Shortage of HIV specialists hinders care

Medical advancements since the first cases of HIV surfaced mean more people are living longer with the virus. But it also means they require more complex care over a longer period and that there aren't enough physicians and other health professionals trained in HIV treatment to meet patient needs, says an Institute of Medicine report.

"The nature of HIV care has been transformed in the last 30 years," said Paul Cleary, PhD, dean of the Yale School of Public Health at Yale University in New Haven, Conn., and chair of the committee that wrote the IOM report. "Some of that is remarkable and fantastic. The consequence of that is when treating an individual with HIV, often someone is treating very chronic, complex issues."

An estimated 1.1 million Americans are living with HIV, and 21% of them don't know they are infected, according to the Centers for Disease Control and Prevention. About 56,000 people are infected with HIV annually.

In July 2010, the Obama administration issued the National HIV/AIDS Strategy to increase access to care for people with the virus, reduce disparities in care and decrease the number of HIV infections. But there are several challenges to implementing the strategy, including limited funding and an inadequate health care work force, according to the IOM report, released March 17.

Trouble attracting new professionals

In 2006, the CDC recommended routine HIV testing for people ages 13 to 64. While identifying new cases of HIV is crucial, the challenge is ensuring that there are enough trained health professionals to care for newly diagnosed HIV patients, said Paul Simmons, RN, executive director of the Center for AIDS in Houston. The center provides health information and training and helps recruit patients to participate in HIV research.

"In the early days of the epidemic, lots of the physicians who treated HIV patients were either gay or in some other way identified with the cause," Simmons said. "Now, 30 years later, a lot of those physicians are retiring."

Fewer health professionals are being drawn to specialize in HIV treatment for a variety of reasons, Cleary said. Funding for HIV care is limited, and many physicians and other health professionals receive little training in such care. Most training programs are in a hospital setting, while the bulk of HIV treatment has shifted to outpatient clinics, he said.

Simmons said it's difficult to draw health professionals to the field because many HIV patients are medically complex with multiple chronic conditions.

The IOM report emphasizes a need for the nation's health system to be more flexible to treat HIV-positive individuals. Physicians and other health care professionals must collaborate and better distribute the responsibilities of care, the report said.

"The health system isn't using different providers to their full capacity," Cleary said. "Almost everyone who testified [before the committee] thought we had to be more creative and thoughtful about using the full array of health care providers."

Regardless of what approach is taken, the need for a national response is urgent, the report said.

"The present capacity of the health care system to administer a greater number of HIV tests and to accommodate new HIV diagnoses is critically strained," the report said.

The report is the third and final one produced by a committee convened by the White House Office of National AIDS Policy in 2009. The first report explored barriers to expanded HIV testing, and the second studied the impact of policies on HIV care.