The undersigned organizations serving the needs of people living with HIV write to ask that Congress provide a minimum of $162 million in additional federal funding for AIDS Drug Assistance Programs for FY 2003.
This year, 13 state AIDS Drug Assistance Programs (ADAPs) have been forced to take steps to limit access to life-saving HIV medications for uninsured and underinsured Americans due to inadequate funding. Texas, for example, has recently announced that in order to close its deficit, it will retroactively lower its income limits from 200% of the federal poverty level (300% with spend downs) to 140%. That action will require the removal of 2500 presently enrolled ADAP clients from the program by June 1, 2003. New York must also address a $10 million structural deficit in 2003 and a projected $50 million deficit in 2004 if either state and/or federal funding is not increased by that amount. According to the most recent National Alliance of State and Territorial AIDS Directors (NASTAD) Report, the following states have also initiated waiting lists as of 12/5/2002: Alabama (175), Indiana (34), Kentucky (62), Montana (2), North Carolina (60), Oregon (18) and South Dakota (43).
Idaho, Nebraska and Wyoming have closed to new enrollees. In addition to New York and Texas, Colorado, Florida, Georgia, Nevada and South Carolina have projected the need to impose access restrictions in early 2003.
One major factor driving increased ADAP need is enrollment growth, which is due to the success of the new drugs in decreasing deaths and slowing progression to AIDS. Since the introduction of effective combination HIV therapies in 1996, America's death rate from AIDS has fallen by over 50%. Because people are staying alive longer, they need ADAP longer and so enrollment continues to climb. While this should be taken as a sign of the program's success, resources flowing to ADAPs are not being increased to take care of the swelling numbers of people that are being kept alive.
Ironically, attempting to save money in the short term may cost taxpayers more money in the long term. Recent data presented by the University of Alabama at Birmingham at the International AIDS Conference in Barcelona demonstrates that the average cost of care for a person with early HIV disease is approximately $14,000 a year while waiting to treat that person until they are disabled costs about $34,000 a year.
Fears of particularly serious problems for FY 2003 are exacerbated by the expected arrival of new drugs that few programs in crisis are likely to be able to afford. Fuzeon (T- 20), the first fusion inhibitor to reach the market, could provide urgently needed support for patients whose anti- retroviral options have run out when it is approved in early 2003 but the drug is expected to be expensive, which could force ADAPs to ignore the need for the drug. The second class of drugs that most ADAPs are unlikely to be able to afford are those to treat HCV. While HCV has become the number one cause of death among people with HIV, most states are resistant to adding new classes of treatment when resources are scarce.
Finally, in order to make best use of ADAP funding, we ask that you fund all services provided under the Ryan White CARE Act at the highest possible levels. Without the support services provided by the CARE act, many ADAP clients would have no realistic access to the medical care and auxiliary services they require to maximize the usefulness of anti-HIV medical regimens.
We believe that it is imperative to provide life-extending HIV drugs to all Americans in need. We hope that you will agree.