North Carolina Approves ADAP Premium Assistance

By: Lee Storrow, Executive Director, North Carolina AIDS Action Network

This year, North Carolina took a big step forward to increasing access to health insurance for individuals on our state’s AIDS Drug Assistance Program (ADAP).

For years, the HIV advocacy community has been concerned about the state’s failure to provide premium assistance for individuals who purchase their own health insurance. The majority of states across the country have such programs in place, which help subsidize the cost of health insurance for ADAP eligible patients so they can receive a broader array of health services instead of just medication. Our state took a small step forward by providing co-payment assistance for medication in 2014, but the governor’s administration claimed they were prohibited from going any further.

We knew that if we were going to gain premium assistance in North Carolina, we needed to start speaking up.

In 2015, we began preparing for a robust campaign for premium assistance for ADAP. We met with leadership at the Department of Health and Human Services that December to share information with them and make sure they understood the importance of this topic to the advocacy community. Because of changing federal guidance, the state stood to lose millions of dollars in pharmaceutical rebates that helped keep the program fully funded, which gave increased urgency to our campaign.

We built a diverse team of stakeholders who could speak up on this issue, including local Health Directors, individuals living with HIV, representatives from the pharmaceutical industry, and health care providers. We started meeting with state legislators who were members of the Health and Human Services Appropriations Committee. Everything was lined up, and although I had some skepticism that we would be successful in 2016, was cautiously optimistic.

Then on March 26th, the General Assembly passed HB2.

HB 2 was passed in response to an ordinance passed by the Charlotte City Council to protect the LGBTQ community from discrimination. Prior to the ordinance’s passage, the Governor and leadership of the General Assembly voiced their opposition to the ordinance and passed HB2 to strip Charlotte’s (and other cities in North Carolina) power to pass nondiscrimination ordinances. HB2 gained national notoriety for also requiring trans individuals to use the bathroom of the gender they were assigned at birth.

HB2 inspired significant media attention and protest, and the bill has continued to dominate statewide and national media. The business community came out strongly against the bill, and national associations and performers cancelled conferences and concerts. All of the noise started to make me nervous about our premium assistance campaign. NC AIDS Action Network supported the Charlotte ordinance; we know that LGBTQ discrimination and HIV stigma are closely linked. Though we know that HIV impacts everyone, it’s no secret that it has a disproportionate impact on the gay and trans community, and I feared that our policy change could get caught up in the tense political environment around LGBTQ rights.

Under these adverse conditions, we stayed true to our original message. Premium assistance was good health policy that would increase access to a wide range of services for low-income individuals and was good economic policy to secure needed funding to keep ADAP solvent. We generated media attention across the state and continued to meet with legislators to discuss the importance of this policy shift.

I still remember where I was when I saw the first copy of the House’s proposed budget.

Rep. Josh Dobson was a co-chair over the Health and Human Services Appropriations Committee in the House, and we had been trying to meet with him for several weeks. We finally got a couple minutes, and I sat down with him ready to make a fast pitch about why premium assistance was vital for our state. We anticipated the proposed budget would be released that week, possibly that day. After I spoke for a couple minutes, he stopped me, pulled out a copy of the draft budget, and pointed to the section that included language authorizing premium assistance for ADAP. “Is this what you’re talking about?”

I quickly realized I didn’t need to explain any more, and thanked him for his support. He explained that several of his colleagues we had already met with spoke well of this proposed change, and he was happy to support it.

From there, everything fell into place. The House budget passed without changes to our provision, and the Senate included it in their proposed budget, as well. The General Assembly passed the final state budget at the end of June, and the Governor signed it on July 14th.

I know for many states this might seem like a very small victory. The vast majority of states in the United States have already implemented premium assistance administratively without having to run a legislative campaign. We didn’t have that path in North Carolina, and we can’t help but feel victorious of the victory we achieved this year. We were lucky to have bipartisan support for this provision and leadership that understood that this was good for public health and good for the state’s economic bottom line. We now move to implementation, and supporting the Department of Health and Human Services in making premium assistance a reality for North Carolina.

From left to right- Allison Rice, Alicia Diggs, and Lee Storrow

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Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.

