Browsing Category: Policy/Advocacy

OraQuick In-Home HIV Test: Another Tool in the Toolbox

On Tuesday July 3, 2012, OraSure Technologies, Inc. announced that the U.S. Food and Drug Administration (FDA) has approved the Company’s OraQuick In-Home HIV Test, which would be available for purchase online and at retail stores beginning in October.  AIDS United interviewed Ace Robinson of Gay Men’s Health Crisis (GMHC) and Joseph Interrante of Nashville CARES (Community AIDS Resources, Education and Services) about their opinions concerning FDA’s approval of the first and only rapid over-the-counter (OTC) HIV test.

AIDS United Policy Update: What are the benefits and challenges you foresee following the FDA’s approval of the OraQuick In-Home HIV Test?

Ace Robinson: The FDA’s approval of Over-the-Counter (OTC) HIV test kits is a step forward in the battle against HIV.  This additional instrument in the HIV Prevention tool chest will help reduce a barrier to testing for some individuals.  The CDC estimates about 20-25% of HIV-positive people in the United States are unaware of their status.  Additionally, qualitative studies have confirmed what we already assumed: that people who are aware of their HIV-positive status adapt their behavior to lower their risk of infecting other people upon learning their status.

Some people will avoid being tested for HIV for a variety of reasons:

  1. Being seen in the clinic
  2. Shame after detailing risk behavior
  3. Accessibility due to location and/or opening hours (especially for non-urban dwellers)

These hindrances, and other factors, will be reduced with OTC testing for the general population.  However, the overarching fear is that people who test positive for HIV will not have the supportive resources and environment currently required in most states at HIV testing centers.  These OTC tests also will include a help desk to immediately console and educate a newly diagnosed person as to the best follow-up to immediately improve the health outcomes, both for themselves and also their activity partners.  The fear of OTC home test kits, e.g. hormone pregnancy tests, leading to immediate rash and unhealthy behavior has been great historically dispelled over time.

Joseph Interrante: The in-home HIV Test increases available resources for testing and has the potential for helping to “normalize” and de-stigmatize the process of testing for individuals.  I suspect that a significant segment of those who use the in-home test will be people who, for a variety of reasons, do not and will not come in for face-to-face testing.  (We’ll have to see if carrying an HIV test kit up to the counter at your local pharmacy doesn’t pose as great a barrier, given the stigma that sometimes accompanies the very process of asking/going for a test.  As/if we get reports of people being treated poorly or prejudicially, advocates and educators will want to be prepared to intervene.)  So the in-home test increases access along with other initiatives like face-to-face testing through pharmacies in rural communities.

But this underscores the greatest challenge to in-home testing, which is ensuring linkage to care for those who test HIV-positive.  In a face-to-face HIV test (at least the way we do it at Nashville CARES), personal follow up and linkage occurs immediately at the time of the preliminary positive test result.  While a web site and a toll-free hotline to provide both education and referral information will be available in connection with the Orasure Test Kit, these strategies have in the past proven far less successful in helping people get into care than face-to-face support from an actual specialist, both during and after that traumatic moment when you discover you are HIV-infected—no matter how well prepared you may think you are for such a result.  Will the same fears and concerns that deter people from face-to-face testing also deter them from seeking the care that makes knowledge of HIV infection meaningful?   That is one of my main concerns, one with implications for both treatment and prevention.

We also need to ensure that information and education is available widely about HIV testing and what a single test result may and may not tell you about whether you are infected, much less whether you are at risk for HIV infection.  Many of the limitations to the in-home test are the same as those for HIV testing offered in any context, such as the so-called “window period” for antibody development.  There may be additional limitations to the in-home test due either to the technology or to user error.  (I am concerned by the reported 8% error rate in negative test results, if that in fact proves to be the case.)  Linkage to care could also be enhanced by having local resources for education and support distributed along with test kits at point of sale, though how we implement that without creating additional, excessive burdens on already strapped local organizations is unclear.

As with any technology, there is also the potential for misuse.  For example, private purchase of test kits makes possible the forced testing of women, minors or gay men in relationships of powerlessness without their consent in order to use HIV-positive status to perpetuate (or initiate) the exercise of power, control, and/or abuse.  Potential for misuse should not in itself be a reason not to have the technology available, of course, but we need to recognize that potential and be prepared to address it and even prevent it—probably through collaboration with groups whose primary mission is domestic violence and/or sexual abuse, and making sure that our own educators and service providers are educated about these benefits and challenges.

