The Female Condom: Safe, Sexy, and Cost-Effective

March 30, 2012 in Policy/Advocacy

by Jessica Terlikowski, Director of Regional Organizing
AIDS United

This week the journal AIDS and Behavior published study findings stating that the Washington, D.C. female condom education and distribution program is a cost effective strategy for reducing new HIV infections. The data overwhelmingly demonstrated that dollars invested in the program resulted in a cost savings of more than $8 million due to the prevention of nearly 23 HIV infections. The program is administered by the Washington AIDS Partnership (an AIDS United Community Partnership) and the D.C. Department of Health.

The female condom is an essential safer sex option for all genders seeking to protect the health of themselves and their partners. It is the only receptive partner initiated HIV, STI, and pregnancy prevention tool available. The female condom can be used for vaginal or anal sex.

The study’s findings shatter the notion that female condoms and not a worthwhile expenditure for HIV prevention programs. The reality is female condoms work.

Lead author and chairman of the Department of Health Behavior and Society at Johns Hopkins Bloomberg School of Public Health, David Holtgrave, stated in the Washington Post that “When we think about what it means for a city or state to have a comprehensive HIV program, this study really says you ought to include female condoms as one element of a comprehensive program because it’s acceptable, effective and cost-saving.”

Atlanta, Chicago, Houston, New York City, and San Francisco have launched similar programs focused on increasing awareness, acceptance, and use of female condoms through equipping community educators, health care professionals, case managers, and other services providers with skills necessary to effectively promote female condoms within their communities. Each of these jurisdictions reports greater acceptance of female condoms among end-users and increased willingness among providers to promote them as a result of their work. Other jurisdictions are currently laying the groundwork to launch their own programs.

The energy and enthusiasm around female condoms has increased tremendously since the new and improved female condom, the FC2, hit the market in 2010. Last year each of the female condom programs in the U.S. came together to launch the National Female Condom Coalition to increase awareness, access, and use of female condoms through education, advocacy, and collaboration. The Coalition now counts approximately 40 health departments and organizations dedicated to sexual health and reproductive justice, gay men’s health, HIV prevention, family planning, and HIV-positive women from across the country. This study will further strengthen advocacy efforts to ensure women and men in the U.S. and around the world are aware and can access this highly effective, pleasurable, and cost-effective prevention tool.

For more information about the National Female Condom Coalition, email jterlikowski@aidsunited.org.

North Carolina Harm Reduction Coalition (NCHRC) Organizes North Carolina Advocates to Participate in the National Day of Action on Syringe Exchange

March 26, 2012 in Southern Initiatives

By Robert Childs, Executive Director
North Carolina Harm Reduction Coalition

On Wednesday, March 21st, 2012, North Carolina Harm Reduction Coalition (NCHRC) organized local clergy, law enforcement, diabetics, people of transgender experience, lawyers and drug users from around North Carolina to particpate in the National Day of Action on Syringe Exchange. Congress recently reinstated the ban on federal funding for syringe exchange programs (SEPs).  SEPs provide sterile syringes and collect used syringes to reduce transmission of viral hepatitis, HIV, and other bloodborne infections associated with reuse of contaminated injection equipment by drug users and diabetics.  Most SEPs are part of a comprehensive health promotion effort that includes HIV & hepatitis testing, education on reducing sexual and drug use-related health risks, and referrals to drug treatment & other medical and social services. Republicans in the House were successful in reversing policy on syringe exchange through FY 2012 Appropriations in December 2011. They re-imposed a complete ban on the use of federal funding for SEPs despite overwhelming scientific evidence showing decreased HIV, viral hepatitis and drug abuse among SEP participants, not only improving public health but also saving tax payers millions of dollars.

On March 21st NCHRC organized three actions: a mass letter writing campaign, a phone bank and a meeting with Senator Hagan’s office in Raleigh, NC.  We asked Senator Hagan to be our champion on this public health issue and to commit to the following actions:

  1. Ensure negotiations restore Congress’ FY 2010 syringe exchange language for both the federal and Washington, DC jurisdictions in FY 2012 appropriations legislation.
  2. Include language from FY 2010 on syringe exchange in the programmatic appropriations request letters due March 29th.
  3. Release a statement in support of restoring federal funding for syringe access programs.
  4. Encourage the North Carolina legislature and governor to decriminalize syringes and/or legalize syringe exchange.

Sen. Hagan’s office personnel gave us an indication of support, but promised to run the issue by Senator Hagan for a definitive answer on her position. At our meeting in Raleigh with Hagan’s office, we brought together advocates from various backgrounds to discuss the issue during our 30 minute meeting. As Executive Director, I covered an overview of SEPs and the history of federal funding while Ronald Martin (one of NCHRC’s law enforcement consultants with over 20 years of law enforcement experience) explained why law enforcement benefit from SEPs.  He stated, “Why would we not want syringe exchange? Research has shown a 66% reduction in law enforcement needlesticks in communities where SEPs exist. One out of three law enforcement can expect a needlestick in their career and I support any measure to reduce harm against our officers.” Reverends Jenna and Andy outline the moral imperative for life-saving SEPs, and our diabetic and transgender allies discussed the need for syringe access among these populations. To round out the meeting, Lucas Vrbsky from the NC Chapter of the National Association of Social Workers discussed the social justice benefits of federal funding for SEPs, Lisa Hazirjian from the NC AIDS Action Network demonstrated the financial benefits of SEPs as well as HIV prevalence among injection drug users, Faina Shalts (from Harvard’s SHARP crew) explained SEPs’ public health benefits and Tessie Castillo (NCHRC’s Harm Reduction Coordinator) completed the ask.

