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May 6, 2007

Dr. Bob,

I am from Canada and I was just reading a recent question about some Americans not being able to get antiiral drugs. I am not to informed on the access to Antivirals drug in Canada but I believe all who have HIV can get these drugs. Why is it that some countries all HIV postive people have access to the drugs and other contries people are waiting therefore, possibily makeing them sicker?? If this is the case it is not fair that only certain people with HIV can get the meds, while others have to remain sick!!!!!

Response from Dr. Frascino


You are absolutely correct: Canada and every other developed nation in the world for that matter, has a health care system in place that would never allow uninsured HIV-positive folks to die while on waiting lists to obtain life-sustaining drugs. This is not only "not fair," but it's shamefully immoral. (See below.) The discussion as to "why" and how this system has developed is complex. You can read about it online. The more pertinent question is why are we allowing it to continue. All of the Democratic candidates for President are supporting some type of universal health care system, which would address this and many other problems posed by our 47,000,000 uninsured Americans. 2008 can't get here too soon for anyone with a moral conscience or a modicum of common-sense decency.

Dr. Bob

health insurance Jan 20, 2007


How are people who dont have any health insurance supposed to afford HIV medication. I have read that it comes out to something like 2,100 dollars a month. That is basically an entire yearly salary for most people. Why are these drugs so expensive and do you ever think the price will come down so that normal people can afford them.

Even if you have health insurance, wont your premium skyrocket as soon as you start taking HIV meds? How can insurance companies justify this? Isent it an infrigement on ones civil liberty to deny them medical coverage that could save their life just because they dont have enough money?

In countries where HIV meds are free, like GB and Canada, is it hard to get meds because of waiting lists?

If someone from the US becomes HIV positive can they move to Canada to get free meds?

Response from Dr. Frascino


1. You ask how are people without health insurance supposed to afford HIV medication. Good question! It should be expanded to how are people without health insurance supposed to afford any type of significant medical problem broken bone, pregnancy, diabetes, cancer etc., etc., etc.! There are currently over 46,000,000 Americans with no health insurance! Dubya and his Republican cronies continue to believe tax cuts for the wealthy are apparently more important than something as trivial as health care for the needy.

2. If you have health insurance, your premiums should not skyrocket simply because you become ill and require care (HIV, cancer, etc.).

3. Health care may not be a "civil liberty" by definition, but it is certainly a moral issue and the U.S. should be ashamed that we have HIV-positive folks on waiting lists to get life-sustaining HIV meds, due to lack of funding of ADAP (AIDS Drug Assistance Program). Perhaps if we had listened to Hillary's plan to provide health care for all way back when, we wouldn't be in such a mess now. Who knows, she just might get another chance in 2008 if she's elected President!

4. In countries that provide HIV medications, like Brazil, Canada, etc., no, there are no waiting lists. You get the medications as soon as you need them.

5. No, Canada is not interested in having folks move there just to get free HIV meds.

If you're concerned about the appalling number of uninsured Americans, advocate for change! Vote for change.

Dr. Bob

ADAP Tragedy in South Carolina: Three Die While on "Waiting List" for AIDS Treatment

November 4, 2006

South Carolina's Health Department confirmed that three people with HIV/AIDS died while on a waiting list for the State AIDS Drug Assistance Program (ADAP). Currently almost 300 ADAP-qualified patients are on the South Carolina waiting list for HIV therapy. "It's like standing on a track watching the train coming at you, but you can't move," said Kathie Hiers, Chief Executive Officer of AIDS Alabama and a member of a group of advocates, legislators, and public health officials who met in South Carolina earlier this week. "The ADAP waiting list in South Carolina keeps getting longer; they expect it to be about 350 people by the end of the year. The State only provides $500,000 for their ADAP program, and federal funding has been essentially flat for the last four years. Additionally, the federal Ryan White funding short-changes states like South Carolina that don't have concentrated case counts in a major urban area. In a poor state like this one, it's inevitable that these tragedies will continue to occur, simply due to a lack of resources."

South Carolina's ADAP program currently serves about 1,800 clients. The participants are 67% African-American and 85% earn less than 200% of the federal poverty level (approximately $19,000 a year).

"I am saddened by this terrible news," stated Congresswoman Donna Christensen MD, Chair of the Congressional Black Caucus Health Braintrust. "We must do a better job of raising awareness among and achieving more action from federal legislators to address the funding crisis for ADAP or we are likely to see even more people pass away -- as they did a few years ago in Kentucky and West Virginia -- while waiting for ADAP access to today's successful HIV treatments."

"We have been asking for $197 million in additional federal funding for next year's ADAP budget. This would be enough to fund a year's treatment for about 16,607 new ADAP clients in all States & Territories," states Bill Arnold, Director of the Title II Community AIDS National Network. "At this point, however, ADAP could even be flat funded in FY 2007. If that is the case, we must expect more awful news like this in the coming months. ADAP is entering month number 8 of its inadequate FY 06 federal funding. Many states already have ADAP waiting lists or have announced the need for other program reductions in the coming months. The handwriting is on the wall," elaborates Arnold. "Communities in South Carolina are just the first -- and not the last, if resources are not quickly found -- to have to deal with the human tragedy issues of inadequate domestic ADAP & HIV/AIDS resources."

"The saddest part of this," stated US Representative Maurice Hinchey, "is that everyone in Congress is well aware that these drugs save lives. It isn't ignorance; instead it's a dangerous incapacity in Congress to be able to prioritize saving human lives. The New York House delegation -- Democrats and Republicans -- asked for $105 Million in ADAP emergency funding six months ago. Congress knows the ADAP need, they just haven't acted on the obvious. Thus, thousands of local communities dealing with HIV/AIDS are left holding the bag."