AUPU: What impact would the availability of the OraQuick In-Home HIV Test have on HIV prevention efforts?  Do you think physicians and other health care providers would recommend the use of OraQuick HIV Test in your region?

Ace Robinson: OTC HIV testing will help HIV prevention efforts on two fronts.  It will lead to greater accessibility to testing and also will reduce the burden of cost for HIV testing at clinics.  Insomuch, the scarce resources available for HIV prevention can be redirected to other HIV/STI preventative initiatives.

Yes, healthcare providers in NYC have historically led in the incorporation of HIV Prevention and Intervention measures that increase a person’s autonomy over their personal health.

Joseph Interrante: I don’t think that it will lead to any meaningful reduction in targeted testing and counseling or broad-based screening in clinical settings, to the extent that those activities are focused (like ours at Nashville CARES) on poor and marginalized populations.   Frankly, this test is not an affordable option for poor people.

There is a possibility, maybe even likelihood, that (repeated) personal testing could be used by some individuals at high risk as a substitute for other prevention measures like condom use.  (I’m reminded here of Walt Odets’ discussion of substance abuse among some purportedly HIV-negative gay men, as a pretext for rather than a cause of risky behavior.)  Prevention efforts will need to address this within the broader discussions about risk-taking and why/how it occurs.

Will health care providers here in Middle Tennessee recommend use of the in-home test?  Some may, hopefully within a conversation with their patients about HIV and risk reduction, though I fear that such contextual discussions will continue to be all too infrequent.  I certainly hope that providers will encourage use of face-to-face HIV testing, which is free and confidential through CARES and other agencies, as the preferred option for individuals.

AUPU: What do you think the next steps are in furthering HIV prevention and more generally, confronting the HIV/AIDS epidemic?

Ace Robinson: Accessible combination therapy for HIV Prevention must be enhanced especially for populations with the highest HIV incidence.  These methods must include behavioral modification and biomedical intervention.  Treating HIV-negative and HIV-positive persons must not be segregated between those two arms of Prevention.  The first and foremost challenge to confronting HIV/AIDS is education.  People must know the basics to HIV infection, increased susceptibility and available care and how to quickly access care, if necessary.  While AIDS ravaged many urban cities, it was brought under control due to massive education and treatment advances.  Unfortunately, that is no longer the case at the same level. Many youth do not learn how to best protect themselves and/or loved ones from infection.

Joseph Interrante: We need to continue to build on our recent successes in reducing the number of HIV-infected individuals who do not know they are positive and linking to care those who are positive as well as sustaining their involvement in care.   There are still far too many individuals who are diagnosed concurrently with HIV and AIDS or develop AIDS within a year of testing HIV-positive.  Use of strategies like social network assessment to guide our targeting of testing resources can help us ensure that we are focusing on those (sub)groups within disproportionately impacted populations where the disease burden truly is heaviest.

Treatment is prevention—we know that.  The individual and public health benefits are clear.  But let us not focus so narrowly on “treatment adherence” or preventing subsequent HIV transmission that we ignore other health concerns much less other social and material needs that people with HIV/AIDS have.  If we really want to build and support self-management skills, a holistic approach is vital.

Important as they are, these efforts should not be accompanied by a reduction, much less abandonment, of prevention work with HIV-negative individuals at high risk.  There’s enough research that has identified significant co-factors for risk that enable us to move beyond mere prevalence or incidence by race, ethnicity, gender, or sexual orientation to target these activities for greatest impact.  I realize that in a flat or reduced funding environment, there is tremendous pressure to shift scarce resources to HIV-infected individuals where “results” or at least surrogate markers are more easily measured.  But I think we lose much in the larger battle to end AIDS by doing so.  We put ourselves in a bit of a conundrum wherein we fight (and rightly so) against stigma, and its most pernicious manifestation in HIV criminal exposure laws, on the one hand, while in practice we end up doing something that comes dangerously close to the same thing by focusing on those with HIV infection as our sole approach to preventing transmission.

