Point of View

Restore an AIDS lifeline

April 7, 2010 

— Imagine getting an upper respiratory infection. A fever begins to develop, and it is now time to make a trip to the hospital. As you wait impatiently, in pain and tired from your illness, you hear your name being called to register, only to be asked the question you have feared the most: Do you have insurance or self-pay?

Forty-six million Americans currently don't have health insurance. If you are one of them and come to the emergency room to get your infection treated, your choice becomes paying thousands of dollars in hospital bills or forgoing treatment altogether. If you opt for the treatment, the bad news is you will have a very big bill waiting for you; the good news is your infection will be cured.

Now imagine the same scenario, but this time your upper respiratory infection is the result of your immune system not being able to repair itself because you are person living with HIV.

You cannot afford medication because you lost your job six months ago and now are without health insurance. You have tried to apply for a prescription assistance program, but were put on a wait-list.

This time, the bad news is you have a mountain of debt. More bad news, your life is being shortened because you can't afford to pay over $1,000 a month for HIV medication out of pocket. There is no good news.

The scenario just listed is a reality for hundreds of Americans right now. According to the National Alliance of State and Territorial AIDS Directors, almost 800 people are currently on a wait-list to receive funds through a program called the AIDS Drug Assistance Program (ADAP). The ADAP program was created in 1990 through the Ryan White Comprehension AIDS Resource Emergency (CARE) Act. Low-income individuals are eligible to receive prescription benefits for all or some of the cost associated with medications commonly used to treat HIV/AIDS.

Given the economic climate, with unemployment and underemployment high, more Americans with HIV/AIDS will need state and federal assistance to maintain their drug prescriptions. Unfortunately, programs like ADAP are being forced to close because of insufficient funds from the state and federal governments.

In North Carolina, the ADAP program has experienced a 29 percent increase in enrollment since 2008, and this has resulted in a 43 percent increase in cost. North Carolina now has the largest ADAP waiting list in the country. Kentucky, Utah and Iowa are among the other states with the highest numbers of people on ADAP wait-lists.

The North Carolina ADAP was closed to new enrollees on Jan. 22, and 246 North Carolinians were on the ADAP wait-list as of March 18, with more persons in need of being added daily. The current threshold for ADAP qualification in North Carolina is 300 percent of the federal poverty level, but if North Carolina is able to reopen ADAP, only individuals earning less than 125 percent of the federal poverty level will qualify (less than $13,538 per year).

With the increase in unemployment rates, the need for state and federal funds will need to increase significantly if we are going to solve this crisis. The state Communicable Disease Branch projects it would take $18.5 million to re-open ADAP and serve eligible clients at 125 percent of poverty through June 2010. A state appropriation of at least $15.6 million, in addition to what has already been set aside for the program in 2010-11, is needed to keep ADAP open in 2010-11. On the federal level, we need the Obama administration and Congress to appropriate $126 million in federal emergency funds to help meet current ADAP needs.

Access to HIV medications not only saves lives; it also equals HIV prevention. Lack of access to HIV medications will result in higher HIV viral loads and greater risk of transmission. We cannot allow this to happen in North Carolina.

We call on Gov. Bev Perdue and the General Assembly to appropriate the state funds necessary to reopen ADAP. The cost of inaction is a person's life, and that is something that is not affordable. There should never be a wait-list to live.

John Bartlett is a professor of medicine and co-director of the Duke Center for AIDS Research. Carolyn McAllaster is the founder and director of the AIDS Legal Project and a clinical professor of law at the Duke University School of Law.

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