June 25, 2010 Dear President Obama and members of the Midwest Congressional Delegation: As Midwest HIV/AIDS organizations, we work on the front lines to improve the lives of people living with HIV/AIDS in our nation’s heartland. We thank you for the passage of health care reform which will enable greater health outcomes of HIV-positive people through expanding access to essential medical treatments and preventative care. However, people living with HIV/AIDS cannot wait until 2014 when key reforms will be implemented. Your immediate action is critical to ensure that people living with HIV/AIDS are able to access the medications they need to keep them alive. On behalf of the more than 103,000 people living with HIV/AIDS in the Midwest, we urge your leadership in securing $126 million in emergency supplemental funding for the AIDS Drug Assistance Program (ADAP). ADAP is an essential safety-net for HIV-positive people who have no other means to afford their lifesaving HIV therapies. However, the economic downturn, high unemployment, and loss of private health insurance are driving the unprecedented need for the program across the nation. More than 1,400 people from 12 states are now in the position of waiting for the medications that will keep them alive. These numbers are unprecedented. The number of people added to wait lists as grown by more than 116% over the last three months. Without federal intervention and leadership, these numbers will continue to rise at a rapid rate and people living with HIV will die. The Midwest is not immune from this crisis. Two states in our region, Iowa and South Dakota, have already instituted ADAP waiting lists. As of June 10, 112 HIV-positive individuals from these states cannot access the drugs they need to stay healthy and productive. Additionally, Illinois, Iowa, Missouri, and North Dakota have instituted cost-containment strategies such as reducing the financial eligibility, capping enrollment, and decreasing the number of drugs available on the ADAP formulary. Last month, a state advisory board voted to recommend that the Illinois Department of Public Health immediately institute a waiting list for ADAP to avert the program’s total financial collapse. Ohio sits poised to institute client cost-sharing measures, an expenditure cap, enrollment limits, and reductions in its formulary and financial eligibility. We implore you to appropriate emergency funding to end the ADAP funding crisis in the Midwest and around the nation for the following reasons: ADAP wait lists for HIV medications will cause people with HIV in the Midwest and across the nation to become needlessly sick and die. Medications provided through ADAP mean the difference between life and death for people with HIV. Without HIV medications, people with HIV will experience preventable sickness and hospitalizations, and likely die sooner. ADAP waiting lists will worsen existing racial and economic health disparities by denying HIV treatment to African Americans and Latinos, who represent two out of three people newly diagnosed with HIV.

President Barack Obama Members of the Midwest Congressional Delegation June 25, 2010 Page 2 Investing funds in ADAP will save money elsewhere in the health care system by keeping people with HIV healthy and preventing illnesses and unnecessary hospitalizations. When someone with HIV gets sick—for example, because they cannot obtain medications—the annual cost of medical care can become 2.6 times more expensive, or $23,000 more costly per person per year. ADAP funding will promote jobs and employment by keeping people with HIV healthy enough to work. Without access to HIV medications, many people with HIV who are working will become too sick to work, and will go on disability. In fact, many ADAP clients are working and able to work as result of their ability to access HIV therapies. Providing widespread HIV treatment will reduce new HIV infections. Research strongly indicates that people on HIV treatment are significantly less likely to transmit HIV to others. Antiretroviral medication is another tool like sterile syringes, male and female condoms, and behavioral interventions that effectively reduce new HIV cases. Ultimately, the need for ADAP will continue to grow as people with HIV live longer thanks to medications provided through the program, and as stepped-up HIV testing efforts identify more people with HIV and link them to medical care. National health reform will provide critical relief in 2014, but a bridge is needed to keep people with HIV healthy until then. Please feel free to contact Dr. Scott Clair, Community HIV Hepatitis Advocates of Iowa Network, Des Moines, Iowa at [email protected].

Sincerely, Iowa Community HIV Hepatitis Advocates of Iowa Network Des Moines, Iowa Positive Iowans Taking Charge Des Moines, Iowa AIDS Project of Central Iowa Des Moines, Iowa Illinois AIDS Foundation of Chicago Chicago, Illinois Pediatric AIDS Chicago Prevention Initiative Chicago, Illinois

President Barack Obama Members of the Midwest Congressional Delegation June 25, 2010 Page 3 Perinatal Rapid Testing Implementation in Illinois Chicago, Illinois Universal Family Connection, Inc. Chicago, Illinois Citizens AIDS Project - CAVDA Mount Prospect, Illinois Chicago Recovery Alliance Chicago, Illinois Test Positive Aware Network (TPAN) Chicago, Illinois Asian Human Services Chicago, Illinois Canticle Ministries, Inc., Wheaton, Illinois Rec Room Chicago Chicago, Illinois The Care Center of Jackson Park Hospital Chicago, Illinois Howard Brown Health Center Chicago, Illinois Haymarket Center Chicago, Illinois Better Existence with HIV (BEHIV) Chicago, Illinois Human Resource Development Institute Chicago, Illinois Lawndale Christian Health Center Chicago, Illinois

President Barack Obama Members of the Midwest Congressional Delegation June 25, 2010 Page 4 Chicago Women’s AIDS Project Chicago, Illinois aChurch4Me? Metropolitan Community Church Chicago, Illinois Illinois Caucus for Adolescent Health Chicago, Illinois Center on Halsted Chicago, Illinois Chicago Child Care Society Chicago, Illinois David Ostrow & Associates, LLC. Chicago, Illinois Total Health Awareness Team Chicago, Illinois Chicago House and Social Service Agency Chicago, Illinois Illinois Alliance for Sound AIDS Policy Chicago, Illinois Indiana Step-Up, Inc. Indianapolis, Indiana Indiana Minority Health Coalition Merrillville, Indiana AIDS Ministries Aids Assist of North Indiana South Bend, Indiana Minority Health Coalition of Marion County Indianapolis, Indiana Brothers Uplifting Brothers, Inc. Merrillville, Indiana

President Barack Obama Members of the Midwest Congressional Delegation June 25, 2010 Page 5 Tri- County Health Coalition of Southern Indiana Inc. New Albany, Indiana Harm Reduction Institute Indianapolis, Indiana Minnesota Minnesota AIDS Project Minneapolis, Minnesota Michigan AIDS Partnership Michigan Detroit, Michigan HIV/AIDS Alliance of Michigan Detroit, Michigan HIV/AIDS Resource Center Ypsilanti, Michigan Lansing Area AIDS Network Lansing, Michigan Missouri Doorways Interfaith AIDS Housing and Services St. Louis, Missouri Saint Louis Effort for AIDS St. Louis, Missouri Erise Williams & Associates, Inc. St. Louis, Missouri The Missouri AIDS Task Force St. Louis, Missouri Nebraska Nebraska AIDS Project Omaha, Nebraska Ohio Ohio AIDS Coalition Columbus, Ohio

President Barack Obama Members of the Midwest Congressional Delegation June 25, 2010 Page 6 Columbus AIDS Task Force Columbus, Ohio AIDS Resource Center Ohio Dayton, Ohio Wisconsin AIDS Resource Center of Wisconsin Milwaukee, Wisconsin AIDS Network Madison, Wisconsin HIVictorius, Inc. Madison, Wisconsin

cc:

Tina Tchen, Director of the White House Office of Public Engagement Jeff Crowley, Director of the White House Office of National AIDS Policy