HIV Communities Face Challenges in Blue States & Red States

By: Ranier Simons, ADAP Blog Guest Contributor

Funding is the backbone of most healthcare initiatives, including navigating the landscape of HIV/AIDS. The fight against HIV includes testing, surveillance, treatment, education, and supporting basic life needs. Community centers provide many of these services to vulnerable populations, getting their funding from federal dollars through states. Budgetary decisions that adversely affect such funding can set back strides made through successful initiatives. Two states, New York, and Tennessee are in the spotlight due to controversial proposed decisions.

Photo Source: City & State New York

One such questionable budgetary decision comes from the governor of New York, Kathy Hochul. In the past, the governor has expressed dedication to ending the HIV/AIDS epidemic in New York state. In December 2022, she signed legislation requiring insurance companies to cover PrEP and PEP.[1] However, many view her present proposal to end a current Medicaid drug plan as being damaging. The program, known as the 340B Drug Pricing Program, allows safety net providers to purchase discounted life-saving HIV-related drugs and use the savings to provide essential services.[2] Operationally, the program enables centers to buy the drugs at cost but get reimbursed at the high rate that health insurance company plans pay for the medications. As a result, they can use the difference to pay for other services that are instrumental in supporting the needs of the populations being served.

In addition to supplying medications, many facilities use the extra funds to help with housing, food, and transportation. Losing the funding would result in many centers losing large parts of their budgets, which would be detrimental to the vulnerable populations that depend on their services. Losing the ability to continue to help the PLWHA with affordable housing could mean that some could become homeless. Unstable housing results in poor HIV/AIDS outcomes resulting from issues such as poor medication adherence. 

Hochul’s budget proposal is a continuation of Governor Andrew Cuomo’s Medicaid Pharmacy Carve-Out. The Medicaid Pharmacy Carve-Out is an attempt to boost the state’s revenue. Advocates argue that it adversely affects the 340B program because it gives the money directly to the state instead of directly to the facilities, as is the current status quo. The funds from the program help 2.3 million New York residents, 90 percent of who are low-income and 70 percent are people of color.[2] The New York State Department of Health states that Hochul plans to transition to the Medicaid Pharmacy Benefit of the Medicaid Pharmacy Carve-Out on April 1, 2023, but remains dedicated to ensuring facilities still get needed funds. Many health centers say that the proposed changes do not include enough money to replace the millions of dollars they would lose and have proposed legislative compromise that would give Hochul the savings she wants without destroying the pipeline of funding in place that is the lifeline for other services.[3] 

Photo Source: Rolling Stone

Another budgetary decision receiving push-back comes from Tennessee. Governor Bill Lee announced, in January 2022, that the state would start refusing federal funds for HIV-related programming. The funding being cut is for HIV prevention, detection, and treatment programs that are not affiliated with metro health departments.[4] The funding pots specifically identified to be rejected are P.S.18-1802 and P.S.20-2010. One is for HIV surveillance and prevention, with the other supporting state health departments in ending the HIV epidemic.[5] Currently, Tennessee receives about $8.3 million in total from the two funding sources. 

Parts of Tennessee are hotspots for HIV transmission, with Memphis being among the top 50 communities nationwide for HIV transmission rates.[6] Shelby County, which contains several cities, including Memphis, is one of the areas targeted by the CDC’s EHE (Ending the HIV Epidemic in the U.S.) initiative. The EHE focuses first on 50 local areas that account for more than half of the nation’s new HIV diagnoses and seven states with a substantial rural burden.[7] Additionally, the CDC’s 2020 analysis included forty-two counties in Tennessee among the top two hundred and twenty counties nationwide most vulnerable to an HIV outbreak.[7] 

State officials and the Governor state that they will start refusing the $8.3 million in funding to be more independent and less reliant on federal dollars. Governor Lee has also stated that he can ensure HIV funding is spent in ways that best serve Tennessee better than what he feels are strings attached to federal funding.[8] The Tennessee Department of Health also expressed that priorities in HIV prevention funding would be shifted to focus on first responders, victims of human trafficking, and pregnant women. Data from amfAR, The Foundation for AIDS Research, shows that it is not evidence-based decision-making as such a shift would only prevent about nine cases of HIV transmission annually. The most at-risk populations in the state include transgender individuals, people who inject drugs, cisgender women, and men who have sex with men. According to amfAR, focusing on these at-risk groups would prevent more than 500 new infections yearly.[9]

