Congress is Knocking on 340B's Door, Saying "Show Me the Money"

By: Ranier Simons, ADAP Blog Guest Contributor

Many members of society are adversely affected by inequalities stemming from diverse circumstances and socio-economic realities. Disparities in public health result from those inequalities. Policy is one avenue for improving the health of those in need. One policy response by Congress was the creation of the 340B Drug Pricing Program as part of the bipartisan Veterans Healthcare Act of 1992.[1] The 340B program allows qualifying safety-net providers and qualifying hospitals, otherwise known as covered entities, to purchase prescription drugs at significantly discounted prices from manufacturers and re-invest those dollars in expanding access to care and treatment. A growing chorus is concerned that the legislative intent of the program is being obfuscated by large hospital systems and mega service providers. 

Photo Source: USA Today

These covered entities serve low-income and vulnerable populations who are uninsured, on Medicaid or Medicare. The savings generated from the program are used to offer patients free or discounted drugs and provide many other services that meet the healthcare needs of the communities these entities serve.[1] Other services include prevention-focused primary care, mental healthcare, and substance abuse treatment. What started out as a good idea has evolved into a system where inefficiencies and abuses have corrupted 340B’s intent and harmed some patients. As a result, on a federal and state level, numerous pieces of 340B reform legislation have been introduced to stop abuses, protect patients, and overall ensure the program operates as intended.

One issue is the sheer number of covered entities taking advantage of the 340B discount pricing.[2] At the program's advent, safety-net hospitals, outpatient clinics, and community health centers were the first entities allowed to participate. Later, Congress expanded eligibility to add children’s hospitals, outpatient cancer center hospitals, rural referral centers, sole community hospitals, and critical access hospitals. Covered entities are supposed to serve large numbers of vulnerable community members by providing charity care and passing on savings. However, the lack of robust oversight and ambiguity in the 340B legislative language has allowed some entities to take advantage of the program. Some entities abuse the program by using the savings for profit instead of passing them on directly to patients or using them for services to serve them. Some entities participate in the program when they should not be qualified. Some larger hospitals do this by manipulating their business structures by acquiring smaller entities that qualify in the true spirit of the program.

Another significant issue is bad faith actions from some covered entities who are using 340B rebates to fund exuberant executive compensation, which is entirely made more egregious by the hospital systems simultaneously cutting their charity care for indigent patients.[3]

A notable piece of legislation recently introduced in Congress to affect 340B reform is a discussion draft bill entitled the ‘SUSTAIN 340B Act’ - which stands for ‘Supporting Underserved and Strengthening Transparency, Accountability, and Integrity Now’.[4] It was introduced by U.S. Senators John Thune (R-S.D.), Debbie Stabenow (D-Mich.), Shelley Moore Capito (R-W.Va.), Tammy Baldwin (D-Wis.), Jerry Moran (R-Kan.), and Ben Cardin (D-Md.), all members of the Senate 340B bipartisan working group. This bill is a comprehensive attempt at reform targeting many of the current weaknesses of the 340B program. It addresses multiple areas, such as transparency, contract pharmacy operations, program integrity, and accountability. 

Sen. John Thune | Photo Source: TIME

In one vein of accountability, this bill amends the current 340B legislation by defining parameters for what can be considered ‘child sites’.[4] Many covered entities operate more than one physical location. An example is a non-profit hospital that may have multiple clinics or service centers outside the main hospital where all entities are partaking of the 340B discount. This bill explicitly defines the operating relationships required to be considered a qualifying child site. This is necessary because many entities are improperly spreading their 340B privilege across outlets under their umbrella. 

Another accountability measure defined by the SUSTAIN 340B Act relates to reporting. Concerning patient and community benefits, the bill requires covered entities to show their proverbial ‘receipts’ and thus bringing some much-needed transparency to the program. The legislative verbiage mandates the reporting include data such as the financial demographics of covered entities served populations, specifics on how the 340B prescriptions utilized by patients improved their health, explanations of policies covered entities use to promote access and adherence to prescribed medication, and even detailed reporting of how the discounts received from the program are used.[4]

The legislation, in part, reads: “We believe that requiring covered entities to report detailed information regarding their program savings, policies, patient and prescription information, and then enabling that information to be publicly available by the Secretary will help ensure all stakeholders have trust and confidence that the program is being used as intended.”[4]

A more contentious part of the bill targets drug manufacturers. The bill specifically defines things that drug manufacturers cannot do. An example is where it explicitly states a drug manufacturer cannot impose a restriction on a covered entity as a condition to receive a discount, such as “…requiring the submission of claims data directly to the manufacturer out of submissions to the entity receiving the contract to maintain the clearinghouse under section 1150D of the Social Security Act.”[4] Most importantly, the bill defines prohibited activity, legal remedies, and monetary penalties that can be assessed if drug manufacturers break the rules.

The SUSTAIN Act also aims to enhance program integrity by implementing stronger guidelines for government audits of covered entities, preventing duplicate discounts by bad actors gaming the system between the 340B program and Medicaid, and reigning in health plans and pharmacy benefit managers attempts to restrict access to drugs in the 340B program.[4]

Dusty Garner, a long-time survivor of HIV and member of the ADAP Advocacy 340B Patient Advisory Group, passionately summarized: "Listen, it is about damn time Congress opened the books on this $54 Billion program and asked the corporate healthcare providers who are benefiting the most from it to do the same with their ledgers. Too many patients are drowning in medical debt, yet they're residing in areas with so-called nonprofit hospitals supposedly best suited for expanded access under the 340B Program. Where is all of this money going, cause we know too much of these 340B rebates aren't helping the patients who most need it."

Photo Source: CANN

Another less notable piece of legislation introduced was the ‘340B Pharmaceutical Access To Invest in Essential, Needed Treatments & Support Act of 2024’, known as the 340 B PATIENTS Act.[5] It was introduced by Rep. Doris Matsui (D-Calif.), a known drug industry antagonist and a favorite of the American Hospital Association. Despite the legislation's short title, it appears to be more concerned with providers than patients. The 340B PATIENTS Act is not as comprehensive as the SUSTAIN Act. Its specific focus is to make amendments concerning contract pharmacy dealings and drug manufacturer enhanced reporting requirements. One section of the bill adds amended language to clarify that drug manufacturers are required to “offer 340B pricing for drugs purchased by a covered entity regardless of the manner or location in which the drug is dispensed, and section 340B prohibits drug manufacturers from placing conditions on the ability of covered entities to purchase and use 340B drugs, regardless of the manner or location in which they are dispensed.”[5]

Thomas Johnson, Executive Director of ASAP 340B, expressed sentiments concerning the 340B PATIENTS Act. He states, "While we welcome efforts to address 340B contract pharmacy arrangements, the 340B program needs comprehensive reforms that will restore its integrity and accountability and, most importantly, ensure underserved communities are benefiting. ASAP 340B was formed because nearly all stakeholders involved in the 340B program have grave concerns about its ability to serve the nation's safety net as was originally intended 30 years ago. Community Health Centers, patient, provider and consumer advocates, and leaders from the biopharmaceutical industry are at the table together, working with Congress on solutions that will go further to address the flaws in the 340B program currently putting America's safety net at risk."