As someone living with HIV, I am firmly committed personally and professionally to fighting HIV-related stigma in all its manifestations.  But I wonder if we set ourselves an impossible (and somewhat naïve) goal by aiming to eliminate stigma, which is how I hear the goal articulated to an increasing degree.  Maybe it’s my Catholic upbringing, but I often think that trying to eliminate stigma is like playing “whack-a-mole” (or trying to argue with an AIDS denialist if you prefer a more relevant analogy).  We’ll be far more successful working to make sure that stigma presents no barrier to prevention, testing or care for those who need them.

Finally, prevention depends on effective and responsible public policy.  That means advocating for comprehensive and inclusive sex education (especially for young people).  It also means advocating for comprehensive strategies to address injection and other forms of substance abuse, including syringe exchange and other harm reduction as well as more traditional abstinence-based strategies.  I’ve already mentioned HIV criminal exposure laws and the need to advocate for repeal or at least for an end to their application. These are truly policy challenges in much of the south, but policies and practices to which we at CARES and many of our sister organizations are fully committed.

Ace Robinson is the Managing Director of Community Health & Research, Public Policy, and Advocacy at Gay Men’s Health Crisis (GMHC). Ace is a specialist in HIV prevention with a diverse array of experience taken from his work in Senegal, South Africa, Chicago, Los Angeles, Haiti, and New York City. He worked on HIV vaccine design and harm-reduction programs in Africa; led strategic structural-change initiatives on HIV with faith-based leaders, CBOs, and elected officials in Chicago; and directed infectious disease programs in Haiti. Ace also served as the AIDS Prevention Unit Director at the David Geffen School of Medicine at UCLA and recently has been working as an advisor to the International AIDS Society and Black AIDS Institute.

Joseph Interrante is Chief Executive Officer (CEO) of Nashville CARES (Community AIDS Resources, Education and Services), the oldest and largest AIDS services organization in Tennessee.  On an annual basis, Nashville CARES provides HIV prevention education, testing and linkage to care, and social services support to 60,000 Middle Tennessee adults and youth.  He joined the staff of CARES in May of 1994.

Interrante received his B.A. from Brown University in 1974 and his Ph.D. from Harvard University in 1983, and has taught at Harvard University and Oberlin College.  In the mid 1980s he moved from academics to nonprofit work with the AIDS Action Committee of Boston MA and later the AIDS Taskforce of Cleveland OH.  In the early 1990s, he was a member of the Education Advisory Committee for the American Foundation for AIDS Research (AmFAR) and the Citizen’s Committee on HIV/AIDS for Greater Cleveland.  More recently, he has served on the boards of the Center for Nonprofit Management and the AIDS Action Council of Washington DC and as a community advisor to the National Quality Center for HIV/AIDS.  Currently Interrante is a member of the Public Policy Committee of AIDS United, the Board of the Southern AIDS Coalition and the Greater Nashville Ryan White HIV/AIDS Planning Council. In 2005, Interrante was recognized as Nonprofit CEO of the Year by the Middle Tennessee Association of Nonprofit Executives and in 2006 as Public Citizen of the Year by the Tennessee Chapter of the National Association of Social Workers.  He is a 2005 graduate of Leadership Nashville. Interrante has been an AIDS caregiver and has been living with HIV infection for more than 27 years.

To read the FDA’s consumer update about the approval of OraQuick, click here.

To read AIDS United’s written testimony to the FDA in support of the approval of OraQuick, click here.

Finding Common Ground With Lawmakers, Law Enforcement, Substance Users and the Community

by Tessie Castillo, NC Harm Reduction Coalition

It’s not every day that law enforcement and active drug users agree on something, or that Democratic and Republican politicians find common ground. But on Tuesday, June 12th, the Summit on Law Enforcement Safety and Drug Policy forged unlikely collaborations on issues of law enforcement safety in North Carolina. During the event, law enforcement, civil servants, academics, public health workers and concerned community members discussed various topics affecting law enforcement, including the importance of preventing needle-stick injuries to officers and the community, the need to include law enforcement to address the epidemic of prescription drug overdose, and reducing recidivism among prison populations.

Preventing Needle-Sticks to Law Enforcement

The Summit was held at the legislative auditorium in downtown Raleigh. During the first panel of the morning, former officer Jen Earls spoke articulately about her first needle-stick as a rookie cop in Chicago. “Getting stuck by a needle was one of the scariest moments of my career,” said Earls. “I pulled over a woman driving a posh Lexus in a rough neighborhood. She told me her driver’s license was in her purse and when I put my hand in, I got stuck on a needle. I didn’t know what to do and didn’t want to make a big deal out of it because no rookie wants that kind of attention. So I put a band-aid on it and went on with work.”

