Letter To The Editor: Access to Lifesaving HIV Medications is a Real Problem Here in Broward, We Must Find a Better Way

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Directly across the street from Lauderdale Memorial Park, 3.5 miles from where the majority of those who are HIV positive reside, lies the Broward County Health Department.

Many have dubbed it the Hell Department because of how difficult it has become to maintain their drug regimen due to the state requirement for those on ADAP (AIDS Drug Assistance Program) to travel to pick up their medications every thirty days at that location or one at equal distance in Pompano Beach.

ADAP helps those with little to no income access lifesaving medication for free, or a low affordable cost. It is a service that has been available since 1987 and one that should not be taken for granted. However, in South Florida, picking up these medications is not the easiest of processes. The majority of those that are HIV positive and on ADAP in Broward County live in or near Wilton Manors. Many of those patients do not own a vehicle to travel once a month to pick up their medication.

By bus with one transfer it can take up to two hours travel time and then possibly the same amount of time home -- an all day affair, once a month. If you bring a bicycle to cut down on time and the bicycle rack is full, you may have to wait nearly an hour for another chance at getting a ride. Public transportation is known for being pretty inconsistent to begin with. In the summer it is not a viable option to ride a bicycle from Wilton Manors to State Road 84.

If you are fortunate enough to have someone drive you to one of the locations, it would still be about a 30 minute to 1 hour drive depending on traffic. Uber is always an option except for those on a tight budget. It can be very frustrating and a deciding factor for those that might be on the fence with taking their medications.

Pete Povoli, the Managed Care Specialist at AHF on Oakland Park Boulevard explained that, "unfortunately this type of thing happens every day and people miss picking up their medication."

Povoli mentioned that a recent patient who lives in Hallandale, "now has 49 T Cells (full blown AIDS) due to not having transportation to keep up with the requirements to stay successful with her treatment and cannot travel the distance to pick up her medication." Another problem he mentioned was that, "patients today who are working to make ends meet sometimes have their ADAP expire. There are too many departments and Ryan White A/B should be combined to make it easier for the patient. Many stop taking the medications because the whole system is overwhelming for those who are dealing with dual diagnoses like depression and

other mental health illnesses."

For Brian who is 35 and living with HIV, it took him nearly two hours to arrive at the Health Department. He traveled by bus from AHF on Oakland Park Blvd. He didn't bother with the transfer because he didn't know how reliable it would be so he walked the final distance and "was caught in the rain." This being his first time picking up his medication after recently testing positive he describes the experience as, "it's like watching paint dry."

Dorothy who lives in Port Saint Lucy travels nearly two hours sometimes once every two weeks to pick up medication for her daughter who is currently living with her. Both Dorothy and her daughter believe the process at The Health Department is, "a pain in the butt and a major inconvenience."

ADAP saves lives and it is essential for lower income people to maintain their health, stay undetectable and not develop an opportunistic infection which could lead to serious illness or death. The requirement to travel to one of 2 locations is a burden for many and according to Povoli, "could possibly lead to one not complying with their drug regimen. Unfortunately this happens every day."

An experience at the Health Department Pharmacy can be a quick twenty minutes which includes taking a number, waiting for a droning robotic voice over the PA system to call your number, then to sit again waiting for your medication to be filled.

If things don't go the way you planned, expect 45 minutes to an hour or hours wait. The service at the Health Department Pharmacy has improved and the staff are polite and patient and do their best, but the customer satisfaction is not very high.

David Poole who was Administrator of Patient Care for the Bureau of HIV/AIDS and in charge of

ADAP/Ryan White (1993 - 2005) and now is AIDS Healthcare Foundation Director of Legislative Affairs Southern Bureau regrets that during his time in Tallahassee he didn't,"move the program forward and bring it into the 21st Century before leaving." Poole mentioned that, "behind the scenes the Florida Department of Health are currently in the process of updating to more pharmacies, but nothing is guaranteed depending on who wins in November. I fear that it will be forgotten."

Poole goes further and points out that, "it is safe to say that whenever you limit access, the more likely you will have issues, such as new infections, and those not getting good access to their medications could be more susceptible to illness or even death."

Missing doses can lead to resistance to the medications as well which could cause them to not be effective in fighting the HIV virus. James Colonel at AHF pharmacy in Oakland Park mentioned that if you are an AHF patient and cannot make the trip to pick up your medication, he would "provide up to five days worth until they can make the trip to the Health Department."

A very recent positive development is that clients of the Health Department are now considered eligible for 90 days’ worth of medication, but as of today only 214 out of 4,617 people are enrolled. There are several strict requirements. Clients must have picked up medications in 11 of the last 12 months. They must have had at least 1 Viral Load test in the past 24 months and they must have Viral Load test results of 200 or less on all Viral Load tests covering the past 24 months/two years. This latest development, still doesn't excuse

that these medications are not available at more pharmacies throughout the state. Povoli states that only about, "a third would probably be eligible."

In other major cities like Denver, Los Angeles, NYC and Washington, DC, the medications through ADAP are available at a wide variety of pharmacies. For example, Washington, DC has over twenty-five pharmacy locations available. In Los Angeles they even give you the option of having them delivered to your doorstep. That might seem extravagant compared to Florida's archaic system, but in South Florida it doesn't seem unreasonable for patients to have access to their medication at their local pharmacies and it is time the system is adjusted to meet the patient's need for better access and help more people live a

healthy life.


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