In January, 2002, Californians living with HIV scored a major victory as Governor Gray Davis proposed a new regulation to establish the definition of HIV medical specialists under the Standing Referral law (AB2168). The new regulation will utilize a credentialing process created by the American Academy of HIV Medicine (AAHIVM), a national group of HIV healthcare providers. This is probably one of the first times you have heard about AAHIVM, but the organization hopes to significantly affect the quality of care HIV patients receive.

What is AAHIVM?

The American Academy of HIV Medicine was formed in January 2001 as an independent organization of HIV Specialists and others dedicated to promoting excellence in HIV/AIDS care. As of March 2002, our 1,300 members directly care for over 270,000 HIV patients. This is more than half of patients in active treatment for HIV disease. The membership is diverse with an equal distribution of specialists (Infectious Diseases, Internal Medicine, and Family/General Practice) as well as 10% PharmD, Nurse Practitioner, and Physician Assistant membership.

What Are the Academy's Goals?

To increase quality of care and to ensure up-to-date knowledge, AAHIVM members believe it is essential to distinguish HIV as its own medical specialty. They are actively working towards that goal. The objectives of AAHIVM are:

• Improve the quality of HIV care in the United States
• Define the standard of care for HIV
• Determine the expertise and training necessary for physicians to specialize in HIV
• Create a nationwide network of HIV specialists, serving as a resource to link patients and service providers to qualified specialists

AAHIVM began to meet these goals by publishing their Core Curriculum, which is a compilation of over 250 Educational Objectives a healthcare provider should know to call oneself an HIV Specialist. Next, the organization developed a definition for an HIV Specialist (see below) and finally a process to evaluate and credential them. In December 2001, AAHIVM mailed out over 5000 credentialing kits. Next, AAHIVM is developing a Study Guide for HIV Specialists. It will contain all of the information that summarizes the 250 Educational Objectives to lower entry barriers to the field of HIV medicine by publishing the necessary knowledge in one source.

What Are the New Regulations In California?

When written in 2000, AB2168 required managed care companies to provide HIV patients with access to HIV medical specialists -- similar to cancer patients' access to oncologists. But AB2168 did not establish a clear definition of what constitutes an HIV specialist. According to the President of AAHIVM, Dr. Scott Hitt, "AB2168 hit a brick wall because insurers had no standardized way of identifying HIV specialists. The Governor's proposal will recognize HIV specialists who are credentialed by the AAHIVM or meet the specific AAHIVM criteria which were developed over 12 months by 50 of the nation's leading HIV/AIDS clinicians, experts and educators." AAHIVM is the only organization in the country to provide HIV specialist credentialing. The new regulation containing this definition goes into effect July 1, 2002. There is no fee for participating in the AAHIVM's annual credentialing process, and providers do not have to be members of the organization to participate. "Changes in treatment for HIV/AIDS occur more rapidly than any other disease," said Dr. Hitt. "Yearly credential testing is necessary to help HIV medical specialists stay up-to-date with the latest in advancements for the benefit of their patients."

AAHIVM Definition of an HIV Specialist

To become a credentialed HIV specialist through the AAHIVM, a provider will need to fulfill the following requirements:

• Maintain current and valid MD, DO, PA or NP state licensure
• Clinically manage at least 20 HIV patients in the past two years
• Demonstrate continuous professional development in one of three ways:

1. Successfully complete the Infectious Diseases Board certification or maintenance of certification/re-certification for the current year (M.D.'s and D.O.'s); or
2. Complete annually at least 30 hours of HIV-related CME Category 1 credits (continuing education for NPs); or
3. Complete annually at least 15 hours of HIV-related CME Category 1 credits (continuing education for NPs) and pass the HIV Medicine Credentialing Exam, scored by the AAHIVM and weighted to emphasize the most recent educational objectives.

What Does This Mean for People Living with HIV?

Previously, there were no standards or defining criteria to determine an HIV Specialist. This is detrimental to patients, as they have no way to measure if their doctors are providing state-of-the-art HIV care. People with HIV are often limited in their choice of physicians to those whose services are covered under their insurance plan, regardless of their qualifications as HIV care providers. Establishing HIV care as a medical specialty will benefit patients in the following ways:

• Patients would have access to an HIV Specialist who had passed a standard "credentialing" process
• Patients would know that their HIV Specialist had made a commitment to stay current with the continuously evolving HIV care practices and information
• Patients would have the same access to specialized care that a cancer patient, for example, has through his or her oncologist
• Health insurers and managed care companies would be required to ensure a patient's access to an HIV specialist

AAHIVM has already begun to credential HIV Specialists. For a complete list of AAHIVM credentialed HIV Specialists, you can visit its Web site www.aahivm.org

Jerry Calumn is Senior Director of the American Academy of HIV Medicine

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