which has allowed PLWHA to live longer and healthier lives (CDC, 2011b), and to a steady number of new HIV infections occurring each year. Nearly 1.2 million individuals age ≥13 were living with HIV infection (both AIDS and non-AIDS cases) at the end of 2008, the most recent year for which national prevalence data are available (CDC, 2011c). The total prevalent cases represent a 6.5 percent increase in the number of PLWHA from the estimate for 2006 (CDC, 2008, 2011c). Despite overall improvements in survival, there continue to be many challenges to curbing the HIV epidemic. For example, an estimated 50,000 people in the United States were newly infected with HIV each year from 2006 through 2009 (Prejean et al., 2011), and approximately 16,000 people with AIDS die each year (CDC, 2011c). Many PLWHA remain undiagnosed; 20 percent of the prevalent cases estimated for 2008 were among those whose infection was undiagnosed. The Centers for Disease Control and Prevention (CDC) estimates that 77 percent of people who are diagnosed are linked to care within 3 to 4 months and that only 51 percent are retained in ongoing care (CDC, 2011c). ART can help to reduce the level of HIV virus in the blood, sometimes to viral suppression (i.e., to an undetectable level), resulting in improved health outcomes for PLWHA and reduced risk of HIV transmission (Cohen et al., 2011; Granich et al., 2009). 1 Yet, only 19–28 percent of PLWHA are virally suppressed (Gardner et al., 2011).
The evolving and often complex health care needs of PLWHA highlight the importance of making available continuous and coordinated quality HIV care. It is estimated that by 2015, more than half of PLWHA in the United States will be 50 or older (Effros et al., 2008; Justice, 2010). With improved survival and the aging of the population of PLWHA, there is a need for care models that address changing patterns of comorbidity that include increasing rates of chronic “non-AIDS” conditions, such as cardiovascular disease, diabetes, hypertension, certain cancers, and psychosocial comorbidities, and the influence of HIV infection and long-term treatment on the etiology and progression of disease (Chu and Selwyn, 2011; Justice, 2010; Mugavero et al., 2011; Shiels et al., 2011).
HIV care should also be oriented to address the full range of care and supportive service needs of PLWHA so that they may better manage their HIV infection. HIV disproportionately impacts populations with care and supportive service needs that, when unmet, reduce access and adherence to HIV care and treatment (Robertson et al., 2004; Weaver et al.,
1Being in HIV care may help to reduce risk of HIV transmission in ways besides having a reduced viral load as a result of being on antiretroviral therapy (ART). For example, provider counseling and linkage to supportive services may help to promote behaviors (e.g., consistent use of ART, safer sex, use of clean syringes) that reduce risk of HIV transmission (Parashar et al., 2011; Sikkema et al., 2010).