Photo Source: KevinMD.com

Moreover, the state has not indicated how it will make up for the $8.3 million lost and has suggested that funding will go through state-funded metro health centers. This does not address the needs of rural areas. Without the funding, much evidence-based community programs will end. Testing, a keystone of HIV prevention, will be drastically reduced, access to services will decrease, and some clinics and community centers that do the most work will close.[10]

It is imperative that funding structures stay in place that allow trusted community centers to continue to do the work that they do prevent HIV, treat HIV, and wholistically support the lives of PLWH. People’s lives are at stake, and funding decisions should only be based on scientific data, not political and ideological paradigms. HIV advocates and healthcare providers are closely watching the activities in New York and Tennessee, and many are also hoping that harmful legislation does not spread to other states.

[1] Reisman, N. (2022, December 22). Hochul approves law meant to reduce HIV infections. Retrieved from https://spectrumlocalnews.com/nys/central-ny/ny-state-of-politics/2022/12/22/hochul-approves-law-meant-to-reduce-hiv-infections-

[2] PRivas, S. (2022, February 7). HIV/AIDS activists urge Hochul to repeal Medicaid carve-out. Retrieved from https://www.news10.com/news/hiv-aids-activists-urge-hochul-to-repeal-medicaid-carve-out/

[3] DeWitt, K. (2023, February 14). HIV/AIDS health centers say Hochul's proposal could gut services for most vulnerable. Retrieved from https://www.wamc.org/2023-02-14/hiv-aids-health-centers-say-hochuls-proposal-could-gut-services-for-most-vulnerable

[4] Kennedy, C., Watts, M. (2023, January 2023) Tennessee to cut off funding to nonprofits for HIV prevention, testing, treatment. Retrieved from https://www.commercialappeal.com/story/news/health/2023/01/18/tennessee-cuts-funding-hiv-treatment-testing-prevention/69820175007/

[5] Laws, J. (2023, January 30). Tension in Tennessee: HIV Crisis Looms. Retrieved from https://www.hiv-hcv-watch.com/blog/jan-30-23

[6] Farmer, B. (2023, February 3). Why Tennessee is turning down millions of federal dollars for HIV prevention. Retrieved from https://www.marketplace.org/2023/02/03/why-tennessee-is-turning-down-millions-of-federal-dollars-for-hiv-prevention/

[7] CDC. 2022. Ending the HIV Epidemic in the U.S. (EHE).Retrieved from https://www.cdc.gov/endhiv/jurisdictions.html

[8] Straube, T. (2023, January 24). Tennessee Rejects “Free Money” From U.S. Government to Prevent HIV. Retrieved from https://www.poz.com/article/tennessee-rejects-free-money-us-government-prevent-hiv

[9] Kennedy, C. (2023, February 14). 'A public health crisis': What state's rejection of HIV funds could mean for Shelby County. Retrieved from https://news.yahoo.com/public-health-crisis-states-rejection-110047477.html?soc_src=social-sh&soc_trk=tw&tsrc=twtr&guccounter=1

[10] King, P. (2023, February 14). Shelby County leaders urge the state to keep federal HIV prevention funding. Retrieved from https://www.msn.com/en-us/news/us/shelby-county-leaders-urge-the-state-to-keep-federal-hiv-prevention-funding/ar-AA17uEkN

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.  

Increased HIV Infection Numbers Spark Concern

By: Ranier Simons, ADAP Blog Guest Contributor

One of the most influential and basic tenets in the fight against HIV/AIDS is prevention. Testing is an integral tool for prevention. It is imperative to identify people living with HIV who are unaware of their status, which is globally estimated to be around six million people.[1] Testing stops individual disease progression by getting people into treatment and curbs the spread of HIV by informing individuals of their status in hopes of influencing behavior modification regardless of status. With the exception of the Washington, D.C. area, whereby decreased testing was actually associated with increased HIV diagnoses,[2] testing was adversely affected by the COVID-19 pandemic. National data shows that in healthcare and non-healthcare settings, there was a 43% and 50% drop in the number of the Centers for Disease Control & Prevention (CDC)-funded HIV tests administered.[3] 

