Browsing Category: Policy/Advocacy

FEM-PrEP Study Closes Early, Implications Yet to be Determined

julia_chengBy Julia Cheng, Zamora Fellow, AIDS United

On Monday April 18th Family Health International (FHI), the organizers of a clinical trial testing the combination antiretroviral (ARV) drug Truvada as an oral Pre-Exposure Prophylaxis (PrEP), announced that the FEM-PrEP study would begin to close.   FHI released a statement after a scheduled review by an Independent Data Monitoring Committee advised that the study of the effectiveness of using the drug to prevent HIV among African women at high risk for contracting the virus would be unlikely to come to conclusive results.

For many in the HIV community, the closure of this study is disappointing.  Previous studies of Truvada and tenofovir (one of the ARVs contained in Truvada) had shown promising implications and advocates had hoped they were nearing a breakthrough in preventing HIV.  The CAPRISA trial released results in July 2010 showing that a microbicidal vaginal gel containing 1% tenofovir had an overall 39% effectiveness rate in preventing HIV and a 54% effectiveness rate for women who used the gel for the majority of their sexual encounters.  The iPrEX study, which used the same drug as the FEM-PrEP study, released its results in November 2010 showing a 43.8%  average reduced risk for men who have sex with men (MSM) and transgender women who have sex with men but a 72.8% reduced risk for those with high adherence to the drug regimen. PrEP and vaginal microbicides both have delivery methods that are helpful because they do not need to be applied or used during sexual intercourse and can be used without having to negotiate with a partner.  Since social inequities play a large role in determining those most affected by HIV, giving greater tools to people may have less power over their HIV exposure, particularly women, can play a huge role in reducing infection.

Upon the announcement of the FEM-PrEP trial closure, both CAPRISA and iPrEx researchers released statements commending the researchers and participants of the trial, while urging caution at making conclusions from the still preliminary data.  They noted that this news needs to be studied further and that the study may have large implications for the use of PrEP and Truvada or conversely may have no significant impact on the existing science.  In the meantime, the Centers for Disease Control and Prevention (CDC) released a letter reiterating that its interim guidelines for PrEP only apply to MSM.  For now, little will change until more details of the study come to light as the researchers close the study and analyze their data.  Whatever the case, the closing of the FEM-PrEP trial at this point continues to show that communities and people at risk of HIV need more tools to prevent HIV that are supported by science.

FY 11 Budget: The Impact on HIV/AIDS

Donna Crewsby Donna Crews, AIDS United Government Affairs Director

On Friday, April 8, President Barack Obama and Congressional leaders John Boehner (R-OH) and Harry Reid (D-NV) reached an agreement on the budgetary framework to fund the government for the remainder of the fiscal year 2011 (FY 2011). The deal was reached in the final hours before midnight, narrowly averting a government shutdown that would have gone into effect.

The package will fund the government over the entirety of FY 2011. Spending will be approximately $78.5 billion less than the President’s original FY 2011 budget proposal and about $37.6 billion dollars less than was appropriated for fiscal year 2010 which expired on September 30, 2010. Because the President’s proposed budget for FY 2011 was not authorized by Congress by the September 30 deadline, the government has been funded by a series of seven temporary appropriation bills or continuing resolutions (CR) that kept spending at or near 2010 levels. The government is funded by the seventh CR until April 15, as it was expected to take several days to translate the agreement into a legislative draft.

Public health programs as well as programs and agencies that specifically benefit people living with HIV are impacted by the budget agreement. While all the details of where cuts will be distributed are not finalized, here is what we know so far:

