After several decades of intensive research and practice, researchers now know that good medical care—especially treatment with antiretroviral (ARV) medications—can dramatically extend health, life, and productivity for Ohioans living with HIV/AIDS. And over time, costs for basic care have continued to come down, while treatment has become simpler and easier to handle. HIV disease, once thought to be fatal for every diagnosed person, has become a manageable disease for a growing number of people—if good care is accessed and maintained.

These advances in treatment don’t just benefit individuals; they benefit entire communities as well. Just last month, the U.S. National Institute of Allergy and Infectious Diseases announced dramatic results in a comprehensive study confirming what scientists have long suspected: that treating HIV disease can significantly reduce transmission of the disease, and thus slow down the epidemic—if individuals get access to comprehensive treatment early in their disease.

Those are big “ifs,” and in Ohio, the promise of improved health and productivity, and the hope of new ways to reduce spread of the disease, are seriously threatened. To understand why, a brief review is in order.

In 1990 Congress and then-President Bush approved the Ryan White CARE Act (RWCA), which received wide bipartisan support at the outset, and in every reauthorization since then. The Act recognized that many Americans living with HIV/AIDS needed help accessing care, and thus created federal/state partnerships to help pay for medical services for those who couldn’t afford them—thereby helping individuals stay healthy and productive.

A key provision of the RWCA is the AIDS Drug Assistance Program (ADAP). Administered by states, ADAP helps pay for life-saving medications for those who need, but cannot afford, the drugs. Housed within the Ohio Department of Health’s overall RWCA state program, Ohio’s ADAP—the Ohio HIV Drug Assistance Program—helps thousands of Ohioans pay for HIV drugs, thus preserving health and independence.

OHDAP receives federal funds from the Department of Health and Human Services through a state/federal match: every dollar Ohio invests results in $2 of federal support for HIV/AIDS care and treatment. The match need not be in the form of General Revenue Fund (GRF) dollars: states may use a “paper match,” in which dollars already spent on HIV care in other state departments can be counted toward the requirement. For example, Ohio has historically designated dollars already spent in HIV prevention and care, and through Corrections, to help meet the match—thus reducing the need to use GRF dollars to meet the requirement. In Ohio’s last budget cycle, Ohio’s investment of $5.5 million of GRF for HIV/AIDS care and treatment allowed us to draw down $23 million in federal resources.

Under multiple Ohio administrations, OHDAP operated as a model program, efficiently providing support for the essential medical services so many Ohioans needed.

But with the growing impact of the financial crisis on the public sector, state ADAP programs, including Ohio’s, began to suffer. By 2009, many states were witnessing unexpected increases in new ADAP applicants—a challenge multiplied by the economic situation. By 2010 many U.S. states, including Ohio, were reporting ADAP deficits. Ohio’s ADAP program reached a fiscal crisis last summer, necessitating major changes: reducing financial eligibility; creating a waiting list for life-saving medications (a first for Ohio); and removing many medications from the OHDAP list of covered drugs. As a result, hundreds of individuals lost OHDAP coverage. As of on a waiting list.

Despite the evidence of need, however, Governor Kasich’s budget this year, presented in March, 2011, recommended only $5,542,314 for each year in the next biennium—$3 million less per year than the $8,546,326 ODH calculated the program needed when the agency conducted budget planning last fall. Recently the Ohio House of Representatives voted to add another $300,000 per year to the total Governor Kasich requested, but the total amount is still far short of the need estimated by public health experts.

State resources are needed to fill the growing need. According to the latest information provided by ODH in budget testimony, GRF funding at the $5.8 million level is sufficient to maintain current individuals on the OHDAP program in fiscal year 2012 only because of expected one‐time income from drug rebates. However, for fiscal year 2013, that level of funding will be $5.5 million below what is necessary to merely maintain the current number of patients in the OHDAP program.

And these amounts do not address expected increases in the waiting list, which ODH estimates will grow by 56 persons each month. An additional $16.7 million in state funds would be needed to remove the waiting list for the biennium. Otherwise, the waiting list will grow to more than 2,000 Ohioans by 2013.

For people with HIV/AIDS, being unable to receive proper medication can be life‐threatening. While some individuals may be able to access patient assistance programs run by pharmaceutical companies, many experts believe that relying on such programs to manage a life-threatening disease is dangerous public policy.

An adequately-funded OHDAP is smart policy. It leverages federal dollars, thus reducing state costs for medical care. It helps people stay healthy. And since treatment reduces the chance of HIV transmission, access to care reduces community HIV rates. We can help people live, stay productive, and keep communities safer—all for small public investments.

It is not exaggeration to say that a complete collapse of OHDAP was narrowly avoided this current fiscal year only through dramatic cuts and changes in eligibility, and through other drastic measures (such as redirecting HIV prevention dollars toward care and treatment—a move that almost guarantees future increases in HIV rates). OHDAP is still in trouble; further cuts will translate into increased sick, death, and suffering. We must work together to ensure a minimal, continuing state match for federal RWCA funds—and thus keep the promise, for more life.