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Obama to Release U.S. AIDS Plan as Waiting Patients Top Record

U.S.  Domestic Strategy Against AIDS
The White House displays a large red ribbon for World AIDS day in 2009. Photographer: Alex Ogle/AFP/Getty Images

The White House is poised to release the country’s first comprehensive domestic strategy against AIDS, as funds to prevent infections have failed to halt the epidemic in those most at risk of the disease, AIDS groups said.

Release of the National AIDS Strategy may come as early as today, fulfilling Obama’s campaign pledge to unify priorities among federal agencies and state partners, said Mitchell Warren, executive director of the New York-based AIDS Vaccine Advocacy Coalition, a nonprofit advocacy group.

HIV is contracted by about 56,000 Americans each year, and the mounting tally of people living with the disease shows no sign of stopping, according to the U.S. Centers for Disease Control and Prevention. While the U.S. attack on AIDS overseas has been led by the President’s Emergency Plan for AIDS Relief, or PEPFAR, domestic efforts are a patchwork of programs with little oversight, said Chris Collins, director of Public Policy at the American Foundation for AIDS Research, or amfAR.

“Our response to the global epidemic is squarely focused on outcomes, and we need to get to that point in our domestic responses,” Collins said. “In the United States we have a concentrated epidemic among a few populations but we don’t have a response that fits our epidemic.”

Obama’s new AIDS strategy needs to focus more on gay men and blacks, among whom new HIV infection rates outweigh other groups, Collins said.

Proposed Budget

The administration’s proposed 2011 fiscal year budget called for an estimated $27.2 billion in total spending for domestic and international efforts against AIDS, according to a report by the Kaiser Family Foundation, a Menlo Park, California-based nonprofit health research group. The foundation lists more than 20 U.S. programs or agencies that receive money to prevent the disease or help patients cope with it.

The number of poor patients on waiting lists to receive AIDS drugs rose to a record 1,781 patients on June 24, topping the previous high of 1,629 in 2004, according to the National Alliance of State and Territorial AIDS Directors. The U.S. strategy to be announced by the White House aims to ensure that prevention and treatment programs reach those who need them most and show measurable results, AVAC’s Warren said.

State governments facing budget crises have curtailed funding for the AIDS Drug Assistance Program, or ADAP, just as U.S. guidelines were broadened to start treatment earlier, according to the alliance of state directors. About 125,479 patients received medicine from the program last year.

Cutting Costs

The shortfall is greatest in North Carolina, with 769 patients waiting for drugs to combat the disease, and Florida, with 361 patients, the agency said in an e-mail. Other states have capped enrollment, reduced reimbursements made it more difficult to qualify for assistance, the alliance said.

This year Gilead Sciences Inc., the world’s biggest maker of AIDS drugs, expanded its assistance programs to cover as much as $2,400 a year in out-of-pocket patient expenses and extended pricing freezes to mitigate the shortfall in funding, according to Citibank analyst Yaron Werber. About 22 percent of Gilead’s U.S. sales come from the state-run funds, he said in a note to clients on June 4.

“It’s kind of amazing that more than 25 years into it, we’ve been operating without an AIDS strategy,” Warren said in a June 25 telephone interview. “Overall, people are going to see this as a great strategy. The tough part is going to be when we get into the implementation: How big is the budget, what’s the implementation plan and who is leading it?”

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