San Francisco Chronicle - Saturday, November 4, 2000
Dan Levy, Chronicle Staff Writer

The study was done by the University of California at San Francisco's AIDS Policy Research Center and scheduled to be released in March, although a copy was leaked to a wire service reporter yesterday.

It shows that huge numbers of low-income people covered by Medicaid programs in the nation's four largest states are falling through the bureaucratic cracks in their struggle to combat the deadly virus.

Texas was the worst-performing big state in delivering the drugs, with nearly two-thirds of eligible AIDS patients failing to get proper treatment, the report says.

California and Florida were only slightly better, with about half of eligible patients having access to the drugs. New York performed best of the group, with more than half of people receiving the treatments.

DRUGS EFFECTIVE, EXPENSIVE

The drugs being studied are protease inhibitors, highly effective but expensive treatments that have radically lowered the AIDS death rate since they were introduced in 1995.

The drugs are taken in a "cocktail" with other treatments such as AZT and have been hugely successful in reducing the viral load of HIV in the body. Patients following a protease regimen seem to keep HIV at bay and live healthier lives, researchers say.

The leak of the report seemed an attempt by AIDS activists to discredit Republican George W. Bush in the final days before Tuesday's presidential election.

Representatives of ACT-UP contacted reporters yesterday to criticize the Texas governor on the findings and about his state's health system in general.

"It's pretty damning as far as lack of access goes among people with AIDS in Texas," said Asia Russell of ACT-UP Philadelphia. "What do you do when you're stuck in a situation that you're used to dealing with in Third World countries?"

Ray Sullivan, a Bush campaign spokesman in Austin, said he could not comment on the specifics of the Texas health system. But he said annual funding for HIV drug and education programs in the state during Bush's tenure has increased to $87.9 million from $39.8 million.

"More people in Texas have access to health care under Gov. Bush than they did under (Democratic) Gov. (Ann) Richards," Sullivan said. "Meanwhile, there were 4 million more people in this country without health insurance during the Clinton-Gore administration."

But UCSF researchers said there are more barriers between poor AIDS patients and drug treatment programs in Texas than there are in other states. For instance, Texas requires that AIDS patients make a $5 copayment per prescription, while California, Florida and New York do not.

BARRIERS TO TREATMENT

The study also found that Texas had a limited number of pharmacies willing to fill the orders and that the state required central processing of prescriptions, meaning that patients had significant delays in getting the drugs.

"We did not set out to do a report card on the states, but there are distinct policies in Texas which reduce access to and the utility of these drugs," said a scientist on the UCSF research team who requested anonymity. "There are fewer limits in the other states."

Protease treatment costs about $12,000 per year for optimal results, according to federal guidelines.

The UCSF study, which researchers say is the first of its kind, seeks to document how much access to protease treatments low-income patients in big states are getting. Congress has appropriated Medicaid funding for the drugs to the states, which are responsible for delivering them to patients.

AIDS advocates say a main problem in Texas and Florida is that those states limit patients to three prescriptions per month, which is not enough to keep them healthy.

In addition, Texas limits the treatments to people with incomes of $16,000 or less. California, in contrast, sets the cutoff at $50,000.

E-mail Dan Levy at danlevy@sfchronicle.com.

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