CQ

Waiting List Grows for Cash-Strapped AIDS Drug Programs, Coalition Says

By Anne L. Kim

January 21, 2010

A national coalition of HIV/AIDS groups says a drug assistance program for needy patients requires an additional $126 million in emergency funding for fiscal year 2010 to be able to continue to provide medication assistance for its current patients and also meet growing demand.

"The funding levels are far from what is needed," said Carl Schmid, deputy executive director of The AIDS Institute, concerning the AIDS Drug Assistance Program funded under the Ryan White HIV/AIDS Treatment Extension Act.

Schmid’s group is a member of the Federal AIDS Policy Partnership, which held a congressional briefing Thursday on the impact of state budget cuts on HIV/AIDS programs.

As of January 7, 2010, 540 people were on waiting lists for the drug assistance program in Arkansas, Iowa, Kentucky, Montana, Nebraska, South Dakota, Tennessee, Utah, and Wyoming, according to a survey by the National Alliance of State and Territorial AIDS Directors.

This number is "troubling," said Heather L. Hauck, Maryland’s director of Infectious Disease and Environmental Health Administration, who is also a member of the National Alliance of State and Territorial AIDS Directors. Two years ago, there was no waiting list, Hauck said.

According to figures provided by the AIDS directors group, this number has fluctuated since 2002, with a high of 1,629 in 2004 and a low briefly reaching zero in 2007. Since then, the number of people on the program’s waiting list has been increasing steadily, but has not risen to levels that ranged from approximately 540 to 1,600 between 2002 to 2004.

The current waiting list can be attributed to a combination of factors including state economic woes, a rise in new infections, aggressive testing efforts and people losing their health insurance, Schmid said.

States don’t have the money to contribute additional funds, and that’s why more federal assistance is needed, he added.

If emergency assistance isn’t provided for the current fiscal year, the program will need an additional $370.1 million in fiscal year 2011 for a total of $1.2 billion to meet needs, according to Schmid.

State budget cuts have resulted in a decline in funding for HIV/AIDS programs, particularly in preventive services, that have trickled down to the county and individual organization level while at the same time the number of patients needing HIV/AIDS services has increased, according to panelists who spoke at the briefing.

"We have a double whammy," Schmid said.

According to the survey by the National Alliance of State and Territorial AIDS Directors, state budget cuts have resulted in a reduction of more than $170 million from HIV/AIDS program budgets in 29 states.

In Los Angeles County, where an estimated 61,000 people live with HIV/AIDS, state funding for HIV/AIDS programs decreased from approximately $24.3 million in 2008-2009 to $13.4 million in the 2009-2010, according to Mario J. Perez, director of the county’s public health department’s Office of AIDS Programs and Policy.

The most significant cut proportionally was in prevention services, he said. Los Angeles and similar jurisdictions have seen a loss of about 73 percent of state funding for preventive services since 2006. "The prevention cuts really sort of compromised our efforts," Perez said.

And while the county kept its HIV counseling and testing programs fully intact, it made cuts to other programs like its peer support and case management services, he said.

For the organization AIDS Project Los Angeles, state budget cuts have meant cuts to the organization’s wellness center and home health services as well as salary freezes, said Phillip Curtis, the organization’s director of government affairs. But cuts to preventive services are nothing new — something that has been "peeling away over time," Hauck said. "We’re really again at the level where we’re making very hard decisions about where we invest our HIV prevention resources at this point."