Photo Source: ASAP 340B

The 340B program is a lifeline for covered entities and the communities they serve. Fighting to legislate its survival is imperative to improve the health and lives of those truly in need of its benefits. In a joint statement to the U.S. Senate Bipartisan 340B Working Group in response to a Request for Information, ADAP Advocacy and Community Access National Network perfectly described the dire need for reform. They explain: “When originally drafted, Congress did not include extensive parameters to govern the entities. This means that the statute is silent on many critical program requirements that are necessary for it to function correctly today, ensuring that patients, and not hospital networks, are seeing the benefit of discounted medicines. But it is now more than 20+ years later, and difficult to argue about what occurred then as compared to now. The challenge and the opportunity are to focus on what Congress wants the program to be today, who it should serve, what healthcare providers should be qualified as “covered entities,” etc.[6]

The current toxic political environment on Capitol Hill, which is exacerbated by the continued dysfunction in the House of Representatives, makes it highly unlikely anything gets done in Congress other than funding the government. But the introduction of 340B-specific legislation does demonstrate that the growing calls for reform of the 340B Program are finally being heard. The simple truth of the matter is the more patients learn about how the 340B Program could be better serving them rather than lining the pockets of corporate healthcare providers, they’re left asking: “340B: What about me?” Congress appears to be listening.

[1] HRSA. Sec. 340B Public Health Service Act. Retrieved from https://www.hrsa.gov/sites/default/files/hrsa/rural-health/phs-act-section-340b.pdf

[2] The Commonwealth Fund. (2022, September 8). The Federal 340B Drug Pricing Program: What It is, and why it’s facing legal challenges. Retrieved from https://www.commonwealthfund.org/publications/explainer/2022/sep/federal-340b-drug-pricing-program-what-it-is-why-its-facing-legal-challenges#:~:text=In%202015%2C%20the%20U.S.%20Government,left%20largely%20to%20police%20themselves.

[3] Hopkins, Marcus J.. (2023, November 2). 340B Covered Entities’ Revenue Witnessed Huge Executive Compensation Increases, Alarming Charity Care Decreases. The ADAP Blog Retrieved from https://adapadvocacyassociation.blogspot.com/2023/11/340b-covered-entities-revenue-witnessed.html 

[4].Thune, J., Stabenow, D., Moore, S., Baldwin, T., Moran, J., Cardin, B. (2024). SUSTAIN Act. Retrieved from https://www.thune.senate.gov/public/_cache/files/c3a678e3-12a5-4175-8a80-9246b76576ec/75E01A8968B679E3525395E2BB0CE7DB.ss340b-act-discussion-draft-.pdf

[5] Matsui, D. (2024, March 12). 340B PATIENTS Act. Retrieved from https://matsui.house.gov/sites/evo-subsites/matsui.house.gov/files/evo-media-document/MATSUI_022_xml_final.pdf

[6] ADAP Advocacy, Community Access National Network. (2023, July 23). Joint Statement. Retrieved from https://www.adapadvocacy.org/pdf-docs/2023_ADAP_CANN_Public_Comment_Senate_RFI_340B_07-24-23.pdf

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates. 

Understanding Atlanta’s Persistently High Rate of HIV

By: Ranier Simons, ADAP Blog Guest Contributor

Since the 1950s, Atlanta is commonly known as “Hot Lanta” popularized by the Allman Brothers Band’s song because of its hot and humid climate.[1] But the weather isn't the only thing "hot" in Atlanta as the metro area surrounding the city has become a burning epicenter of new diagnosis for HIV.

Photo Source: ANIZ

Proper data collection and analysis take time. This is especially true regarding public health surveillance and research. It is better to have robust sourcing of quality data collection than analysis of rushed volumes of collected data.[2] The Centers for Disease Control & Prevention (CDC) recently released a national HIV data analysis of infection rates from 2021. Overall, the national rate of new HIV infections has been decreasing over the past few years. However, this is not entirely true for the South.[3] Reporting indicates problematic infection trends in several southern metropolitan areas, one such area being metro Atlanta. 

Data shows that in 2021, metro Atlanta had the third highest new HIV infection diagnosis rate of metropolitan areas, only bested by Miami, Florida, and Memphis, Tennessee.[3] This data gives added context to preliminary data observed presently in 2024. According to Dwayne Ford, director of HIV prevention services with AIDS Atlanta, there are more reported positive individuals living with HIV in the first quarter of 2024 than in the first quarter of 2023.[4]

Various treatment and prevention tools exist, so healthcare professionals and community groups are trying to identify where more work needs to be done to reverse Atlanta and Georgia’s new infection rates. While metro Atlanta is the third highest ranking in new infections for metropolitan areas, Georgia is fourth overall as a state. One challenging area of concern is funding. Georgia is one of the few states that have not expanded Medicaid. If Georgia fully expanded Medicaid as allowed under the Affordable Care Act, over half a million Georgia residents would become eligible for health insurance.[5] 

Photo Source: Atlanta Journal Constitution

This would enable over half of the Georgian residents who are uninsured and enrolled in the Ryan White program to be moved to Medicaid. They would still be able to get all the care they received under Ryan White in addition to other services not available through Ryan White. That, in turn, would free up approximately $53.7 million of Ryan White funding to help non-Medicaid eligible people living with HIV not presently accessing services.[4] Treatment is prevention since increasing the number of people on ART means increasing viral suppression, lowering the number of those able to transmit HIV. Moreover, expanding Medicaid would mean increasing access to PrEP since Ryan White Funding cannot be used for PrEP medications nor its associated medical visits and laboratory testing.[6] African American and Hispanic males comprised the majority of reported new HIV infections yet have much lower utilization of PrEP in comparison to white residents.[3]

Access is a significant issue for low-income residents and the African American and Hispanic populations, which are disproportionately represented in new infection numbers. However, stigma is also still an issue.[3] In African American and Hispanic communities, HIV stigma remains a barrier to care, testing, and support. Efforts to encourage and expand testing lose impact when those who discover their positive status do not seek treatment. It is vital to bolster efforts to get newly diagnosed individuals into treatment as soon as possible and to help them remain in treatment. Support is needed since fear and privacy concerns hinder vulnerable populations from wanting their medications discovered by friends and family. Additionally, fear of the stigma of being seen at public clinics or other healthcare facilities hinders proper follow-up care and testing.

