HIV/AIDS assistance can’t meet demand

July 28th, 2010 by CHHS RAs

By Melissa Kim
CHHS Research Assistant, summer 2010

HIV and AIDS made headlines back in the early 1980s when doctors discovered that HIV was being transferred through blood donations. At the time, being infected with HIV was a death sentence, and the number of deaths from HIV and AIDS continuously increased until 1995, when protease inhibitors were introduced to the market. The advancement of medicine allowed HIV/AIDS patients to live longer and healthier lives; it just cost them roughly $12,000 a year. Today, HIV/AIDS may be making a comeback, only this time the culprit is not lack of science, but lack of money.

The need for public assistance has escalated in the wake of the recession, as lost jobs and lost health benefits have compounded the financial strain on people infected with HIV. The AIDS Drug Assistance Programs (ADAPs) are one critical form of public assistance. ADAP is a safety net under Medicare and Medicaid that provides financial help to people nationwide who cannot afford the expensive HIV-related medications. In 2008, more than 200,000 people relied on ADAPs for their medications, a 14 percent increase from the previous year. Instead of meeting the demand, however, budget shortfalls are forcing states to cut back on funding. Within three years, the recession has managed to increase the number of HIV/AIDS patients on the waiting lists from zero to record levels. Now, almost 2,000 HIV/AIDS patients in 12 states are waiting for help to purchase life-saving HIV treatment. These waitlists are expected to grow; Illinois and New Jersey plan to cut enrollment and limit eligibility before the end of summer. Louisiana has also capped enrollment but decided against having a waiting list because, “It implies you’re actually waiting on something” and the state doesn’t “want to give anyone false hope.”

Under the new health care reform law, people who are ineligible for ADAP and Medicaid would be eligible for subsidies for health care coverage. Unfortunately, this option is not available until 2014. To temporarily bridge the gap, pharmaceutical companies have increased their contribution to nearly $500 million, negotiating discounts for the state drug plans, and accepting patients into their patient assistance programs to provide free medication. Still, HIV patients have to reapply to these programs every 90 days, hardly making the programs a reliable source for their medications.

The National Alliance of State and Territorial AIDS Directors (NASTAD) estimates that an additional $126 million in emergency funding is needed to allow states to continue their programs. Unfortunately, the U.S. Department of Health and Human Services has only approved $25 million to help buy medications until the end of the federal fiscal year on September 30. According to the AIDS Healthcare Foundation, the $25 million fails to include future budget cuts and the growth rate of the waiting lists. Florida alone expects to add about 300 patients per month to its waiting list. Without more funding, many states plan to strip their formulary to include only medications that directly target HIV and opportunistic infections, eliminating coverage for co-morbid conditions, like diabetes and high blood pressure. Although this restriction of coverage may mitigate the HIV crisis, it still leaves HIV patients with co-morbid conditions at risk for other life-threatening complications, such as a stroke or heart attack.

The gravity of the situation is not lost on members of Congress, who have described it as a public health crisis. Because HIV is an infectious disease, the waitlists present a two-fold public health problem: treating those already infected with HIV, and preventing others from getting infected. Once patients start taking HIV medication, they must stick to the drug regimen like clockwork for the rest of their lives. Missing even five percent of the required doses gives the virus an opportunity to mutate and develop drug resistance, which can make subsequent treatment very difficult or ineffective. With ineffective treatment, the virus will multiply within the bloodstream and progression to full-blown AIDS is likely to follow. It is important to note that the more virus there is in an individual’s bloodstream, the easier it is for that person to infect others. Therefore, these wait lists may also have a negative impact on current HIV prevention efforts.

On July 13, the White House unveiled the National HIV/AIDS strategy (NHAS). The NHAS is a comprehensive plan focused on: 1) reducing the number of people who become infected with HIV; 2) increasing access to care; and 3) reducing HIV-related health disparities. The strategy aims to reduce the rate of new HIV infections by 25 percent over the next five years and treat 85 percent of patients within three months of their diagnosis. Unfortunately, NHAS fails to identify any new government money to implement the new strategy.

With no monetary relief in sight, there are fears the HIV/AIDS epidemic may revert back to early 1980s levels. This ADAPs dilemma serves as a reminder that natural causes aren’t the only source of public health crises; policy decisions can inadvertently create a man-made public health emergency. As budget cuts are predicted to continue through fiscal years 2011 and 2012, Louisiana could be right: don’t count on a financial rescue. Even so, there is a place for cautious optimism amidst the HIV/AIDS crisis, as the next generation of medical breakthroughs seems to show great promise.

A follow-up to this post will explore how medicine could save the day a second time.

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