Wednesday, April 26, 2006

HHSC strategic plan: No goals for HIV/AIDS

In preparing for Friday's hearing on the Department of State Health Services Legislative Appropriations Request for the coming biennium, I stumbled across another set of hearings being held on the Health and Human Services Commission's FY 2007-2011 Coordinated Strategic Plan.

The plan itself is a lengthy read, which I cannot claim to have completed. I did, however, race to the pages that dealt with HIV/AIDS and found some interesting tidbits. Herewith some tidbits:

In Texas, the number of persons diagnosed with HIV/AIDS in the next five years is expected to increase approximately 5 percent between years 2006 and 2010. Due to the cumulative effect of longer survival, the number of persons living with HIV/AIDS is expected to increase by 35 percent over the same five-year span from 56,000 at the end of 2005 to 75,600 by the end of 2010.

Quality of life continues to improve for persons with HIV disease with advances in medical management and treatment. The antiretrovirial medications reduce the likelihood of transmission of the virus as they reduce the viral count in infected individuals. Improved physical health in general correlates with better mental health. However, these concomitant gains in mental health are to some degree mitigated by the strong stigma often associated with mental health care in African American communities and by the dwindling availability of HIV-specific mental health care as funds are re-directed to primary medical care and medications.

Costs continue to rise for the medications that have led to tremendous gains in life expectancy and quality of life. Factors driving these costs include:

  • Longer use of medication regimens as patients live longer;
  • Increased emphasis on HIV testing to identify those infected, which increases the number of persons receiving treatment;
  • Use of more medications per person (minimum of three antiretrovirals, with some physicians prescribing four or five antiretrovirals);
  • Prices of older medications increasing at a greater rate than inflation; and
  • Higher prices for new medication and new formulations released in the market.
The new information here is the projection of a 5 percent increase in the number of persons living with HIV/AIDS in each of the coming five years (including 2006 apparently). This will presumably increase the number of clients in the Texas HIV Medication Program by 35 percent by the end of 2010, adding (roughly) 4375 clients in that period.

The interesting information is the reference to pressure on mental health programs caused by the redirection of funds to "primary medical care and medications" and the lack of any goal statement for HIV/AIDS. The former is interesting (to me) because it makes no mention of the pressure on any other services that might be needed by people living with HIV/AIDS. These services are also facing declining federal funding and pressure from the redirection of funds. The latter is interesting because this entire discussion occurs in the midst of a section on goals for the department.

Indeed there are goal statements for other programs, some quite perfunct ("prevention of obesity") and some more elaborate ("DSHS will improve the health of children, women, families, and individuals, and enhance the capacity of communities to deliver health care services"). There is nothing that speaks of optimizing or preserving services, improving the medication program, or anything else. There's just a list of causes and effects combined with some projections.

This is "interesting" because, in a plan that will likely set the direction of programming and departmental advocacy for the foreseeable future, HIV/AIDS is just a problem for which no solutions have been proposed. "Interesting" is now another word for heartbreak, I guess.

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