Policy Initiatives

The Duke HIV/AIDS Policy Clinic is a law school clinic focused on policy research and advocacy on issues of importance to people living with HIV/AIDS and those at risk. Under the supervision of Carolyn McAllaster, students engage in policy research and advocacy with a primary focus on North Carolina.

Our Current Policy Projects:

Health Care Reform Implementation in North Carolina

We are researching and working with partners to ensure that health care reform implementation takes into account the needs of people living with HIV/AIDS. This includes ensuring that the state Insurance Exchange and Medicaid Expansion meet the needs of people with HIV/AIDS. States will be responsible for determining the Essential Health Benefits that will be required in the Insurance Exchange. We are working to make sure policy makers are aware of the needs of people living with HIV as this benefit is determined on a state level. Health Care Reform implementation will transform the environment in which the Ryan White program operates. We will be working with partners to plan for the transition on a state level, as well as to have input a federal level on Ryan White Reauthorization in 2013. We also are providing education about Health Care Reform for people living with HIV/AIDS and the broader HIV community.

Medicaid Transportation

The State Health Access Research Project, operated by the Harvard Center for Health Law and Policy, identified access to transportation for medical services as a major barrier to access to health care for people living with HIV/AIDS in North Carolina. We have been researching Medicaid Transportation policies and practices in 10 eastern rural counties. We will be providing education and advocacy around this issue.

Medicaid Prior Authorization for Antiretroviral Drugs

Because of a funding crisis in North Carolina Medicaid which resulted from the 2011-12 state budget bill, the Department of Health and Human Resources is considering a wide range of cost saving measures, including prior authorization for antiretroviral medications. Our research tells us that such a policy is not likely to save money and may adversely affect the health of individuals and the public. We will advocate with the state to avoid implementing this measure.


The NC AIDS Drug Assistance Program is a life-saver for the thousands of low income people living with HIV/AIDS in North Carolina. But funds are short in North Carolina, as they are across the country. We are researching cost saving measures, including coordination with the federal Pre-Existing Condition Insurance Pool ("PCIP") operated by Inclusive Health. We are researching efforts in other states to conserve limited funds by using ADAP dollars to pay for PCIP insurance for eligible ADAP beneficiaries. We hope to support efforts by the state of North Carolina to implement this kind of cost saving measure.

HIV Confidentiality and Stigma

Sadly, an HIV diagnosis is still stigmatized in the United States, especially in the South. We are focusing on protecting the confidentiality of people's HIV diagnosis in the justice system and in health care facilities, particularly emergency departments. We are providing education to lawyers and medical providers about HIV stigma and sensitizing them to the need to maintain confidentiality of this sensitive information.

Occupational Licensing

In mid 2010, the US Department of Justice wrote to all state's Attorneys General urging them to examine state occupational licensing laws that might discriminate against people living with HIV/AIDS. Laws in many states contain language excluding those with "contagious," "communicable," or "infectious" diseases from obtaining licenses to be barbers, cosmetologists, etc. This kind of language can be used to exclude people living with HIV/AIDS, even thought there is no risk of transmission in these occupations. We are examining North Carolina occupational licensing rules and laws and will be seeking rules changes in occupations where there is a risk of discrimination against people living with HIV/AIDS.

Southern HIV/AIDS Strategy Initiative

With funding from the Ford Foundation, we are coordinating the response of advocates in southern states to the National AIDS Strategy. The Southern HIV/AIDS Strategy Initiative ("SASI") is a broad-based coalition of HIV/AIDS Advocates and their supporters lead by the Duke Health Justice Clinic. SASI is developing research-based policy and strategy recommendations aimed at securing a federal commitment for the next steps in the implementation of the National HIV/AIDS Strategy.