Background and Resources

Subtopic 1: Ethics and Values

Activity 1.1

Activity 1.2

Activity 1.3

Subtopic 2: Bioethical Problems Identification

Activity 2.1

Activity 2.2

Activity 2.3

Subtopic 3: Methods and Strategies for Decision-Making

Activity 3.1

Activity 3.2

Activity 3.3

Module Summary

Developer Bio

User Evaluation Form

The Case of HIV-AIDS and ADAP Funding

This activity introduces students to a current problem confronting public health professionals and consumers that includes the kind of conflicts in values addressed by this teaching module.  Students are asked to research and identify these problems, to consider their possible solutions, and to analyze those solutions in terms of the values on which those solutions are predicated.

Activity 2.1

In 1990, the Congress of the United States enacted The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act to meet the public health problems posed by the HIV/AIDS epidemic. Since then, this legislation has been twice renewed. The act is divided into four separate titles. These are:

Title I: The part of the CARE Act that provides emergency assistance to localities (EMAs) disproportionately affected by the HIV epidemic.

Title II: The part of the CARE Act that enables States and territories to improve the quality, availability, and organization of health care and support services to individuals with HIV and their families.

Title III(b): The part of the CARE Act that supports primary medical care and early intervention services to people living with HIV disease through grants to service organizations.

Title IV: The part of the CARE Act that supports research and services for children with HIV and their families.

This subtopic deals with a problem that arose in 2003 when funding to Title II programs was cut at the Federal level. Title II funding includes monies appropriated by Congress for medications to treat HIV disease (AIDS Drug Assistance Program, ADAP). These monies are distributed on a state by state basis and are administered by state agencies charged with operating the program. In Texas, the administrative agency is the Texas Department of Health (TDH). 

In simple terms, ADAP is a publically-funded prescription drug program that is supplemental to a qualifying individual's private health insurance prescription drug coverage. Accordingly, payments are made only after the maximum benefit has been reached under the terms of that private coverage. When this occurs in Texas, qualifying individuals continue to receive the drugs necessary to treat his or her HIV disease as if they are still receiving benefits under their insurance plan, including the payment of copays. The problem is that with funding cuts, states are now faced with either providing the short-fall themselves, or cutting benefits to persons whose lives depend on them. The question is whether it is ethical to cut these benefits, no matter what the reason.

Students will research this issue as it is affecting People Living With AIDS (PLWA), both in Texas and elsewhere. Every state has its own program, and the solutions that have been offered for meeting this issue have varied greatly. The instructor will divide the class into small groups and assign each group a different state to investigate, including both a before and after budget cuts picture of ADAP eligibility. Research may also include interviews out in the community with social service agency representatives and persons involved in community-based organizations (CBOs) involved in meeting the needs of the affected community. This might extend to meeting with non-profit charitable organizations set up to raise monies for local HIV/AIDS programs, and churches that have taken on the cause as part of their community mission. Another possibility is for the instructor to set up focus groups with members of the affected community. While some members of that community are reluctant to do so, there are many PLWAs and their supporters who are pro-active in sharing their concerns and experiences.  Search for organizations and lobbying groups set up specifically to voice these interests.

Students are to note the reasons for any changes being considered or made in ADAP benefits including their impact on individual lives, as well as any reasons found for not making such changes. These reasons are then to be related to possible associations with values, both ethical and not ethical. Each group will then present its findings to the entire class, either online or in a traditional classroom setting.