Support and prevention are the two areas many concerned parties are focusing on. Expanding prevention efforts such as PrEP access, education, and culturally competent messaging are imperative. Improving upon existing measures to help those negatively affected by social determinants of health, such as lack of transportation and insurance, is also necessary. 

Photo Source: endhivatl.org

The Fulton County Department for HIV Elimination recently launched a new website, ENDHIVATL.ORG,  in response to the metropolitan Atlanta area epidemic. Citizens can use the site to find service providers based on the services they provide and their proximity to where they live. The site also provides up-to-date information concerning how and where to access PrEP and other medical and non-medical services. To help address stigma, the site has a prominently displayed section entitled ‘Positive & Proud.’ It contains personal stories of local community members living with HIV regarding their lives in general and their experiences with utilizing the Department for HIV Elimination services. There is even a section of the site dedicated to assisting healthcare providers.

Atlanta’s high rate of HIV infection has persisted for years. While rates have declined slightly, they are still disproportionately higher than the rest of the country. Hopefully, continued efforts to highlight the status quo, maintain awareness, and provide further support and prevention will soon result in improved lives and outcomes.

[1] Kane, Deborah (2024, April 10). What is the nickname of Atlanta Georgia? NCESC. Retrieved from https://www.ncesc.com/geographic-faq/what-is-the-nickname-of-atlanta-georgia/

[2] Chiolero, A., Tancredi, S., & Ioannidis, J. P. A. (2023). Slow data public health. European journal of epidemiology, 38(12), 1219–1225. https://doi.org/10.1007/s10654-023-01049-6

[3] Gaines, J. (2024, April 1). New HIV case rate in metro Atlanta third highest in nation. Retrieved from https://www.ajc.com/news/atlanta-news/new-hiv-case-rate-in-metro-atlanta-third-highest-in-nation/6TDMS6CUTZG7RPVPRLE6O3JZCY/

[4] 11Alive. (2024, April 4).HIV cases on the rise in metro Atlanta - What local clinic says about it. [Video]. YouTube. https://www.youtube.com/watch?v=h2jh2TgxfcQ&list=WL&index=1

[5] Equality Foundation of Georgia. (2022). Implications of Medicaid expansion on Georgia's HIV Budget. Retrieved from https://georgiaequality.org/wp-content/uploads/2022/01/REPORT-Medicaid-Expansion-and-Ryan-White.pdf?emci=61ee3ed9-f179-ec11-94f6-c896650d4442&emdi=ea000000-0000-0000-0000-000000000001&ceid=

[6] Department of Health and Human Services. (2021, November 16). HRSA Letter to Ryan White Program Colleagues. Retrieved from https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/hiv-care/prep-dcl-november-2021-508.pdf

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates. 

What's up with CRISPR Therapy's Impact on HIV Replication and the Potential for a Cure?

By: Ranier Simons, ADAP Blog Guest Contributor

Scientific innovation in the fight against HIV created the current landscape of antiviral treatment, which allows people living with HIV (PLWH) to manage chronic viral infection and lead long, healthy lives. Recent medical advancements give a glimmer of hope for advanced viral suppression and the potential for a future cure. A recent University of Amsterdam laboratory study using CRISPR-Cas9 gene editing technology was able to eliminate HIV from infected cells in a controlled environment outside of the body.[1,2] This development is proof of concept, which could mean eradicating HIV from the bodies of PLWH will be achievable one day.

Photo Source: YouTube | SciTech Alerts

CRISPR stands for ‘clustered regularly interspaced short palindromic repeats.’[3] It is technology based on how bacteria naturally use gene editing systems to protect themselves from viral infection. CRISPR-Cas is a system. Cas is an enzyme, and Cas9 is an enzyme that specifically can cleave DNA. CRISPR is a sequence of RNA. In simple terms, the CRISPR-Cas9 complex is effectively a ‘seek and destroy’ pair of molecular scissors that can search for and cut out undesirable genetic material.[4]

When the HIV invades the body and infects cells, it integrates its genetic material into the host cell’s genome. Current antiviral medications help to prevent the virus from replicating in the body. However, ART does not attack the dormant virus that lies in wait in viral reservoirs. This is why lifelong ART is necessary since HIV infection can rebound from these reservoirs if medication is discontinued. Dr. Elena Herrera-Carrillo and her team at the University of Amsterdam recently used CRISPR-Cas9 technology to completely eliminate the HIV virus from cell cultures.[5]

The team focused on a specific part of the HIV viral genome that seems to be present in all known HIV strains. Testing with infected CD4+ T-cells, the team modified their CRISPR-Cas9 complex to inactivate and excise the targeted HIV viral DNA. Thus, HIV was eliminated entirely from the cells since the genetic code necessary to form it was removed, effectively destroying HIV’s building blueprint. Additionally, they were able to target what they described as hidden reservoir cells by identifying specific proteins present on their cell surfaces.[5]

Photo Source: Newsmax

This study is promising, but by no means is an immediate cure for HIV. The experiment was a very specified cell culture exercise outside of the body. HIV can infect many kinds of cells and tissues of the body with varying characteristics and environments. Future research needs to investigate how to target HIV in all those circumstances and conditions.[5] Also, HIV reservoirs have long half-lives and can be found in many different cells and tissues, such as the central nervous system and the male urogenital tract.[6] To effectively eradicate HIV from the body would require eliminating HIV from every infected cell and every latent reservoir. No proverbial stone could be left unturned since even the smallest one percent of a reservoir could potentially reactivate and spawn HIV replication.

