ADAP Shortfall Relief - The proposed project is to use ADAP Emergency Relief Funds to cover the extant need for the Vermont Medication Assistance Program’s (VMAP, VT’s ADAP) expenditures. Expenses include prescriptions, insurance premiums, co-pays and co-insurance. Population groups served are those qualifying for ADAP assistance - the lowest income, highest need people living with HIV in Vermont, which includes 55% of all Vermont PLWDHI. Vermont is a small, rural state with 14 counties ranging in population size from 5,900 to 168,000. There is one city over 44,000 people, and four cities over 10,000. Of 121 incorporated areas such as cities and towns, 86% (104) meet the Census definition of rural – under 2,500 people in residence. Vermont’s age demographic skews older than the nation, with a median age of 43 years versus 38, and a total population of 65 or above of 21% versus 16%. The state’s population has remained over 90% White throughout its history and US Census data indicates 94.2% of the total current population is White, with all other race representations ranking at 2% or lower. Sexual orientation breakdown totals 90% heterosexual, 6% bisexual, 2% gay or lesbian, and 2% other sexual orientation. At least 93.9% of VT adults have at least a high school education and 40.9%, a Bachelor’s degree or above. Six in ten VT adults (62%) are employed, followed by 5% unemployed, 22% retired, and 5% currently unable to work. The state’s unemployment rate rests at 2.8%. Vermont’s rate of persons in poverty stands at 10.3%. The household median income is $76,079 while Income Tax Returns indicate 52% of VT residents filing a tax return had an Adjusted Gross Income of less than $50,000 per year. As of December 31, 2023, there were 731 people living with diagnosed HIV infection (PLWDHI) in VT. The state’s HIV case rate stands at 112.5 persons per 100,000 population. This represents an increase of approximately 5 people per 100,000 over the five-year period 2017 – 2021. There were eleven new reports of HIV in 2021, for which no report could be identified in another jurisdiction, all of whom were linked to care within one week. Of those eleven, the majority were Male and White. Due to VT’s small population, demographic data on a number as small as eleven individuals cannot be released at a granular level. Based on the most recent fully-confirmed HIV surveillance data of December 31, 2021, VT’s HIV epidemic continues to be primarily Male (81%) and White (75%). This has been the state’s historical trend and it was further sustained in the new 2021 diagnoses. MSM Sexual Contact remains the most common transmission category, at 54.1% of HIV cases. It should be noted that while the large majority of HIV burden is white males, Black and Hispanic individuals are disproportionally represented among the state’s HIV positive population, as compared to their overall presence in the state. Vermont’s ADAP functions efficiently, with only 1.5 FTEs devoted to the program. The individuals qualifying for VMAP are a close microcosm of the overall epidemic – older white males, who primarily fall within the transmission category of male-to-male sexual encounters. The ADAP has been level funded for some time, and has seen steadily decreasing rebates at a time when expenses are skyrocketing. The need for additional resources is due to the combined pressures of increasing utilization, increasing expense of new medications, increased cost for insurance, and a drastic jump in the number of full-pay clients in the past few years. If awarded, ERF will go toward covering the needs that will remain following the exhaustion of the X07 Base Award, the X07 ADAP earmark, and the X08 Part B Supplemental Funds. ERF may make it possible to redirect some Supplemental funds to other Part B programs that have needed additional assistance for some time, but have fallen in priority below fully funding ADAP.