Conference participants, including Republican Representative Glen Bradley, Democratic Representative Dianne Parfitt, Jon Sanders of the Jon Locke Foundation (a conservative think-tank), and several members of law enforcement, articulated the need for syringe decriminalization laws in North Carolina. Syringe decriminalization would allow residents, whether the state’s 680,000 diabetics or 25,000 urban injection drug users, to carry clean syringes without fear of arrest. Current N.C. laws, which categorize syringe possession as a Class A misdemeanor, discourage people from declaring syringes to an officer during a search and result in 1 in 3 officers receiving a needle-stick during their careers, with 28% receiving multiple sticks. Syringe decriminalization has been shown to reduce the incidence of needle-sticks to officers by 66%, as well as to reduce HIV and hepatitis transmission in communities where it has been enacted.

“Representative Bradley and I are usually on opposite ends of the political spectrum,” said Representative Parfitt during the Summit, “But we are in 100% agreement on this issue [of syringe decriminalization]. I think the will is there and we will look at a way to make this happen.”

“I believe a combination of harm reduction programs and syringe decriminalization will make a vast difference in the lives of law enforcement officers,” explained former officer Earls. “I think officers need to know how to safely handle paraphernalia and needles. They need to know when to wear gloves and when to take extra precautions.”

“There are many costs associated with needle-sticks, such as the lifetime costs of HIV and hepatitis infections that are born by taxpayers for people without insurance,” said Jon Sanders of the John Locke Foundation. “Even diabetics who live in a bad neighborhood are afraid to carry their own needles and they put their own health and the health of law enforcement at risk. Syringe decriminalization is a low cost measure that will lower health costs and raise public health, and for those reasons I support it.”

Reducing Recidivism

Following the needle-stick panel, Republican Representatives Leo Daughtry and John Faircloth, as well as Democratic Senator Ed Jones, led a discussion on the need to reduce recidivism rates in North Carolina, which have climbed to nearly 40% for adults in recent years. The legislators championed the Justice Reinvestment Act, passed by the NC General Assembly in spring 2012, which aims to reduce recidivism by allowing parole officers to intervene more quickly to discipline parole violators instead of waiting months while the case lags in the courts and the negative activity continues. “The Justice Reinvestment Act is about taking money that goes into prisons and putting it into rehabilitating people,” explained Representative Daughtry.

“Communities will be safer, law enforcement will be safer, if there are more efforts directed towards opportunities to find housing and jobs [for ex-offenders],” said retired officer Ronald Martin.

“When I started [in law enforcement] 35 years ago I had the idea that we should lock up everybody and throw away the key,” said Senator Jones. “I know now that we can’t do business that way…we have to think about people as being a part of society and not remove them from society…I would ask you to make every effort to see that these [ex-offenders] have a decent starting life when they get out.”

The Representatives spoke alongside Dennis Gaddy, Executive Director of the Community Success Initiative, Bill Rowe, General Counsel and Director of Advocacy at the NC Justice Center, and Jon Sanders of the John Locke Foundation.

Utilizing Law Enforcement to Decrease Overdose Deaths

The final Summit panel addressed law enforcement’s roll in reducing the epidemic of drug overdose deaths. Overdose death from prescription painkillers has recently passed motor vehicle fatalities as the number one cause of accidental death in the United States. North Carolina suffered over 1000 overdose deaths last year alone, mostly from opiate painkillers. Research shows that most people overdose in the presence of another person. However, current laws discourage witnesses to an overdose from calling 911 for fear of drug possession charges. Consequently, many witnesses wait too long to call emergency services, or don’t call at all, often resulting in the death of the person who has overdosed.

Some police departments around the country have begun requiring their officers to carry Narcan, a drug that reverses fatal overdoses. As police are often first to arrive at emergency scenes, especially in rural areas where ambulance arrivals are delayed, law enforcement officers have a unique opportunity to save lives with Narcan.

Lieutenant Detective Pat Glynn, champion of a Narcan program at the Quincy police department in Massachusetts, joined the Summit to discuss the success of the Quincy program.