Gene editing can also have unintended consequences.[7] When genes are cut with CRISPR technology, the process by which cells heal the excisions and reform introduces errors into the genome. Without precise targeted CRISPR techniques, gene sequences can be edited and rewritten in ways that cause mutations, resulting in cancer promotion or other unwanted biological process alterations. The human body is a very complex system of systems. Developing a CRISPR cure for HIV would require foolproof ways to enter appropriate cells while avoiding others, in addition to ways to mitigate dangerous side effects.

While a CRISPR cure for HIV is nowhere near to becoming a reality, the Amsterdam study is a source of hope and a guide for the future. Innovation is incremental. This study will be a steppingstone and guidepost for other scientists to build upon and spawn future breakthroughs. Dr Carrillo states, “We hope to achieve the right balance between efficacy and safety of this CURE strategy…Our aim is to develop a robust and safe combinatorial CRISPR-Cas regimen, striving for an inclusive ‘HIV cure for all’ that can inactivate diverse HIV strains across various cellular contexts.”[1] While we will not see human clinical trials until the science reaches this point, at least we have a newly developing tool to add to the HIV antiretroviral arsenal.

[1] Good News Network. (2024, March 23). Scientists discover potential HIV cure that eliminates disease from cells using CRISPR-Cas gene editing. Retrieved from https://www.goodnewsnetwork.org/scientists-discover-potential-hiv-cure-that-eliminates-disease-from-cells-using-crispr-cas-gene-editing/

[2] Wilson, C. (2024, March 19). CRISPR could disable and cure HIV, suggests promising lab experiment. Retrieved from https://www.msn.com/en-us/health/other/crispr-could-disable-and-cure-hiv-suggests-promising-lab-experiment/ar-BB1kbDkU

[3] National Institutes of Health. (2024, March 27). CRISPR. Retrieved from https://www.genome.gov/genetics-glossary/CRISPR#:~:text=CRISPR%20(short%20for%20%E2%80%9Cclustered%20regularly,editing%20systems%20found%20in%20bacteria.

[4] Hussein, M., Molina, M. A., Berkhout, B., & Herrera-Carrillo, E. (2023). A CRISPR-Cas Cure for HIV/AIDS. International journal of molecular sciences, 24(2), 1563. https://doi.org/10.3390/ijms24021563

[5] American Association for the Advancement of Science. (2024, March 19). HIV in cell culture can be completely eliminated using CRISPR-Cas gene editing technology, increasing hopes of cure. Retrieved from https://www.eurekalert.org/news-releases/1038161

[6] Pierson, T., McArthur, J., & Siliciano, R. F. (2000). Reservoirs for HIV-1: mechanisms for viral persistence in the presence of antiviral immune responses and antiretroviral therapy. Annual review of immunology, 18, 665–708. https://doi.org/10.1146/annurev.immunol.18.1.665

[7] Hunt, J. M. T., Samson, C. A., Rand, A. D., & Sheppard, H. M. (2023). Unintended CRISPR-Cas9 editing outcomes: a review of the detection and prevalence of structural variants generated by gene-editing in human cells. Human genetics, 142(6), 705–720. https://doi.org/10.1007/s00439-023-02561-1

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates. 

Fed-Up with Medical Debt Owed to Hospitals, States and Municipalities Respond

By: Ranier Simons, ADAP Blog Guest Contributor

Medical debt is a significant financial burden in the United States. It affects both insured and uninsured adults. Medical debt encompasses the high bills consumers are saddled with, in addition to the credit card and other personal loan debt incurred while trying to pay the medical bills.[1] Approximately 100 million Americans hold $195 billion in medical debt, with most owing less than $1,000.[2] A previous ADAP Advocacy blog discussed how patients are even being failed by what is supposed to be charity care by nonprofit hospitals. Nonprofit and for-profit hospitals send patients into financial ruin using predatory collection agencies and other tactics.[3] Medical debt is unavoidable debt, often from singular emergent occurrences, dissimilar to other consumer debt incurred by choice. Realizing the need to help communities, cities have taken innovative measures to relieve their citizens' medical debt woes.

Photo Source: Urban Institute

According to the Urban Institute, over 74% of medical debt is owed to hospitals.[10] Hospital debt has become big business. Noam Levey, senior correspondent for KFF Health News, explains, “Our healthcare system is now generating medical debt on an industrial scale…And a good part of that is coming from not-for-profit health care.”[11] About two-thirds of hospitals will take legal action against outstanding debt, including collections, with some even denying non-emergent care for unpaid debt. Patients’ best interests are not at the forefront when a hospital denies access to needed care due to bills in arrears. Some hospitals have even placed liens on patients’ homes. Liens are an additional financial burden and affect generational wealth since one cannot sell or pass down a property saddled with liens.[3]

One route being utilized by cities is to take advantage of the existing system. Patients' unpaid medical debts are sold to collection agencies as bad debt for small fractions of the actual amounts. Customarily, collection agencies buy this second market debt cheaply and then try to collect as much as possible as profit. Several cities, including Washington, D.C., New Orleans, Louisiana, and Toledo, Ohio, have used funds to buy patients medical debt and forgive it.[2] A large portion of the funding municipalities have used to erase the debt is pandemic relief money. Some municipalities, such as Cook County, Illinois, have partnered with a nonprofit named RIP Medical Debt to purchase medical debt.[2,4]

Photo Source: KFF

Since 2014, RIP Medical Debt has abolished over $11.8 billion in medical debt for over seven million people.[5] With donations, they have purchased large bundles of medical debt at pennies on the dollar and then canceled the debts instead of trying to make a profit. They are contracting with cities and counties to do the same. RIP Medical Debt helps municipalities analyze their hospital systems' medical debts. They identify those with medical debts that are five percent or more of their income and or patients who are at or below 400% of the poverty level.[6] People cannot apply for assistance, nor do they have to. Once it is verified that criteria are met, qualified purchased medical debts are canceled, and beneficiaries are sent letters notifying them of their debt forgiveness. Over 16 cities, 12 counties, and seven states have expressed interest in collaborating with RIP Medical Debt.

