Summary of the 41st Presidential Advisory Council on HIV/AIDS (PACHA) Meeting

By Rob Banaszak on February 1, 2011 in Policy/Advocacy

By Donna Crews, Director of Government Affairs
AIDS United

The Presidential Advisory Council on HIV/AIDS (PACHA) met on January 27th & 28th in Washington, D.C.  AIDS United Board member Douglas Brooks is a PACHA member and was in attendance, and AIDS United Vice President of External Affairs Victor Barnes offered public comments on day two of the meeting.

Following opening remarks by Dr. Howard Koh, Assistant Secretary for Health at the Department of Health and Human Services (DHAS) and Jeffrey Crowley Director of the White House Office of National HIV/AIDS Policy (ONAP), Crowley provided an update on the National HIV/AIDS Strategy (NHAS) and the public release of the NHAS operational plans. Crowley also indicated that ONAP will be publishing the first NHAS annual report, which will be less a “federal report” and more a “nation’s reponse” to the domestic HIV/AIDS epidemic.  Crowley expressed ONAP’s host for positive results from the 12-city coordination model of DHHS agencies in the highest impacted jurisdictions accounting for 44% of the HIV epidemic.

Operational plan updates

Office of HIV/AIDS Housing at the Department of Housing and Urban Development (HUD)

David Vos, Director of the Office of HIV/AIDS Housing at the Department of Housing and Urban Development (HUD) explained that HUD’s operational plan focused on Housing Opportunities for People with AIDS (HOPWA) while developing ways to bring the HIV epidemic into other parts of HUDs work, especially the homeless division of the agency.  Homelessness is a known risk factor for HIV.

Veterans Affairs (VA)

Maggie Czarnogorski, Deputy Director National Clinical Public Health Program at Veterans Affairs (VA) explained that the VA is the largest single provider of HIV care in the country,  treating over 24,000 veterans.  The agency uses (electronic?) medical records and confirms that:

  • 95% of their HIV positive patients/clients are linked to care within 90 days of diagnosis
  • 91% of those eligible to be on medication are receiving HIV medication; and
  • 84% of patients/clients are virally suppressed.
  • With its detailed client level data, the VA is also able to determine that 60% of the HIV positive veterans are over 55 years old, 80 HIV positive veterans are over eighty years old.

Federal Bureau of Prisons (BOP)

Chris Bina, Director of the Pharmacy Program at Federal Bureau of Prisons (BOP), Department of Justice (DOJ) emphasized that prison health is public health.  There is a 1.6% HIV prevalence rate in the federal prison system.  HIV testing is offered to all inmates at their first physical and is mandatory for those prisoners who are “at risk”.  BOP works with the VA to evaluate inmates’ CD4 count and viral load data.  BOP is working to increase the number of re-entry coordinators to assist ex-offenders connection to care and treatment after release from prison. Released inmates are given a 30 day supply of medication.

Department of Justice (DOJ) Civl Rights Division

David Knight of  DOJ’s Civil Rights Division explained the agency’s charge to reduce stigma and eliminate discrimination involving HIV. The DOJ Civil Rights Division gives incoming HIV/AIDS discrimination a top priority, while educating the public on HIV and stigma.  HIV is explicitly protected under the Americans with Disabilities Act , and the DOJ Civil Rights Division charged with informing the public of this protection through conferences, fact sheets, and conferences.

Social Security Administration (SSA)

A representative of the Social Security Administration (SSA) explained that the SSA is working to make faster decisions on Social Security Disability designation cases.  SSA helps individuals return to the workforce and is developing ways to raise community awareness of the role of Social Security Administration.

