Medication becomes like diamonds: An access & patient compliance story

"Carlos," a slight, soft-spoken man who makes a living ferrying tourists around Boca Chica in the Dominican Republic, arrived at the doctor’s office in 2000, near death. He had tested HIV-positive a few years before, but had been unable to afford the 30,000 pesos, or $1,000 a month, for medicine on the black market. The doctor started him on an older, cheaper drug combination, and then Carlos’ brother-in-law in the Bronx began buying medication from a "non-control" drug dealer (of prescription, non-controlled substances). Now, Carlos supplements his $300 monthly income by reselling pills he doesn’t need for about $80 a bottle.

"Medication becomes like money," says his doctor, "like diamonds for somebody, because they see their life in there. And it is in there."

Advice for patients like Carlos: If your doctor says you need the pills, take them.

Read a related black market access story, or Kai Wright’s source story in the May/June issue of Mother Jones.

Psst, Got antriretrovirals?: A wrong patient & compliance error story

For years, "Jerry" bounced in and of various jails for burglary, theft and armed robbery. He tested HIV-positive 10 years ago, apparently from having shared an HIV user’s needle. Later, while while nodding off on heroin, he stumbled in a subway platform, and lost most of his front teeth. Still, he has a wide, boyish smile.

He would use his New York State Medicaid card to buy prescriptions worth hundreds of dollars, then turn around and sell them on the street for as little as $20. "You’d take it, out of desperation," he says.

These days, he’s clean, and not desperate for cash, so he’s unloading his painkillers and the Marinol his doctor prescribes to help his appetite. When he finally finds the "non-control man”"who buys prescription ("non-controlled" substance) drugs, Jerry nets $80. The non-control man can sell them for huge profits.

Advice to HIV patients: Only ask for the meds you need. For the others, don’t ask, don’t sell.

Advice for Medicaid program managers: Look into possible fraud by tracking the prescription patterns of habitual criminals who are HIV-positive.

Read a story about access to treatment by a poor family, or Kai Wright’s source article in the May/June issue of Mother Jones.