Improving Access to Care Among Transgender Men & Women Living with HIV/AIDS under the AIDS Drug Assistance Program (ADAP)

By: Brandon M. Macsata, CEO, ADAP Advocacy Association

The ADAP Advocacy Association announced earlier this week that it has launched a new project to improve access to care and treatment for transgender men and women living with HIV/AIDS. The project – “Improving Access to Care Among Transgender Men & Women Living with HIV/AIDS under the AIDS Drug Assistance Program (ADAP)” – aims to raise awareness about issues confronting transgender men and women living with HIV/AIDS who also access care and treatment (or whom could benefit from such care and treatment) under ADAP, as well as provide useful resources and tools to the communities serving them.

According to the Centers for Disease Control & Prevention (CDC), transgender communities in the United States are among the groups at highest risk for HIV infection.[1] The CDC reports the following key demographic data:[2]

• Highest percentage of newly identified HIV-positive test results was among transgender people (2.1%), compared to HIV-positive test results among males (1.2%), and by females (0.4%);
• Among transgender people in 2010, the highest percentages of newly identified HIV-positive test results were among racial and ethnic minorities:
• Blacks/African Americans comprised 4.1% of newly identified HIV-positive test results;
• Latinos comprised 3.0%;
• American Indians/Alaska Natives and Native Hawaiians/Other Pacific Islanders (both 2.0%);
• 73% of the transgender women who tested HIV-positive were unaware of their status; and
• HIV prevalence for transgender women was nearly 50 times as high as for other adults of reproductive age.

Among male-to-female and female-to-male transgender persons, there exists a high prevalence of clinical depression (44.1%), anxiety (33.2%), and somatization (27.5%).[3]  The Department of Family Medicine and Community Health, Medical School, University of Minnesota concluded that the minority stress model necessitated education to “…confront social structures, norms, and attitudes that produce minority stress for gender-variant people; enhance peer support; and improve access to mental health and social services that affirm transgender identity and promote resilience.”[4]

Furthermore, transgender persons experience numerous healthcare-related disparities. The extent of this barrier to health care is unknown, since “U.S. health surveillance systems infrequently include measures to identify transgender respondents or monitor the health of this underserved and marginalized population.”[5]

A cross-sectional, clinic-based sample in Massachusetts between 2001-2002 yielded some interesting findings between transgender and non-transgender adults. Among them:[6]

1. the prevalence of HIV, substance abuse, and smoking did not differ significantly for transgender and non-transgender patients; 
2. transgender patients were more likely to endorse a lifetime suicide attempt and ideation compared to non-transgender patients (p<0.05);
3. transgender patients disproportionately reported social stressors (violence, discrimination, childhood abuse) relative to non-transgender patients (p<0.05).

Despite spotty data, agreement exists on the following:[7]

• Studies reveal high HIV prevalence rates among transgender women in the United States.
• Black/African American transgender women are more likely to have HIV than transgender women of other races/ethnicities.
• Many social and structural factors pose challenges to preventing HIV among transgender people.

The CDC concluded, “Insensitivity to transgender identity can be a barrier for those who are diagnosed with HIV and seek quality treatment and care services. Research shows transgender women with diagnosed HIV infection are less likely to be on antiretroviral therapy (ART) or achieve viral suppression. Furthermore, few health care providers receive adequate training or are knowledgeable about transgender health issues and their unique needs.”[8]

There is no concrete data on the number of male-to-female and female-to-male transgender persons, nor gender-nonconforming persons living with HIV-infection accessing services under ADAP. That said, extrapolating data from the National ADAP Monitoring Project measured against CDC data suggests there is a need for gender-variant, culturally competent awareness and guidelines designed to better serve this underserved community enrolled in ADAP (as well as those persons eligible, but not enrolled).

Whereas excellent resources exist to promote transgender HIV testing, [11] as well as available programs, faith communities, and healthcare services, [12] presently nothing exists specific to ADAP serving the transgender community. There exists a need to raise awareness among key stakeholders – among them, ADAP Directors, community service providers, and state/local advocacy organizations – about existing and emerging issues confronting the transgender community. Furthermore, there is a need to model existing best practices[13] to ADAP across the 50 states and territories in the United States.

“It is important to focus on discussing and identifying competency measures that would aid in providing solid data collection in this area – especially with respect to the number of transgender individuals accessing services under ADAP – as well as expanding access for same by way of competency,” summarized Jen Laws, an independent policy consultant specializing in various aspects of healthcare policy and focusing on the needs of the HIV affected and transgender communities. “The ADAP Advocacy is committed to improved cultural competency for the transgender community in healthcare, in general, and what that means for the population accessing ADAP, specifically.”