Photo Source: aidsmap

According to the city’s Annual HIV, Hepatitis, Sexually Transmitted Infections (STIs), and Tuberculosis (T.B.) Surveillance Report released on February 7, 2023, there were 230 new HIV diagnoses in 2021, up from 219 in 2019.[2] About 1.8 percent of D.C. residents, 11,904, are living with HIV. The current new diagnosis numbers are much lower than the peak of 1,374 new cases in 2007, yet the upward trend is concerning.[2] The COVID-19 pandemic resulted in the closing of many healthcare facilities and changes in the capacity of remaining centers to deliver care. As a result, people did not seek out their regular preventive health visits and lost access to places that previously provided convenient testing. Kaiser Family Foundation reports that D.C. has the most HIV cases per capita and nearly three times the national rate compared to U.S. states.[2] This historical trend marks D.C. as one of the places the CDC watches closely. Thus, observing the increasing trend could shed light on trends that may be reported nationally as time goes on.

Washington, D.C. officials aim to reduce new infections to 130 per year by 2030, with a plan to have 95% of all people aware of their status, with 95% of diagnosed people on treatment, with 95% of those reaching undetectable viral suppression status.[2] HIV disproportionately affects Black residents, who comprise about 44 percent of the population of D.C. but almost 75 percent of HIV cases.[2] In response to this data, public health officials are looking into ways to reduce the stigma associated with prevention, testing, and treatment. Additionally, efforts to reduce socioeconomic barriers to HIV prevention are being explored.

Having stable housing is one crucial factor that contributes to improved health prevention. Stable housing enables people to have a home base to maintain their lives. Having a consistent place to stay makes it easier to maintain regular habits of antiretroviral treatment or PrEP. Stable housing also increases a sense of safety and community, giving people a support network. To examine the result of stable housing on the unhoused, in 2022, D.C. started a pilot program. The federally funded program paid for housing for one year for seven at-risk residents requiring them to set aside 30 percent of their income, undergo employment training, stay on PrEP, and participate in intensive case management.[2] The goal is to have all seven at a point where they can live independently. All seven have stayed in the apartment building and have maintained their PreP treatment.

Photo Source: aidsmap

To further reduce barriers to testing caused by the pandemic, D.C. started a free at-home HIV and STD testing program in June 2020. D.C. residents can request an at-home testing kit, mail it in and see their results on a secure online portal. This is in addition to free walk-in testing available at any Labcorp patient service center, even if someone does not have insurance or their insurance does not cover lab testing.[4]

As people slowly begin to resume pre-pandemic levels of preventative care behaviors, medical professionals are predicting continued increases in HIV infection numbers. It is imperative that all jurisdictions nationally examine their populations with the same rigor as D.C. has done to curb increasing rates of HIV infection. D.C. is just a microcosm of the nation at large.

[1] Ong, J. J., Coulthard, K., Quinn, C., Tang, M. J., Huynh, T., Jamil, M. S., Baggaley, R., & Johnson, C. (2021). Risk-Based Screening Tools to Optimise HIV Testing Services: A Systematic Review. Current HIV/AIDS Reports, 19(2), 154-165. https://doi.org/10.1007/s11904-022-00601-5

[2] Portnoy, J. (2023, February 7). HIV diagnoses up slightly in D.C. after testing dipped during pandemic. Retrieved from https://www.washingtonpost.com/dc-md-va/2023/02/07/hiv-dc-pandemic-testing-disparities/

[3] CDC. (2022) HIV Testing Dropped Sharply Among Key Groups During First Year of COVID-19 Pandemic. Retrieved from https://www.cdc.gov/media/releases/2022/p0623-HIV-testing.html

[4] D.C. Health. (2022). Get Checked DC. Retrieved from https://www.getcheckeddc.org/

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.  

