The "biggest impediment" to routine HIV testing is not "state restrictions" or "insufficient funding," but rather "government health insurance, Medicare and managed care insurance companies," Gary Blick -- an HIV/AIDS specialist in Norwalk, Conn. -- writes in a Washington Times letter to the editor in response to a recent Times opinion piece. According to Blick, Medicare reimburses $12.14 for the $17.50 HIV test, and United Healthcare, which covers 70 million U.S. residents, reimburses $6.04 for the test, "making it impossible to routinely test anyone."

It is "ironic" that CDC recommends routine HIV testing because Medicare prevents it by reimbursing 30% below cost for the test, Blick writes. Meanwhile, the number of new HIV cases is increasing, and President Bush has "significantly" reduced "funding for HIV prevention and testing," he adds.

Blick also writes that FDA in 2004 approved the drug Sculptra for correction of facial lipoatrophy, a "serious, disfiguring and stigmatizing complication" that occurs among people living with HIV/AIDS. The disease, also called facial fat wasting, "causes severe depression" and can lead "people to divulge their HIV status to others." However, Medicare and managed-care companies "routinely deny" Sculptra for HIV/AIDS patients as a "cosmetic procedure without it having a cosmetic indication," Blick writes. According to Blick, it also is "ironic" that FDA has approved a treatment that would help "reverse stigma" so that "Medicare can deny it for irrelevant, cost-saving reasons" (Blick, Washington Times, 12/15).