The purpose of the project – “Improving Access to Care Among Transgender Men & Women Living with HIV/AIDS under the AIDS Drug Assistance Program” – is to raise awareness about issues confronting the transgender community accessing care and treatment under the AIDS Drug Assistance Program, as well as provide useful resources and tools to the communities serving them. 

To that end, key elements of the project include:

1. Infographic on Ryan White/ADAPs & Serving Transgender Community;
2. Community Forum on Transgender Health & Provider Friendly Care;
3. Educational Webinar on Ryan White/ADAPs & Transgender Health;
4. White Paper on Model Policy for Ryan White/ADAPs Serving Transgender Clients; and
5. Twitter Chat on Ryan White/ADAPs & Transgender Health.

To learn more about the ADAP Advocacy Association's Transgender Health Project, please email info@adapadvocacyassociation.org. 

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[1] Centers for Disease Control & Prevention, “HIV Infection among Transgender People,” August 2011; last viewed online at http://www.cdc.gov/hiv/transgender/pdf/transgender.pdf. 
[2] Centers for Disease Control & Prevention, “HIV Among Transgender People,” December 17, 2015; last viewed online at http://www.cdc.gov/hiv/group/gender/transgender/index.html. 
[3] American Journal of Public Health, “Stigma, mental health, and resilience in an online sample of the US transgender population,” May 2013; last viewed online at http://www.ncbi.nlm.nih.gov/pubmed/23488522. 
[4]  Sari L. Reisner, MA, ScD, et al, LGBT Health, “Transgender Health Disparities: Comparing Full Cohort and Nested Matched-Pair Study Designs in a Community Health Center,” April 10, 2014; last viewed online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4219512/. 
[5] Sari L. Reisner, MA, ScD, et al, LGBT Health, “Transgender Health Disparities: Comparing Full Cohort and Nested Matched-Pair Study Designs in a Community Health Center,” April 10, 2014; last viewed online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4219512/.
[6] U.S. Centers for Disease Control and Prevention, “HIV Among Transgender People,” Apri 18, 2016; last viewed online at http://www.thebody.com/content/63509/hiv-among-transgender-people.html?ap=1200. 
[7] U.S. Centers for Disease Control and Prevention, “HIV Among Transgender People,” Apri 18, 2016; last viewed online at http://www.thebody.com/content/63509/hiv-among-transgender-people.html?ap=1200.
[8] American Journal of Public Health, “Stigma, mental health, and resilience in an online sample of the US transgender population,” May 2013; last viewed online at http://www.ncbi.nlm.nih.gov/pubmed/23488522.
[9] National Alliance of State and Territorial AIDS Directors (NASTAD), “National ADAP Monitoring Project: 2016 Annual Report,” page 16, February 1, 2016.
[10] National Alliance of State and Territorial AIDS Directors (NASTAD), “National ADAP Monitoring Project: 2016 Annual Report,” page 17, February 1, 2016.
[11] The Center of Excellence for Transgender Health, University of California, San Francisco, “Transgender HIV Testing Toolkit,” April 11, 2016; last viewed online at http://transhealth.ucsf.edu/trans?page=ev-nthtd-2016. 
[12] Transcending Transgender Program and the Alameda County Office of AIDS Administration, “Transgender Resource Guide,” 2016; last viewed online at http://www.acphd.org/media/269820/transgender_resource_guide.pdf. 
[13] JoAnne Keatley, MSW, YMSM+LGBT Center of Excellence, “Transgender People - Exploring Diversity and Health Service Needs,” August 28, 2015; last viewed online at https://vimeo.com/141821792. 

Discriminatory Design: HIV Treatment in the Marketplace

By: Sean Dickson, Senior Manager, Health Systems Integration, National Alliance of State & Territorial AIDS Directors (NASTAD)

The National Alliance of State and Territorial AIDS Directors (NASTAD published a groundbreaking report on the treatment of HIV medications by Affordable Care Act insurance plans available on the Federally-facilitated marketplaces. This report – Discriminatory Design: HIV Treatment in the Marketplace – reveals pervasive deficiencies in marketplace plans’ coverage and pricing of HIV medications.

