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Ensuring HIV treatment for all in the USA (ADAP Editorial)
  If you are an HIV-positive person living in the USA with a low income and no or inadequate health insurance, then AIDS drug assistance programmes (ADAPs) are an important and vital safety net that pay for your treatment. That was until recently.
State-run ADAPs, which currently cover around 191 000 Americans, are facing fi nancial diffi culties and are struggling to accommodate all those requiring assistance. As of May 12, 8100 people with HIV in 13 states were on waiting lists to join an ADAP-a record number. This is a shockingly high fi gure for the world's richest nation but, worryingly, the true scale of the crisis could be much bigger. Several states have been forced to tighten fi nancial eligibility criteria for their programmes. On July 1, in Illinois, for example, eligibility for the state's ADAP will change from a yearly income of US$54 450 to $32 670. And some ADAPs have even scrapped their waiting lists, effectively closing their programmes to new patients.
A mix of factors have led to this troubling situation, number one being the economic downturn, which has meant that more people with HIV are unemployed and are in need of assistance. Between June, 2008, and June, 2009, alone, the number of new people who relied on ADAPs for their medication increased by 80%.
The federal government has increased funding for ADAPs by 13% to $1·79 billion in the fi scal year 2010. State funding has also increased by 61% to $346·2 million. And, thanks to negotiations led by the ADAP Crisis Taskforce, 12 drug companies have lowered or frozen the prices of their HIV drugs. Still, these individual measures have not been enough to meet the increasing demand for assistance.
When President Barack Obama's major health reform-the Patient Protection and Aff ordable Care Act-is fully implemented in 2014, pressure on ADAPs will decrease, but until then federal and state governments need to find more funding for these essential programmes. And drug companies that have not reduced their HIV drug prices, or have not guaranteed long-term lowering of prices, must do so without delay. A collective eff ort is required to solve the ADAP crisis and ensure that every American in need of HIV drugs receives them. The Lancet June 4, 2011
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