  • Funding for syringe exchange programs (SEPs) remains available for use at the federal level and at the local level for the District of Columbia
  • All discretionary non-defense related agencies will be assessed a 0.2 % cut in addition to the cuts listed below. It is not clear if the across the board cuts will be taken before or after the below cuts. The number will vary based on when the across the board cut is taken.
  • The Centers for Disease Control (CDC) is funded at $5.66 billion, a $740 million cut across the agency. There will be some unspecified Congressional direction and some flexibility at the agency level. We do not know yet how these CDC –wide cuts will impact the domestic HIV portfolio.
  • You may have seen a chart or media report that stated the HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Center received a $1.045 billion cut below FY10. This was incorrect information.
  • Health Resources and Services Administration (HRSA), the primary Federal agency for improving access to health care services for people who are uninsured, isolated, or medically vulnerable, is funded at $6.27 billion a $1.2 billion cut below FY10 level.
  • For the Ryan White Care Act (RWCA), Part A, grants to eligible metropolitan areas, and Part B, grants to states, seem to be flat-funded at $1.098 billion. We assume the rest of the Ryan White Program is also flat-funded, but the figures are not yet officially released.
  • AIDS Drug Assistance Program (ADAP) will total $885 million, an increase of $25 million over FY10.
  • AmeriCorps is funded with a $30 million cut from FY10; the Social Innovation Fund has maintained flat funding at $50 million.
  • Housing Opportunities for Persons with AIDS (HOPWA) is flat-funded.
  • Title X, funding for family planning, remains. It is appropriated at $300 million, a $17 million cut below FY 10 level.
  • Teen Pregnancy Prevention Initiative is funded at $110 million, $5 million below FY10 level.

It’s Time To Defend and Protect Health Care Reform!

By James Schneidewind, Public Policy Associate

On March 23, 2010, President Obama lifted his pen and signed into law The Patient Protection and Affordable Care Act (ACA), and forever changed the way the U.S. cares for the health needs of its citizens. Passage of the Act marked an historical resolution by our government to make good on its compact with the people to offer quality and affordable health care to all citizens, not just a privileged few. A year later, we have watched as campaigns for and against the law have raged, listened as debate in Congress over the law has been resurrected due to Republican repeal bills, and witnessed a change in the way health care is distributed in the country as provisions from the law have gone into effect.

Despite the misinformation and confusion associated with the ACA, we know and have known that millions of uninsured and vulnerable Americans will have access to health care and insurance as a result of its passage. We know that many of the health disparities in the United States that run along racial, ethnic, geographical, and income lines will be reduced or even eliminated by this law. We also know that it will become the base for expanding coverage in the future, offering more benefits to those in need and, we hope, making the United States the healthiest country in the world. This enormous potential is understood by most politicians, pundits, and citizens from across the political spectrum.

Unfortunately, as debate over the ACA has been reignited by Republican efforts in Congress to repeal the law, we find ourselves recycling old arguments and talking points from 2009 and 2010. Our public dialogue has not evolved as benefits have kicked in, facts from reputable sources have emerged, and Americans have begun telling their stories about how they have benefitted from the ACA. We do not live in the same climate as we did two years ago, nor do we face the same challenges. It is time for our discourse on health care reform to evolve.

In March 2011, according to a Gallup poll, 13% of Americans see the federal debt as the most important problem facing our nation, more than at any other point in the last 10 years. In response, a small group of Senators and other leaders have pledged to look at sustainable and long-term plans to reduce the deficit as opposed to focusing on immediate, superficial budget fixes that do little to alleviate our deficit strains. This makes staying the course with the ACA much more germane. In January, the Congressional Budget Office (CBO), an unbiased and nonpartisan agency that makes projections on the federal debt and estimates on the cost of legislation, issued a report that shows repeal of the ACA would add $230 billion to the federal debt over the next decadeand leave 32 million more Americans uninsured, according to a preliminary analysis. It also found that repeal would add $1.2 trillion in the second decade after passage. Last year, the CBO estimated that the ACA would reduce the deficit by $143 billion by 2019. These are real facts and figures that cast the cost-effectiveness of health care reform in a different light than the information available to us a year ago.

