Three HIV-positive people in West Virginia have died waiting to receive free antiretroviral drugs through the state's AIDS Drug Assistance Program since it stopped taking new patients nearly seven months ago, the AP/Charleston Daily Mail reports (AP/Charleston Daily Mail, 8/28). 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 ADAP programs are experiencing financial trouble due to high demand for the drugs, soaring prescription costs and state budget shortfalls (Kaiser Daily HIV/AIDS Report, 8/11). West Virginia's ADAP currently has 340 people enrolled in the program, and enrollment has been increasing over the past two to three years, Dr. Faisal Khan, director of the state's HIV/AIDS/STD program, said. However, the program does not have enough funds to cover everyone who needs treatment; 14 people remain on the program's waiting list. "People are now starting to die while they're on the waiting list," Khan said, adding, "It is a crisis that will continue." Federal funding for the program is based on the number of people in the state who have been diagnosed with AIDS, not on the number of people who use the program, according to the AP/Daily Mail (AP/Charleston Daily Mail, 8/28). According to the state Department of Health and Human Resources, 554 people have been diagnosed with AIDS in the state, a small number compared with other states. That number does not include HIV-positive people who have not yet developed AIDS or HIV-positive people who moved to West Virginia after being diagnosed and counted in another state (Heys, Charleston Gazette, 8/28).

Restrictions Felt Nationwide
The National Alliance of State and Territorial AIDS Directors today released its September 2003 "ADAP Watch," a listing of ADAPs that have implemented or anticipate implementing restrictions. Fifteen states currently have waiting lists or access restrictions on their ADAPs, and four more states anticipate having to impose new or additional restrictions on their programs in fiscal year 2003 (NASTAD release, 8/29). ADAP representatives from California, Florida, Maryland, Massachusetts, New Jersey, New York, North Carolina and Texas -- states that collectively account for 75% annual ADAP drug expenditures -- since March have been negotiating with representatives from Bristol-Myers Squibb, Roche, GlaxoSmithKline, Merck, Pfizer, Abbott Laboratories, Boehringer Ingelheim and Gilead Sciences to discuss ways of alleviating the budget shortfalls that state ADAPs are currently facing. Earlier this month, state and territorial health officials announced that they had negotiated about $65 million in annual price concessions from the companies for antiretroviral drugs supplied through their ADAPs (Kaiser Daily HIV/AIDS Report, 8/6). AIDS treatment policy experts have said that an additional $283 million is needed for ADAPs in FY 2004 to help the programs alleviate their restrictions. The Senate appropriations bill that funds the ADAPs includes a $24.7 million increase, "which will greatly fall short of meeting the demand of those in need of life-sustaining drugs," according to NASTAD. The group encourages the Senate to increase ADAP funding, according to the release (NASTAD release, 8/29).

New Prevention Initiative May Threaten Funding
Health departments around the country also are concerned about funding changes that could come with the new federal HIV/AIDS prevention initiative announced by the CDC in April. The new initiative urges more emphasis on identifying and counseling people who are already HIV-positive. "There are huge question marks about how this will be funded," Khan said, adding that if the federal government does not provide additional funding for its new prevention initiative, money may have to be pulled from other programs, which would be "self-defeating," according to the Charleston Gazette. NASTAD last month released a statement calling several parts of the new initiative "highly troublesome to health departments." Khan said that although the state's 13 community-based AIDS organizations are probably safe from direct budget cuts as a result of the new prevention initiative, cuts to other budget items for the HIV/AIDS/STD program are possible. The funding requests for next year are due in October, and state officials should know by the end of November or early December how much money they will receive from CDC, the Gazette reports (Charleston Gazette, 8/28).

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