Youth with Health Insurance Half as Likely to Have High HIV Transmission Risk

Single Site-based Study Suggests Access to No-cost HIV Treatment May Be Key to Curbing Epidemic

Philadelphia, Pa. – April 4, 2018 – Youth living with HIV who have health insurance may be half as likely to be at high risk for transmitting HIV than their uninsured peers, according to new research from PolicyLab at Children’s Hospital of Philadelphia (CHOP). The study, published in AIDS, looked at transmission risk and health outcomes of youth living with HIV who had public or private insurance, or pharmacy benefits through the federal Ryan White HIV/AIDS Program.

The researchers found that over a 13-year period, youth with health insurance who visited one adolescent HIV clinic were less likely to have a detectable viral load, or measurement of HIV in the blood, and sexually transmitted infection (STI) at the same time – a combination that creates the highest HIV transmission risk. Insurance coverage can lower HIV transmission risk by providing access to antiretroviral therapy (ART), medication that if adhered to daily suppresses the HIV virus and halts disease progression, and keeping youth continually engaged in HIV treatment.

“Despite the significant advances we’ve made in HIV prevention and treatment, youth are much less likely than adults to know their HIV status, be engaged in HIV care, and adhere to HIV treatment, creating an urgent need for interventions to help this population,” said Sarah Wood, MD, MSHP, lead author on the study, adolescent physician and faculty member at PolicyLab. “Our study found that health insurance not only reduces the risk of youth living with HIV transmitting the virus but protects their own health by preventing HIV treatment failure and STIs, both of which pose significant health risks for youth.”

When the researchers took Ryan White pharmacy-only coverage out of the analysis and only looked at youth living with HIV who had private or public insurance, they found a weaker link between insurance and HIV transmission risk. This suggests that uninterrupted access to no-cost ART is the primary component of insurance coverage that reduces HIV transmission risk.

“With the knowledge and medications we have today, HIV progression is entirely preventable, yet youth living with HIV remain highly vulnerable to experiencing poor health outcomes. One way we can combat this is by providing universal access to safe, effective HIV medications,” Dr. Wood said. “Federal efforts, like the Ryan White HIV/AIDS Program, have a long history of providing access to support services and no-cost therapies for uninsured and underinsured people living with HIV. These programs have never been more important for youth, yet have faced threats to funding for several years. We hope our research can educate policymakers about the critical role insurance coverage and the Ryan White program play in controlling the ongoing U.S. HIV epidemic.”

More than 60,000 youth in the United States are living with HIV, the vast majority of whom do not achieve viral load suppression. Previous PolicyLab research showed that even among youth who did suppress their viral load for over two years, more than 1 in every 10 of them experienced treatment failure throughout the remainder of their treatment period. Uninterrupted, daily adherence to ART can halt progression and transmission of HIV and development of AIDS.

Limitations: This was a small, single site-centered study, so the results may not be generalizable to the larger U.S. HIV epidemic or youth living with HIV in other states. More research is needed to understand if the link between insurance coverage and HIV transmission risk exists across larger populations.

Citation: Wood S, Ratcliffe S, Gowda C, Lee S, Dowshen N, Gross R. Impact of insurance coverage on HIV transmission potential among antiretroviral therapy-treated youth living with HIV. AIDS. 2018;32(7):895-902. doi: 10.1097/QAD.0000000000001772

Funding: National Institute of Mental Health (NIMH) grant number K23MH102128


About PolicyLab at Children’s Hospital of Philadelphia: PolicyLab at Children’s Hospital of Philadelphia (CHOP) is dedicated to achieving optimal child health and well-being by informing program and policy changes through interdisciplinary research. Founded in 2008, PolicyLab is a Center of Emphasis within the CHOP Research Institute, one of the largest pediatric research institutes in the country. With more than 25 highly-regarded faculty and 55 passionate staff who bring expertise from myriad of fields covering health, research and health policy, our work focuses on improving public systems, improving health care delivery and improving child health outcomes. For more information, visit

About Children’s Hospital of Philadelphia: Children’s Hospital of Philadelphia was founded in 1855 as the nation’s first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals and pioneering major research initiatives, Children's Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country. In addition, its unique family-centered care and public service programs have brought the 546-bed hospital recognition as a leading advocate for children and adolescents. For more information, visit