The U.S. AIDS epidemic is at a turning point. It’s been there before, first during the Reagan administration, which hoped to ignore AIDS but was shaken up by celebrity deaths and such courageous public servants as Dr. C. Everett Koop. Then, in the mid-’90s, drugs were developed that made HIV a manageable disease, but Food and Drug Administration approval lagged science until patients took to the streets.
The new millennium brought opportunity to rescue desperate Africans and Asians with the treatments that were saving lives in Europe and America. Thanks to leadership from the AIDS activists and President George W. Bush, we launched ambitious international initiatives that offer hope to millions in despair.
Today we face another historic opportunity. Science has proven what many at the people doing primary care and others at the forefront of the epidemic have long suspected: HIV treatment is remarkably effective HIV prevention. A recent study from the National Institutes of Health has shown that treating HIV patients with antiviral drugs makes them 96 percent less likely to pass on the virus.
The public health implications are earthshaking: If we aggressively test for HIV and make treatment readily available, we can slash the rate of new infections. The Centers for Disease Control and Prevention estimates that new U.S. infections were 56,000 per year in 2006. That rate might be cut in half with more aggressive testing programs coupled with improved treatment access. Reducing new infections by half could save this country nearly $15 billion each year over the long-term.
Instead of making wise, cost-effective investments in AIDS testing and treatment, the Obama administration and Congress are being penny-wise and pound-foolish. The AIDS Drug Assistance Program (ADAP) provides drugs for as many as 200,000 patients. The number of people on waiting lists for ADAP ballooned from 99 in June 2009 to 2,939 in September 2010; 8,506 people were on the waiting list as of June 23. Additional thousands have been kicked out of the program or disqualified from joining because of program restrictions. It has literally become easier to obtain AIDS drugs in some African countries than in many states in this country.
Blame for failure to provide more vigorous and thorough HIV-testing programs lies with the government. The pharmaceutical industry must share blame for restricted access to treatment.
When the idea of treating the worldwide epidemic caught fire in 2000, the drug industry resisted. But, after recognizing the humanitarian crisis and the opportunity, it responded by lowering Third World HIV drug prices to where the poorest of the poor can be treated.
Today most U.S. AIDS patients are impoverished. To remain well, stay on their jobs and off welfare, many depend on ADAP. However, the prices the drug companies charge ADAP for a year’s regimen have escalated to $12,000 per patient, while federal and state funding for the program have failed to keep pace. The companies do offer rebates as well as patient assistance programs for those on waiting lists. The rebates are preferable because they allow treatment to continue through ADAP, which is more user-friendly than the patient assistance programs are.