FDA to Ease Restrictions on Blood Donations From Gay Men

By: Ranier Simons, ADAP Blog Guest Contributor

About 6.8 million people in the United States donate blood annually, and about 13.6 million units of whole blood and red blood cells are collected.[1] Not only are whole blood and red blood cells used to treat people, but blood components such as plasma and platelets are also used for treatment. Because blood and platelets cannot be manufactured, ensuring the safety and efficacy of the blood supply is paramount. Security includes protocols to keep the blood supply free from disease, primarily focusing on reducing the risk of HIV transmission through blood and blood products. Historically, these protocols included permanently barring or discouraging men who have sex with men (MSM) from donating blood. As a result of scientific data domestically and globally, in January, the U.S. Food & Drug Administration (FDA) released guidance planning to ease those previous rules that had been in place for decades.[2] 

Photo Source: The Boston Globe

The emergence of HIV/AIDS in the early 1980s irrefutably changed the blood system landscape. Initially, the disease was identified in MSM, associated with people who used intravenous drugs and people who exchanged sex for money. Before screening tests were created to test donor blood, the FDA was tasked with figuring out how to reduce the risk of HIV transmission through blood and blood products. In 1983, the FDA created official guidance and recommendations for educating donors about risk factors for AIDS. Blood collection agencies started using risk questions and rejecting blood from specific donors based on those factors. These measures helped reduce disease transmission, yet thousands of people still contracted HIV from blood transfusions before testing was available.[3]

HIV was identified as the cause of AIDS in 1984, which spurred research into the creation of donor blood screening tests. The first FDA-approved screening tests for antibodies against HIV occurred in 1985.[3] In September 1985, it was first recommended by the FDA that no male donors who had ever had sex with another man from 1977 onward would be allowed to donate blood.[3] In 2010, an Interagency Blood, Organ & Tissue Safety Working Group (BOTS Working Group) consisting of representatives from the Center for Disease Control and Prevention (CDC), Health Resources and Services Administration (HRSA), National Institutes of Health (NIH), HHS Office for Civil Rights (OCR), Office of the Assistant Secretary for Health (OASH), and FDA, was put together to investigate scientific evidence-based ways to change the policy.[3] Many different studies were conducted. The results from those studies, in combination with data from countries that had already shortened the indefinite deferral period for blood donation by MSM, resulted in the FDA recommending a 12-month deferral instead of a permanent ban in December 2015.[3]

The evolution continued. In 2014, FDA launched the Transfusion Transmissible Infections Monitoring System (TTIMS). It was to monitor the rates of relevant transfusion-transmitted infections (RTTIs) detected among blood donors before and after policy changes.[3] Two years after the 12-month referral was initiated, data showed there was no increased risk to the U.S. blood supply for HIV. Over time, other countries, including the United Kingdom and Canada, moved to a 3-month deferral recommendation with no reports of adverse outcomes from the change. Using the results from continued surveillance, the evidence from other countries, and the ongoing usage of testing that can detect HIV, HBV, and HCV within three months of initial infection, the FDA updated the recommendation to a 3-month deferral period for MSM in April 2020.[3] In addition to MSM, the proposal to move the indefinite ban to 3-month referral for people who exchanged sex for money and those who used non-prescription intravenous drugs was also instituted.[3]

Photo Source: Medical Express / Health Day

January 2023 has brought a new proposed policy change that is not wholly focused on MSM. As a result of ongoing U.S. research, in addition to epidemiological data from other countries that have already changed, the FDA is proposing to move to a gender-inclusive risk-based, individual behavioral assessment for blood donor referral. The new guidance suggests asking all donors the same questions regardless of gender. 

Donors, regardless of gender, would be asked if they have had a new partner or multiple partners in the past three months. If yes, they will be asked if any sex was anal. If the answer is yes, that person would be deferred from donation for three months. If the sex were vaginal only, they would be allowed. Donors are also to be asked about PrEP usage. If donors use oral PrEP, they will be deferred from donation for three months from their last dose. If they use a long-acting injectable form of PrEP, they will be postponed for two years following the most recent injection. Data shows that the usage of PrEP may delay the detection of HIV by currently licensed screening tests for blood donations, potentially resulting in false negative results in infected individuals.[3] Individuals living with HIV who have reached undetectable status with antiretroviral treatment are permanently denied blood donation. While undetectable status means untransmissible through sexual contact, antiretroviral drugs do not entirely eliminate HIV from the body; thus, transfused blood could still potentially transmit HIV infection.[3] The above questions highlight the newly proposed questions and deferral recommendations. To view a more exhaustive explanatory list, please view the FDA guidance document here.

Changing the guidance to ease restrictions on MSM and other risk-identified groups will potentially help with the nation's blood supply shortage. Most importantly, the move to gender-inclusive individual risk assessment will change the future research paradigm to be scientific and evidence-based to consider the fluidity and intersections of all genders and sexual preferences.

