Browsing Category: Policy/Advocacy

Republicans Release Appropriations Package for Fiscal Year 2011

by Julia Cheng, AIDS United Zamora Fellow

With less than a month before the Continuing Resolution (CR) expires, Congress is struggling to complete the Fiscal Year 2011 budget.  On February 3rd, Representative Paul D. Ryan (R-WI), Chair of the House Committee on the Budget, released figures that set caps for the Fiscal Year 2011 budget at $1.055 trillion.  Representative Ryan’s plan outlined cuts of $32 billion compared to the current level of spending at FY 2010 levels.  In total, $40 billion would be capped for non-security discretionary programs while an $8 billion increase would go towards defense, homeland security, and veterans programs.  The $8 billion increase in security related funds still falls $16 billion below President Obama’s 2011 requested budget, while funding towards other discretionary programs is $58 billion lower than President Obama’s FY 2011 request.

Using Representative Ryan’s ceiling, appropriations Chairman Representative Harold Rogers (R-KY) further defined allocations by appropriation subcommittee to begin drafting a bill.  The Labor, Health and Human Services, and Education Subcommittee will have to reduce appropriations by $6.5 billion and the Transportation and HUD Subcommittee will lose $11.5 billion from 2010 levels.  These caps were approved 27-22 by the House Appropriations Committee.  All Democrats voted “No” while two Republicans joined them, calling for greater cuts.  On February 9th, Chairman Rogers announced a partial list of the implementation of those spending cuts which included $1.3 billion from Community Health Centers, $1 billion from the National Institutes of Health (NIH), $755 million from the Center for Disease Control and Prevention (CDC), $530 million from the Housing and Urban Development (HUD) Community Development Fund, $139 million from the National Science Foundation (NSF), and $96 million from Substance Abuse and Mental Health Services Administration (SAMHSA) compared to the President’s 2011 requested budget.

Despite approval from House Appropriations Committee, conservative Republicans indicated that the draft proposal would not pass, delaying the release of the legislation originally scheduled for February 10th.  House Appropriations Chairman Rogers subsequently announced that the difference between the FY 2011 request budget and the proposed legislation would be $100 billion, therefore meeting the targeted “cuts” as outlined in the Republicans’ “Pledge to America”  document.  Some Republicans have argued that the four months of the Fiscal Year that have passed should go to the $100 billion, while others have argued that the $100 billion promise should be applied to the remaining levels of funding.  Currently, the plan falls in between the two figures, making a total of $58 billion reduction from the remaining levels of funding.  The proposed CR was released on Friday, February 11th and debate will begin Tuesday with final vote expected on Thursday, February 17th.  However, even if the bill passes in the House, it is unlikely to be approved by the Senate or the President.  Senate Democrats have explained that a series of short-term continuing resolutions will be necessary to avoid a government shutdown.  The legislation as released by the House Appropriations committee can be found below.

A copy of the legislation can be found here: http://www.rules.house.gov/Media/file/PDF_112_1/legislativetext/2011crapprops/AppropCRFinal_xml.pdf

A summary of the bill can be found here: http://republicans.appropriations.house.gov/_files/SummaryFiscalYear2011ContinutingResolutionCR.doc

A list of program cuts can be found here: http://republicans.appropriations.house.gov/_files/ProgramCutsFY2011ContinuingResolution.pdf

Subcommittee savings tables can be found here: http://republicans.appropriations.house.gov/_files/FY2011CRSpendingTablesbySubcommittee.doc

“A Clear and Unyielding Commitment”

President Obama Unveils 2012 Budget

donna_crews1_cropped_webBy Donna Crews, Director, Government Affairs
AIDS United

President Barack Obama submitted his third budget to Congress on Monday, February 14th .  The entire budget was $3.7 trillion with $79.9 billion for the Department of Health and Human Services (HHS) (where the bulk of the HIV domestic portfolio is kept).  In these austere budget times the HIV/AIDS domestic funding portfolio fared well.  At HHS where the discretionary portion of the budget decreased by $72 million, or 0.9 % President Obama showed his commitment to the National HIV/AIDS Strategy (NHAS) and the domestic HIV/AIDS funding portfolio by increasing funding for HIV/AIDS programs at HHS, and Veterans Affairs, and maintaining level funding for HIV/AIDS programs at the Department of Housing and Urban Development (HUD), HOPWA received $335 million, and the Department of Justice.  In this overall budgetary spending environment the increases that were announced in the FY12 President’s Budget shows his clear and unyielding commitment.