“A couple years ago we had 47 overdose deaths in Quincy over an 18 month period,” said Lt Det. Glynn. “After we started the Narcan program, from October 2010 to June 2012 overdose deaths dropped to 16, and our officers conducted 90 successful overdose reversals with Narcan…We had a family member feel so comfortable [with police using Narcan] that they pulled up to the parking lot of the police station, knocked on the door and the police were able to come out with Narcan and save the individual’s life. It’s refreshing to see people coming to us and looking at [law enforcement] in a different light.”

In addition to Narcan programs, legislators participating in the Summit discussed 911 Good Samaritan laws, which would grant amnesty to witnesses to an overdose who call emergency services to save a person’s life.

Representative Parfitt offered a personal perspective on overdose. “At one point my 85 year old aunt was admitted to Duke with a drug overdose from Valium…we have to overcome the idea that [drug overdoses happen to] other people, not us…a lot of people are affected because someone inappropriately uses drugs…there are some simple solutions and one thing we can do here is look at the 911 Good Samaritan bill.”

“There is a larger problem with prescription drugs in America than there is with illegal drugs,” said Representative Bradley. “We have here potential programs to help reduce the rate of overdose and death… and one is immunity for emergency 911 calls, the medical amnesty program, and another is the Narcan program to keep Narcan in vehicles so we can respond right away.”

“The Good Samaritan laws and Narcan programs honor life…this is an issue that unites people across the political spectrum and I find that personally refreshing,” said Jon Sanders of the John Locke Foundation.

Comments on the Summit from Participants

“I thought [the Summit] was fantastic. [We] had a great cross section of people from different professional groups, which was really important. The only thing [we] needed was some people who were really not believers so we can hear them and ask what their problems are… I need to find out what is standing in the way, what those road blocks are.”

– Representative Dianne Parfitt, (D)

“[Last year] I said we needed to reach out more to law enforcement [on syringe decriminalization], and that has been done. The foundation is now really solid to walk up to groups who can really make [syringe decriminalization] happen in the legislature, the Sheriffs Association for example, or the Police Benevolence Association… if you get these groups on board not only will you get legislation passed, but you will get it passed overwhelmingly.”

– Representative Glen Bradley, (R)

“I thought it was a remarkable event and a tribute to NCHRC that [they] were able to pull this off. I wish every state would do this. It’s good to raise awareness with legislators and let them know what is going on.”

– Leigh Maddox, retired Captain of Maryland State Police

“If I had had a chance to work with the guys like [Lt Det Glynn], I might have stuck around [the force] longer…nobody is talking about [these law enforcement issues]. It almost has to come from the top down. A lieutenant needs to bring it up and say, here is what we are going to do.”

– Jen Earls, retired Chicago police officer

“There is really no down side to [adopting these measures].”

– Ronald Martin, retired law enforcement detective from the New York police department

“I really enjoyed the forum today, and I learned a lot. [The Summit] will help build agency collaboration on issues we have been fighting for over the last 3-4 yrs at the legislature.”

– Dennis Gaddy, Executive Director of Community Success Initiative

On the Scene of a Historic Health Care Victory

by Tran Doan, Pedro Zamora Fellow

The first on the scene was also the least practical place to be at if I wanted to be the first to hear the Supreme Court’s decision on the Patient Protection and Affordable Care Act (ACA). Yet there I was standing outside of the Supreme Court on an oppressively hot Thursday June 28th morning with a yellow notepad and pen eagerly awaiting the ruling. Accompanying me is a political circus, and its diverse band of performers — the supporters and protestors of President’s Obama health care legislation, pro-life and pro-choice advocates, tea party and occupy movement activists, church-goers, doctors in white coats, single-payer belly dancers, numerous news media (i.e. journalists, news anchors, cameramen, photographers, bloggers), hundreds of signs plastered with clever sayings (like “Keep Your Ovaries Off My Rosaries”), and even one Obama Chia Pet  — all showed up to hear the Supreme Court ruling.

Despite the diverse, often heated opinions regarding the ACA, at this moment we could all agree on one thing — that everyone, absolutely every single American citizen, has a stake in this decision. The United States does not have universal healthcare, but health itself is universal. Whether a person gets sick, requires vaccination, is involved in an accident, or is born with a pre-existing condition, every U.S. citizen has his or her own health to protect and nurture, and at some point he or she has used the nation’s health care system. Health is personal.

