For Americans with HIV, there are many obstacles to successful treatment

The Clinton Health Access Initiative — a branch of the former president’s charitable foundation — is in the process of creating a single portal to these more than half-dozen drug company programs. Patients — or, more often, their case managers — would have to fill out a single application, which is far simpler than what they do today. The program, managed by a new foundation called HarborPath, is opening pilot projects in five Southern states this month.

Texas is one of them. For Paula McNeely, the program can’t come a moment too soon.

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A photographic history of the AIDS epidemic in the United States.

She is a 38-year-old case manager at the Tarrant County Public Health Preventive Medicine Clinic in Fort Worth. She has worked there for 11 years. The clinic cares for 800 HIV patients. Fewer than half have health insurance. Each day, she spends about three hours helping them fill out applications to the Texas ADAP or the many pharmaceutical company programs.

“It’s pretty time-consuming,” she said. “I know that other patients who don’t have access to case managers go without the medicines. But we don’t ever let patients fall through the cracks.”

Falling through the cracks — that’s America’s AIDS problem.

Thomas Decker, 59, knows it and is determined not to become one of the statistics.

He was infected more than 20 years ago. He started antiretroviral therapy in 1997, went off it for two years in the early 2000s and then back on.

In 2009, the printing company in Northern Virginia where he worked closed down. For the first time in 30 years, he was without health insurance. With the help of the Arlington County health department, he began to get his medicines through Virginia’s AIDS Drug Assistance Program.

A year later, however, he was dropped when the state changed the ADAP eligibility rules in order to save money. (His CD4-cell count was normal, indicating his immune system wasn’t yet damaged.) With the help of the Inova Health System, a hospital chain in Northern Virginia, he turned to several pharmaceutical company programs and started getting his medicines for free.

“For me, it’s been seamless. But I’m not saying that’s been true for everyone,” he said recently. “It’s really important to live in an area where people are willing to help you work around obstacles.”

More obstacles remain.

Decker is still without health insurance. He recently learned of a federal program that will sell him insurance despite his “pre-existing condition” — his HIV infection — and will also provide his medicines. But to qualify, he must be rejected by a commercial insurance company. He’s just applied to Aetna and is looking forward to a letter of denial.

Decker acknowledged the irony that in America today, some people with HIV infections have to prove they’re too sick to be insured in order to get the drugs that will keep them healthy.