Dramatic progress in treatment options for persons living with HIV/AIDS has made treating the disease vastly more sophisticated and complex than it once was, requiring HIV-treating physicians to acquire ever greater experience and expertise related to the disease. This increasing complexity of HIV clinical management makes critical the need to ensure that physicians and allied healthcare professionals are provided ample opportunities and incentives to attain training and continuing medical education in HIV care and treatment. In the realm of HIV medicine, this is underlined by a wealth of evidence in the research literature suggesting that care and treatment by experienced HIV physicians translates into improved clinical outcomes for patients. Various studies have also suggested that treatment by physicians with higher levels of HIV experience results not only in better, but less expensive care for patients, due in part to lower cost and more effective resource utilization.

It is with the foregoing in mind that the International Association of Physicians in AIDS Care (IAPAC) recently entered into a promising new partnership with the HIV Medicine Association (HIVMA) -- a U.S.-based association established by the Infectious Diseases Society of America (IDSA) -- to increase support for HIV-treating physicians in the United States. In October 2003, IAPAC and HIVMA launched a two-pronged initiative designed first to recognize HIV care specialization for current providers and second, to advocate for adoption of an added, HIV-specific training and certification option within the realm of formal medical education and licensure available to medical doctors in the United States.

The first component of the partnership between IAPAC and HIVMA surrounds a joint definition of "HIV care specialization" in the context of the U.S. healthcare system that the two associations have recommended for adoption by state Medicaid and Medicare programs. Through this joint definition, IAPAC and HIVMA hope to ensure that patients across the full spectrum of need within the United States are able to access care from providers who have documented their updated medical knowledge and experience in providing HIV care by satisfying the following requirements:

• in the immediately preceding 24 months provided direct and continuous medical care to a minimum of 20 patients who are infected with HIV; and

• in the immediately preceding 24 months successfully completed a minimum of 30 hours of Category 1 continuing medical education (CME) in the diagnosis and treatment of HIV-infected patients; or

• received re-certification in the subspecialty of infectious diseases or initial board certification in infectious diseases within the preceding 12 months.

In the case of communities or geographic areas where no physicians meeting these criteria are available, a primary care physician should have an established consultative relationship with at least one physician meeting the criteria outlined above.

Based on the greater extent to which infectious disease specialists are trained in management of HIV infection within the context of formal medical education, emphasis within this definition is placed on the access to specialist designation available to physicians who are certified in infectious disease medicine. At the same time, IAPAC and HIVMA clearly acknowledge the experience and leadership provided by physicians from all fields of practice, noting a set number of CME hours as an equally acceptable criterion for access to and use of the definition.

The definition, contained within a document entitled "Qualifications for Physicians Who Care for Patients with HIV Infection," jointly promoted by IAPAC and HIVMA, precedes a second component of the partnership. The two associations are exploring the feasibility of incorporating a Certificate of Added Qualification (CAQ) in HIV medicine for both aspiring and currently practicing medical doctors. The CAQ, as it is envisioned, would provide an opportunity for physicians from various fields of medical training and practice to access an additional rigorous, observed, and documentable training and examination process specifically in HIV medicine in order to bolster clinical practice and enhance the access that all Americans living with HIV/AIDS have to quality care.

As this process unfolds, both associations look forward to harnessing the collective strength and guidance of their members and colleagues whom, as those at the forefront of the continuing battle against this evolving disease, are best placed to advocate for the care and treatment that all men, women, and children living with HIV deserve.

Scott A. Wolfe is Director of Global Health Policy at the International Association of Physicians in AIDS Care.