At HHS’ Centers for Disease Control and Prevention (CDC) HIV prevention funding was increased by nearly $58 million for a total investment of $858 million in FY12.  Of the $58 million increase, $30 million is an investment from the Prevention and Public Health Fund from the Affordable Care Act.  The prevention program that has garnered wide interest and support, Enhanced Comprehensive HIV Prevention Planning (ECHPP) received $10 million in new funding for a total of $22 million.  This project targets the 12 most highly impacted jurisdictions based on AIDS prevalence in 2007.  To ensure better coordination of the HIV prevention messages with existing STD programs for young people, $40 million of the HIV portion of the school health program in the Chronic Disease Prevention and Health Promotion Program has been transferred to the National Center for HIV, STD, Viral Hepatitis and TB Prevention.

At HHS’ Health Resources Services Administration (HRSA) the Ryan White Program received an increase of a little more than $88 million for a total of $2.376 million.  Due to varied rounding math, in some publications of the budget it appeared to receive $85 million; however the more detailed Congressional Budget Justification for each HRSA verified the $88 million.  Again due to rounding, some documents show ADAP’s increase as $80 million, though our analysis shows it at $82 million.  The breakdown is as follows:

Part A + $1 million

Part B base flat

Part B ADAP +$82 million

Part C +$5 million

Part D +$.166 million

Part F AETC +$.074 million

Part F Dental +$.029 million

At HHS’ National Institutes of Health (NIH) the Office of AIDS Research (OAR) has received a $74 million increase for the HIV/AIDS research portfolio. HIV funding at Substance Abuse and Mental Health Services Administration were flat at $178 million for FY12. Title X programs such as Planned Parenthood where many HIV tests are preformed received an $11 million increase.  Abstinence only programs were not funded again this year.  The teen pregnancy prevention initiative received flat funding of $114.5 million.  New in the budget this year is a provision to provide the Secretary of HHS access to no more than 1% of all discretionary funds for FY12 appropriated to the domestic HIV/AIDS activities, programs, and projects to support the National HIV/AIDS Strategy.  According to the FY 2010 funding levels in HHS’s just released “HHS Operational Plan: Achieving the Vision of the National HIV/AIDS Strategy,” this funding would be 1% of $6.5 billion.

It Takes a Village to Fight HIV/AIDS!

AIDS United Observes National Black HIV/AIDS Awareness Day 2011

by Ronald Johnson
AIDS United Vice President of Policy & Advocacy

Vice President, AIDS United recognizes the 11th annual observance of National Black HIV/AIDS Awareness Day, February 7, 2011.  We keep in our memory the many thousands of black Americans, who have died as a result of AIDS.  We honor black Americans who are living with HIV/AIDS and we reach out to black Americans who are vulnerable to HIV infection.

The theme of this year’s awareness day is “It Takes a Village to Fight HIV/AIDS!”  This theme especially resonates as we approach, on June 5, the 30th year of the recognized HIV/AIDS epidemic here in the United States and worldwide.  In 2011, we continue to face the toll of HIV and AIDS on communities of color, especially African American communities.  By nearly every measure, black children, women, and men are the Americans most disproportionately impacted by HIV/AIDS.

As reported by the Centers for Disease Control and Prevention (CDC), at the end of 2007 black people accounted for nearly half, 46%,  of people living with a diagnosis of HIV in the 37 states and 5 dependent areas with long-term name-based HIV reporting.  In 2006, 45% of the estimated new cases of HIV infection were among black people.  The rate of new HIV infections among black women is almost 15 times as high as the rate among white women and nearly 4 times that of Hispanic women.  From 2001-2006, new HIV diagnoses among young black men who have sex with men (MSM) aged 13-24 in 33 states increased by 93%, a pace that should be alarming and disturbing to everyone.

National Black HIV/AIDS Awareness Day has a particular focus on community mobilization to increase HIV testing and treatment.  HIV prevention is still critical and in 2010 we saw further advances that demonstrate the linkage among testing, treatment and prevention.  Transmission of HIV is driven to a large degree by people who do not know that they are infected.  Voluntary HIV testing and counseling must be scaled up to decrease the number of black Americans who do not know their HIV status.  There is solid evidence that when people know that they are infected with HIV, they take the necessary precautions to protect themselves and to protect others from transmission, included getting into care and treatment.  Recent research findings are showing the efficacy of treatment as prevention, as the recent findings from the iPrEx study and the CAPRISA 004 microbicide study demonstrate.

