New research indicates that expansions to Medicaid facilitated by the Affordable Care Act led to increases in the identification of undiagnosed HIV infections and the use of HIV prevention services.
The research, done by Dolores Albarracín, a professor of psychology and business administration at Illinois, and Bita Fayaz Farkhad, an economist and a postdoctoral researcher in psychology at Illinois, found that in states where Medicaid was expanded, HIV diagnoses rose 13.9 percent. Most of the newly discovered infections were in individuals who used injectable drugs or were in rural counties with a high share of pre-ACA uninsured rates.
“We find that HIV diagnoses increased in Medicaid expansion states compared with nonexpansion states and that the general knowledge that HIV can be prevented through prophylaxis drugs also increased,” said Farkhad, the lead author of the research. “When we consider these two findings together, our conclusion is that access to health care and health insurance has increased the percentage of people living with HIV who are aware of their status, which is an important finding for HIV prevention efforts. According to 2016 Centers for Disease Control and Prevention estimates, a high proportion of new HIV infections were transmitted by people who were unaware of their HIV-positive status.”
Researchers analyzed data from 2010-2017 that looked at the effects of Medicaid expansion on HIV diagnoses per 100,000 population, awareness of HIV status and preexposure prophylaxis (PrEP) before exposure by calculating differences in new diagnoses and PrEP use before and after states adopted the expansions.
The researchers found that as access to health insurance and HIV testing improved, more people living with HIV were aware of their status.
“Although many social factors contribute to rural-urban and other social-health disparities, health insurance accounts for much of the variation in access to care. Hence, expanding health insurance coverage has important implications for HIV prevention and disease transmission,” Farkhad said.
The study has important health policy implications, the researchers said.
“It’s a very important lesson in terms of, if you want to eradicate HIV, you’re going to have to increase health coverage,” Albarracín said. “Otherwise, HIV will continue to spread under the public health radar.”