Recession Forces States to Slash AIDS Drug Assistance Programs

In February, coalitions of North Carolina HIV/AIDS service providers, gay activists and health-care advocates met in Charlotte and Raleigh. The topic: fighting recent budget cuts in the state's AIDS Drug Assistance Program (ADAP). State officials also recently capped ADAP enrollment, and budget cutbacks still loom. "If that happens," says Jason Pauley (name changed), an HIV-positive Charlotte-area resident who depends on ADAP, "I could lose my benefits and my life."

Federal- and state-funded AIDS Drug Assistance Programs pick up the cost of expensive antiretroviral drugs and other medications for the low-income HIV-positive. Without these lifesaving pharmaceuticals, the virus can multiply, making the person not only sicker but also more contagious. ADAPs reach approximately one-quarter of all people with HIV/AIDS; approximately 60 percent are people of color.

But with soaring state deficits nationwide and rising HIV caseloads--particularly among Black people--budget reductions are hitting HIV programs and ADAPs especially hard, from North Carolina to California.

Lives in the Balance in North Carolina

Black, gay and only 29 years old, Pauley was diagnosed with HIV in 2006. He was approved for ADAP in 2008. "I'm working two jobs, and my insurance doesn't cover all my meds," he explains. "Without ADAP, just one bottle would cost more than $700 a month. I couldn't afford that."

Yet in September 2009, North Carolina's HIV/STD Prevention and Care Branch cut $3 million from its budget by slashing its AIDS-drug inventory--a move that it claims will not affect ADAP-patient care. In January it froze ADAP enrollment at about 4,400, according to the Greater Raleigh News & Observer, even as unemployment has spiked and thousands have lost health benefits, thus increasing demand for ADAP services. A year ago about 4,000 people had relied on ADAP, and state legislators had allocated $11 million for the program. But that was only about half of prior years' budgets. If not already enrolled, Pauley would have been placed on a waiting list, which North Carolina GLBT publication qnotes reports already has 120 names on it.

The budget rollbacks come at a critical time. Newly reported HIV/AIDS cases have jumped some 54 percent in Charlotte-Mecklenburg County, home of Charlotte, the state's largest city. The seroconversions are overwhelming Black men who have sex with men, according to qnotes.

Pauley says he recently received a letter from the state about potential cuts in funding and is worried. "ADAP is a lifeline," he says. "Cutting people at this time...man, that's like a death sentence."

California Struggles to Provide HIV/AIDS Services

But North Carolina's challenges pale in comparison with those of the nation's largest state, California, where ongoing battles over the budget and threatened lawsuits have played out like a soap opera.

In the summer of 2009, the Golden State faced a $24 billion deficit. To meet the shortfall, Gov. Arnold Schwarzenegger's health-care budget reductions targeted "everything [AIDS-related,] from housing and medical treatment to access to drugs and prevention services," wrote the Bay Area Reporter. The governor's original proposal chopped $68 million from state HIV programs and $12.3 million from ADAP. Such decreases would have had a domino effect, causing the state to lose some, if not all, of its grants from the federal Ryan White HIV/AIDS Program as well as from the Centers for Disease Control and Prevention. Thirty-five thousand Californians, many of them Black or Latino, would have lost access to HIV medications.