After years of an abysmal response to the still deadly and growing HIV/AIDS epidemic, North Carolina is now making significant public health strides fighting the disease, even as the state’s changing population presents new challenges. Thirty thousand people are living with HIV/AIDS in North Carolina and 1,800 more people are infected every year.

Not too long ago, the state’s HIV/AIDS policies were an embarrassment in the medical and public health world, primarily because of the state’s eligibility restrictions for the AIDS Drug Assistance Program (ADAP) that provides lifesaving medication for people with no health insurance who are living with HIV.

The drugs cost as much as $13,000 a year. North Carolina denied access to the assistance program to people making more than 125 percent of the national poverty level, which is also $13,000 a year and was even less a few years ago. The national average is 300 percent of poverty.

Governor Mike Easley was asked about raising the eligibility level in a gubernatorial debate in 2004 and brushed off the question claiming the state didn’t have the money to raise it, though it only cost a few million dollars. 

One powerful legislator said he didn’t want to do anything to help “those people” and for years the woeful appropriation for AIDS prevention and treatment reflected that sentiment.

But something seemed to change two years ago.  The General Assembly increased the income eligibility for ADAP to 250 percent of poverty, $26,000 a year, still lower than the national average, but a dramatic increase. More money was also directed toward prevention, including funds to address the vast disparities of infections by race.

Sixty-nine percent of the new HIV/AIDS infections in the state are among African-Americans and the infection rate is rising four times faster in the Latino population than the state’s population as a whole.

The state Division of Public Health last year launched an aggressive campaign to get more people tested for HIV and recently announced a new initiative targeting the Latino community. The state received close to $9 million more in federal funding for HIV/AIDS programs as part of the reauthorization of the Ryan White legislation.

A public health task force recenlty recommended that state awmakers raise the ADAP eligibility to the national average of 300 percent of the federal poverty level.

That makes sense. Prevention and education can help reduce the infection rate, but getting people tested and into treatment early means that not only will they be healthier, but they will be much less likely to infect someone else.

There are still plenty of challenges fighting HIV/AIDS. There is still no cure or vaccine The drug regimens are vastly improved, but even that brings new problems, as some at-risk populations may not take as many precautions if infection is longer considered a certain death sentence.

Policymakers’ work is far from done too. The disparities of infection rates by race continue and a significant number of new cases can be traced back to IV drug use.

A clean needle exchange program would help, but lawmakers continue to balk at approving it, worried about the political risk. And the stigma surrounding the disease continues to influence the state’s overall response to it.

But advocates for people with HIV/AIDS and the public health professionals in the Department of Health and Human Services fighting the epidemic deserve a lot of credit for persevering and prompting North Carolina’s recent progress.  

Time to build on that success and do more this year. Policymakers need to help too. Lives are depending on it.