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

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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.

Resumen

Estudiamos las motivaciones de demanda y oferta de medicamentos antiretrovirales (ARVs) en el mercado negro del área metropolitana conformada por Atlanta, Sandy Springs y Roswell en Georgia. Encontramos que estas dos acciones de mercado son considerablemente interdependientes: 39.53% de los participantes indicaron que vendieron sus ARVs para pagar por necesidades personales, y 20.93% de los mismos indicaron que compraron ARVs porque los habían previamente vendido para pagar por necesidades personales. El patrón que emerge de estos resultados sugiere que los mercados negros de ARVs se han convertido en mecanismos a través de los cuales pacientes con HIV cooperan para satisfacer multiples objetivos: cubrir necesidades personales y mantener, aunque no perfectamente, su régimen medico. También encontramos que pacientes con HIV recurren a mercados negros de ARVs porque enfrentan deficiencias institucionales como la exclusión del programa Ryan White/ADAP, largos tiempos de espera para ser atendidos por un doctor y demoras en obtener sus prescripciones.

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Notes

  1. 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].

  2. 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.

  3. This methodological approach is commonly used to identify and recruit potential participants that are difficult to reach [18,19,20,21].

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

  5. 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.

  6. 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].

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

  8. 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.

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

  10. 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.

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

  12. 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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Funding

Funding

This study was funded by The Quality Enhancing Program office at Mercer University (grant awarded on February 25, 2016).

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  1. Stetson School of Business and Economics, Mercer University, 1501 Mercer University Drive, Macon, GA, 31207, USA

    Antonio Saravia & Robert Mueller

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  1. Antonio Saravia
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Correspondence to Antonio Saravia.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Saravia, A., Mueller, R. Demand and Supply Motivations for Antiretroviral Drugs in Illicit Street Markets: The Case of Atlanta, Georgia. AIDS Behav 23, 2079–2087 (2019). https://doi.org/10.1007/s10461-018-2359-z

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