A year ago, many Americans were confused about how the ACA would benefit them due in part to misleading and unsubstantiated claims made by many in regards to health care reform. A year later, Americans are still confused and divided on the issue, according to a recent poll conducted by the Kaiser Family Foundation. The poll finds that public approval and disapproval ratings of the law are about even, showing that roughly 46% of Americans have an unfavorable opinion of the health care reform law while 42% felt favorably about it, compared with 46% and 40% respectively in April of 2010. However, when broken down by individual provisions, the law is overwhelmingly popular. Eighty-two percent of Americans want to keep the tax credits to small businesses; 76% want to keep the provision that gradually closes the Medicare “doughnut hole”; 74% want to keep requirements that guarantee the issuance of insurance to all citizens regardless of health, income or age; 72% want to keep the provision that affords financial help for low and moderate income Americans in need of coverage; and a somewhat surprising 58% want to keep the provision that increases the Medicare payroll tax on the wealthy. It is now clear in March of 2011 that more Americans than ever before like the contents of this law, if not the name of the law itself or the confusing rhetoric surrounding it.

As we move forward with the implementation of the ACA, let’s move the debate forward as well. Let’s avoid the wasteful back and forth made up of hypothetical what-ifs that are intended to confuse Americans and stick to the established facts and real stories. A year into the process it’s time to talk less about how people will benefit and more about how they have already benefited. Most importantly, it’s time to DEFEND and PROTECT the ACA from repeal efforts.

Visit Healthcare.gov’s “Better Benefits, Better Care” page to see specifically how health care reform has benefitted small businesses, seniors, young adults, women, and all Americans in general with the Patient Protection Act.

Read how the ACA will specifically benefit people living with HIV/AIDS.

Hear personal stories of people who have already reaped the benefits of the ACA, highlighted by an under-graduate student from my Alma Mater, Michigan State University!

Why the Latest Sex Survey Isn’t Surprising…

…and How it Offers an Argument for Comprehensive Sexuality Education

by Julia Cheng, AIDS United Zamora Fellow

On Thursday March 3rd, the National Center for Health Statistics at the Centers for Disease Control and Prevention (CDC) released the latest report on data from the National Survey of Family Growth.  Though the report, “Sexual Behavior, Sexual Attraction, and Sexual Identity in the United States: Data from the 2006-2008 National Survey of Family Growth,”  focuses on many aspects of sexuality among the 13,495 males and females ages 15-44 interviewed in the household population of the U.S., the headlines — “For Young, Sex Falls in Survey” (New York Times), “US Teens, Young Adults ‘Doing it’ Less, Study Says” (Washington Post), “More Young People Scorning Sex, Study Finds” (NPR)—emphasize the increase from 22% to 28% in young individuals ages 15-24 reporting no sexual contact with another person.  Here is why the report is not surprising and why it demonstrates the importance of comprehensive sexuality education and HIV/AIDS prevention and awareness education.

1. Over the last two decades, there has been a steady decline in vaginal sex among teens
While proponents of abstinence-only-until-marriage programs may point to an increase in refraining from sexual behavior as success of abstinence programs, the decline in vaginal sex among teens has persisted whether or not abstinence programs have mainstream traction.  While data surveillance on other types of sexual behavior is relatively new, considering the decline in vaginal sex and the correlation of vaginal sex with other types of sexual activity, it is not surprising that there would also be a decline in all types of sexual behavior among teens.

2. Seventy two percent of individuals 15-24 are having sexual contact
Even if more young people are refraining from sexual behavior, the fact remains that the majority of them are not.  According to the 2009 Youth Risk Behavior Survey (YRBS) from the CDC, 5.9% of students had sexual intercourse for the first time before age 13, demonstrating the vast differences of sexual behavior among the national population.  Furthermore, both surveys demonstrate that differences exist among social and demographic categories, often correlated with populations disproportionately affected by HIV.  Since sexual behavior among young people runs the gamut, comprehensive sexuality education that is open to the versatile needs of young individuals and their sexuality is necessary.

3. Ninety eight percent of 25-44 year olds have had vaginal intercourse; for most, sexual activity begins before 25
If 98% of 25-44 year olds have had vaginal intercourse (as opposed to all types of sexual contact), for the vast majority of the population refraining from sexual contact means delaying.  Furthermore, in the cohort 25-29, less than 3.4% and 3.8% of women and men respectively have never had sex, suggesting for most, sexual activity begins before 25.  As numerous studies (here, here, here, and here) have demonstrated, sexuality education works best when taught before initiation of sexual activity.  Those who have not be provided with sexuality education before they initiate sex, no matter how long they have delayed, are more likely to have unprotected sex and be uninformed of such risks.  According to the latest CDC surveillance data on HIV/AIDS, there was an increase of HIV diagnoses for persons ages 15-19 and 20-24, with persons aged 20-24 having the highest percentage (15%) and highest rate (36.9 per 100,000) of all diagnoses.  Providing comprehensive sexuality education and HIV/AIDS prevention and awareness information to young adolescents will prepare them for the day when—because almost certainly they will—engage in sexual activity.