Department of Health and Human Services (DHHS)

Dr. Ron Valdiserri presented excerpts of the Health and Human Services (HHS) operational plan, which features the most detailed description of the $16 billion HHS HIV budget that has ever been compiled, including both entitlement and discretionary funding on the HIV domestic portfolio with some global line items as well. The twelve city initiative has expanded the CDC coordination and planning grant Enhanced Comprehensive HIV Prevention Planning and Implementation for Metropolitan Statistical Areas Most Affected by HIV/AIDS (ECHPP) to include coordination with Health Resources Services Administration (HRSA) HIV/AIDS Bureau (HAB) and Bureau of Primary Health (BPH), Substance Abuse Mental Health Services Administration (SAMHSA), Indian Health Service (IHS), Center for Medicare/Medicaid Services (CMS), and National Institutes of Health (NIH).   The intent of the initiative is to share information on funding priorities in each of the twelve jurisdictions, and to  serve as a model for the country-wide coordination of the National HIV/AIDS Strategy (NHAS). This initiative may also be an opportunity to attain a common metrics for collecting HIV data.

Other HIV-related activities at HHS include:

  • An NIH study to determine the effects of stigma on access to HIV testing, and HIV care and treatment.
  • A consultation organized by ONAP at HHS with lesbian, gay, bisexual, and transgender community leaders to discuss how the United States government can be better partners in the HIV domestic epidemic.
  • An emphasis on the importance of  public/private partnerships to ensure the HIV domestic epidemic realizes the goals of NHAS.

Subcommittee Reports

Access to Care subcommittee

Andrea Weddle, Executive Director, HIV Medicine Association and Laura Hanen, Director of Government Relations, National Alliance of State and Territorial AIDS Directors presented a health care reform update with a focus on HIV.  The subcommittee also discussed the importance of increased HIV testing, increased resources for the HIV workforce, and the need to evaluate the Ryan White Program in light of healthcare reform.

HIV Incidence subcommittee

PACHA member Dr. David Holtgrave began the presentation with the statement “fully funding prevention is the least expensive way forward” in the HIV epidemic.  Subcommittee members believe a metrics for measuring the factors associated with HIV is important, but it must be a metrics that can be used by federal, state, and local governments as well as by community based organizations.  Such a metrics have not been defined yet. The subcommittee also explained the importance of discussion and knowledge of community viral load across the country.  Subcommittee members noted that treatment as prevention must be discussed in more detail by the subcommittee and PACHA as a whole.

Global Affairs subcommittee

The majority of the subcommittee report was on a resolution to scale up global AIDS funding.  The discussion led to a conversation on how PACHA wants to use its resolution resources and how and when PACHA should weigh in on the budget and appropriations conversations annually.  The resolution was pulled but PACHA decided to send a letter expressing strong support for the United States to live up to its financial commitments in PEPFAR and the global fund.

Health Disparities subcommittee

The subcommittee report explained their monitoring of three issues 1. How the Veterans Administration monitors its 8.5 million clients/patients, 2. The need to develop system to gather data on safe disclosure issues by the end of the year as detailed in the NHAS, 3. The modernization of the HOPWA formula through the HUD Secretary’s overall housing modernization congressional plan.  The subcommittee then presented two panelists, Catherine Hanssens, Executive Director of the Center for HIV Law & Policy and Alison Nichols, from the Department of Justice, Disability Rights Section, Civil Rights Division to discuss the proliferation of laws across the nation on HIV criminalization. This issue will continue to be discussed and debated to see where PACHA members fit in to the conversation.

Public Comments

Thirteen individuals made public comments at the two -day PACHA meeting. The comments were varied focusing on ADAP, prevention funding, Ryan White Program doctors concerns, and inclusion of young people in PACHA debates and membership.  Victor Barnes, Vice President of External Affairs at AIDS United addressed PACHA about the importance of inclusion of public/private partnerships as the country works on implementation of the National HIV/AIDS Strategy.  Daria Boccher-Lattimore spoke on behalf of the National AETC network to explain how they are working to meet the NHAS goals using a cost-effective and coordinated approach to educational and clinical skills.  For example, AETCS seek to reduce new HIV infections by providing front line clinicianswith the ability to turn every visit into an HIV prevention opportunity regardless of the client’s HIV status of a client.

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