Gordon Nary is editor of the Journal of Timely and Appropriate
Care of People with HIV Disease and executive director of
Medical  Advocates for Social Justice.

Our most important resources in addressing the challenges of the state AIDS Drug
Assistance Program (ADAP) waiting lists are (1) the advocacy community’s efforts
to convince Congress and state legislatures to provide adequate funding for HIV drugs
and services and (2) the often heroic efforts of state healthcare officials and their staffs
 in responding to the often impossible challenges of meeting the diverse needs for drugs
and services of people with HIV disease. But there is more that can be done. And doing
more is the moral challenge that each of us faces.

Like the knight in Ingmar Bergman’s The Seventh Seal who challenges Death to a game
of chess, we must also stare Death in the face and try to outwit the master chess player
to save those on ADAP waiting lists who are pawns in the ultimate cosmic chess game.
Our strategy must be to do whatever is necessary to postpone the inevitable checkmate.

Medical Advocates for Social Justice offers two recommendations that we believe are central
to resolving this challenge. First, to follow up on Dr. Bartlett’s recommendation on the
importance of prioritizing people on state ADAP waiting lists (see page 16 of the Journal), we
recommend holding a workshop as soon as possible for state ADAP directors and other relevant
state and  federal healthcare officials to establish voluntary guidelines for the triage of people on
state ADAP waiting lists.

For those who may die without immediate access to HIV drugs, these drugs are as critical as
an organ transplant to those with advanced heart, kidney, liver, and other diseases for whom organ
transplantation is the only hope for life. If we can develop an equitable system for rationing donated
organs, then we can develop a more equitable system for rationing HIV drugs for the medically
indigent when our government chooses not to provide funding for these drugs. Medical Advocates is
therefore working with our partners in seeking funding for a workshop on the establishment of these
guidelines.

Second, we need to have a mechanism for the private sector to share the responsibility with
government to make HIV drugs accessible to those who will die without access to these drugs.
Medical Advocates recommends the establishment of an ADAP foundation  whose mission would
be to:

• Provide emergency funding for people on state ADAP waiting lists that are prioritized according to
proposed national guidelines with the agreement that such funding will not affect their eligibility for
state ADAP benefits.

• Fund case management studies of people on state ADAP waiting lists to determine eligibility for
other benefit sources.

• Provide temporary case management support on request from understaffed state ADAP directors.

• Provide assistance and financial support as necessary to enroll people on state ADAP waiting lists
into clinical trials.

Medical Advocates invites those who may be interested in serving as a trustee of this proposed
foundation to submit their curriculum vitae via e-mail to adapfoundation@medadvocates.org  or by
direct mail to ADAP Foundation Organizing Committee, Medical Advocates for Social Justice, 320
West Illinois Street, Ste 211, Chicago, IL 60610.