States and the Centers for Medicare & Medicaid Services (CMS) are currently reviewing plan designs for 2017, and this report will help guide their review to reduce discriminatory plan design for persons living with HIV. The report highlights the direct relationship between drug prices and insurer restrictions, underscoring the need for comprehensive drug pricing reform in addition to monitoring and enforcement of non-discrimination protections.

Key findings include:

• 20% of plans only cover one single-tablet regimen, Atripla, the oldest and least-recommended regimen
• One-third of plans place all covered single-tablet regimens on the specialty tier
• Over 45% of Bronze plans subject all covered single-tablet regimens to co-insurance
• 15% of plans do not cover any HIV drugs introduced since 2013
• 34% of plans place Truvada, which can prevent HIV infection as Pre-Exposure Prophylaxis (PrEP), on the specialty tier
• 29% of plans require patients to “fail-first” on another HIV drug before taking Stribild, a leading single-tablet regimen
• Cost-Sharing Reduction plans, intended to help low-income individuals access affordable insurance, have the same high levels of co-insurance as Silver plans
• Increases in drug list prices lead to increased frequency of co-insurance at statistically significant levels

The full report can be downloaded online at https://www.nastad.org/resource/discriminatory-design-hiv-treatment-marketplace.

Please contact Sean Dickson with any questions at sdickson@nastad.org.

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Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.

Finding the right doctor can be challenging—this new service can help

By: Carine Carmy, Head of Marketing, Amino

When you need to find a doctor, how do you find the right one? If you have health insurance, you might start with your insurance plan, and check which doctors are in-network. You might look at online resources, and Google which doctors are located nearby. You might look at Yelp or other review sites to see what people say about the doctors (and if you’re lucky, those reviews might be relevant to your condition or to the procedure you need). If you have a friend or family member with your condition, or know someone with a medical background, you might be able to ask one of them for a recommendation.

Even if you went through all that to find a doctor, would you feel confident that you made the right choice? With all the resources available for health care decision-making, you might still be missing a crucial piece of information: how much experience does this doctor have with what you need?

Research shows that when it comes to doctors, experience matters—not necessarily years of experience practicing medicine, but rather the volume of patients a doctor has treated with your condition. That’s the philosophy behind Amino, a free website that launched in October 2015, which lets you find and book doctors and estimate health care costs for medical procedures. With Amino, you can get matched with a doctor based on his or her experience with the condition you have or the treatment you need. Amino measures a doctor’s experience by analyzing data from health insurance claims (the records doctors send to insurance companies to get paid for what they do) to uncover what they focus on and how they treat their patients.

Below, you can use the embeddable Amino search to see how the product works and find doctors who have experience with HIV-related care and treatment—you can also change any of the search filters to look up other conditions or procedures (Amino has over 800 topics to choose from).

Here are five quick guidelines for using Amino:

1. If you’re looking for doctors who have experience with HIV-related care and treatment, you would first enter in some information about yourself or the patient you’re taking care of.

Photo Source: Amino

2. Then, enter your location and insurance (if you have it—it’s optional to enter in your insurance).

Photo Source: Amino

3. You’ll get a list of doctors who have the most experience with testing people like you—of the same age and sex, and with the same insurance—for HIV-infection. Amino will search its database of 893,000 doctors to provide this list. You might see a variety of doctors in your match list, and depending on your preferences you can filter by a doctor's specialty.

Photo Source: Amino

4. When you click on the doctor’s profile, you can see what they treat patients for and which services, tests, and procedures they provide, along with other important information like their credentials.

Photo Source: Amino

5. From there, you can book an appointment via email or text message at no cost to you.

Amino also offers cost estimates for 49 medical services and procedures for dermatology, diagnostics, men’s health, orthopedics, preventative care, surgeries, and women’s health—and you can view those cost estimates for individual doctors as well as research costs in your area and insurance network.

Health care is not one-size-fits-all—what’s right for you can change depending on your health and your preferences. Your search for a doctor should be customized to your condition or the procedure you need, and you should be able to see as much information about a doctor as possible before making the time commitment to see them in-person.

Using Amino, you get a data-driven and personalized experience, which can help you choose care with confidence. If you have any feedback or questions, please don’t hesitate to reach out to the team at feedback@amino.com.


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Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.