Utilizing medical debt erasure is a significant relief to many. However, funding is limited, and it does not address the deeper issues. Many Americans are uninsured or underinsured. Many people with insurance have high-deductible plans, which place them in the guillotine of runaway medical expenditures. Additionally, many people can’t afford their high co-payments or coinsurance payments when they are stuck with receiving out-of-network care. Allison Sesso, President & CEO of RIP Medical Debt, expressed, “Across all health care services, the pricing is just way too high for people to afford, and we need transparency on pricing to make informed health care decisions.”[7]

Legislation is another avenue states are using to help with medical debt. While it’s not debt forgiveness, Maryland has laws that raised the income threshold for hospital care and prohibited wage garnishment or home liens in certain medical debt judgments.[2] There is a current bill being considered in Maryland, HB328, that “expands the number of patients receiving free and low-cost hospital care by ending arbitrary asset and geographic tests used by 27 hospitals to bar patients who were eligible for low-cost care’.[8]

Photo Source: CNN

States are also working towards preventing medical debt from ruining individuals’ credit. California Attorney General Rob Bonta is a sponsor of Senator Monique Limón’s bill, SB-1061, which would block healthcare entities and associated collections agencies from sharing bad medical debt with credit bureaus. If it becomes law, California would be the third state to remove medical bills from credit reports, following Colorado and New York, which enacted laws in 2023.[9] Hospitals and collection agencies have used credit reporting to force people to pay bad debts. However, credit reporting can result in the denial of housing and job applications and disrupt families’ financial lives with repercussions that lower quality of life and social mobility.[3]

Medical debt is not going away in the foreseeable future, nor are the high costs of medical care. The challenges of medical debt disproportionately hinder the lives of the poor, ethnic minorities, and other marginalized groups. Creating solutions to shield consumers from the ravages of medical debt is essential. However, dismantling the root causes of unregulated and disparate medical services pricing is paramount. Band-Aids of temporary relief do not override the foremost requirement of systemic change.

[1] Lopes, L., Kearnet, A., Montero, A., Hamel, L., Brodie, M. (2022, June 16). Health care debt in the U.S.: The broad consequences of medical and dental bills. Retrieved from https://www.kff.org/report-section/kff-health-care-debt-survey-main-findings/

[2] Biron, C. (2023, July 21). Americans owe billions in medical debt. Can cities help? Retrieved from https://www.reuters.com/article/idUSL8N38W2UP/

[3] Simons, R. (2023, November 30). Provider ‘smash and grab’ tactics fueling medical debt, hurting patients. Retrieved from https://adapadvocacyassociation.blogspot.com/2023/11/provider-smash-and-grab-tactics-fueling.html

[4] MacDougall, H., Tuttle, M., Henning-Smith, C. (2024, March 18). To address the crisis of medical debt, lawmakers should focus on Greater Minnesota. Retrieved from https://www.minnpost.com/community-voices/2024/03/to-address-the-crisis-of-medical-debt-lawmakers-should-focus-on-greater-minnesota/

[5] RIP Medical Debt. (2024). https://ripmedicaldebt.org/

[6] Walsh, J. (2023, April 25). Cleveland City Council approves medical debt relief; here's what that means. Retrieved from https://www.news5cleveland.com/news/local-news/investigations/cleveland-city-council-approves-medical-debt-relief-heres-what-that-means

[7] Vollers, A. (2024, February 22). Governments can erase your medical debt for pennies on the dollar — and some are. Retrieved from https://www.thelundreport.org/content/governments-can-erase-your-medical-debt-pennies-dollar-and-some-are

[8] End Medical Debt Maryland. (2024, February 14). Testimony to the House Health & Government Operations Committee. Retrieved from https://mgaleg.maryland.gov/cmte_testimony/2024/hgo/1bQYmcYDHBKw2yjI4-IgapCig5mvNIusH.pdf

[9] Work, M. (2024, March 11). California attorney general boosts bill banning medical debt from credit reports. Retrieved from https://kffhealthnews.org/news/article/california-attorney-general-medical-debt-ban-on-credit-reports/

[10] Urban Institute. (2023, October 10). Debt in America: An interactive map. Retrieved from https://apps.urban.org/features/debt-interactive-map/?type=medical&variable=medcoll

[11] Thompson, I. (2023, September 5). Nonprofit hospitals pursue aggressive medical debt collection. Retrieved from https://nonprofitquarterly.org/nonprofit-hospitals-pursue-aggressive-medical-debt-collection/

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates. 

Alternative Funding Programs are Simply the Rich Robbing the Poor

By: Ranier Simons, ADAP Blog Guest Contributor

Patients who utilize specialty medications are living with serious and often chronic health conditions, such as cancer, cystic fibrosis, diabetes, or HIV. Barriers to obtaining those medications can literally be a matter of life and death. Many people obtain their specialty drugs via their private health insurance, often employer-sponsored plan. Unfortunately, some insurance plans engage in very anti-patient policies, such as copay accumulators and copay maximizers, placing profit above the patient’s well-being. The most recent anti-patient cost-shifting scheme is the alternative funding program (AFP). AFPs are characterized as “sinister” by some patient advocates because they force patients with private insurance to utilize public safety net programs taxing already limited resources earmarked for those who are truly in need. Additionally, AFPs create barriers to access and adversely affect healthcare outcomes.[1]

Photo Source: Health Policy Today

Alternative funding programs' primary mode of operation is to convince self-insured health plans to exclude most if not all, specialty prescription drugs from coverage in their formulary.[2] In 2020, the average cost of a specialty drug for a chronic health condition was $84,442.[1] Specialty prescriptions cost about ten times more than regular medications. Their exclusion from a plan’s drug formulary essentially renders beneficiaries ‘uninsured’ regarding their medication. When patients are prescribed a non-covered specialty medication, their plan denies the claim, and the AFP then seeks to enroll the patients in patient assistance programs.[2] If the patient qualifies for a patient assistance program from a manufacturer or charity, they receive the medication for free or at a significantly reduced cost. If they do not qualify for any programs, the claim returns to the plan and is covered under the standard pharmacy benefit with cost-sharing.

This cost-cutting scheme is multidimensionally problematic. It is dangerous regarding the continuity of patient care. Applying for these programs takes time. These third-party AFPs must gather financial and demographic information for the process, and approval could take two to four weeks or sometimes months.[2,3] Being without prescriptions for that long can cause serious medical problems and create or exacerbate symptoms. It is possible that resulting adverse outcomes could even be irrevocable. 

This is especially dire for those taking HIV antiretroviral medication, where adherence is vital in maintaining viral suppression. Tim Horn, Director of Medication Access at NASTAD, reports, “What we're seeing in a number of states are AFP administrators referring people requiring antiretrovirals or other high-cost drugs to manufacturer patient assistance programs, which may in turn end up recommending enrollment in the state AIDS Drug Assistance Program.” He adds, “the denial of the original pharmacy claim by the employer's plan, the capacity it takes to apply for and be turned down by a manufacturer PAP, followed by the time and energy it takes to apply and be confirmed eligible for ADAP support effectively means someone can go for weeks without being able to access essential medicines – and that's if they haven't given up on the whole process entirely.”

