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Why does S.C. have a short fall of ADAP funds?
• HIV drug therapy has increased both the life-expectancy and cost of care for persons living with HIV. Nearly 75% of early HIV care costs are for HIV medications, until a person develops AIDS then other drugs and hospitalization costs are the largest portion of care costs.
• Federal funding for AIDS Drug Assistance Programs (ADAPs) have not kept pace with the demand for medications. Many ADAP programs across the country and in S.C. face budget shortfalls. Other Southern states invest much more state funding in ADAP than S.C.: NC - $12 M; GA - $11M; TN - $3M; and AL - $5M. SC - $500,000.
• The South has greater challenges for all HIV services due to greater poverty, more rural, less city/county and private funding, and reduced federal Ryan White dollars comparatively. It costs more to provide care services for persons who are indigent and living in more rural areas.
• Many persons are with HIV are uninsured or low income who must rely on Medicaid, Medicare, disability insurance, federal Ryan White Care Act, and the AIDS Drug Assistance Program (ADAP) to receive necessary treatment.
• Most Federal funds for HIV medical care are allocated to states based upon where a person was diagnosed. Many HIV-infected persons are diagnosed in large urban areas and then return home to rural areas for family support (Southern State Manifesto, 2003). S.C. does not get its equitable share of limited federal funds to support HIV care for persons who have come here since their initial diagnosis. Example: Of 15,865 persons living with HIV at end of 2005,
2, 273 were diagnosed out of state and have/are receiving care in S.C. but are not counted in the formula for our Ryan White funding.
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Why should the state provide this funding?
• HIV costs our state more than $6 billion ($151 million in medical care and $5.7 billion foregone earnings in 2002).
• If South Carolina is going to move forward with economic development and improving the health of our families, we must address HIV (sickness has a cost). It makes good business sense, good economic sense to provide funds for services that can reduce these costs.
• One in four people in S.C. are on Medicaid and the number continues to grow as poverty rates increase. Medicaid is the largest source of public funding for HIV medical care. Medicaid paid for half all S.C. HIV-related hospitalizations (51%) in 2004.
• The longer S.C. waits to fund early HIV treatment and care, the more it will cost our state: increased unrecovered hospital costs, more Medicaid costs, less healthy workforce especially in more economically challenged counties. And, increased employer/private insurance costs for hospitalizations will occur from cost-shifting to cover indigent HIV care charges, e.g. mean chargein 2004 for uninsured patients was $32, 980 vs $45,946 for private insurance patients (SC Hospital Discharge Summary data). While the number/type of procedures may be more with private insurance patients, these are not likely to account for all of the difference in charges.
• An untreated HIV-infected patient will progress more quickly to advanced disease (AIDS). Annual costs for patients with advanced illness can cost 2.6 times more than care for patients in earlier stages. This increased cost is due to hospitalizations and other needed medications.
• Estimated medication and care costs for persons with early disease are about $15,000 per person per year (includes $10,500 for annual HIV medication/ADAP costs per patient). Cost of late stage disease ranges between $30,000 - $40,000 per patient/per year. For an investment of about $15,000 per patient a year for early ADAP and care services we can save about $25,000 per year per patient in additional drug and hospitalization costs needed for persons with advanced disease.*
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How is HIV/AIDS different (than heart disease, cancer, etc) and why does it deserve more resources?
• HIV is a communicable, chronic disease – thus it is different than cancers, heart disease, diabetes, and other costly diseases handled by public health.
• Medications are preventive – persons with HIV can inadvertently transmit the virus to others; transmission reduces for people in care and on treatment as they have less virus in their system and can learn steps to protect others.
• Other diseases do not have the stigma that HIV does – it is still judged by many. Stigma prevents many persons from accessing and staying in care, and to get tested when they are in early stages of disease.
• HIV disproportionately impacts young adults and women of childbearing age. Most people with HIV in S.C. are in their 20’s – 40’s. This results in significant foregone earnings when people get sick and can’t work. The average person with HIV in our state will ‘lose’ 31 productive-work years and lose an average $454,465 of foregone earnings.
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How will the $8M be used? Is this one-time or recurring funds?
• $5 million recurring funds will supplement federal ADAP funds and eliminate the wait list. Note: $3,864,000 is needed to remove 368 persons from the wait list. The annual cost of medications per person averages $10,500 (368 x $10,500 = $3,864,000). However, to avoid instituting a wait list again in next year, DHEC 's FY08 budget request is for $5 million to meet demand for the program due to NEW cases diagnosed, more current ADAP clients living longer/staying healthy, and due to newer, more effective drugs being approved by FDA (which are likely to be more expensive.
• $3 million recurring funds is for core HIV services needed to ensure 100% access to ADAP/HIV treatments. S.C. received about $1 million less funding in 2006 for care services than in 2005. HIV providers need a base level of funds to care patients, determine when to begin treatments,and help minimize side effects of medicines. $3 million will be used to restore funding levels and provide core service needs for an increasing number of patients.
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What will be the return on our investment, and What are the estimated
savings to SC (short term and long term) if $8M is appropriated?
Investing in ADAP and HIV care will:

• Save money - for Medicaid, Hospitals, HIV care system, patients and families.
• Help get people back to work - and off of public assistance programs, Medicaid.
• Help prevent new infections - treatment lowers amount of virus.
• Lengthen and improve lives - more years of earning potential.<.li>
• Garner more federal funds - for match requirement if S.C. gets more Ryan White funds.