North Carolina health officials yesterday announced a continuation of a waiting list for HIV-positive people who wish to obtain antiretroviral drugs through the state's AIDS Drug Assistance Program, the Raleigh News & Observer reports. The "indefinite holding pattern" was announced amid concerns from AIDS advocates that federal funding for such programs is not keeping pace with rising infection rates, especially in the Southern United States, according to the News & Observer (Avery, Raleigh News & Observer, 9/16). The federal-state ADAP program provides free or low-cost medication to low-income HIV-positive individuals who do not qualify for Medicaid or other drug assistance programs. Many state ADAPs are experiencing financial trouble due to high demand for the drugs, soaring prescription costs and state budget shortfalls. Fifteen states currently have waiting lists or access restrictions on their ADAPs (Kaiser Daily HIV/AIDS Report, 9/11). North Carolina's ADAP has some of the country's toughest eligibility requirements, requiring that individuals earn less than $12,000 a year. Other states' income cutoffs range from $17,000 a year to $44,000 a year for an individual. In the past, waiting lists have had negative consequences for both patients and the state health system, according to Steve Sherman, AIDS Policy/ADAP Coordinator with the state Department of Health and Human Services. The waiting lists wear down patients' health and can contribute to higher incidence rates because people who are not on treatment have higher viral levels and therefore a greater change of transmitting HIV. In addition, the state ends up spending more to hospitalize people than it would have spent paying $12,000 a year for their antiretroviral drugs, Sherman said (Raleigh News & Observer, 9/16).

New Funding?
The Senate earlier this month voted against an amendment, proposed by Sen. Charles Schumer (D-N.Y.), that would have provided additional funding for the Ryan White CARE Act, including an increase in funding for ADAP. According to the ADAP Working Group, ADAP will require a total of $214 million in new federal funding during fiscal year 2004 in order to restore stability and serve the people currently on waiting lists, and the amendment would have fully funded ADAPs (Kaiser Daily HIV/AIDS Report, 9/11). As a result, AIDS advocates expect funding to remain essentially the same, which Patrick Lee, an AIDS advocate from N.C. Counsel for Positive Living, said is "inadequate," according to the News & Observer. Lee this week is attending a meeting in New Orleans of the Southern AIDS Coalition, which hopes to call attention to the problem and ratify a manifesto calling for additional federal funding, the News & Observer reports. This year, the state is expected to receive more than $12 million in federal funding for its ADAP. Combined with $8.3 in state funding and rebates from pharmaceutical companies, total state ADAP spending will reach about $25 million, according to Sherman. According to Lee, the waiting list is "going to make it almost impossible to get new funding. As the number of people infected continues to grow, the amount of funding we have to ask for will be so ridiculous that it sets us up for complete failure" (Raleigh News & Observer, 9/16).

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