News Sexual Health

New AIDS Treatment Guidelines: Expensive, But Expected to Save Millions

Martha Kempner

The World Health Organization has released new guidelines for AIDS treatment around the world. The guidelines come with a hefty price tag but may save millions of lives around the world and make a real dent in the HIV epidemic.

The World Health Organization (WHO) has released new guidelines for AIDS treatment around the world. The guidelines come with a hefty price tag but may save millions of lives around the world and make a real dent in the HIV epidemic.

The new guidelines, released Sunday at the meeting of the International AIDS Society in Kuala Lumpur, Malaysia, recommend earlier treatment for HIV-positive adults as well as treatment right after diagnosis for all children under age five, pregnant women, individuals with tuberculosis or hepatitis B, and adults who have uninfected partners.

While many wealthier countries already follow similar guidelines, this is not the case in some places where HIV rates are there highest. WHO says that expanding treatment would add about 10 percent to the $23 billion that’s already spent on HIV treatment each year but estimates it could prevent three million deaths and avert 3.5 million new infections by 2025.

The new guidelines suggest that HIV-positive adults start taking antiretroviral (ART) medication when their CD4 cell count drops to 500, which is still in the healthy range. (People with healthy immune systems have a CD4 cell count between 500 and 1,600.) CD4 cells, also referred to as T cells, are an important part of the immune system that help people fight off infection. AIDS is diagnosed when a person with HIV has a CD4 count of 200 or less. The previous guidelines postponed treatment until a CD4 count of 350. The WHO, however, believes that starting while a person has a healthy immune system will not only keep them healthy longer but will also prevent infections, because people on ARTs also have lower viral loads, which makes the virus much less contagious.

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The new guidelines also suggest that all adults starting ART be given a new medicine that combines three drugs—tenofovir, lamivudine (or emtricitabine), and efavirenz—into a single pill that is taken once a day. This combined medication is easier to take and less expensive. In countries with negotiated lower prices, this pill can be taken once a day for a year for approximately $127.

In a press release, the WHO explained the change in the guidelines:

WHO has based its recommendation on evidence that treating people with HIV earlier, with safe, affordable, and easier-to-manage medicines can both keep them healthy and lower the amount of virus in the blood, which reduces the risk of passing it to someone else. If countries can integrate these changes within their national HIV policies, and back them up with the necessary resources, they will see significant health benefits at the public health and individual level.

The organization’s director-general, Dr. Margaret Chan, went on to say, “With nearly 10 million people now on antiretroviral therapy, we see that such prospects—unthinkable just a few years ago—can now fuel the momentum needed to push the HIV epidemic into irreversible decline.”

Still, it will be challenging to get widespread access and compliance. Currently, only about 60 percent of individuals who are eligible for the drugs are getting them, and the guidelines increase the number of people eligible by about nine million. Moreover, it can difficult to get some people to continually take their drugs, especially if they have yet to feel ill. Dr. Sarah Fidler, an HIV expert at Imperial College London who is doing research in Africa, told the Boston Herald, “For people struggling with other issues like poverty, taking pills for a disease that isn’t making them sick yet might not seem like the most important thing in the world. This is not going to be as simple as just giving drugs to everybody.”

However, WHO’s HIV-AIDS director, Dr. Gottfried Hirnschall, said the new guidelines could have a tremendous impact. He summed it up this way when talking to the BBC: “It will be very difficult to end AIDS without a vaccine—but these new guidelines will take us a long way in reducing deaths.”

News Contraception

New Hawaii Law Requires Insurers to Cover a Year’s Supply of Birth Control

Nicole Knight Shine

Insurance companies typically cover only a 30-to-90-day supply of birth control, posing a logistical hurdle for individuals who may live miles away from the nearest pharmacy, and potentially causing some using oral contraceptives to skip pills.

Private and public health insurance must cover up to a year’s supply of birth control under a new Hawaii law that advocates called the nation’s “strongest.”

The measuresigned by state Gov. David Ige (D) on Tuesday, applies to all FDA-approved contraceptive medications and devices.

Hawaii joins Washington, D.C., which also requires public and private insurers to cover up to 12 months of birth control at a time.

Oregon passed a similar measure in 2015, but that law requires patients to obtain an initial three-month supply of contraception before individuals can receive the full 12-month supply—which the Hawaii policy does not.

“At a time when politicians nationwide are chipping away at reproductive health care access, Hawaii is bucking the trend and setting a confident example of what states can do to actually improve access,” Laurie Field, Hawaii legislative director for Planned Parenthood Votes Northwest and Hawaii, said in a statement.