Take me, for example. I am a 24 year old young adult and graduate student.  I grew up with a single mother and younger brother in Pittsburgh, Pennsylvania­­. After high school, my brother joined the U.S. Marine Corps, and has health insurance coverage through the military. When I turned 19,  I was not eligible for the Pennsylvania Children’s Health Insurance Program or CHIP (which covers all uninsured children and teens in the state) any longer. As a result, my mother (a naturally anxious person who refuses to let me go without health insurance) paid out-of-pocket for “bargain basement” health insurance- that is “low-cost” monthly premium, high deductible, high co-pays, and minimum coverage of benefits. I hardly used the health plan because I did not want to pay towards the high deductible for simple preventative health services that would require ten minutes of a physician’s attention. In my opinion, the health plan does not do much to promote better health practices. Since the passage of the ACA in 2010, parents are able to enroll their children under the age of 26 onto their health plan. I enrolled right away on my mother’s health plan, saving my family $100 a month!

The ACA does not only provide peace of mind for my family, but also for millions of families. For example under the ACA, no one will be denied health coverage or charged a discriminatory premium due to a pre-existing condition (resources to additional benefits listed below). Almost every Western country believes that its government has a responsibility to protect its people. Both provisions in the World Health Organization Constitution and United Nations Universal Declaration of Human Rights (1948) believe that access to quality health services is a fundamental right of every human and nations should protect this right. Shouldn’t the United States, one of the richest and most powerful countries in the world, believe in protecting its people too?

As the 10 a.m. designated time of announcement approached, the intensity of emotions on the steps of the Supreme Court was noticeably heightened with nervousness,  excitement, fear, amusement, hope, anger, and desperation. Ten minutes until 10 a.m., groups were still marching; several people were on microphones at the same time; the church-goers are singing “Amazing Grace,” and finally at 10:08 a.m., we hear a burst of cheering from one side. Which group is cheering? Which group is crying? The liberals? The conservatives? The belly dancers? Around me I hear, “My heart is beating so fast right now,” “I’m so nervous,” and “I couldn’t sleep last night.” What I cannot hear was the ruling itself. In fact, most people can’t hear! Almost everyone buried their heads into smart phones attempting to look up the results, but the internet connection was too sluggish. We were receiving conflicting rulings, mostly due to a misreporting of a certain news source. After even more minutes (that felt like hours), I felt that I was the last person to hear that the Supreme Court ruled 5-4 to uphold the Affordable Care Act. But the wait was worth it.

With a huge smile plastered on my face, I realized that I was on the scene of a historic health care victory.  As I walked away, I decided to take a piece of history with me by picking up a marching sign left on the ground of the Supreme Court.

Tran Doan is a Pedro Zamora Fellow at AIDS United and graduate student at the University of Pittsburgh Graduate of Public Health.

ACA Benefits impacting families are outlined in a statement from Families USA, a non-partisan nonprofit organization dedicated to the achievement of high-quality, affordable health care for all.

ACA Benefits impacting people living with HIV/AIDS are outlined in the AIDS United Statement on the Supreme Court decision.

AIDS United Convenes Congressional Roundtables Addressing HIV in the South

by Charles Stephens, Regional Organizer, South

It started with a bus tour through Alabama in March. AIDS United invited a group of stakeholders along with our partners in the state to witness firsthand the impact of the HIV epidemic in the South. As they listened to heartbreaking story after heartbreaking story, from service providers to advocates, the charge as well as the mission became clear. The faces and personal stories provided not only a sharper lens but a deeper context to understand the effects of HIV/AIDS on the region. And though there has already been considerable work and investment in the South by many groups, the size of the challenge reminds us exactly how much is left to be done.

On Tuesday, June 19th, AIDS United convened two bipartisan Congressional roundtables: one for House members and staff hosted by Representatives Hank Johnson, a Democrat from Georgia, and Ileana Ros-Lehtinen, a Republican from Florida. Representatives Barbara Lee (D-CA) and. Shelia Jackson Lee (D-TX) also attended.  Senators Jeff Sessions, a Republican from Alabama, and Kay Hagen, a Democrat from North Carolina, hosted the roundtable for Senators and staff.

