Will Obama’s National AIDS Strategy Help States Struggling To Afford Medication?

The White House unveiled its long awaited National HIV/AIDS Strategy this afternoon with the twin goals of cutting new infections in the U.S. by 25% over the next five years and ensuring that 85% of patients begin receiving care within three months of diagnosis. HHS Secretary Kathleen Sebelius described the strategy as, “not a white paper,” but a “detailed action plan” that calls on federal agencies, the states and community organizations to act in a coordinated manner to help reduce the number of people who become infected with HIV, increasing access to care and optimizing health outcomes for people living with HIV, and reducing HIV-related health disparities.

The LA Times’ Noam Levey gets into some of the details, noting that the biggest sticking point is the lack of new federal funding:

Obama’s strategy includes broad goals as well as dozens of directives for the Centers for Disease Control and Prevention, the Agency for Healthcare Research and Quality, and other federal agencies. Those steps include developing standards to evaluate care, investigating community programs to see whether they’re effective and simplifying grant applications. The Bureau of Prisons would expand HIV screening of inmates, and the Justice Department would fast-track investigations of discrimination involving those with HIV.

The report warns about the need for more attention on gay and bisexual men, who account for more than half of new infections annually, and on African Americans. […]

But the president’s strategy contains no additional federal spending. That drew pointed criticism from Michael Weinstein, who heads the Los Angeles-based AIDS Healthcare Foundation, a leading provider of medical care to those with HIV/AIDS. “It’s really shocking,” Weinstein said. “We have thousands people on a waiting list for AIDS drugs. So, the whole premise is that we are going to test more and treat more. But we don’t have the capacity. Why should anyone be tested if they don’t have access to medications?

That’s the sense I got from Julie Scofield, director of the National Alliance of State and Territorial AIDS Directors (NASTAD), which “represents the nation’s chief state health agency staff who have programmatic responsibility for administering HIV/AIDS” programs. She praised the document for identifying the communities at highest risk for HIV and acknowledging the “urgency of addressing the epidemic among gay and bisexual men of all races.” “We’ve seen past efforts that want to continue to suggest that everyone is at equal risk for HIV, and it’s not true,” she told me.


She also said the report broke new ground in calling for greater coordination across federal agencies, noting that “that is very much needed.” “We’ve got too many funding silos with too many different reporting requirements and evaluation measures that make these programs extremely difficult and complex to administer at the state and local level.” But Scofield acknowledged that the strategy — while itself admits the need for greater investment — will not do enough to help states struggling to meet the needs of AIDS patients. Last week, HHS announced that it would provide $25 million more to help states buy needed medicines, but advocates argue that this is not enough. Across the country, states have narrowed eligibility, limited enrollment or restricted the drugs for which they will pay to help deal with growing budget deficits. Here is just a sampling:

SOUTH CAROLINA: “The current version of the state budget for the 2010–11 fiscal year, which starts July 1, eliminates all money for the Drug Assistance Program, which provides life-saving HIV/AIDS drugs to the state’s low-income, uninsured and underinsured residents. The budget also eliminates all money for the state’s HIV/AIDS prevention programs.”

OHIO: “The Ohio Department of Health cut 320 people from HIV-medication assistance, instituted a waiting list and made other cuts yesterday to a program that serves about 5,000 people who have the virus.”

FLORIDA: The state Department of Health will start a waiting list for the program on June 1, will reduce the number of covered drugs in the program on Aug. 1, and will study other cuts, said Tom Liberti, chief of the department’s HIV/AIDS bureau.”

“I’m really hoping that the administration and all of us in the community will use this to mobilize for additional resources.” “There is no question that we need more funding to accomplish this strategy, but I’m at this point thinking, I rather use it to mobilize and garner that support and turn to the Congress and ask for those resources than try to shoot down this strategy without even trying to garner the resources to make it successful,” Scofield said.


Federal agencies will now have 150 days to submit a report on operationalizing the strategy and the federal agencies will begin to work with state and community groups to meet the goals of the plan. But going forward, Scofield expects that the plan will “inform the President’s next budget request, and next budget request, and next budget request.”