Mr. President, please “stimulate” the AIDS Drug Assistance Programs

Today, there are 7,372 people living with HIV/AIDS (“PLWHAs”) in the United States being denied access to life-saving medications under the AIDS Drug Assistance Program (“ADAP”). ADAP – which is a federal-state, payer-of-last-resort program – is authorized under the Ryan White Comprehensive AIDS Resources Emergency (“CARE”) act. The law in general has enjoyed strong bipartisan support since it was first passed in the 1990s, and ADAPs specifically have been a Return on Investment (“ROI”) model since the federal government began pumping money into them when President Clinton and Speaker Gingrich were in office.

It is hard to imagine that in the most powerful, richest nation in the world there are people on ADAP waiting lists. But it gets worse!

There are thousands more PLWHAs being denied care because States are enacting “cost containment” strategies – including changing eligibility requirements. In other words, one day PLWHAs are eligible to receive assistance, then the next day they aren’t eligible. These are known as the “invisible” ADAP waiting lists. This has already played out in Arkansas, Florida, Ohio, Utah, and Virginia.

How is that for fair? How is that for protecting the safety net? How is that American?

Maybe fighting HIV/AIDS is no longer “sexy” here stateside. It sells well in the media to fight cancer, obesity or Autism because HIV/AIDS is a problem “somewhere” overseas, right? Unfortunately, facts tell a different story because HIV infection rates are climbing rapidly – and not just in the gay community. They are increasing in rural communities, as well as certain metropolitan areas (e.g., DC has HIV-infection rates equivalent to Third World countries); it is a problem disproportionately impacting women, and racial and ethnic minorities; and it is showing alarming signs of exploding in younger generations of Americans.

That aside, ADAP waiting lists are putting thousands of lives at risk because they deny access to care and treatment (thus making PLWHAs more prone to opportunistic infections). Furthermore, ADAP waiting lists are potentially putting even more people at risk for getting infected with HIV, because PLWHAs not receiving anti-retroviral therapy are more infectious.

How is that fair? How is that for protecting public health? How is that American?

The ongoing ADAP crisis is being fueled, by in large, because federal spending has been inadequate – despite small budget increases under both President Bush and President Obama since 2005. The federal share of ADAP spending decreased in FY2009 to 45% from 49% 2005, while state share increased from 14% to 19%. Insufficient federal funding is evidenced by only 3% increase over previous fiscal year, compared to 61% increase in state level funding.

Here is the real “kicker,” too. The ongoing ADAP crisis could be solved with as little as $126 million for the current fiscal year. That’s “M” as in “million” and not “B” as in “billion.” That’s about as much as the U.S. Department of Defense spends on paperclips in a month.

But recognizing the fiscal climate in Washington, DC and the need to address the federal government’s addiction to spending money it doesn’t have – as well as the necessity to address this nation’s ballooning federal debt – it makes sense to be cautious about spending more money. That said, ADAPs have routinely proven their cost-effectiveness and demonstrated excellent ROI – especially for a public health program. But that’s another conversation.

However, there is an immediate short-term solution that warrants consideration!


[Photo: Sen. Richard Burr (left), Sen. Tom Coburn (center) and Sen. Jon Cornyn (right)]

For the better part of one year, many in the HIV/AIDS community have supported legislation introduced by Sen. Richard Burr (R-NC) that would use unobligated stimulus funding. The "Addressing Cost Containment Measures to Ensure the Sustainability and Success of the ADAP Act" (S.3401) – or ACCESS ADAP Act – would transfer $126 million from discretionary amounts appropriated under the American Recovery and Reinvestment Act (“ARRA”), Public Law 111-5, that remain unobligated, to be used by the Secretary of Health & Human Services in fiscal year 2010 to provide assistance in reducing waiting lists under the AIDS Drug Assistance Programs.

Unfortunately, President Obama and many in Congress have been shy toward S.3401. Opponents to the legislation claimed that the stimulus money isn’t supposed to be spent in such a manner – despite the law’s unambiguous language to the contrary. The law includes language citing a public health emergency as an example of when unobligated funds should be sent to the States.

Yet, stimulus money has been spent funding anti-obesity television campaigns to the tune of $650 million. The Department of Health & Human Services (“HHS”) has used the money to fund its Communities Putting Prevention to Work (“CPPW”), including grants to 31 states and the District of Columbia. New York City received $31.1 million, with $15.5 million directed toward anti-obesity efforts and another $15.6 million for anti-smoking campaigns. HHS referred to these as “interventions.”

What about the money spent to beautify the District of Columbia? That’s right! The District is proudly displaying signs touting stimulus money being used to pay for mulch in and around the District of Columbia, as seen in this recent photo. “This green project is funded by U.S. EPA,” reads the sign.

Sure it makes the District of Columbia look great, and is probably helping to pay for some public employee’s paycheck – but it begs the question about priorities?

To make matters worse, yesterday during a House Energy & Commerce Committee’ Oversight and Investigations Subcommittee hearing, lawmakers examined stimulus spending by the Department of Energy. Only $12.4 billion out of $35 billion appropriated has been spent thus far. Sure it was a partisan hearing, but aren’t they all in today’s political climate.

This isn’t a matter of partisan politics – especially considering the partisan debate surrounding President Obama’s stimulus package – but rather a matter of life and death. If the stimulus is good enough to pay for anti-obesity and anti-smoking ads, or landscaping projects, then surely the lives of people living with HIV/AIDS deserve the same level of commitment.

A hypothetical example yields a compelling argument that President Obama and Congress should consider:

Charlie is a 29-year old black single father living in Gadsden County Florida. He and his wife found out they were infected with HIV when she died from complications of AIDS-related pneumonia the previous year. Charlie is on a waiting list to receive AIDS drugs but between his depression and efforts to care for his children he is unable to access the help he needs to navigate the Pharmaceutical Patient Assistance Programs. He himself gets sick. He enters an emergency room in Tallahassee, FL and is subsequently admitted for a five-day stay.

His emergency room visit is near the average for this hospital at $2,783 (source Florida Heath Finder.org.) The hospital stay is near the national average of $24,000. He receives additional bills from doctors, radiologists and therapists for $750. You can compare this total to the cost of the AIDS drug he would need for an entire year. Charlie is what is known as therapy naive so the most inexpensive combination therapy drugs would be effective in reducing the virus to undetectable levels. The annual drug cost would be around $15,000 per year. Compare that to $33,830 in 6 days for hospitalization.

A penny wise, pound-foolish?

ADAPs need to be “stimulated” now with stimulus money, but more importantly, PLWHAs need Presidential leadership now. They’re losing hope!

Brandon M. Macsata, CEO
ADAP Advocacy Association (aaa+)