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Texas Refuses to Expand its Medicaid to Help Combat HIV

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Researchers say communities of color will be the most affected if the expansion doesn't happen. 

As Medicaid starts to enact expanded coverage in a number of states, Texas’s refusal to do so could have catastrophic outcomes for Black men who have sex with men (MSM) in Houston.

The analysis, published in Medical Care, focused on HIV transmission among Black MSM between 18 to 34 years old. This disproportionately affected group accounted for 19 percent of all new diagnoses in Houston, according to News Medical.

Texas is one of 11 states that hasn’t adopted the Medicaid expansion. Even if they do, researchers also note a need to put a focus on increasing antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) distribution in order to eliminate HIV transmission.

Medicaid coverage under the Affordable Care Act (ACT) has allowed for an increase in health benefits, including increased use of ART and PrEP to prevent HIV transmission. With Houston as the most populous city in the Southern United States, the lack of coverage creates “massive coverage gaps that disproportionately burden people of color.”

Study models were used to show a considerable projected decline in HIV transmission among young Black MSM. The new diagnoses rate was projected to decrease by 17.5 percent within ten years based on Medicaid expansion alone.

Ambitiously increasing the use of ART and PrEP is also expected to reduce the HIV incidence rate by nearly 50 percent, with the new infection rate expected to go down 44 percent in the same time period. 

“Improved ART and PrEP engagement have shown promise in reducing HIV transmission in a number of U.S. populations that bear a disproportionate burden on the epidemic,” said Dr. Francis Lee of the University of Chicago.

Without “concerted efforts to reach the uninsured,” however, “this change has the potential to increase rather than to decrease the disparities in HIV incidence that disproportionately affect Black MSM.”

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