HIV Budget Cuts: A Life-or-Death Matter

Facing budget shortfalls, states are cutting medicine funds for low-income HIV patients -- and a coalition of black church folks is fighting back.

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Protesting AIDS-treatment budget cuts in 2009 (David McNew/Getty Images)

This month marks the 30th anniversary of the first reported cases of HIV/AIDS in the United States, an occasion that has prompted reflection on advances made in fighting the epidemic. Antiretroviral drug treatments have transformed the virus in this country from a fatal disease to a manageable chronic condition. HIV transmission to newborns has been virtually eliminated. The national infection rate has declined by 60 percent.

Of course, the epidemic continues despite the successes -- especially among African Americans, who account for nearly half of the nation's new HIV infections. And recent economic challenges actually threaten to roll back decades of progress, as cash-strapped states reduce access to lifesaving medicine for thousands of HIV patients.

Facing budget shortfalls, 17 states have scaled back AIDS Drug Assistance Programs (ADAPs), which help about 174,000 poor or uninsured patients pay for expensive HIV medication. Through lowered income-eligibility thresholds or direct funding cuts, HIV-positive people have been thrown off insurance rolls, and a record high of 8,111 are on waiting lists (pdf) for antiretrovirals and other drugs. The actual need is likely greater, since some states have eliminated waiting lists altogether.

The federal government pays for most of ADAP funding, supplemented by states. But the contributions have not kept pace with a demand that has only increased with rising unemployment as more Americans lose their health insurance. AIDS activists say that while they understand the challenge of both federal and state budget constraints, medication that thousands depend on to stay alive is a terrible place to look for savings.

"The budget is not just a fiscal document but a moral document," Raphael Warnock, senior pastor of Atlanta's Ebenezer Baptist Church and chair of the Black Leadership Commission on AIDS of Metro Atlanta, told The Root. "It is a statement about what we the people view as important, and who we think is unimportant. Too often our deficits are balanced on the backs of those who can least afford it."

The Funding Fight

Spilling with 1,599 people, the ADAP waiting list of Warnock's state of Georgia is the second-longest waiting list in the country. He and other local activists find it particularly galling, then, that the state recently cut $100,000 from its program.

Officials from the Georgia Department of Community Health say that they're doing the best they can with insufficient federal funding to help them cover newly eligible patients. With the average cocktail of HIV/AIDS drugs costing $12,000 a year per person, it's a tall order for a cash-strapped state.

To help bridge the wide coverage gap, Georgia is relying on charity programs in which pharmaceutical companies donate medication. The majority of people on Georgia's waiting list are being served by them, but it's an unreliable, quick fix, which depends on whatever donations they can get.

Florida, which has the nation's longest ADAP waiting list at 3,520, is also leaning on assistance from pharmaceutical companies to cover most of their frozen-out patients. As a possible solution for trimming their list, state officials are considering cutting in half the income eligibility for their program, to $21,780 or less. The decision is still pending. "We are currently covering as many patients as we can with the funds that are available," Jessica Hammonds, press secretary for the Florida Department of Health, told The Root.

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