Recorded presentation

Ernest Drucker, PhD, Epidemiology and Population Health, Montefiore Medical Center, 111 E 210 St, Bronx, nyc, NY 10467, 718 920 4766, emdrucker@earthlink.net, Peter Arno, PhD, Department of Epidemiology and Social Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, and Virginia Shubert, LLD, Hudson Planning Group, 20 Wall Street, nyc, NY 10010.

Background: New York City (NYC) has undergone an important shift in the course of its AIDS epidemic, with a 75% reduction in AIDS deaths (since 1993) and >50% in the annual incidence of new cases. These gains may be attributed to changes in risk behavior and expanded access to anti-retroviral treatment (ART). One consequence has been a doubling of the number of people living with HIV and AIDS (PLWHA): from <60,000 in 1995 to >126,000 in 2002. Methods: Based on current data, conservative assumptions about future AIDS incidence and mortality trends, and no major loss or gain of ART efficacy, we estimate the size of the PLWHA population and the costs of AIDS drugs in NYC for the years 2005 and 2010. Results: The PLWHA population of NYC will grow to 154,737 in 2005 and 208,123 by 2010, dramatically escalating the costs of health care. We project that public (Medicaid and ADAP) expenditures on AIDS drugs alone in NYC will total $576 million in 2005 and $774 million in 2010. Conclusions: Rising AIDS drug prices and reductions in government support for AIDS treatment are creating new barriers to care. By early 2004, 15 state ADAP programs, covering uninsured and underinsured individuals, closed enrollment to new clients or limited access to medications. As public financing declines, NYC and other localities facing large costs for AIDS care should negotiate lower prices for AIDS drugs, as is being done abroad. Learning Objectives: To use AIDS surveillance data to project future prevalence and costs.

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