disproportionately affected by the HIV epidemic. Grants are awarded to the chief elected official of the city or county that administers the health agency providing services to the greatest number of people living with HIV in the EMA. An HIV health services planning council representative of providers and people living with AIDS sets priorities for the allocation of funds. Services may include outpatient health care, support services, and inpatient case management. Providers may be public or nonprofit entities. There are 49 EMAs in 19 states, Puerto Rico, and the District of Columbia.
At a minimum, the city must allocate a percentage of grant funds for providing services to women, infants, and children, including treatment measures to prevent perinatal transmission of HIV, equal to the percentage of women, infants, and children with AIDS in the total AIDS population. HRSA FY 1995 data indicate that overall, 34% of those served by Title I grantees were women and children.
Formula grants are given to states and territories for health care and support services. Grants are awarded to the state agency designated by the governor, usually the health department. Services may include home- and community-based health care and support services, continuation of health insurance coverage, and pharmaceutical treatments through the AIDS Drug Assistance Program (ADAP). HRSA data indicate that in 1995, 25% of those served by Title II grantees were women and children.
ADAP provides funds to states to make protease inhibitors and other therapies available to uninsured and underinsured individuals with HIV. These funds are available in all 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, and Guam. Administered by state AIDS directors, each state sets its own financial and medical eligibility criteria, and determines the type and number of drugs covered and their purchase and distribution. In 1996, 83,000 persons with HIV disease were served; $52 million in supplemental funds were appropriated in 1996 to supplement the $53 million committed by states from their Title II awards. The total national ADAP budget for FY 1997 was $385 million, a 221% increase from FY 1996, with the majority of funds coming from federal sources, including the $167 million designated for ADAP (Doyle et al., 1997).
ADAP is the second largest source of payment for HIV/AIDS drugs and is a "last resort" payment program that varies significantly from state to state as to who has access. Fifteen states have waiting lists for ADAP enrollment and/or for access to protease inhibitors (AIDS Policy Center for Children, Youth, and Families, 1998). The demand for ADAP funds has increased dramatically as the number of persons with HIV has grown and new therapeutic regimens have been developed. In 1997, four state programs did not cover protease inhibitors and two states covered only one. Five states did not cover any of the prophylactic drugs strongly recommended in the 1997 guidelines, and only two states had the full complement recommended. (CDC, 1997; Doyle et al., 1997).