The waiting list for the state's prescription program for impoverished and uninsured HIV and AIDS patients has been growing at a brisk clip recently, adding at least one person per day since the beginning of January. The drug program is seriously underfunded and the legislature continues to shirk a $3 million request from the Department of Health and Environmental Control, a request that has already been surpassed by the growing need.
South Carolina ranks an abysmal ninth in the nation for HIV infections and sixth for AIDS cases. Through the prescription program, the state provides about $885 in medicine to 1,300 people a month. Local and state facilitators say the static levels in funding aren't keeping up as patients live longer, new ones are diagnosed, and drug costs continue to climb. While the problem is recognizable, the solution is elusive. In the complicated world of state finance, it has basically been presented like this: DHEC can put feelers out to legislators that they need the money, but it's up to the legislature to create a supplemental spending bill that could include money for the drug program. Without the bill, the agency, local advocates, and HIV and AIDS patients can only sit and wait.
In a recent New York Times article, the South Carolina legislature got its butt handed to it in a comparison with neighboring states. North Carolina provides $11 million for its program, or 40 percent of the total cost. Georgia provides $12 million, or 26 percent of its drug program's total cost. South Carolina's contribution remains at $500,000, only 3 percent of the total cost of the program.
In budget requests to a House subcommittee, DHEC asked for $5 million in the next fiscal year, beginning July 1, to take care of the waiting list, but as the agency waits for money, the need for the program grows. At the end of the year, the waiting list had reached 370. Six weeks later, the list had grown to 421. Not only has the waiting list grown, but the number of people the state assists through the program has dropped by about 100 as spots are left unfilled when people die or find other means to pay for their medicine. This practice ensures there's enough money to take care of those already in the program.
The alternative for impoverished and uninsured HIV patients is an emergency program administered by pharmaceutical companies that's available for only the few states that have a waiting list. At the end of the year, that included South Carolina and Alaska, which has only 13 on its list.
The programs require HIV patients to fill out applications for individual prescriptions every 30 days. Typically these patients are taking at least three drugs at any time, making the monthly request process laborious and time-consuming for them, says Bradley Childs, executive director of Lowcountry AIDS Services.
"It takes a toll on them," he says.
With differing eligibility requirements, some patients also may not be getting the drugs that they need.
Rep. Joseph Neal (D-Richland), a member of the state's House Ways and Means Committee, is leading an AIDS Drug Assistance Program crisis task force to lobby the legislature for the funding.
"It's all about educating," Childs says.
That education should reach beyond ADAP to include other AIDS-related programs that are coming up short in state dollars, Childs says, including HIV prevention education that gets no state money.
"The state of South Carolina receives a million dollars in federal money a year (for prevention education) and contributes nothing," Childs says. "People think that if they don't talk about it, it goes away. But, instead, it festers."
While he doesn't doubt that news of the waiting list was just slow to reach some legislators, Childs says that for others, ignorance was bliss.
"I think for some, it was a choice not to know," he says.
The legislature can't be held solely culpable for the shortfall. Federal funding for the drug assistance program has been woefully inadequate for years, says Lynda Kettinger, director of DHEC's STD and HIV program.
There is hope that a change in how federal dollars are doled out will mean an infusion for South Carolina. Changes will account for a state's HIV population, not just AIDS patients, when it comes to federal dollars, Kettinger says. There's also an expectation that the allocations will be modified to account for the modern-day reality that HIV and AIDS are no longer "big city diseases," Childs says.
"When the epidemic first started, you saw it in the larger cities, so that's where all the dollars went," he says. "Now that it has spread into the rural areas and smaller cities, those dollars have not been redistributed."
Last year, Florida had $6 million in federal money that went unspent, Childs notes. "That would take care of our problem."
National AIDS activist groups released statements earlier this month criticizing the $21 million President Bush is proposing in his 2008 budget for AIDS medicine and services through the recently renewed Ryan White CARE Act, which distributes the money to states.
"It is woefully duplicitous for the president to have signed The Ryan White Care Act into law in December and then fail to allocate sufficient funding to meet the growing need in our country," says Rebecca Haag, executive director of the AIDS Action Council. "We have said from the start, and it remains true today, that more money is needed; the needle is pointing in the wrong direction, and lives of people in this country are at stake."
The lives of the people in South Carolina were in the spotlight on Tues., Feb. 20, as members of the AIDS drug taskforce called on the legislature to approve the $5 million budget requested for the drug program, as well as $3 million for other support services, including testing and transportation.
Last week, the legislature excitedly approved more than $130 million for the new port road, $23 million for school buses, $3.7 million for ice storm repairs, $3 million in airplane hangar repairs, and $4 million for a regional water plant.
All of these projects are important for one reason or another, but will the legislature work so efficiently to find the money for the AIDS drug program? Not surprisingly, we'll have to wait and see.