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Rationing HIV Medications: What Do Patients and the Public Think About Allocation Policies?

Green Michael J.; Fong, Steven; Mauger, David T.; Ubel, Peter A.
JAIDS Journal of Acquired Immune Deficiency Syndromes: January 1st, 2001
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Background:New medications for treating HIV/AIDS are effective, but expensive, and funding shortfalls have led many state AIDS Drug Assistance Programs (ADAPs) to ration these drugs. Little is known about the views of those most directly affected by rationing policies. This study explores attitudes of patients with HIV and the general public toward specific rationing strategies.

Methods:A Likert-style, self-administered questionnaire about rationing expensive HIV medications in the context of a budget shortfall was administered to patients with HIV and shopping mall patrons in central Pennsylvania. Subjects were asked how much they agreed or disagreed with seven drug rationing policies.

Results:In all, 100 patients and 101 shoppers completed the survey (response rate = 89%). A majority in both groups “strongly” or “somewhat” disagreed with six of the seven rationing policies described, and patients more strongly disagreed with the policies than did the public. The five policies actually used by state ADAPs (first come first serve, limiting expensive medicines, limiting new patient enrollment, giving the expensive medicines to the sickest, using a spending cap) lacked support in either group.

Conclusions:HIV drug rationing policies currently in use do not reflect the preferences of patients and the public. Integrating the views of those affected by the rationing decisions would raise difficult challenges to current programs.

Address correspondence and reprint requests to Michael Green, Department of Humanities, H134, Penn State College of Medicine, Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033 U.S.A.; e-mail:

Some data contained in this manuscript were presented at the 21st Annual Meeting of the Society of General Internal Medicine, Chicago, IL, U.S.A., April 24, 1998.

Peter Ubel is currently Director, Program for Improving Health Care Decisions, Co-Director, General Internal Medicine Fellowship, Ann Arbor VAMC and University of Michigan, Ann Arbor, Michigan, U.S.A.

Manuscript received June 2, 2000; accepted August 31, 2000.

© 2001 Lippincott Williams & Wilkins, Inc.