Combatting the Dual Epidemic of Substance Use and HIV-Infection

By: Brandon M. Macsata, CEO, ADAP Advocacy Association

Since the earliest days of the AIDS epidemic, there has been a significant link between substance use, abuse, and dependence and HIV-infection. Aside from injection drug use ("IDU") -- which can cause direct exposure to the virus -- substance use, abuse, and dependance "can affect people’s overall health and make them more susceptible to HIV infection and, in those already infected with HIV, substance use can hasten disease progression and negatively affect adherence to treatment."[1]

Photo Source: We Do Recover

According to the CDC, some of the populations most vulnerable populations include people who live in disadvantaged neighborhoods, gay, bisexual and transgender men, people with mental illness, and people who have experienced sexual, physical, or emotional abuse. Among some of the most common substances used are alcohol, crack cocaine, heroin, Methamphetamine ("Meth"), and poppers.[2]

Unfortunately, many prevention strategies -- otherwise known has Harm Reduction -- often fall victim to the political kickball because many right wing conservatives view them as condoning drug use. Also, often the scarcity of available funding in public health can push these programs to the back burner. The lack of prevention dollars has long plagued the fight against the AIDS epidemic, and it is one that continues today (though some progress has been achieved over the last decade in this area).

To that end, earlier this month the National Alliance of State & Territorial AIDS Directors (NASTAD) released a Fact Sheet on ADAP Formulary Coverage of Substance Use Treatment. The fact sheet demonstrates how AIDS Drug Assistance Programs (ADAPs) cover substance use treatment medications, related client services, as well as drug-specific information for medications.[3]

It includes the following sections:

• Substance Use Treatment Needs among PLWH
• Use of Ryan White Part B and ADAP Funds to Expand Access to Substance Use Treatment
• Substance Use Treatment Medications: Drug-Specific Information

NASTAD summarized the important role played by ADAPs: "When used in combination with behavioral therapy, substance use treatment medications allow individuals to manage addiction or dependency by reducing their risk for overdose, cravings, and/or symptoms of withdrawal.  For PLWH who use substances, these treatments bolster multiple “bars” within the HIV care continuum, including adherence to ARV treatment and viral load suppression."[4] 

The fact sheet can be downloaded online at https://www.nastad.org/resource/adap-formulary-coverage-substance-use-treatment.

There is no one-size-fits-all to the prevention and treatment of substance use, abuse, and dependence. One thing is certain though, there isn't enough being done in this area. Resources and tools -- such as the one made available by NASTAD -- are important to community leaders trying to tackle the dual epidemic of substance use and HIV-infection.

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[1] U.S. Centers for Disease Control & Prevention (CDC), "HIV and Substance Use in the Unite," March 2013; available online at http://www.cdc.gov/hiv/pdf/risk_HIV_Substance.pdf.
[2] U.S. Centers for Disease Control & Prevention (CDC), "HIV and Substance Use in the Unite," March 2013; available online at http://www.cdc.gov/hiv/pdf/risk_HIV_Substance.pdf.
[3] National Alliance of State & Territorial AIDS Directors (NASTAD), "ADAP Formulary Coverage of Substance Use Treatment," July 5, 2016; available online at https://www.nastad.org/resource/adap-formulary-coverage-substance-use-treatment.
[4] Bowes, Amanda, National Alliance of State & Territorial AIDS Directors (NASTAD), "AIDS DRUG ASSISTANCE PROGRAMS’ (ADAPS) SUPPORT OF SUBSTANCE USE TREATMENT FOR THE CLIENTS THEY SERVE," July 5, 2016; available online at https://www.nastad.org/blog/aids-drug-assistance-programs-adaps-support-substance-use-treatment-clients-they-serve.

Access to HIV/AIDS Medicines in Exchange Plans

By: Brandon M. Macsata, CEO, ADAP Advocacy Association

The ADAP Advocacy Association earlier this week announced the framework for its 9th Annual Conference, which includes seven (7) town-hall style panel discussions about various issues impacting access to care and treatment for people living with HIV/AIDS. Among them, a discussion on the access to HIV/AIDS medicines (and other services) in exchange plans.

The panel on the "Affordable Care Act: Marketplace Cost Sharing & Barriers to Healthcare" will be moderated by Scott Evertz, former Director for the Office of National AIDS Policy, and current board member for the Community Access National Network (CANN). It is an opportunity to dig deeper into the ongoing discriminatory practice by insurance companies, requiring inordinately high co-payments and co-insurance for medications used in the treatment of HIV and AIDS.