"The ADAP waiting lists are the tip of the iceberg. There are thousands with people with HIV who are not being treated in America that aren't even on waiting lists. This is unacceptable when the federal government is spending billions of dollars every year on HIV/AIDS. Congress must provide the necessary funding to care for these and other Americans who lack proper health care in a fiscally responsible manner. This requires making tough decisions such as abandoning the billions of dollars in 'pork' projects and earmarks contained in the appropriations bills we will vote on later this month in order to provide treatment that could literally be the difference between life and death for thousands of our fellow Americans," says United States Senator Tom Coburn, M.D.

"As this painful story unfolds in South Carolina the local coalition -- The South Carolina HIV/AIDS Care Crisis Task Force -- of local HIV/AIDS stakeholders devoted to finding a solution at the grass roots level deserves the support of everyone, everywhere, in the United States who is committed to fighting the battle against AIDS here in the United States" said Bill Arnold of TII CANN. "Despite this tragedy in South Carolina, we can take solace in the fact that people are out there, working hard to get the resources to prevent these tragedies from happening again -- anywhere in America."

South Carolina: Death Number Four AIDS Drug Waiting List Claims Another Life; Budget & Control Board Meets Tuesday -- Call Gov. Mark Sanford Monday!

December 8, 2006

This family traveled from Mississippi to rally with South Carolinians in November. The South Carolina Department of Health and Environmental Control confirmed this week that another South Carolinian has died while waiting for AIDS drugs from the state's ADAP program. That brings the total to four deaths since SC started a waiting list for the AIDS Drug Assistance Program last June. At least 324 people are on the waiting list now -- up from 313 two weeks ago.

A press conference has been called for this Sunday at the Governor's Mansion in Columbia, where local people living with HIV/AIDS will demand action from SC Governor Mark Sanford.

Our Lives Are In Their Hands AIDS activists from South Carolina and around the world have called on state officials to provide $3 million in emergency funding to end the waiting lists. But so far, they haven't acted. "The Department of Health and Environmental Control has so far refused to put a request in to our Budget and Control Board for emergency AIDS funds," says Karen Bates, Co-Chair of the South Carolina Campaign to End AIDS (SC-C2EA). "They did, however, request a million dollars for a facility to store bird flu vaccine."

"Now, there have been no bird-flu-related deaths in South Carolina, but we do have people dying of AIDS," said Bates. "Our most vulnerable people are dying: poor people, people of color, women and young people. It will take emergency funding to get people off the wait list, out of the hospital and away from the grave. Commissioner Hunter and DHEC can ask for the money. Governor Sanford and the BCB can appropriate it. Our lives are in their hands."

South Carolina's Budget and Control Board can appropriate the funds or reorganize the DHEC budget even without the Department's request or blessing.

Advocates are looking to State Treasurer Grady Patterson to put emergency funding for ADAP on the agenda for the Tuesday meeting of the Budget and Control Board. While working with state and federal legislators to win ADAP funding as part of next year's budgets, they say they need the emergency funds to save lives now.

Kelly's Story Kelly is one of 324 South Carolinians currently waited listed for life-saving medications. She says when she was put on the list, she thought she had time, but "in that three to four month period, I went from having HIV to AIDS." Right now, Kelly is back in the hospital and is not sure when or how she will reliably access treatment. Kelly and others cannot afford to wait on legislative calendars. Next Tuesday's 10 AM meeting of the state Budget and Control Board offers a chance for immediate action.

Governor Mark Sanford Either through a request from one of its members or at the request of the Department of Health and Environmental Control (DHEC), the BCB can approve the $3 million necessary to keep new applicants off the waiting list until March 2007, when next year's funding will kick in.

South Carolina Health Department to Request $3 Million Supplemental, $4.5 Million Annual Funding Increase for State ADAP, Official Says

January 2, 2007

The South Carolina Department of Health and Environmental Control on Jan. 9, when the state Legislature assembles, plans to make a request for $3 million in supplementary funding for the remainder of the current fiscal year for its AIDS Drug Assistance Program, as well as a $4.5 million increase in annual financing, Clair Boatwright, a spokesperson for the department, said last week, the New York Times reports. More than 350 HIV-positive people in South Carolina are on a waiting list to be enrolled in the state's ADAP, a federal- and state-funded program that provides HIV/AIDS-related medications to low-income, uninsured and underinsured HIV-positive individuals. South Carolina's ADAP provides about 1,300 people monthly with antiretroviral drugs, which cost an average of $885 per month (Dewan, New York Times, 12/29/06). The state is scheduled to receive an increase in federal funding for HIV/AIDS treatment programs after the passage of a compromise bill (HR 6143) that would reauthorize the Ryan White CARE Act, which provides funding for HIV/AIDS programs in the U.S. Congress in last month passed the bill by voice vote. The CARE Act funds will help cover a $3 million budget shortfall in South Carolina's ADAP (Kaiser Daily HIV/AIDS Report, 12/13/06). Boatwright said that the health department does not have emergency funds to remove some people from the waiting list and that no uncommitted money is available to be diverted to the state's ADAP. South Carolina health officials, physicians and HIV/AIDS advocates in response to the budget shortfall have started preparing what they call the first organized campaign to put HIV/AIDS financing on the state's legislative agenda, the Times reports. According to state health officials, all but 10 people on the waiting list are now on so-called patient assistance programs, an emergency measure in which drug companies temporarily provide antiretrovirals at no cost to HIV-positive people. Patients must submit an application to each drug company if they need medications from more than one manufacturer, and some experts say many people are unable to obtain every drug they need (New York Times, 12/29/06).

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