A month after metro Atlanta was announced as a focus of a federal anti-HIV initiative, Georgia lawmakers are moving forward on their own to fight the disease here.
The Georgia House has passed legislation to facilitate needle exchange programs to help prevent new infections among intravenous drug users. Such programs allow drug users to get clean needles instead of sharing and reusing the old ones.
The chamber has also approved a measure to expand the Medicaid drug formulary, a list of available drugs, to include more HIV medications.
And the House has passed a bill (HB 290) to set up a pilot program for distribution of a pill known as PrEP to people at high risk of HIV. The pill, whose name is short for pre-exposure prophylaxis, can lower these people’s chances of getting the virus if taken daily.
None of the three bills met significant opposition, but they still have to pass the Senate and receive Gov. Brian Kemp’s signature to become law. Nevertheless, patient advocates are pleased with the progress so far.
“It’s time to step up on this,’’ Rep. Sharon Cooper (R-Marietta), chair of the House Health and Human Services Committee, said recently.
She pointed to the alarming HIV statistics for Georgia.
Georgia is the No. 1 state in rates of new infections, and metro Atlanta is No. 3 among the nation’s metropolitan areas.
HIV is the virus that causes AIDS, a disease that has killed millions around the world. Much progress has been made in keeping patients alive by thwarting the development of the full-scale disease, but a key to anti-HIV strategy is preventing new infections.
President Trump announced the anti-HIV plan in his State of the Union address last month. Four metro Atlanta counties have been targeted: Fulton, DeKalb, Gwinnett and Cobb.
Those four counties — the most populous in our state — are among 48 counties in the nation that the Trump administration is targeting. The administration is also focusing on seven states with high rates of the disease in rural areas: Oklahoma, Missouri, Kentucky, Arkansas, Alabama, South Carolina and Mississippi.
On Monday, Trump proposed $291 million in the fiscal 2020 Health and Human Services budget to begin his administration’s multi-year initiative focused on ending the HIV epidemic by 2030. The initiative aims to reduce new HIV infections by 75 percent in the next five years and by 90 percent in the next 10 years.
The idea of facilitating needle exchange programs (as in the current House Bill 217) has been pushed in past General Assembly sessions. Last year, Dr. Betty Price, a state representative at the time, sponsored similar legislation that ultimately was not approved by the General Assembly. Price is the wife of Dr. Tom Price, a former HHS secretary.
Critics of needle exchange programs fear that they tacitly encourage unhealthy behavior. But many experts say that given the realities of intravenous drug abuse, supplying clean needles to addicts lessens the spread of infections, saving lives and money. Exchanges have gained acceptance in some states that once resisted them.
The formulary legislation, House Bill 158, would expand Medicaid’s drug lineup to match the AIDS Drug Assistance Program. ADAP is a state-administered program that provides HIV/AIDS medications to low-income individuals living with the disease who have little or no coverage from private or third-party insurance.
“Because HIV is such a serious disease, it’s really critical that people stay on the same medication,’’ state Rep. Deborah Silcox (R-Sandy Springs), a sponsor of the bill, said recently.
The bill specifically mentions including a single-tab HIV medication. That’s a single pill containing a combination of several different HIV drugs, and it’s considered a major advance in treatment.
Uncontrolled HIV can cost the state much more than keeping an infected person in treatment, Silcox said. “It’s a humane thing to do and fiscally the right thing to do,’’ she recently told a Senate committee.
A budgetary analysis, known as a fiscal note, shows the legislation would lead to an extra $12.9 million in state spending.
State Sen. Nan Orrock (D-Atlanta) said the bill “is the moral thing to do and medical thing to do and the right thing to do.’’
Taken together, the anti-HIV legislation represents shows “a greater determination to address the epidemic and getting Georgia to zero new HIV infections,’’ said Cathalene Teahan of the Georgia AIDS Coalition.
She also pointed to other bills as potentially helpful, including the governor’s plan to increase coverage under the Medicaid program. Teahan also cited legislation that would help patient obtain exceptions to the insurer drug protocols known as “step therapy.’’ These rules require that a patient “try and fail” on one or more medications before insurers agree to cover the drug that was originally prescribed.
HIV experts describe Georgia’s problem as severe.
“We have a huge epidemic, a lot of new infections,’’ Dr. Carlos del Rio, chair of the Department of Global Health and professor of epidemiology at Emory’s Rollins School of Public Health, told GHN recently. “This is not a Republican or Democrat issue. This is an American issue.’’