``The bad news is more medical providers are being caught in a revenue crunch,''
with no money for the flood of patients who now need outpatient care, said
Dr. Victoria Sharp of St. Luke's-Roosevelt Hospital in New York.
Worse, says the advocacy group AIDS Action: More and more poor people simply
cannot afford the expensive drugs that promise to prolong their lives. The
drug combinations, which include the powerful protease inhibitors, cost
$15,000 per person every year.
``AIDS is not over. If we act like it is, it may never be,'' said AIDS Action's
Daniel Zingale.
The government announced Monday that deaths from AIDS dropped 19 percent
during the first nine months of 1996, due partly to a slowing of HIV infections
in the late 1980s among white homosexual men _ but also due to better therapy.
Deaths among all men dropped 22 percent, but among women dropped just 7
percent, the Centers for Disease Control and Prevention reported. Deaths
among black Americans dropped 10 percent and Hispanics 16 percent, while
there was a 28 percent decline among whites overall.
``People of color do not have the same access to quality health care,''
Dr. Helene Gayle, CDC's chief of sexually transmitted diseases, said in
explaining the racial discrepancies.
While deaths from AIDS are declining, new cases are increasing but more
slowly than a few years ago. In 1995, about 62,200 people were diagnosed,
an increase of less than 2 percent over the 61,200 new cases in 1994. The
growth rate from 1993 to 1994 was 5 percent.
Congress this week will debate whether to increase the $167 million AIDS
drug assistance program, which buys medicines for poor AIDS patients who
don't qualify for Medicaid. The demand for expensive protease inhibitors
has left the program so cash-strapped that 23 states have had to cut patients
or restrict their access to the drugs.
But the financial problem is broader, said Sharp. Hospitals get far less
reimbursement from either public or private insurance for outpatient care
than for admitting the seriously ill _ so outpatient AIDS clinics are in
trouble, she told a meeting of AIDS experts Monday.
Take St. Vincent's Hospital in New York. Hospital admissions of seriously
ill AIDS patients dropped from 110 a month in 1994 to 50 a month last year,
while the hospital doubled the people treated as outpatients to 2,000 a
month, Sharp said.
That saved insurers $2 million on hospital admissions, Sharp said. Yet even
as outpatient services doubled, insurance payments for those services rose
from just $110,000 a month in 1994 to $182,000 a month in 1996, she said.
And individual patients are feeling the crunch, too. AIDS activist Winnie
Fairchild of Washington said a doctor recently tried to stop her prescription
for protease inhibitor.
The doctor ``said it was not his policy'' to provide expensive drugs to
Medicaid patients, Fairchild said Monday. ``It's not my policy to die, either.''
Denise Stokes of Atlanta described how she went to that city's public hospital
for the poor with a 104.5-degree fever and covered in a rash, a side effect
from her AIDS medication.
``In that physical condition I was expected to stand in line three hours
for medicine'' before she collapsed, said Stokes, an adviser to the Clinton
administration on AIDS issues. ``I made it to the curb, and I laid there
in my own urine while ... (ambulance workers) stepped over me and laughed.''
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