4. Abstinence-only-until-marriage only applies to those who marry
Among other reasons, abstinence-only-until-marriage programs are problematic because they discriminate.  While certainly many individuals choose not to marry, most LGBT individuals do not have the right to marry legally.  By definition, abstinence-only-until-marriage programs either ignore or actively discourage sexual behavior outside of a legal marriage between a man and a woman.  The role that stigma and discrimination play in HIV health inequities is broadly recognized and is exists as one of the major points in the National HIV/AIDS Strategy.  In the National Survey of Family Growth, 6% of men and 12% of women between 25-44 reported having same-sex sexual contact, while differences between racial and ethnic groups in reporting same-sex sexual behavior seem to underscore the role that stigma still plays.  It is ludicrous to believe that ignoring the sexuality of LGBT individuals, especially MSM, can be an effective strategy in preventing HIV.

Abstinence or delaying sexual initiation is a choice that should be included in comprehensive sexuality curriculums, but it should not be the sole choice provided to adolescents who will need the tools to make fully informed decisions.  Instead, we must aim to give young individuals the comprehensive education and tools to achieve healthy sexuality and prevent disease and unwanted pregnancy. .

All We Are Sayin’ is Give Female Condoms a Chance

by Jessica Terlikowski, Director of Regional Organizing

Exactly one week before the annual commemoration of National Women and Girls HIV/AIDS Awareness Day, the feminist blog Jezebel responded with intense skepticism to the USA Today headline claiming that female condoms (FCs) are gaining broader acceptance in U.S. cities. Citing the experience of one woman who did not enjoy using FCs and had difficulty locating them, the blogger casts them as nothing but a “sad sack of contraception options.”  Several readers’ comments belittled the safer sex tool as novelty or a joke and questioned why anyone would use it. While such mockery of the female condom is not uncommon, it is particularly disappointing when dismissed by those who purportedly support the reproductive health and rights of women and girls.

The female condom has endured more than its fair share of criticism since coming on the scene nearly 20 years ago. It’s ugly. It’s strange. It’s noisy. It’s difficult to use. It’s like having sex with a plastic bag. It’s too expensive. You get the idea. Such negative portrayals of the female condom are nothing new. However, they are ultimately a disservice to the women, men, transpeople, and youth who need and deserve an expanded range of HIV and STI prevention tools. We now have a second chance with the new generation of the female condom, the FC2, to create a more positive conversation.  The latest product is stronger, softer, quieter, seamless, hypo-allergenic, and more affordable. In short, it is a vast improvement from its predecessor.

The female condom is currently the lone receptive partner initiated HIV, STI, and pregnancy prevention tool available. And as such, it should be promoted and distributed with the same gusto with which we encourage male condom use. Several studies show that when female condoms are promoted and provided alongside male condoms, the total number of protected sex acts increases. Reduced infections and unintended pregnancies are exactly what we reproductive health, HIV and STI prevention, and sexual health professionals and advocates work to achieve. Yet, many among us are reluctant, and sometimes even loathe, to affirm or to offer female condoms because of bias against female condoms. Nearly 60,000 new HIV infections occur annually in the U.S. More than half of all new HIV infections occur among gay men and men who have sex with men.  Twenty-seven percent of the new HIV infections each year occur among women.  If we are to stem the HIV epidemic, we must work to expand the current array of prevention options beyond what is currently available. Ongoing advocacy for prevention technologies such as pre-exposure prophylaxis, vaginal and rectal microbicides, post-exposure prophylaxis, vaccines, and testing, treatment, and linkage to care is essential. Simultaneously, we have to ensure greater access to what we know works—male condoms, sterile syringes, and female condoms.  The more options we have the better.

