Dying for AIDS Drugs

Article excerpt

AIDS deaths, which increased ferociously in the United States throughout the 1980s and early '90s to a peak of 51,000 a year, suddenly abated in 1996 with the advent of antiretroviral combination therapy, a pricey and toxic brew that pulled people from their hospital beds like Lazarus. The relief was so intense that Andrew Sullivan announced "the end of AIDS," and researcher David Ho held out the hope of "eradication." It's often forgotten that AIDS deaths didn't fall to 9,000 a year by 2001 because of drug discovery alone. Those lives were also saved by a national commitment to provide access to the new medications. Throughout the late 1990s, Congressional support for the AIDS Drug Assistance Program was so strong on both sides of the aisle that appropriations exceeded presidential requests every year.

That has now changed. As the growing epidemic slams up against state austerity measures, ADAP has descended into crisis, and Republicans in Washington have refused to intervene. As of early October, more than 600 people with HIV have been denied access to medications through the program. Three states have tightened income eligibility requirements; five have restricted the list of drugs they cover, hampering competent treatment; thirteen have capped their programs, leaving the sick to languish on waiting lists. ADAP has served as the payer of last resort since 1987, providing HIV medicines for hundreds of thousands of people with HIV who lack insurance, or whose prescription benefits don't come close to matching the drugs' exorbitant price tag. Most ADAP users are the working poor, earning too much to qualify for Medicaid at jobs that don't provide health plans. Study after study has confirmed that the program saves public-health dollars by preventing expensive hospitalizations--and saves lives. But since February, two people have died while on the West Virginia waiting list, and five more just died on Kentucky's. There are no death tallies for those whose income puts them a few dollars above states' new restrictive income requirements.

Doctors, social workers and people with HIV describe a desperate scramble to gain access to lifesaving medications. In Alabama, the waiting list is 137, growing by nine or ten a week; to save additional dollars, the state just blocked coverage of the latest HIV drug, Fuzeon, a treatment used almost exclusively by those who have run dry of options. In Oregon, when the cash-strapped state temporarily eliminated some Medicaid prescription coverage, the ADAP waiting list ballooned; administrators responded by restricting covered drugs and instituting "cost sharing. …