[1] American Red Cross. 2023. U.S. Blood Supply Facts. Retrieved from https://www.redcrossblood.org/donate-blood/how-to-donate/how-blood-donations-help/blood-needs-blood-supply.html

[2] Firth, S. (2023, January 27). FDA to ease restrictions on blood donations from gay men. Retrieved from https://www.medpagetoday.com/washington-watch/fdageneral/102863

[3] FDA. (2023, January). Recommendations for Evaluating Donor Eligibility Using Individual Risk-Based Questions to Reduce the Risk of Human Immunodeficiency Virus Transmission by Blood and Blood Products. Retrieved from https://www.fda.gov/regulatory-information/search-fda-guidance-documents/recommendations-evaluating-donor-eligibility-using-individual-risk-based-questions-reduce-risk-human

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.  

Colorado's Negligence: Drug Importation Continues to Miss the Mark

By: Jen Laws, President & CEO, Community Access National Network (CANN) & Board Co-Chair, ADAP Advocacy Association

Since 2019, Colorado has been trying desperately to put together a plan to import medications from Canada, known as a Section 804 Importation Plan (SIP) when applying for approval from the U.S. Food and Drug Administration (FDA). In December 2022, Colorado submitted its plan to the FDA (Colorado, 2022), thus joining Florida in a misguided state importation effort. Right now for patients living in both states, only the FDA is positioned to protect them from an ill-advised public policy.

Photo Source: Yahoo! News Canada

For what it’s worth, Florida’s plan has not yet been approved as that state continues to go back and forth with the FDA over clarifying language. The process has dragged on so long that Florida sued the FDA to speed things up (Kansteiner, 2022). Regardless of anything else that may or may not happen in either Florida or Colorado (protip: lots of things are not going to happen), Governor Polis’ promise that Coloradans are going to begin enjoying the fruits of this labor “soon” is just not going to be a thing. But beyond process, there’s some serious problems with this idea of importing medications from Canada and the idea that it will save Americans any dollars at the pharmacy counter. Those problems have been around since the idea of importation was introduced a government “solution” nearly 20 years ago and the answers to these problems has not changed or improved.

Back when the United States started toying with importation as an idea, the Canadian government balked and even introduced legislation to block the possibility. While that legislative effort failed, it’s being revived now as Colorado and Florida push to have access to the drug supply of a country with one tenth the size of the population of the United States. Outside of Canadian legislation, distribution agreements in Canada generally curtail what can and cannot be exported to other countries, a regulatory and enforcement move that neither the United States nor Colorado can do anything about. Canada’s biggest concern remains rooted in the potential for medication shortages to meet the needs of their own population, especially given the global issue of supply shortages on critically necessary medications.

It's not just the government of Canada or even manufacturers that remain concerned about the whole host of issues importation brings. Both the Canadian Pharmacists Association and the American Pharmacists Association have repeatedly cautioned against these proposals (CPhA, APhA, 2022). Despite what Colorado says these efforts will do, helping pharmacies isn’t in the reality of this effort. Targeting contracting tricks pharmacy benefit managers use to push out competition, particularly ridiculously low reimbursement rates and narrowing of network pharmacies, would go much further toward protecting independent pharmacies and ensuring patient access to them.

Photo Source: CPhA, APhA

Moving to another issue, the idea of “savings” offered under Colorado’s SIP are not rooted in reality. The first and foremost issue with any politician pitching “savings” on medication costs comes down to exactly “who” is going to enjoy these savings. Proposals to date do not establish “loss ratio” parity in medical and prescription insurance benefits – the Affordable Care Act (ACA) capped profits for medical coverage at fifteen or twenty percent but no such similar rule applies to pharmacy benefits or more commonly known as prescription drug coverage. These plans for “savings” do not necessarily translate to lower cost medications at the pharmacy counter for patients but for lower costs for governments and government programs – which should already be enjoying if those pharmacy benefit managers (PBMs) were actually fulfilling their promise of extending cost savings to their clients. They’re not and, respectfully, that’s precisely the issue most Americans care about – “What am I going to pay?” And it’s the answer politicians very carefully avoid giving.

An additional problem with Colorado’s assessment of savings is the SIP explicitly cites retail medication costs, not the costs the state government actually pays (which is often steeply discounted or enjoys rebates that bring those list prices down considerably). The calculation Colorado cites, very blatantly, is a lie.

