April 9, 2009

ADAP Struggles to Adapt in Tough Economy

More than 183,000 HIV-positive people were enrolled in an AIDS drug assistance program (ADAP) in the 2007 fiscal year, meaning that state ADAPs served at least one third of all people living with HIV in the United States who receive treatment.

This was the major finding of the 2009 "National ADAP Monitoring Project Annual Report,” a comprehensive survey of 54 out of the 58 jurisdictions receiving federal funding through ADAP. A key component of the federal Ryan White Program and operating in all 50 states—including the District of Columbia and U.S. territories—ADAP provides HIV medications to low-income people who have limited to no access to prescription drug coverage.

Authored jointly by the Kaiser Family Foundation and the National Alliance of State and Territorial AIDS Directors (NASTAD) and released on April 7, the report also found that the total ADAP budget reached $1.5 billion in the 2008 fiscal year, up more than $100 million from 2006. Despite most ADAPs finding a balance between a demand for services and available resources, three states—Montana, Nebraska and Indiana—were forced to create drug waiting lists.

“We know that states are experiencing difficulties because of the recession and their own state’s fiscal environment, so we know that ADAPs are going to be struggling to continue to provide medication to all of those who need their services,” said Murray Penner, report coauthor and deputy executive director of domestic programs for NASTAD, during a live webcast discussing the report.

Heather Hauck, director of the Maryland Department of Health and Mental Hygiene’s AIDS Administration, acknowledged that the efficiency of Maryland’s ADAP has been compromised because of a two-year budget deficit, requiring the state to reduce program funding despite a recent swell in enrollment.

“We’ve actually seen in Maryland a 20 percent increase in applications over the past two years for ADAP and a 60 percent increase in insurance enrollment at a time when we don’t have staff capacity to process either new applications or the recertifications that are required by a person every six months,” Hauck said

The 2006 reauthorization of the Ryan White CARE Act, which allocated $774 million in funding to ADAP in the 2008 fiscal year, ends on September 30 and must be acted upon by Congress in order to further extend the program. While it is unclear what specific changes or new developments this reauthorization would bring to ADAP, Penner is confident that the program will remain dedicated to keeping HIV-positive people thriving—even though, at present, the economy is not.

“We know that there’s a growing number of individuals living with HIV,” Penner said. “And ADAPs will continue to fill the gap between other programs.”

For information on ADAP in your state, visit statehealthfacts.org.

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