Skip directly to content

Policy Corner

tagline 2009 November

AIDS Drug Assistance Programs Face a Dire Situation as Waiting Lists Expand for HIV Treatment

In the midst of increasing state health budget cuts and service eliminations, people living with HIV/AIDS and advocates are worried about increasing AIDS drug assistance program (ADAP) waiting lists, formulary reductions, and eligibility constrictions throughout the country. ADAPs provide lifesaving HIV treatment to low income, uninsured, and underinsured people living with HIV/AIDS throughout the United States. In 2004, 1,629 people were on ADAP waiting lists and a number of people died as a result of lack of access to HIV medications in several states.

Advocates say that a number of factors are contributing to the crisis, including the higher demand for ADAP services due to unemployment, flat funding of federal monies toward ADAP programs over the last couple of years, and higher drug costs. According to the National Alliance of State and Territorial AIDS Directors, it is “increasingly apparent that demand for ADAP services has increased as a direct result of lost employment and medical coverage due to the national economic downturn.”

By October 2009, eight states had already established waiting lists totaling over 245 individuals. These states include Arkansas, Iowa, Kentucky, Montana, Nebraska, South Dakota, Utah, and Wyoming. Some states, including Arizona, Arkansas, Iowa, and Washington, have already instituted cost containment measures generally in the form of formulary reductions. Twelve more states will not be considering waiting lists, reductions in formularies, or lowered eligibility levels until March 31, 2010. Those states are Arizona, Arkansas, Hawaii, Idaho, Indiana, Iowa, Ohio, Mississippi, Missouri, North Dakota, Tennessee, and Washington. Finally, California will be considering such measures after March 31, 2010.

Activists worry that if the trend is not reversed there may be over 500 people on waiting lists by the end of 2009 and hundreds more by mid-2010. They are calling for increased federal awards to maintain services for existing clients and for expansion of services for new clients.

For more information about ADAP waiting lists in your state, visit http://www.nastad.org.

National HIV/AIDS Strategy

For more than a decade, HIV advocates have been calling for the creation of an outcomes-based, comprehensive national HIV/AIDS strategy (NHAS) to address the epidemic in the United States. Now, President Barack Obama’s pledge of working toward the reduction of HIV incidence, increasing access to care for people living with HIV, and the reduction of HIV-related health disparities, the long-overdue process toward the development of NHAS has finally begun.

During the last couple of months, the White House Office of National AIDS Policy (ONAP) has been conducting town hall meetings across the country to solicit broad public input about what the strategy should look like. And although thousands of people have attended and testified at these town hall meetings, some community members expressed frustration that ONAP has not gone far enough to ensure substantive community collaboration, especially considering the format and geographical limitations of the town hall meetings and the fact that a draft of the strategy has not yet been released for comment. ONAP is now also soliciting community testimony online, and will be receiving feedback from the soon to be reconstituted Presidential Advisory Council on HIV/AIDS as well as through the establishment of a special interagency task force that will ultimately draft the strategy.

TAG, in collaboration with amfAR and other community advocates organized an independent process of developing NHAS recommendations through discussions with members of the Federal AIDS Policy Partnership and sponsored a meeting of researchers and research advocates (held on 5-6 November 2009) specifically aimed at developing recommendations on HIV/AIDS research for the NHAS. TAG is also collaborating with hepatitis B and C advocates on developing NHAS recommendations specifically related to viral hepatitis comorbidity in the United States. Recommendations from these consultations will be sent to ONAP later this year.

More information about ONAP, dates and times for future town hall meetings, or to submit your comment online can be obtained at http://www.whitehouse.gov/administration/eop/onap/