Photo Source: ONS Voices

Critics argue that AFPs are unethical and fiscally damaging. As Adam J. Fein, Ph.D., CEO of Drug Channels Institute, points out, “You’re basically trying to access money that is explicitly intended for needy, uninsured, financially strapped patients. This is not copay support for commercial benefits, where the benefit kind of stinks or they over-cost-shifted.”[4] Manufacturer and charity patient assistance programs have limited funds. AFPs’ abuse of the system could eventually drain programs to the point of causing programs to close entirely or at least drastically reduce the ability to extend help to the genuinely uninsured and indigent. It is unjust and inequitable for AFPs to use patient assistance funds to subsidize health insurance plans for profit.

Some AFPs utilize a practice that directly endangers the lives of plan members. If a beneficiary does not qualify for the patient assistance programs, AFPs may attempt to source a needed medication through international mail order. This exposes patients to unregulated medicines that could be counterfeit, impure, expired, and otherwise dangerous to their health. Additionally, guidance from the U.S. Food & Drug Administration (FDA) indicates that it is illegal for individuals to import drugs or devices into the United States for personal use under most circumstances.[5]A couple of extremely narrowly defined exceptions exist: the Personal Importation Policy and the Importation of Drugs Originally Intended for Foreign Markets Policy. However, utilizing international mail order for the members of an entire health plan does not fall under either of those exceptions.

In an effort to push back against AFPs, advocacy groups have been flagging AFPs as violations of various regulations under the Employee Retirement Income Security Act of 1974 (ERISA). (ERISA) is a federal law that sets minimum standards for most voluntarily established retirement and health plans in private industry to protect individuals in these plans.[6] This includes employer self-insured plans. ERISA exists to ensure that health plans operate in the best interests of the beneficiaries. ERISA is comprised of many rules. Developing inquiry efforts include exploring how AFPs could be causing health plans to improperly exercise their fiduciary duties and how they may create discriminatory plan design.[7]

According to Carl Schmid, Executive Director of the HIV+Hepatitis Policy Institute, “Most AFPs are taking advantage of a loophole in the ACA that allows employer plans to designate certain drugs as “non-essential health benefit”.  The federal government through regulation seems to be starting to close that loophole for marketplace and small group plans, but for the larger employer plans, that really are the guilty parties, we need to continue to push the administration to act.  Bills are also pending in several states and in the Congress. This is just a start, but to end AFPs, the government must step in stop these nefarious schemes.”

Photo Source: iStock

Alternative funding programs amount to simply the rich robbing the poor, but they are growing in number. Currently, there are over twenty AFP vendors. They are not in the best interests of employers because the cost savings are deceptive. While plan sponsors may celebrate the relief of not paying for expensive specialty medication, they incur high costs from the AFP plan administrators. AFPs charge payers’ large percentages of the savings they achieve, sometimes as high as 25% of a drug’s list price.[8] Plan beneficiaries are harmed by delays in care, the stress of administrative red tape, and increased cost burdens when eligibility for AFP funding mechanisms goes awry. The public is harmed because AFPs divert funds from those who truly are in need. Ongoing developments indicate that it will be crucial for advocacy groups and the government to be vigilant in preventing the proliferation of AFPs and the damage they cause.

[1] Alliance for Patient Access. (2023, June). The high costs of alternative funding programs. Retrieved from https://allianceforpatientaccess.org/wp-content/uploads/2023/06/AfPA_High-Costs-of-Alternative-Funding-Programs_June-2023.pdf

[2] Blum, K. (2023, November 20). ‘Alternative’ model for patient assistance draws stakeholder ire. Retrieved from https://www.specialtypharmacycontinuum.com/Policy/Article/12-23/Alternative-Model-For-Patient-Assistance-Draws-Stakeholder-Ire/72048

[3] Schroeder, D. (2022, November 22). The looming threat of alternative funding models. Retrieved from https://ipghealth.com/news/the-looming-threat-of-alternative-funding-models

[4] AIS Health. (2022, September 1). Industry experts question alternative funding companies that carve out some specialty drugs, ‘abuse’ charities. Retrieved from https://www.mmitnetwork.com/aishealth/spotlight-on-market-access/industry-experts-question-alternative-funding-companies-that-carve-out-some-specialty-drugs-abuse-charities/

[5]  FDA. (2023, December 7). Personal Importation. Retrieved from https://www.fda.gov/industry/import-basics/personal-importation#:~:text=In%20most%20circumstances%2C%20it%20is,unapproved%20new%20drug%20in%20the

[6] U.S. Department of Labor. (2024). ERISA. Retrieved from https://www.dol.gov/general/topic/health-plans/erisa#:~:text=The%20Employee%20Retirement%20Income%20Security,for%20individuals%20in%20these%20plans.

[7] Aimed Alliance. (2022, December 14). Essential health benefits, importation, and more – Do you know the risks?[Video]. YouTube. https://www.youtube.com/watch?v=U9-rJZ9YjLU&t=723s

[8] Fein, A. (2022, August 2). The shady business of specialty carve-outs, a.k.a., Alternative Funding Programs. Retrieved from https://www.drugchannels.net/2022/08/the-shady-business-of-specialty-carve.html

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates. 

CROI 2024 Highlights: Conference on Retroviruses and Opportunistic Infections

By: Ranier Simons, ADAP Blog Guest Contributor

The fight against HIV and other viruses like HCV and SARS-CoV-2 is a worldwide team effort. That is why the Conference on Retroviruses and Opportunistic Infections (CROI) convened from March 3rd through March 6th, 2024 in Denver, Colorado. Since 1993, CROI has brought together scientists, clinical scientists, and epidemiologists to present original groundbreaking research and collaborate to advance the treatment and prevention of HIV and other viral infections and opportunistic diseases.[8] CROI is one the first places research showing the effectiveness of triple-drug therapy for HIV was shared. It was also one of the first places where the results of the SMART study were shared, which proved that early treatment of HIV provides the best outcomes.[8] This year, 4,000 attendees gathered at CROI. Participants presented a multitude of novel and emerging therapies and studies. What follows are just a few notable highlights.