The group spent the morning and afternoon engaged in intense discussions around the drivers of the HIV epidemic in the South and innovative solutions. One of the challenges discussed included stigma, stunningly illustrated by one of the speakers, Dr. Laurie Dill, Medical Director of Medical AIDS Outreach in Alabama. Dr. Dill shared a story about how some of her HIV-positive clients have been forced to eat off of paper plates rather than use regular dishes at family gatherings.

The gap in resources to fight the epidemic in the South also came up frequently during the discussion. Kathy Hiers, Executive Director of AIDS Alabama, expressed that “We’ve got to move the dollars where people with HIV are in need.”  The impact of HIV among women was referenced throughout the roundtables. Sexism and domestic violence are thought to be part of the driving forces of the epidemic in the region.

Other challenges in the South include poverty, racism, rural challenges, poor education, homophobia and health infrastructure challenges. Late diagnosis is a significant challenge. The later someone is diagnosed, the more expensive and difficult it is to treat them.

Though the challenges of HIV in the South cannot be overstated, and there was considerable time spent discussing them, the group was diligent in offering innovative solutions. As Senator Kay Hagan stated in the meeting, “We’ve got to invest in innovation.”  Approaches that were highlighted include: A telemedicine program in Alabama funded by AIDS United, where doctors, nurses, and other clinicians are able to communicate with patients virtually, while being physically located in different spaces. This is critical because transportation is often a barrier to accessing care for people in Alabama.  Another innovative approach echoed through the discussions was the importance of public/private partnerships as an instrument of innovation.

Ronald Johnson, Vice President of Policy for AIDS United, provided insight on how we can build on the Congressional roundtables and advance the work moving forward. In particular, AIDS United has suggested that new research be performed to get improved metrics and other indicators that can provide a better picture of the severity of the epidemic in the South and on the social drivers of the epidemic.  Such research could become an important tool for policy development.  Mr. Johnson also stressed the critical value of public/private partnerships and how an AIDS free generation is within our grasp.

Senate Appropriations Committee Approves HIV Funding

by Bill McColl, Director of Political Affairs

In relatively short order this week, the Senate Subcommittees on Labor, Health and Human Services, Education and Related Agencies and on Financial Services and General Government passed their Fiscal Year (FY) 2013 bills followed quickly by votes at the Full Committee level.  The next step for the bills would be to go to a vote on the floor of the Senate and then on to conference with the House, steps that are unlikely to be taken prior to the November election.

The Labor, HHS bill is the appropriations bill that is the largest source of HIV/AIDS treatment and prevention programs. The Committee voted 16-14 to approve the bill which contained a significant increase for the AIDS Drug Assistance Program (ADAP) of $30 million.  The increase is actually $65 million over the original FY 2012 baseline and includes an extra $35 million directed towards ADAP that the President had announced on World AIDS Day, December 1, 2011.  The other Parts of the Ryan White Program remained level-funded.  The amounts designated for the Ryan White Program are as follows:

  • Part A (56 grants towards cities and surrounding areas) – $671.3 Million
  • Part B (States, Territories and the District) – $422.3 Million
  • Part B ADAP – $963.3 Million
  • Part C (Direct grants to HIV clinics) – $215.1 Million
  • Part D (Families, Youth and Children) – $77.2 Million
  • Part F (AIDS Education and Training Centers) – $34.5 Million
  • Part F (Dental) – $13.5 Million
  • Part F (Special Projects of National Significance – SPNS) – $25 Million

Part C’s funding is $10 million above the original FY 2012 baseline, accounting for 2/3 of an increase to that program announced by the President on World AIDS Day.  An additional $5 million that has been designated for Part C providers through the Community Health Center (CHC) program will need to be designated through that program again to maintain the same amount of actual funding.  The funding for Part D remained the same, despite a decrease of nearly $7 million in President Obama’s budget.

Funding for HIV prevention also appeared to be flat funded at a rate of $786.2 million although overall funding for the Centers for Disease Control and Prevention (CDC) was up $55 million.  There was an increase of $2 million for

Prevention advocates were relieved that no funding was included for abstinence-only-until-marriage programs, which have been shown to be ineffective, and that $22 million in unspent Title V abstinence-only funding had been rescinded. Advocates expressed disappointment that the Committee failed to redirect the rescinded funding towards evidence-based pregnancy prevention efforts for foster care youth. The Teen Pregnancy Prevention Initiative (TPPI), which provides funding for programs that reduce teen pregnancy and related risk behaviors, was level-funded at $105 million. Thirty million dollars was provided for the Division of Adolescent and School Health (DASH) at the Centers for Disease Control and Prevention (CDC), which is level funding from FY 2012 but down $10 million from FY 2011.

