San Francisco Chronicle - The Voice of the West, 901 Mission Street, San Francisco, CA 94119 - Tuesday, October 1, 1996 - Page A4
David Tuller, Chronicle Staff Writer

Some activists had hoped that the money would all go to the AIDS Drug Assistance Program, a federal program that helps states provide drugs to those who cannot otherwise afford them or obtain them under private insurance programs.

Under the omnibus appropriations bill just approved by Congress and signed off by the president yesterday, however, the money is to be divided equally between ADAP and other Ryan White programs that offer primary care services to people with HIV, such as viral load testing and treatment for opportunistic infections. Viral load tests measure how much HIV is in the blood.

"I'm afraid this puts us in the position of having to go back to Congress next fall for more money for ADAP, and that will be difficult," said Gary Rose, a lobbyist with AIDS Action Council in Washington, D.C., and a member of a coalition called the ADAP Working Group.

The dispute highlights the dilemmas confronting policy makers as the AIDS epidemic changes course. With a new class of expensive drugs called protease inhibitors drastically improving the health of many people with AIDS, pressure is building to make them as widely available as possible -- even as those taking them and others with HIV live longer and so require more primary care services.

"If you give people protease inhibitors and don't let them see a doctor to check on their progress, you're going to run into some problems," said Timothy Rodrigues, a spokesman for the San Francisco AIDS Foundation.

"Over the long-term, the success we're having with these drugs is greatly changing the demand for other kinds of services," said Steve Morin, an aide to Representative Nancy Pelosi, D-San Francisco, who spearheaded the request for more funds.

Because the new drugs, when taken in combination with other anti-virals, can cost more than $10,000 a year per patient, President Clinton had already requested that $65 million be added to the drug program for 1997.

In recent weeks, AIDS activists sought the additional $100 million on top of the $65 million after determining that the drug program would fall dramatically short even with Clinton's increased appropriations request.

The total approved for Ryan White funding in the coming fiscal year is $996 million, an increase of 31 percent over the previous fiscal year. The program is named for the Midwestern youngster whose fight against the disease inspired people across the country.

In California, the legislature voted to augment the federal ADAP funds this summer so it could cover the costs of protease inhibitors. Even so, without the additional federal funds the program would have run out of money by February because so many people want to take the new drugs, said Rodrigues of the AIDS Foundation.

Because of the shortage of funds, many states have placed restrictions on how many patients can enroll in ADAP or receive protease inhibitors through the program. Some states, like Florida, have decided not to distribute protease inhibitors to anyone because they fear sufficient funds will not be available, said Rose of the AIDS Action Council.

Morin said that much of the money disbursed through other Ryan White programs would ultimately be funneled to ADAP by states and cities.

Among the crucial primary care services to be paid for with the additional funding, he said, are the viral load tests. The protease inhibitors frequently reduce a patient's viral load to undetectable levels.
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