While new medicines and improved services help people infected with HIV/AIDS live longer, more productive lives, the economic burden is high. "HIV is not just a health issue, it's also an issue of economics," Carmen Julious, executive director of Palmetto AIDS Life Support Services, said of antiretroviral regimens that can cost $24,000 a year.

South Carolina's AIDS Drug Assistance Program (ADAP) serves close to 3,000 low-income residents. It covers all Food and Drug Administration-approved antiretroviral medicines and treatments for opportunistic infections like pneumonia and shingles. It also helps with insurance premiums, co-pays and deductibles.

In the face of increasing demand and budget shortfalls, ADAP officials in Columbia have found ways to keep it running without cutting services. Last year, the program received $14 million in federal funding and $500,000 from the state. Through negotiated drug discounts, generic drugs, and low administrative costs, ADAP officials have stretched program dollars.

South Carolina also got low drug pricing as a public-health provider, and it received a $1.3 million supplemental grant last year, said Melissa Villnow, the state's ADAP director. However, it is not clear if the program will get the grant in coming years.

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