FIGURE D-1 Estimated number of people living with HIV/AIDS and proportion not in care, United States, 2000.

SOURCE: Fleming, P., et al., HIV Prevalence in the United States, 2000, 9th Conference on Retroviruses and Opportunistic Infections, Abstract #11, Oral Abstract Session 5, February 2002.

their HIV status (up to one-third of those living with HIV/AIDS8), others do not have access to insurance coverage (or face limits in their coverage) or care programs to help them afford the high cost of HIV treatment and services. The costs of HIV care present significant financial barriers to access for people with HIV/AIDS and strain the systems that serve them.

THE COST OF HIV CARE: A CONTINUING CONCERN

Financing care for people with HIV/AIDS has been of concern since early in the epidemic when people with HIV/AIDS often required expensive hospital inpatient and end-of-life care.9,10,11 The introduction of antiretroviral drug treatment in 1987 did not allay cost concerns—the very first FDA-approved AIDS drug, AZT, carried an initial pricetag of $10,000 a year.12 The current standard of care—combination antiretroviral therapy or HAART—calls for the use of expensive antiretrovirals in combinations of three, four, or even more medications.6 HAART has been largely responsible for significant declines in HIV-related deaths and improved health status for many.13,14 Combination therapy alone costs between $10,000



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