Photo Source: CROI

Long-Acting Injectables Blaze Forward

GSK’s long-acting injectable, cabotegravir, has already shifted the antiretroviral therapy (ART) paradigm. Coupled with rilpivirine, it is one-half of Cabenuva, the first complete ART injectable approved by the U.S. Food & Drug Administration (FDA). Cabenuva allows people who live with HIV (PLWH) to change from taking daily pills to the Cabenuva injection monthly or every two months. Studies have proven it is effective for those who have medication adherence challenges. It also presents an option for PLWH who wish to make medication management a less intrusive part of their lives.

ViiV Healthcare, the HIV-focused subsidiary of GSK, presented data from a clinical trial for a revolutionary new ultra-long-acting cabotegravir at CROI.[7] The new formulation has a higher concentration and double the half-life, potentially allowing it to be dosed every four months instead of every two.[7] Further clinical trials will be conducted to explore the use of the new formulation of cabotegravir as PrEP and as a treatment for PLWH. GSK’s goal is to have the first long-acting injectable for HIV prevention on the market by 2026 and for HIV treatment by 2027. The company also aims for an annual long-acting injectable by the first part of the 2030s.

DoxyPEP for STIs

DoxyPEP stands for doxycycline post-exposure prophylaxis. It is the practice of taking 200mg of oral doxycycline within 24 to 72 hours of condomless sex. Clinical trials have shown that DoxyPEP is effective in reducing the incidence of bacterial STIs such as syphilis and chlamydia. Results of Doxy PEP clinical studies of reducing STIs have been so promising that the CDC proposed guidelines for DoxyPEP usage in October 2022. However, those guidelines are not finalized.[1] 

Infectious disease professionals at CROI presented new data regarding DoxyPEP usage out in the real world among populations of people, mainly cisgender MSM and transgender women. Previous data was from clinical trials in contrast with new data that examined the results of DoxyPEP uptake in over 3,700 clients of sexual health clinics across San Francisco. Usage resulted in a 58% reduction in bacterial STI cases overall, a 67% reduction in chlamydia, and a 78% reduction in syphilis cases.[2] The real-world data indicated that when offered, there was a demand for DoxyPEP, and people consistently integrated it into their sexual health routine. As the Centers for Disease Control & Prevention (CDC) finalizes formal guidelines, DoxyPEP may potentially be solidified as another viable form of population wide STI prophylaxis.

Weekly Oral Antiretroviral Therapy

Long-acting injectable HIV therapy is not an optimal treatment modality for everyone. Nevertheless, other options for medication adherence that do not involve a daily regimen are needed for optimal health outcomes. At CROI, Gilead Sciences and Merck presented data from a clinical trial for a possible weekly oral antiretroviral therapy (ART) solution.

The solution is a weekly dosage of Gilead’s Sunlenca (lenacapavir), and an experimental drug named islatravir from Merck. [3,4] The phase 2 trial compared 104 patients taking daily Biktarvy (bictegravir 50mg/emtricitabine 200mg/tenofovir alafenamide 25mg tablets) with a group taking the weekly oral lenacapavir with islatravir. Data indicated that 94.2% of subjects taking the lenacapavir/islatravir combination maintained their viral suppression compared to 92.3% of the Biktarvy group.[3,4] The study will continue for another 48 weeks as open-label. This means that the study is no longer randomized. Both the medical professionals and the subjects know precisely what they are being given. There is no placebo. Studies move forward to open-label from randomized controlled studies once a high level of efficacy is proven and high benchmarks of defined endpoints are reached. 

Protecting Pregnant Women from HIV Infection

Research has shown there are physiological changes in the female body that cause a threefold increase in the risk of contracting HIV while pregnant.[5] This is especially troubling for countries where HIV is at an endemic level. Medications for HIV treatment and prevention are powerful, and it is crucial to find safe pharmaceuticals that will not harm the mother or the developing fetus.

At CROI, data from a multi-country (South Africa, Uganda, and Zimbabwe) clinical study presented safe options. A monthly flexible vaginal ring containing dapivirine as well as oral daily tenofovir disoproxil fumarate/emtricitabine PrEP (Truvada) were shown to be safe for use for pregnant women. The dapivirine vaginal ring is established in some African countries to be used as HIV prevention for cisgender women who are not pregnant. Truvada has already been proven to be safe for pregnant HIV-positive mothers to use.

The study was a randomized trial where pregnant women aged 18-40 used the dapivirine ring or received the oral PrEP up until delivery or for 41 weeks and six days, depending on which came first.[6] Only 1% experienced stillbirth or miscarriage, 95% of the women’s pregnancies went to term, and 4% of the births were premature.[6] Most importantly, none of the women contracted HIV. The results indicate that both the ring and Truvada are safe for pregnant mothers and their unborn fetuses to protect them from infection.

CROI continues to be a catalyst for pushing HIV and other infectious disease research forward. Scientific communities meet there, spurring the most qualified and passionate minds to collaborate and innovate. Whenever a cure for HIV is found, it would not be surprising if someone at a future session of CROI first presents it.

[1] DiMarco DE, Urban MA, Fine SM, et al. Doxycycline Post-Exposure Prophylaxis to Prevent Bacterial Sexually Transmitted Infections [Internet]. Baltimore (MD): Johns Hopkins University; 2023 Sep. Available from: https://www.ncbi.nlm.nih.gov/books/NBK597440/

[2] Carstens, A. (2024, March 6). DoxyPEP aces first real-world test. Retrieved from https://www.thebodypro.com/article/croi-2024-doxypep-real-world-clinical-data

[3] Clinical Trials Arena. (2024, March 7). Gilead-Merck’s combination therapy maintains HIV suppression in trial. Retrieved from https://www.clinicaltrialsarena.com/news/gilead-merck-hiv-trial/?cf-view

[4] Taylor, P. (2024, March 7). Gilead and MSD say weekly oral therapy controls HIV. Retrieved from https://pharmaphorum.com/news/gilead-and-msd-say-weekly-oral-therapy-controls-hiv

[5] Salzman, S. (2018, March 9).New study shows women's HIV risk triples during pregnancy, quadruples postpartum. Retrieved from https://www.thebodypro.com/article/new-study-shows-womens-hiv-risk-triples-during-pre

[6] HIV.gov. (2024, March 5). Vaginal ring and oral Pre-Exposure Prophylaxis found safe for HIV prevention throughout pregnancy. Retrieved from https://www.hiv.gov/blog/vaginal-ring-and-oral-pre-exposure-prophylaxis-found-safe-for-hiv-prevention-throughout-pregnancy

[7] Reuters. (2024, March 5). GSK's new HIV drug formula could support longer dosing intervals. Retrieved from https://www.reuters.com/business/healthcare-pharmaceuticals/gsks-new-hiv-drug-formula-could-support-longer-dosing-intervals-2024-03-04/

[8] CROI Foundation. (2024). General information about CROI. Retrieved from https://www.croiconference.org/about/

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates. 

