October 1, 2009
HIV vaccine in Thailand = sexy. HIV treatment access in U.S. = yawn.
That's the lesson we can apparently take away from the news of the past two weeks. On the one hand, you have The Big News of the Year: Heralds throughout the U.S. trumpeted the story about an almost-sort-of-successful HIV vaccine, despite the fact that even if it does pave the way toward a fully effective anti-AIDS shot, that may not happen for at least another decade.
Meanwhile, largely ignored has been the rapidly deteriorating situation regarding HIV treatment access in the world's richest country, where we seem not to be able to afford to give HIV meds to some of our neediest HIV-positive citizens.
This winter may be a bleak one for many U.S. AIDS Drug Assistance Programs (ADAPs) and the people they serve. Meant to be a safety net for low-income HIVers with limited or no health insurance, several ADAPs throughout the country are struggling to provide HIV meds to those who need them.
In Utah, for instance, the state ADAP announced on Sept. 24 that it would no longer accept new applications for help, according to the Deseret News.
Not only that, but 99 people who had been receiving life-saving meds through the program are being cut off and placed on a waiting list, putting their health at risk, the Salt Lake Tribune reports.
And Utah is not remotely alone. The ADAP in Arkansas is poised to tell 49 HIVers that they're up a creek, and according to the latest "ADAP Watch" report, six other states have also instituted waiting lists for assistance: Iowa, Kentucky, Montana, Nebraska, South Dakota and Wyoming.
To be fair, most of the people involved in ADAPs are likely not heartless bureaucrats, and many are no doubt scrambling to find other ways to hook up low-income HIVers with the meds they need. (We'll cover this story in more detail soon; stay tuned.) Also, in terms of pure numbers, things aren't yet quite as bad as they were back in mid-2007, when more than 500 people nationwide were on an ADAP waiting list. Nor are they yet as bad as they were in South Carolina in 2006 or West Virginia in 2003; in each of those cases, three people died while on an ADAP Waiting List.
That being said, the situation developing in Arkansas, Utah and many other U.S. states can easily become even more scary than it's gotten in the past. For one thing, it's already happening on a grander scale, with a wider range of state ADAPs struggling to stay afloat. For another, there isn't yet a clear way out. Congress is still haggling over a health care overhaul, and perhaps as a result, the reauthorization of the Ryan White CARE Act (originally set to expire on Sept. 30) was postponed for a month. The Ryan White CARE Act is an enormous program that funds not only ADAPs, but many other critical HIV/AIDS-related services throughout the country. The longer it goes without being reauthorized and without funding levels getting a boost, the more tenuous the health of the country's ADAPs may become.
"I think we will be OK through March 31, when the Ryan White fiscal year ends," said Holly Hanson, Ryan White Part B program manager for the Iowa Department of Public Health, in an interview with the Iowa Independent. (Iowa already had seven people on an ADAP waiting list as of Aug. 19.) "But I'm really worried that if we receive flat-funding from the feds and the state ... I don't know that we could get through our next Ryan White grant cycle with even just the people we currently have enrolled. I guess ... we either need to come up with a new national health care plan or increase funding."
Are you impacted by the squeeze on U.S. ADAPs? Are you a case manager? What tips do you have for people who may quickly need to find another way to get access to their HIV meds?
Is this situation just the latest ugly example of how troubled our economy remains, or is it the depressing but inevitable result of a long-standing lack of political priority paid to people living with HIV within the U.S.? And what is our ultimate road out of this mess? Please share your thoughts.