Insurance companies typically cover only a 30-to-90-day supply of birth control, posing a logistical hurdle for individuals who may live miles away from the nearest pharmacy, and potentially causing some using oral contraceptives to skip pills. Both the American Congress of Obstetricians and Gynecologists (ACOG) and the U.S. Centers for Disease Control and Prevention recommend supplying up to one year of oral contraceptives at a time, as the Hawaii Senate Committee on Commerce, Consumer Protection, and Health noted in a 2016 conference report.

Fifty-sex percent of pregnancies in Hawaii are unintended, compared to the national average of 45 percent, according to figures from the Guttmacher Institute.

Women who received a year’s supply of birth control were about a third less likely to experience an unplanned pregnancy and were 46 percent less likely to have an abortion, compared to those receiving a one- or three-month supply, according to a 2011 study of 84,401 California women published in Obstetrics and Gynecology.

Reproductive rights advocates had championed the legislation, which was also backed by ACOG–Hawaii Section, the Hawaii Medical Association, and the Hawaii Public Health Association, among other medical groups.

“Everyone deserves affordable and accessible birth control that works for us, regardless of income or type of insurance,” Planned Parenthood’s Field said in her statement.

News Abortion

Arizona Anti-Choice Lobby ‘Not OK’ With FDA Update to Medication Abortion

Nicole Knight Shine

A Planned Parenthood spokesperson said the Center for Arizona Policy "has for years endangered women's health and safety by colluding with extremist Republicans to erect as many barriers as possible between women and the health care they are constitutionally entitled to."

Arizona’s chief anti-choice lobby and Republican lawmakers are regrouping from a recent blow to their campaign to legislate away medication abortion, while continuing to insist that the Food and Drug Administration’s (FDA) updated labeling for abortion-inducing medication is misguided.

The FDA’s recent update to medication abortion labeling kneecapped a restrictive GOP-backed medication abortion law, which the state’s Republican governor signed last month.

The law would force Arizona doctors to follow 16-year-old FDA standards—guidelines that the American College of Obstetricians and Gynecologists, and now the FDA, advise against.

six-person house and senate conference committee last week conceded defeat—at least temporarily—by tacking onto an existing bill, SB 1112, language to repeal the GOP’s medication abortion restriction, known as SB 1324. Meanwhile, officials from the state’s influential anti-choice group, the Center for Arizona Policy, say they’re figuring out what they, along with state Republicans, will do next to make medication abortion inaccessible.

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“We’re not saying we’re OK with what the FDA did,” Cathi Herrod, president of the Center for Arizona Policy, said Wednesday.

Herrod had championed SB 1324 because it limited medication abortion, a two-pill regime, to the first seven weeks of pregnancy. The updated FDA labeling makes the regimen available up to ten weeks, at a lower dosage, and with fewer doctor visits.

Herrod told Arizona Central that she remains concerned by the updated FDA guidelines saying the medication can be safely administered longer into a pregnancy than she thinks is best. “We want to take the interim to assess what’s best for women’s health and safety,” Herrod said.

Medication abortion has been proven safe, with serious complications occurring in fewer than 0.4 percent of patients. This isn’t the first time Herrod’s organization and the Arizona GOP tried to impose restrictions on medication abortion.

Lawmakers in 2012 enacted a nearly identical medication abortion restriction, which a state court permanently blocked.

The Center for Arizona Policy “provides no medical or social services whatsoever, and has for years endangered women’s health and safety by colluding with extremist Republicans to erect as many barriers as possible between women and the health care they are constitutionally entitled to,” Jodi Liggett, vice president of public affairs with Planned Parenthood Arizona, said in an email to Rewire.

Liggett continued, “The best thing that Cathi Herrod could do for women’s health and safety would be to butt out.”

Representing an unexpected gain for abortion rights advocates, the new language in SB 1112 rescinds a statute that forced doctors to tell pregnant people that medication abortion may be reversible, a measure a federal court had blocked, as the Arizona Daily Sun reported.

The “evidence” for the statute was a single case study of six patients by an OB-GYN who opposes abortion rights. Bryan Howard, president of Planned Parenthood Arizona, called the provisions “a victory for women’s health.”

The bill reportedly includes new language to require doctors to tell a patient who has taken the first of two pregnancy-ending pills that a single pill does not always end a pregnancy. The bill still needs a floor vote in the house and senate before heading to the governor.

Arizona isn’t the only state to attempt to legislate away medication abortion by making doctors follow outdated FDA guidelines. The FDA’s action last month undercut GOP-supported laws in Texas, Oklahoma, Ohio, and North Dakota that require physicians to follow the agency’s 2000 label recommendation for mifepristone. The original FDA label instructed providers to administer both doses in the office and have a follow-up visit.