This ongoing issue has routinely been covered by the ADAP Blog, because it is one of the most commonly expressed concerns by the patient community. View previous blogs on the topic here, here, and here, as well as here.

The Pharmaceutical Research and Manufacturers of America® (PhRMA) recently released several new fact sheets, which provide an in-depth, state-by-state look at coverage and access in the 2016 exchange plans. In a statement released by PhRMA, they are summarized as follows: "From deductibles and cost sharing to prescription drug coverage and formulary data, each fact sheet lays out the specifics for a given state compared to the national average, according to research analyzing 2016 silver health insurance exchange plans. Based on the data and information gathered, the fact sheets also include suggestions for improving exchange coverage in each state."

The fact sheets are available online at AccessBetterCoverage.org.

Photo Source: AccessBetterCoverage.org

Of particular interest to our readers is the fact sheet on HIV/AIDS medications, outlined in the Formulary Access for Patients with HIV/AIDS. A troublesome finding is approximately 10% of the plans use high tier placement or coinsurance for all single source HIV medicines.[1]

An excellent patient-centric resource available at AccessBetterCoverage.org is the "In Your State" tool. It allows patients to learn more about the marketplace plans in each state, including important fact sheets.

For example, in Alabama the following actions are recommended:[2]

• Enforcing non-discrimination requirements, which apply to benefit design and provider networks; 
• Establishing stronger rules regarding exceptions and appeals processes, which help enrollees get the medicines and care their doctors recommend; and  
• Enhancing the state's marketplace website or advocating for a Healthcare.gov page that allows for easier plan comparisons, including searchable formularies and estimates of total out-of-pocket costs.

To utilize this tool, CLICK HERE.

The rising share of patient cost-sharing is widely viewed as the next frontier in the healthcare reform battle. It is one that disproportionately impacts people living with chronic conditions, such as HIV/AIDS.

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[1] Avalere, "Formulary Access for Patients with HIV/AIDS," page 9, 2016.
[2] AccessBetterCoverage.org, "In Your State: Alabama," 2016; available online at http://accessbettercoverage.org/states/alabama.

HIV-Related Belly Fat: More Than Just an Appearance Issue

By: Brandon M. Macsata, CEO, ADAP Advocacy Association

Excess belly fat, known in medical circles as VAT (visceral adipose tissue), is a type of hard fat that can affect people living with HIV-infection. Research has shown that between 20% and 30% of HIV-positive patients are experiencing excess VAT. For years, there’s been a common misconception that this belly fat is just a physical cosmetic issue that is a side effect of earlier HIV treatments – something that must be accepted as a reality of now living longer with HIV-infection. Recent research dispels that myth so that even with newer anti-retro viral regimens this condition continues to exist.

Photo Source: Don't Take VAT

"Don’t Take VAT" is an educational initiative supported by the ADAP Advocacy Association, that is shedding light on excess belly fat and the medical complications it can potentially create in order to help people living with HIV-infection learn about the condition, how to identify it, and what questions to ask their doctor. Since VAT is a type of hard fat that can surround a person’s organs and make it difficult for people to do things like bend over to tie their shoes or breath normally, the ramifications of this type of belly fat go far beyond the emotional strain caused by the stigma of carrying VAT. Excess abdominal VAT is also associated with a variety of health concerns, including diabetes and cardiovascular disease, which is why it’s important for patients to talk to their doctor about it.

Far too often, people with HIV believe the doughy fat around one’s midsection can be addressed by a healthy diet and exercise alone. But VAT doesn’t work that way. It can be challenging to reduce VAT with exercise and healthy living alone. The "Don’t Take VAT" website – www.DontTakeVAT.com – includes fact sheets about VAT and healthy living with HIV, as well as a video that provides a deeper look at VAT and tips about what to ask your doctor.

A doctor can determine if a person has excess abdominal VAT by assessing the individual’s medical history and HIV therapy regimen and by measuring around a patient’s waist and hips and calculating waist-to-hip ratio. But this often requires a patient’s willingness to make such a request, as often even doctors mistake VAT for regular belly fat and don’t always conduct this type of assessment during routine medical appointments.

While having excess HIV-related belly fat can cause physical, medical and emotional difficulties, nobody should feel ashamed or embarrassed about it. It is important that you take ownership of your own health and take the first step toward talking to your doctor and examining your treatment option.