While supportive of President Barack Obama’s ongoing health reform efforts, a significant proportion of the International Association of Physicians in AIDS Care (IAPAC) has expressed concerns about issues ranging from increased patient caseloads to the possibility of rationing HIV treatment and care. IAPAC, which represents 4,000 HIV physicians across the country, released results of a nationwide survey on Obama’s proposed health plan on August 10.

“Our clinician-members recognize HIV/AIDS is but one of the myriad health challenges posed in reforming the U.S. health care system so that it delivers care at a cost that is affordable, but in a manner that does not sacrifice quality or jeopardize access,” said Jose M. Zuniga, PhD, IAPAC’s president and CEO. “Their concerns, however, must be addressed in the health care reform legislation eventually enacted because the health and well-being of over 1 million Americans living with HIV/AIDS and those as yet undiagnosed are at stake.”

Congress is currently working on legislation that would revamp health care in the United States and expand coverage to the nearly 50 million Americans estimated to be uninsured or underinsured.

According to the IAPAC survey, 57 percent of respondents said that health care reform legislation must include HIV-specific provisions, while 43 percent said HIV should be mainstreamed to sidestep “HIV exceptionalism.”

“HIV-specific implies ‘special status,’ ‘special interest,’ and by the same token, discrimination, or a tiered medical system,” says Neal Rzepkowski, MD, an HIV-positive New York–based HIV physician. “This type of ‘special treatment’ has backfired and hindered good HIV care.”

When asked how Obama’s health reform plan would affect their practices, 23 percent of respondents said Obama’s health reform would expand the number of clients they treat, 23 percent said it would increase their paperwork, 13 percent said it would decrease their reimbursement and 10 percent said it would require them to ration their HIV care. On the upside, 17 percent said it would integrate HIV into primary care, 7 percent said it would stabilize their practices’ finances and 7 percent said it would lower drug and administrative costs.