Through Her Tears, Compassion, and Hope, Hydeia Loren Broadbent Changed the Narrative on HIV/AIDS

By: Ranier Simons, ADAP Blog Guest Contributor

Hydeia Loren Broadbent came into this world on June 14, 1984, and the sun set on her life on February 20, 2024.[1] Having been born with HIV, she literally spent her entire life as an advocate for HIV/AIDS prevention and awareness. Hydeia was diagnosed with HIV at a time when HIV was a death sentence, before the advent of the antiviral medications available today, and when HIV/AIDS stigma and fear ran high due to the unknown. As a child, the doctors predicted she would only have a life span of a few years, yet Hydeia defied their odds and lived 39 full, powerful years dedicating her life to making change.

Photo Source: hydeiabroadbent.com

Normalcy and compassion were what Hydeia desired and were the messages she promulgated. When she was seven years old, during a Nickelodeon news special, she told Earvin “Magic” Johnson, “I want people to know that we’re just normal people.”[4] HIV/AIDS carried a dark stigma during Hydeia’s earliest years as it was viewed as an intravenous drug user and gay men’s disease. Before Hydeia’s journey, Ryan White had to legally fight for the right to attend public schools in Indiana, far away from Hydeia’s home of Las Vegas, Nevada, before he died in 1990. Even though she was able to start public school, she endured travesties and abuses no child should have had to process. One time in kindergarten, a teacher aware of her HIV status sprayed Clorox bleach on her when she sneezed.[2] After that incident, Hydeia was homeschooled with tutors until she started junior high school.[2]

Hydeia was born with HIV in 1984 but was not diagnosed until the age of three. She was adopted at six weeks of age before HIV testing was normalized. Hydeia’s birth mother was denied custody due to drug addiction, hence Hydeia ended up in the adoptive system.[2] Hydeia’s adoptive parents had her tested when they were notified by health officials her birth mother had given birth to another child that she and the child were HIV positive. By age five, Hydeia’s condition had progressed to AIDS. She was one of the first pediatric patients treated with AZT. Rubgie Lucas, an infectious disease investigator in Clark County, where Vegas is located, remembered Hydeia stating, "We had to learn how to treat her because the adult medication was too strong."[3] Anthony S. Fauci remembers treating Hydeia at the National Institutes of Health (NIH). Regarding her life, he stated, “her accomplishments are substantial.”[2]

Hydeia touched many lives both domestically and internationally. She traveled around the world spreading awareness about HIV/AIDS, advocating for treatment and care, and promoting prevention through abstinence and safer sex practices. She is well known for her activism and high-profile public speaking moments, such as when she was on the Oprah Winfrey Show at age 11. Her passion and mission also gave her a platform on shows such as Good Morning America and 20/20.[5] Hydeia was featured in many publications such as The New York Times, People, National Geographic, Ebony, POZ, and was even on the cover of TV Guide.[5] Her knowledge, poise, and personable nature opened doors for many speaking engagements. She spoke to audiences singularly and as a part of panels at institutions such as Morehouse School of Medicine, Duke University, and UCLA. In 2006, Hydeia was a speaker at the International AIDS Conference.

Photo Source: hydeiabroadbent.com

Hydeia gave of herself selflessly while simultaneously dealing with her own humanity. As she spoke to the world as a child, she still dealt with serious health issues such as blood infections, brain fungus, and heart issues. While navigating the demands of being a very public figure, she had to deal with her personal life. She expressed how hard it was to date given her diagnosis yet was optimistic about finding love and being married one day. During her teen years, at the height of her speaking and advocacy, she dealt with depression and perfection anxiety to the point of resenting being such a public figure and speaking to the world. She stated during an episode of Where Are They Now on Oprah’s OWN network that she had to find her inner peace.

In 39 years, Hydeia experienced more life than most people could handle or even comprehend, no matter how long they lived. She experienced HIV/AIDS from the very beginning before there were many treatments through the advent of antiviral drug cocktails. Her life and message touched millions internationally. Hydeia represented children born with HIV, was the face of African American women living with HIV and was a pioneer who forged her way just like Ryan White. She was once quoted as saying, “…with all that we know about the virus, it is clear to me that contracting HIV/AIDS today is a choice, and we can’t allow anyone the power to make that choice for us!”. Hydeia’s legacy is a life fulfilled and a continuing burning torch of compassion and hope to continue to be passed along until we one day conquer HIV/AIDS.

[1] Schilken, C. (2024, February 2022). Hydeia Broadbent, who teamed up with Magic Johnson in HIV/AIDS fight, dies at 39. Retrieved from https://www.msn.com/en-us/health/other/hydeia-broadbent-who-teamed-up-with-magic-johnson-in-hivaids-fight-dies-at-39/ar-BB1iJLdt?ocid=socialshare

[2] Langer, E. (2024, February 23). Hydeia Broadbent, young activist for HIV/AIDS awareness, dies at 39. Retrieved from http://www.washingtonpost.com/obituaries/2024/02/23/hydeia-broadbent-hiv-aids-dead/

[3] Nomura, A. (2024, February 27). Retired county disease investigator reflects on late HIV/AIDS activist from Las Vegas. Retrieved from https://www.msn.com/en-us/health/other/retired-county-disease-investigator-reflects-on-late-hivaids-activist-from-las-vegas/ar-BB1j04HL?ocid=socialshare

[4] Kornelis, C. (2024, February 23). Hydeia Broadbent, Who Helped Change the Conversation About HIV/AIDS, Dies at 39. Retrieved from https://www.msn.com/en-us/health/other/hydeia-broadbent-who-helped-change-the-conversation-about-hivaids-dies-at-39/ar-BB1iMwJU?ocid=socialshare

[5] BounceTV. (2020). Community Activist Award 2020 Trumpet Award Bio. Retrieved from https://www.trumpetawards.com/award-honoree/hydeia-broadbent/1184/#:~:text=Broadbent%20is%20also%20considered%20a,Award%20and%20an%20Essence%20Award.

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.