By last summer, the 2006 federal bucks for South Carolina’s AIDS Drug Assistance Program (ADAP) had already run out—and 400 HIV positive people soon found themselves on the country’s longest state med wait list. Though case managers snagged antiretrovirals through pharma companies’ patient assistance programs, four wait-listed people died. “Nobody in the state seemed worried about getting me medication,” says Kiah Graham, 25, who relies on a patient assistance program.

The Feds weren’t entirely to blame. Though South Carolina has the nation’s fifth highest rate of new HIV infections, its legislators contributed a markedly low budget percentage, just $500,000, to ADAP last year (5% of North Carolina’s contribution). “There’s a lack of political will,” says South Carolina State Representative Joe Neal (D), who is pushing for more state ADAP funds. “People aren’t comfortable talking about AIDS in the south.” Indeed, due to rampant stigma, many South Carolinians do not get tested for HIV until they have progressed to AIDS.

The state legislature recessed from May to January and could not allocate emergency funds. National advocates soon converged on the state capitol, demanding that Governor Mark Sanford (R) cough some up before more people died. A Sanford spokesperson responded, “We have no discretionary or emergency funding powers,” but advocates say he could have asked the Department of Health and Environmental Control. As POZ went to press, there were still no additional emergency or legislature allotted funds.

For years, Congress has flat-funded ADAP, while the number in need grows. Two other states and Puerto Rico have wait lists, with several others predicting lists as funds dry up by fiscal year’s end. Lynda Kettinger, Director of the South Carolina Health Department’s HIV Division, says, “Many ADAPs are going to continue to face shortfalls without additional dollars.” Some states are finding funds elsewhere. West Virginia has eliminated its wait list with savings from the federally sponsored Part D plan, which covers Medicare prescriptions. South Carolinians, meanwhile, await a prescription for change.