While the “toolbox” of demonstrated HIV prevention initiatives expands, the lynchpin of stopping  the spread of new HIV infections remains the development of a safe and effective HIV vaccine.  Black Americans have a clear stake in HIV vaccine research.  Awareness of and support for clinical trials to test potential vaccines, such as the HVTN 505 study that targets MSM, should increase among black Americans.  Myths about and distrust of HIV vaccine research, and fears about vaccines generally, should be addressed and discussed openly.

It will take a village to fight HIV/AIDS among black Americans.  The good news is that this is not new.  Black history, which we also highlight and celebrate this month, shows that collective hope and action dispels despair.  The administration of America’s first black President has developed and is implementing the country’s first targeted and measurable National HIV/AIDS Strategy.  Today we take special notice of HIV/AIDS among black Americans.  But ending the epidemic is something we all can achieve by working together.  Increasing testing, getting every HIV positive person into care, and expanding HIV prevention can be done.  It just takes all of us villagers to be involved.

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

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.

President Seeks Unity With State of the Union Address

by William McColl, Director, Political Affairs

In last night’s State of the Union address, President Obama sought to refocus the terms of the national debate away from last year’s health care reform bill onto the need for jobs.  For the first time at the State of the Union in recent memory, Republicans and Democrats sat together and wore  black and white ribbons to honor the victims of tragic shooting in Tucson, AZ and the ongoing fight for survival of Representative Gabrielle Giffords (D-AZ).

Domestic spending freeze: no cuts “on the backs of our most vulnerable citizens”

The President spoke of seeking common ground with the newly-empowered Republicans in Congress, focusing on deficit reduction and offering a five year freeze on “annual domestic spending.”  Such a freeze seems designed to exclude possible increases in spending through entitlement programs such as Medicaid and Medicare.  However he emphasized that the new health care reform bill would actually slow spending increases in those programs.  The President also sought to carve out space for his priorities noting that deficit reduction could not only come from the 12% of the federal budget devoted to social and health care spending.  Encouragingly he urged Congress not to make cuts “on the backs of our most vulnerable citizens.”

Health care reform: “let’s fix what needs fixing and move forward”

On health care, the President once again sought common ground with Republicans by agreeing to change at least one provision to eliminate bookkeeping burdens on small businesses and offered to review other possible changes.  However he also defended the new Affordable Care Act (ACA) stating that, “this law is making prescription drugs cheaper for seniors and giving uninsured students a chance to stay on their parents’ coverage.”  Finally he challenged Congress, saying “instead of re-fighting the battles of the last two years, let’s fix what needs fixing and move forward.”

Republican response

In the Republican response, Representative Paul Ryan (R-WI) reiterated the Republican message points, promising that the new House majority would find ways to cut spending.  He also claimed that the health care reform bill was “accelerating the country towards bankruptcy and would cause millions of Americans to lose health care coverage due to increased health care premiums.  This conflicts directly with Congressional Budget Office estimates that over ten years the health care reform law would slow the growth of Medicare and Medicaid spending by about $230 billion.  Nevertheless he said that Republicans would continue efforts to repeal the bill and replace it with fiscally responsible reforms.  He did not offer examples of what those reforms would be.  The House last week passed a resolution calling for four committees to develop replacement solutions.

AIDS United is advocating for continued implementation of health care reform;
Opposes repeal of Affordable Care Act

AIDS United opposes repeal of the Affordable Care Act and is concerned that efforts to do so will ultimately result in moving back towards funding HIV/AIDS treatment and care through vulnerable discretionary funding.  This funding is already stretched thin, most visibly resulting in more than 5000 people being placed on waiting lists for AIDS Drug Assistance Programs.  AIDS United continues to hear concerns from people in the field that it is harder for people living with HIV to get necessary doctor visits, dental and vision care or access to support services that help people living with HIV to gain access to good treatment.  Additionally cuts in services threaten not only the ability of people who currently need to access care, but also fail to acknowledge every two years more than 100,000 people are infected with this terrible disease,   who also will require services too.  Failure to deal with this reality, both by preventing disease and failing to treat people living with HIV will take us back to the days in which our public health system verged on collapse.  We cannot and we will not let that happen.