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AIDS and Behavior

Erschienen in:

08.12.2018 | Original Paper

Demand and Supply Motivations for Antiretroviral Drugs in Illicit Street Markets: The Case of Atlanta, Georgia

verfasst von: Antonio Saravia, Robert Mueller

Erschienen in: AIDS and Behavior | Ausgabe 8/2019

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Abstract

We studied the motivations behind supply and demand of antiretroviral drugs (ARVs) in the illicit street markets of the metropolitan statistical area of Atlanta, Sandy Springs, and Roswell, Georgia. We found that these two market actions were largely interdependent: 39.53% of participants said that they sold their ARVs to pay for personal needs, and 20.93% said that they bought ARVs because they had previously sold them to pay for personal needs. The pattern that emerged suggests that illicit street markets have become mechanisms through which HIV patients cooperate to achieve competing goals: cover personal needs and keep up, however imperfectly, with their medication regime. We also found that HIV patients used illicit street markets because they faced institutional deficiencies, such as exclusion from the Ryan White/ADAP program, long waiting times to see a doctor, and prescription delays.

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The Atlanta MSA’s GDP per capita for 2016 was $55,300 and ranked 50 among 383 MSAs in the U.S. The average MSA GDP per capita that year was $42,276 [12].

The obvious risk of participating in illicit street markets for ARVs is non-adherence. Selling medication that was part of a strict treatment increases the probability of missing scheduled intakes. Buying ARVs without a prescription or the supervision of pharmacists or medical personnel increases the probabilities of taking the wrong medication, taking expired medication and/or using wrong doses.

This methodological approach is commonly used to identify and recruit potential participants that are difficult to reach [18‐21].

Although we had not surveyed HIV patients before this study, we both had ample experience conducting qualitative research.

This aspect of our sample did not occur by design. Every person who called interested in participating of the study was African American. HIV in the Atlanta MSA is most prevalent in the African-American population.

Georgia’s ADAP is a state-administered program that provides ARVs to lower income individuals who live with HIV but have no insurance coverage except for Medicare. ADAPs across the country were originally authorized by the Ryan White Comprehensive AIDS Resources Emergency Act of 1990. ADAP funds are used only for the purchase of ADAP formulary drugs that patients cannot afford through other means (i.e., ADAP must be the payer of last resort). There are currently 74 medications on the Georgia ADAP Formulary. Georgia’s ADAP services are available to all eligible residents in the state: 27 enrollment sites in 18 public health districts, including 7 sites in metro Atlanta alone [24].

We defined “illegal drugs” as any drug listed in Schedules I or II of the Drug Enforcement Administration’s Resource Guide [25].

The most frequently cited personal needs included food, transportation and family support. Most participants did not have a stable job and 13.95% (n = 6) of them did not have a permanent residence.

All Ryan White/ADAP participants are required to recertify their eligibility for the program every six months [24].

One of the eligibility criteria required participants to be under formal treatment (defined as having obtained a prescription within the previous six months). Eight of our participants (18.60%) had obtained prescriptions within the previous six months yet reported having no insurance coverage. The reason is that they had received their prescriptions in a different state but had recently moved to the Atlanta MSA and were in the process of gathering documentation to be admitted into the Ryan White/ADAP program.

A list of outreach and charitable HIV/AIDS programs can be found at the Positive Impact Health Centers website [27].

The MSA of Miami–Fort Lauderdale–West Palm Beach, Florida, ranked number 1 in HIV diagnostic rates in 2016 out of 108 MSAs with a rate of 38.7 per 100,000. Recall that the Atlanta MSA ranked third in diagnostic rates that year with a rate of 29.4 per 100,000 [13].

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Georgia Department of Public Health, Division of Health Protection. Georgia Ryan White Part B, AIDS Drug Assistance Program (ADAP), and Health Insurance Continuation Program (HICP) Policies & Procedures 2017. 2017.

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Georgia Department of Public Health. Ryan White required rocuments checklist 2016. www.gacapus.com. Accessed 20 Feb 2018.

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Positive Impact Health Centers. HIV resources and support in metro Atlanta. https://www.positiveimpacthealthcenters.org/advocacy-resources/hiv-advocacy/. Accessed 25 Feb 2018.

Titel: Demand and Supply Motivations for Antiretroviral Drugs in Illicit Street Markets: The Case of Atlanta, Georgia
verfasst von: Antonio Saravia
Robert Mueller
Publikationsdatum: 08.12.2018
Verlag: Springer US
Erschienen in: AIDS and Behavior / Ausgabe 8/2019
Print ISSN: 1090-7165
Elektronische ISSN: 1573-3254
DOI: https://doi.org/10.1007/s10461-018-2359-z

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