Centering AIDS Drug Assistance Programs in the US HIV Response

The AIDS Drug Assistance Program (ADAP) is a pillar of the US human immunodeficiency virus (HIV) response. Founded in 1987, when HIV was a universally fatal infection without treatment, ADAPs provided the needed compassionate care for people with and then dying from AIDS [1]. Over time, with the advent of effective antiretroviral therapy, ADAPs evolved to become the payer to secure access to antiretroviral therapy for people with HIV who did not have other insurance. In the 2000s, as more states adopted Medicaid expansion and the Affordable Care Act, many ADAPs again evolved to pay premiums for comprehensive health insurance for people with HIV infection who had no other source of insurance. With the discovery that “undetectable = untransmissible,” ADAPs may now also contribute to HIV prevention, by reducing the number of people who have a detectable HIV RNA. If ADAPs do contribute to prevention, then the ADAP mission and identity would again evolve toward being a program that advances the health and well-being not only of people with HIV infection, but also those who are not infected and people with HIV risk.