Expanding Medicaid Eligibility Increases HIV Diagnoses

Medicaid expansion has resulted in the increased identification of undiagnosed HIV infections along with the use of HIV prevention services such as preexposure prophylaxis drugs.

In fact, expanding Medicaid eligibility was associated with a 13.9% increase in HIV diagnoses, according to new study findings.

The results suggested the changes in new HIV diagnoses, awareness of HIV status, and preexposure prophylaxis were not specifically due to higher incidence or an increase in infection risk.

Dolores Albarracín, Ph.D., and a team of investigators aimed to understand whether increased insurance coverage and access to healthcare could increase identification of undiagnosed HIV infection and use of HIV prevention services. They used the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Atlas from 2010-2017 to gather the HIV diagnoses per 100,000 population for each county-year. The data were classified into five transmission categories: heterosexual contact, injection drug use, male-to-male sexual contact, male-to-male sexual contact and injection drug use, and other. To study the effects on the use of PrEP, the number of people who had at least one day of prescribed PrEP in a year per 100,000 county residents were obtained from the AIDSVu.

The mean for all HIV cases was lower for the expansion states than non-expansion states. The use of PrEP was also greater in such areas. Medicaid expansions were associated with a statistically significant increase in HIV diagnoses, with an average of .508 new cases per 100,000 population, which represented a 13.9% increase from pre-expansion levels (P=.037). Particularly, infections contracted via injection drug use and among low-income, rural counties with a high share of pre-Affordable Care Act uninsured rates, were most likely to be affected by the expansions.

Medicaid expansions were linked with improvements in the knowledge of HIV status and preexposure prophylaxis use. Expansions did not affect incident HIV, substance use, or sexually transmitted infection rates, aside from gonorrhea, which decreased after expansions.

Expanding public health insurance may be a way to curb the HIV epidemic, the study investigators noted.

"Increasing community awareness of HIV and increasing individuals' awareness of their HIV status is key to reducing new infections," Albarracín, said. "This study provides important evidence suggesting that increasing health insurance coverage may play a critical role in curbing the spread of HIV."

The study, “Effect of Medicaid Expansions on HIV Diagnoses and Pre-Exposure Prophylaxis Use,” was published in the American Journal of Preventive Medicine.