The bill also returned language that would allow for federal funding for syringe exchange programs as long as a local public health or law enforcement authority does not object to a specific site. This language had been included in the FY 2009 and 2010 budgets but the overall bill for FY 2012 had restored the federal ban on the use of federal funds for syringe exchange programs. The restoration of the ban was a move strongly opposed by most HIV/AIDS, public health, harm reduction and viral hepatitis organizations. The 2013 Financial Services appropriations bill, which contains the budget for Washington D.C., also contained the restored syringe exchange language and specifically excluded Washington D.C. from its application, allowing the District to continue funding syringe exchange with its own local funding.

Other measures of interest in the Labor, HHS budget included an additional $100 million to the National Institutes of Health, although it was not clear if the additional funds would directly go to HIV research. The committee also agreed to increase funding by $547 million for the Centers for Medicare and Medicaid Services, an increase that is expected to help with Affordable Care Act (health care reform) implementation issues. Community Health Centers (CHCs) received an increase of $300 million to their total budget as well (including mandatory funding in the health reform law)

The Social Innovation Fund, which provides match grant funding for AIDS United’s Access to Care program, was level-funded at $45 million for FY 2013. Funding for Americorps was set at 346.4 million. Although this amount is $2 million above FY 2012, it includes a disability grants program which had previously been separate so in reality this is also flat funding).

The Financial Services bill did not include the President’s proposed one percent transfer of domestic HIV/AIDS spending within the Department of Health and Human Services to support the implementation of the National HIV/AIDS Strategy.  Additionally, a $1.4 million set aside for the Office of National AIDS Policy (part of the White House Domestic Policy Council) was not included. Finally, the full committee also refused an amendment to defund IRS spending on the health care law, also in the Financial Services bill.

Click here to see the FY 13 appropriations for federal HIV/AIDS programs chart, produced by the AIDS Budget and Appropriations Coalition, which gives an overview of the above-mentioned numbers and is expected to be updated shortly.

The AIDS United Organizing Team Gears Up for Elections 2012

by Charles Stephens, AIDS United Southern Regional Organizer

This year’s elections will perhaps be the most critical for the HIV/AIDS community in recent memory. Our entire public health landscape is shifting, and has the potential to move our county toward greater health access and parity — or further away. Much of this will be determined at the polls. The people we vote into office will be faced with issues ranging from the Affordable Care Act and women’s access to reproductive health care to HIV criminalization laws, and the social safety net programs put in place to protect the most vulnerable.

To help communities “get out the vote,” AIDS United’s organizing team has launched a voter mobilization initiative. This initiative consists of a webinar series, in-person trainings around the country and a voter mobilization tool kit. To kick off our initiative this week, I presented on “HIV/AIDS Issues and the 2012 Elections: Strategies for Engagement” at the Statewide HIV/AIDS Advocacy Conference in North Carolina. The conference was a collaborative event between two of AIDS United’s grantees: The North Carolina AIDS Action Network (NCAAN) and the North Carolina Harm Reduction Coalition (NCHRC). Many of our grantees and partners in the state were present, and participants had the opportunity to attend workshops and meet with their legislators.

Some of the topics I covered during the presentation included: what’s at stake in 2012, voter engagement best practices, strategies to bring attention to HIV/AIDS issues to elected officials and candidates, and an overview of our voter mobilization toolkit.

On June 6, AIDS United hosted a webinar entitled “Mobilizing the HIV/AIDS Community for the 2012 Elections.” In addition to sharing strategies around voter engagement and mobilization, we highlighted the new toolkit, and  featured brief presentations by two of our partners: Nic Carlisle from AIDS Alabama and Sarah Sobel from the Ohio AIDS Coalition. Both spoke about what their organizations are doing to get out the vote for this year’s elections.

Our next webinar in our voter mobilization series is on voter suppression and will be June 27 More information for this webinar will be available here in the Policy Update in the next two weeks. Meanwhile, to learn more about our voter mobilization efforts, or if you would like to find out how you can get involved, please contact us.