Next, of the one hundred twelve medications Colorado specifies as targets for importation, HIV treatments are one of the highest cost medications on the list. We’ll get to why that’s particularly problematic for people living with HIV…now.

Safety security in the supply chain from importation does not align with the United States’ effort to ensure quality medications are getting to patients. The United States employs something called “track and trace” which requires electronic monitoring and labeling specific to the United States from the manufacturer throughout the entire chain of handling medications until they land in a patient’s hands. Importation from Canada (or anywhere else for that matter) would necessarily disrupt this system of tracking by requiring relabeling and Colorado, in its SIP, is challenging the FDA’s requirement to disclose when a medication is imported and from where (pg. 44-45 of the SIP). Colorado notes that while it disagrees with the relabeling requirements (which include notation when a medication is being imported without a manufacturer’s agreement), the state says it will not import medication without those same manufacturers agreeing. Generally speaking, manufacturers aren’t going to agree to participate in this program. They’ve already said so.

Photo Source: PhRMA

Safety and fear of counterfeit is such a significant concern that Colorado has promised to have a third party periodically sample medications to ensure they’re authentic. And fake HIV medications have already been an issue in the United States. Part of that comes down to this exclusive reliance on private entities (namely manufacturer) to identify counterfeit medications. ADAP Advocacy Association’s CEO, Brandon Macsata, has already detailed his own, personal, potentially life-threatening experience with counterfeit antiretrovirals. And loose guardrails which muddy up securing medication safety aren’t going to make these issues any better – indeed, they’ll expose more People living with HIV to this risk.

Florida, as the other state pushing hard for importation, already knows this is a bad idea. It’s why their SIP explicitly makes the importation program medications an experiment – to be tested on the poor and imprisoned, touting to effort at addressing the state’s medications needs for Medicaid and prisons. Florida’s plan is, quite frankly, a moral and ethical disgrace. Colorado’s is rife with gimmicks.

It's high time states and the federal government appreciate that the United States, despite our issues, enjoys one of the safest medication supply chains in the world. Few if any of us stop to consider if the medications we pick up from our pharmacy are legitimate. Let’s stop with importation proposals that, in reality, won’t help patients afford medications and only threaten our supply safety, our diplomatic relationships, and patients lives. Bringing down end-user costs of medications absolutely requires government action, but that action isn’t going to be importation.

[1] Colorado (2022, December 5). Section 804 Importation Program - Colorado's Drug Importation Program. Retrieved from https://hcpf.colorado.gov/sites/hcpf/files/Colorado%27s%20Drug%20Importation%20Program%202022%20Formal%20SIP.pdf

[2] Kansteiner, Fraiser (2022, August 31). In new lawsuit, Florida says FDA stalling on drug importation program. Fierce Pharma. Retrieved from https://www.fiercepharma.com/pharma/florida-tees-legal-showdown-fda-over-stalled-information-act-request-canada-drug-import-plan

[3] Panetta, Alexander (2022, December 8). Heads up, Canada: Colorado wants your drugs. CBC. Retrieved from https://www.cbc.ca/news/world/colorado-drug-imports-canada-1.6679290

[4] CPhA & APha(2022). American and Canadian pharmacist associations warn that drug importation policies could put patients at risk. Retrieved from https://aphanet.pharmacist.com/sites/default/files/audience/Joint%20Statement%20APhA%20and%20CPhA%20Importation%20.pdf

[5] Fein, Adam (2022, December 7). Drug Channels. Retrieved from https://twitter.com/DrugChannels/status/1600660225786318848?t=y1oWO_tiLVIuQIHrkOQmmw&s=19

[6] PhRMA (2023). Drug Importation. Retrieved from https://phrma.org/policy-issues/drug-importation 

[7] Partnership for Safe Medicines. (2022, September). Fake HIV Medication Reached U.S. Pharmacies—And Patients. Retrieved from https://www.safemedicines.org/2022/01/counterfeit-hiv-medications-in-the-u-s.html

[8] ADAP Blog (2020, November 19). How Drug Imports Can Endanger Patients. Retrieved from https://adapadvocacyassociation.blogspot.com/2020/11/how-drug-imports-can-endanger-patients.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.