIDS Policy and other relevant bodies to develop such a program, according to a resolution adopted at the AMA Annual Meeting in June.

"Still, 25% of patients with HIV don't know their status, and 50% present late for care," said Baligh Yehia, MD, an internist from Baltimore and an alternate delegate for the American College of Physicians. "We still have not been able to impact the incidence and prevalence for this disease. It's time to focus on the crisis in our own backyard."

According to the Centers for Disease Control and Prevention, the number of people living with HIV/AIDS increased 16% from 492,673 reported cases in 2004 to 571,378 in 2007. The AMA took action because the U.S. has no national strategy, despite the fact that the President's Emergency Plan for AIDS Relief provides funding to other countries only if they have a national policy along with a single countrywide coordinating authority and monitoring system. States and municipalities also are required to have their own plans before receiving federal funding.

"Yes. We need a single national plan," said AMA Secretary Joseph P. Annis, MD. "We ask states to have their state plans. Countries receiving aid have to have a single national plan. Why don't we have the same thing?"

Delegates also debated whether to support states that mandate HIV testing of women in labor who have not been tested during their pregnancies. The organization also considered urging state medical societies to advocate that elected officials give thought to requiring HIV testing in this situation. Delegates voted to refer both issues for further study.

"It would be ideal if women were tested before they became pregnant. Unfortunately, this is not always the case," said Mary Ann Contogiannis, MD, a plastic surgeon who proposed this resolution on behalf of the North Carolina Medical Society.

Current Association policy states that universal HIV testing of pregnant women with notification of the right to refuse should be a routine part of perinatal care. The recommendations of the CDC, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians and the American Academy of Pediatrics are similar.

"We don't support mandatory testing," said Carol Berkowitz, MD, an AAP delegate from California. "Mandates don't guarantee that the mother will accept treatment. We have got to have a more thoughtful approach."

But many spoke in favor of mandates, arguing they would make it more likely that a mother who is positive would be identified as such and steps could be taken to significantly reduce the risk of transmission to the infant. "There are a lot of people at risk for STDs who don't perceive they are at risk," said Sally Trippel, MD, an internist and a delegate for the Minnesota Medical Assn.

Most neonatal HIV transmissions occur during labor and delivery. The CDC reports 8,434 infants have been infected this way since 1981. In 2007, 24 infants became infected through this route of transmission.

ADDITIONAL INFORMATION

Meeting notes: Public health

Issue: Some organizations are lobbying to have obesity declared a disability, but this designation could interfere with physician counseling on the subject.
Proposed action: Oppose such efforts. [Adopted]

Issue: Concerns have been raised about the safety of conducted electrical devices being used by law enforcement officials and others.
Proposed action: Law enforcement departments and other agencies should design and implement guidelines, training and accountability on the use of these devices. These bodies should also have standard approaches to medical evaluation, management and postexposure monitoring. Additional independent research is needed to better understand the risks and benefits of these devices. [Adopted]

Issue: Male breast cancer is uncommon but tends to be diagnosed at late stages. Awareness of this possibility is low.
Proposed action: Recognize that breast cancer affects men as well as women, some men are at increased risk and heightened surveillance may be appropriate for a minority of men. Support Medicare and insurance coverage for screening and testing services for those at increased risk. [Adopted]

Issue: Hormones have been promoted to prevent aging, but there are many open questions as to the risks and benefits of taking those substances for that purpose.
Proposed action: Disseminate the Council on Science and Public Health report that found scientific evidence was lacking and, in some cases, long-term use may cause harm. Take the position that those who promote these treatments have a responsibility to support claims with well-designed, randomized placebo-controlled trials. [Adopted]

Issue: Americans' overall health continues to decline because of preventable conditions, many linked to overweight and obesity.
Proposed action: Make improving Americans' eating and exercise habits a priority, propose draft legislation that would establish innovative programs to encourage people to adopt healthier habits and work with partner organizations to educate patients on how to improve diet and increase physical activity. [Adopted]

Issue: The obesity epidemic is growing, but people do not have easy access to the nutritional information they need to eat healthily in restaurants.
Proposed action: Create a method for displaying calorie and other relevant information on restaurant menus and menu boards for all food and beverage items. [Reaffirm existing policy on nutrition labeling]