Responding to racial and ethnic disparities in use of HIV drugs: analysis of state policies.
OBJECTIVE
The objectives of this study were to assess racial/ethnic trends in surveillance data in four states--California, New York, Florida and Texas, identify structural barriers to and facilitators of access to HIV pharmaceuticals by individuals in Medicaid and the AIDS Drug Assistance Program (ADAP), and identify treatment education and outreach efforts responding to the needs of ethnic minority HIV patients.


METHODS
State surveillance and claims data were used to assess trends by race/ethnicity in AIDS cases and mortality as well as participation rates in Medicaid and ADAP. Key informant interviews with state program administrators and local clinic-based benefit eligibility workers were used to identify social and policy barriers to and facilitators of access to HIV drugs and state strategies for overcoming racial/ethnic disparities.


RESULTS
Racial/ethnic disparities in the reduction of AIDS-related mortality were identified in three of the four states studied. Policy barriers included Medicaid requirements for legal immigration status and residency, limits on Medicaid eligibility based on disability requirements, and state-imposed income and benefit limits on ADAP. Social barriers to accessing AIDS medications included lack of information, distrust of government, and HIV-related stigma. State strategies for overcoming disparities included contracting with community-based organizations for treatment education and outreach, the use of regional minority coordinators, and public information campaigns.


CONCLUSIONS
State policies play a significant role in determining access to HIV drugs, and state policies can be used to reduce racial/ethnic disparities in pharmaceutical access. Overall, eliminating racial/ethnic disparities in access to HIV pharmaceuticals appears to be an achievable goal.
Morin
Stephen F
SF
AIDS Policy Research Center, University of California-San Francisco, 74 New Montgomery Street, Suite 600, San Francisco, CA 94105, USA. smorin@psg.ucsf.edu
Sengupta
Sohini
S
Cozen
Myrna
M
Richards
T Anne
TA
Shriver
Michael D
MD
Palacio
Herminia
H
Kahn
James G
JG
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000208:ethnology*; D001741:Black or African American / Q000193:education; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics* / Q000706:statistics & numerical data*; D002140:California / Q000453:epidemiology; D003159:Community-Institutional Relations; D004608:Eligibility Determination / Q000458:organization & administration*; D004641:Emigration and Immigration; D005006:Ethnicity / Q000145:classification / Q000193:education*; D005431:Florida / Q000453:epidemiology; D006297:Health Services Accessibility / Q000458:organization & administration*; D006630:Hispanic or Latino / Q000193:education; D006801:Humans; D007407:Interviews as Topic; D008484:Medicaid / Q000458:organization & administration*; D008483:Medical Assistance / Q000458:organization & administration*; D009518:New York / Q000453:epidemiology; D016134:Organizational Policy; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D011159:Population Surveillance; D040241:Social Marketing; D013221:State Health Plans / Q000458:organization & administration*; D013781:Texas / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D044465:White People / Q000193:education