A handful of jurisdictions around the U.S. are taking decisive action to dismantle negative biases and increase awareness, access, affordability, and use of female condoms. Chicago, New York City, New York State, San Francisco, Washington D.C., and now Houston equip service providers and front line prevention educators with the skills, language, and materials necessary to effectively promote female condoms within their communities. Following training, an overwhelming majority of prevention educators and service providers become committed female condom advocates. They use positive language when they talk about the female condom. It’s easy to use once you know how to use it. The outside ring increases pleasure for the woman. It helps the receptive partner—male or female—take better control of his or her health.

Six jurisdictions may seem like a small number, but this time last year there were four. And the year before that, there were only two. More comprehensive programs are expected to launch within the year and smaller grassroots initiatives are cropping up across the country. More commercial pharmacies are facilitating greater access to the female condom by charging between $5.99 and $6.99 instead of nearly three times those costs for the old version. March marks one year since CVS pharmacies in Washington, D.C. began stocking the new female condom in all District stores. Additionally, after nearly one year of advocacy, Walgreens is expanding access even further by selling the FC2 in approximately 700 stores across the nation and online.

There is no question that the female condom’s time has come. More work remains to ensure that it makes it into the hands of the people who need it both in the U.S. and around the globe. You can help! On the domestic side, check out the resources and opportunities to get involved with efforts in Chicago, New York City, New York State, San Francisco, Washington D.C. On the global front, check out the Prevention Now Campaign and Universal Access to Female Condoms (UAFC). UAFC is launching a new advocacy campaign to create massive chains of paper doll chains from around the world to demonstrate support for female condoms. They are inviting organizations around the world to write messages on paper dolls about why female condoms are important and needed. The chains will be displayed at the United Nations General Assembly High Level Meeting June 8-10 in New York City. Email Anna Forbes at annaforbes@earthlink.net to find out how you can participate.

Take Charge of Your Lives: A Message from AIDS United to Women and Girls on NWGHAAD

By Donna Crews, Director, Government Affairs
AIDS United

Today, March 10, we observe  National Women and Girls HIV/AIDS Awareness Day (NWGHAAD).  This year’s awareness day comes the day after the Senate voted against a funding measure  passed by the U.S. House of Representatives for the balance of this fiscal year. The spending plan would devastate women’s health by completely defunding Title X family planning programs, and blocking  all Planned Parenthood programs from receiving  federal funding.  It also proposes drastic cuts to global programs that support women’s health.   The bill also bars federal employees from working on the implementation of the Affordable Care Act, which contains many provisions that benefit women directly.  AIDS United is pleased that the Senate did not vote to approve the House passed version of H.R. 1, but we are concerned that we are in a political environment that launches such attacks on women’s and  girls health care and the total Affordable Care Act.

According to the Office of Women’s Health 280,000 women are currently affected by HIV/AIDS, which is growing among women in the United States.  In this political environment, with attacks on women’s  and girls’ health care, it is difficult to envision women feeling safe or comfortable protecting themselves from HIV.  It is difficult to envision women or girls feeling safe to ask for an HIV test, receive an HIV test result, or receive HIV care.  The community must work to ensure that all women can care for themselves and their daughter’s sexual health.

National Women Girls HIV/AIDS Awareness Day gives us the opportunity to encourage all women and girls to learn their HIV status.  If they are negative, they need to learn how to maintain their negative status by hearing prevention messages.  If they are positive, they need to learn how to access vital care and treatment.  The Awareness Day will give organizations that serve women an opportunity to focus on the impact that HIV is having on women, especially women of color.  Delta Sigma Theta and Alpha Kappa Alpha (African American sororities) are both educating their members with HIV prevention messages as well as information about the true impact  of HIV on the African American female population.

Awareness days help us to focus the country on individual populations so that we can discuss the true impact of HIV on different populations nationwide.  AIDS United is pleased after debate on such horrible attacks on women’s sexual health to have an opportunity to encourage women and girls to take charge of their lives and learn their status.