The economic downturn has hurt funding for HIV/AIDS drug subsidies for life-sustaining programs that provide antiretroviral drugs to patients who cannot afford them. In a July 1st article by Kevin Sack in the New York Times, there are eleven states that have closed enrollment to the program including Florida, with the third highest number of people with HIV/AIDS after California and New York. The lack of drugs can cause people who are HIV positive to develop full blown AIDS, increase transmitting the virus, and require expensive hospitalizations. Other measures include paring back the number of drugs on the approved formulary and placing patients on waiting lists to receive necessary treatment.
It is a stark reminder that AIDS is still a major public health issue, not only in developing countries in sub-Saharan Africa, but in communities across the United States. To get a better perspective in my own home town of Tacoma, WA, I asked Duane Wilkerson, Executive Director of the Pierce County AIDS Foundation how bad the problem was here. Duane gave me the reality on the ground in 2010.
GxP Perspectives: Does the cutback in funds mentioned in the NY Times article impact local agencies such as the Pierce County AIDS Foundation (PCAF)?
Duane Wilkerson (DW): Washington State is a little luckier than some states. People who are diagnosed with AIDS are able to get AIDS drugs in a variety of ways. Through the state ADAP program and different insurance options for drug coverage, no one in Washington State goes without AIDS drugs who need them.
GxP Perspectives: How have the current economic problems impacted non-profit agencies like PCAF?
DW: We are seen cutbacks in prevention more than client services. Because of the State budget crisis combined with a reduction from CDC for prevention services, several of our prevention contracts have been reduced from the original award levels.
GxP Perspectives: Have you seen an increase of clients who had previously stabilized their healthcare regimen?
DW: Yes. We saw an increase of 25% in 2009 from 2008. Much of this increase represented clients who had not needed our services for awhile, but came back because of the effect of the economy on their economic situation and consequently their health status.
GxP Perspectives:What is the most cost-effective way to use funds for the treatment/prevention of HIV/AIDS?DW: This has answers at several layers. First prevention is clearly the most cost-effective strategy. If you compare the cost of an effective, evidenced-based prevention program per person to the cost of a lifetime of medical/health/drug care for someone who is living with AIDS, you will see a huge difference. Within effective, evidenced-based prevention programs, group-level interventions are consistently evaluated as being the most effective and cost effective. One-on-one level programs are very cost/labor intensive, though some are very effective; community-level programs are often not as expensive, but affords very little program effectiveness in critical areas of behavior change (e.g., reducing sexual partners, using condoms more consistently, etc.). Treatment programs, started early in the progression of the disease can be cost effective (compared to later initiation of treatment), in they can keep the viral load at a much lower level for much of a person’s life; allowing them to live longer and with better health.
GxP Perspectives: Are clinical trials the answer to the AIDS pandemic? Is there a magic bullet in the works?
DW: Clearly not yet. Will they ever be? It seems a moot question for me at the moment. There have been so many “promising” research trials, in the last ten or more years, that have cost enormous amounts of money. To date, none of them have been successful. Certainly we can’t wait or count on a magic pill. We must increase the prevention efforts because they have been shown to work.
GxP Perspectives: Readers of the Blog are from across the country and are also in international locations. I know that local organizations need funds but how can people help out on a national or international level?
DW:I think one of the most important ways to contribute to (ending) the epidemic, on the national and international level ,is getting involved in policy decisions that guide how prevention is done. For example, in the U.S., one of the most successful behavioral interventions that we know of is needle/syringe exchange. There is no serious debate in the field that this works, and works well. Yet because of political decisions the U.S. government will not fund exchange programs with any federal funds. In addition they put these restrictions on funds for international efforts (through PEPFAR), along with other political motivated restrictions such as not funding any program that also provides family planning services. These restrictions have nothing to do with good public health practices and everything to do with politics.
GxP Perspectives: What else should we be doing about the AIDS pandemic?DW: In the U.S. we can keep the issue of HIV infection in the forefront of public health concerns. In a country which has no attention span to speak of, too many people assume it is no longer a problem. This despite the fact that 56,000 new infections are still occurring in this country each year. Another important contribution would be to be open and public in the support of people who are HIV infected. Stigma and discrimination are still very much alive and contribute to the pandemic through ignorance, fear, and oppression of those who are infected. Finally you can be tested if you have engaged in any of the risk behaviors that can transmit HIV (e.g., unprotected sex with a partner whose HIV status is unknown, using unsterile needles for any kind of reason, but particularly injection drug use).
GxP Perspectives: Why is it important to society that people who are HIV positive receive these expensive drugs?
DW: Because it has a direct impact on public health and the economy. People who are on anti-viral medications (HAART therapy) have a lower viral load (the amount of the HIV virus in their blood system). This in turn makes them less able to infect others compared to those with high levels in their blood. Fewer infections will occur with more HIV infected people on good medications. This then has obvious economic implications related to the cost of treated each person who is HIV positive.
AIDS.GOV for additional informating on HIV/AIDS
And on another issue requiring our attention:
Update: NIH has provided funding for ten international malaria research centers. Read the 8 July 2010 Press Release