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However, he said health plans were active in trying to improve treatment and care for HIV-positive Americans, both their own clients and others. He said insurers did sometimes rescind coverage on grounds that a patient had not fully disclosed required information, but that such instances were rare.

Among HIV-positive people without private insurance, many rely on public programs such as Medicaid and Medicare, but others are not eligible. As a last resort, if they meet the low-income criteria, they can seek financial assistance through the federal Ryan White Care Act.

However, advocates say the result is often patchwork health care _ or no care at all. Many uninsured people don’t get tested, don’t know their HIV status and unwittingly transmit the infection to others.

Antiretroviral treatment is expensive _ often more than $18,000 per year. But advocacy groups say treatment is cost-effective, enabling more people to be self-sufficient and reducing later spending on acute care and stays at hospices.

Advocacy groups also contend that the positive effects of the federal health care act can be foretold by the experience of Massachusetts, which adopted similar legislation in 2006. According to a study last year by Harvard Law School’s Center for Health Law and Policy Innovation, new HIV infections dropped by 37 percent in Massachusetts from 2005 to 2008, while rising by 8 percent in the rest of U.S.

By federal estimate, about 50,000 new cases of HIV infection occur annually in the United States. The Centers for Disease Control’s latest figures show that gay and bisexual men account for about 60 percent of the new infections; blacks also are affected disproportionately, accounting for about 13 percent of the population and about 44 percent of new HIV infections.

The CDC also says the HIV infection rate in poor urban areas is far higher than for the rest of the U.S. _ and is on par with the rate in such AIDS-devastated countries as Haiti and Angola.

“HIV is a disease of poverty,” said Dr. Michael Saag, an HIV physician and researcher at the University of Alabama at Birmingham. “That’s why the health care law is critically important.”

In Alabama, he said, funding to provide HIV treatment for low-income people has not risen to meet growing demand, and clinics lack adequate staff and resources.

“Once on treatment, transmission of HIV is cut to almost zero _ but where do these people get treatment?” Saag asked. “The question to people who are against the Affordable Care Act is, `What are we going to do instead?’”

Saag is a past chairman of the HIV Medicine Association, representing more than 4,800 health care professionals and researchers. The current chair, Dr. Judith Aberg of the New York University School of Medicine, recently pleaded for the health care law to be upheld.

“For the first time in 30 years, thanks to advances in HIV prevention and treatment research, we can realistically envision the end of the greatest pandemic of our time,” she said. “To reach this goal, we cannot afford to take any steps backward.”

In Illinois, state Rep. Greg Harris, who is HIV-positive, has joined with colleagues in fighting to minimize funding cuts for the AIDS Drug Assistance Program, a joint state-federal initiative providing HIV medications to low-income people.

Harris believes the Affordable Care Act can be a huge help in providing more HIV-positive people with health insurance. Were it to be rejected by the Supreme Court, he said, “It would take away a lot of hope for a lot of people.”


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