We would like to thank our allies and NC coalition members from Wilmington to Franklin who made this day a success and allowed us to put a southern stamp of support on this national issue.  Even though NC does not have legal syringe exchange, we support federal funding for syringe exchange because if the federal government shows support by allocating federal dollars for SEPs, it assists us in making the case for southern states to adopt these measures as well.   NCHRC hopes to see the US Senate, especially our representative Kay Hagan, champion this issue and send the message that our state supports an initiative that would improve NC and the nation’s public health and safety.

North Carolina Harm Reduction Coalition is a grantee of AIDS United’s Southern REACH initiative

Ryan Budget Released: AIDS United Opposes

March 23, 2012 in Policy/Advocacy

by Donna Crews, Director of Government Affairs

On Tuesday, March 20 Rep. Paul Ryan (R-WI) chairman of the House Budget Committee introduced his Fiscal Year 2013 (FY13) budget entitled “The Path to Prosperity – A Blueprint to American Renewal.”  The total spending called for in the proposed budget is $1.028 trillion.  That amount is $19 billion below the bipartisan agreement for FY13 reached last August in the Budget and Control Act (BCA) and $15 billion below the current Fiscal Year 2012 level.

The possible program cuts in the Ryan budget for FY 13 could be:

  • Severe cuts to Supplemental Nutritional Assistance Program (SNAP), formerly known as food stamps.
  • Elimination of the Affordable Care Act.
  • Cuts to housing programs to assist those in foreclosure.
  • Changes in the structure of the Medicare and Medicaid programs.

The resolution would also decrease the tax burden for wealthy individuals by lowering the top tax bracket by 10 points from 35% to 25%.  Everyone else’s tax rate would be 10 % thus increasing the tax rate on many low income individuals.  Rep. Ryan’s resolution calls for permanently extending the “Bush era tax cuts” and eliminates the alternative minimum tax rate.

The budget resolution was debated in the Budget Committee on Wednesday, March 21 and adopted on a 19-18 vote.  All 16 Democrats on the committee voted against the proposed budget; they were joined by 2 Republican committee members who thought the total spending amount was too high.  Rep. Jason Chaffetz (R-UT) was the only committee member not present for the vote.  The budget debate will now move to the full House for an expected vote next week.  There are indications that the views of the 2 Republicans who voted against the budget in the committee are reflected in the total Republican caucus in the House.  If this dissension holds up, the fate of the Ryan budget in the full House may be a cliff hanger.

AIDS United is firmly opposed to Rep. Paul Ryan’s (R-WI) budget FY 13resolution.  We believe it would l have a devastating impact on people living with or affected by HIV and AIDS.  We must ensure that the Affordable Care Act is implemented so that HIV positive low income individuals with incomes up to 133% of the federal poverty level (FPL) will be able to have access to care and medications through Medicaid prior to an AIDS defining diagnosis.  The only way to tackle the fiscal crisis is to have a balance of revenue growth and cuts in spending.  All of deficit reduction  cannot be borne by the non-defense discretionary portion of the budget.  We believe the debate between the Ryan  budget and President Obama’s FY 13 budget request show the stark differences between  the philosophies of the House Republicans and the Administration.  Rep. Ryan’s budget increases the coffers of the wealthy and President Obama’s budget continues to work to provide affordable healthcare programs for all.

AIDS United will continue to monitor the Ryan Budget as it moves through the legislative process and will keep you updated.  We encourage you to take action with calls to your Representative to urge a “No” vote when the resolution comes to the House floor.

Helping Latinas in San Diego Prevent HIV

in GENERATIONS

by Veronica Tovar,  MPA
HIV Research and Education
Chicano Federation

For the past five years, Chicano Federation has been conducting the National HIV Behavioral Surveillance (NHBS) in San Diego. NHBS is a Center for Disease Control and Prevention (CDC) program that interviews populations at risk for HIV to track behavioral trends in twenty-one cities in the U.S. with the highest HIV prevalence.

During counseling and testing sessions through this project, Chicano Federation found that many Latinas had never been tested for HIV.  Furthermore, many shared that their male partners were engaged in extramarital affairs, but continued to have unprotected intercourse.  Quite a few others shared that they did not know whether their partner was monogamous.  Both Latinos and Latinas, usually the older, lower-economic status couples, revealed not knowing how HIV is transmitted or how to use a condom.

According to the CDC, Latinas represent nearly one quarter (24%) of new HIV infections in the U.S. (CDC, 2010).  When compared to the United States, California and San Diego County had the largest proportion of Hispanic HIV cases (Epidemiology Report, 2010). In 2003-2007, the most common mode of HIV transmission in females was heterosexual contact (75% of all cases). Additionally, according to the CDC, high HIV risk in heterosexuals is linked to regions of high poverty and high STI rates.

In response to these overwhelming findings, with the financial and technical support of AIDS United and Johnson & Johnson, Chicano Federation created the De Mujer a Mujer curriculum (From Woman to Woman).  This unique health curriculum specifically aimed at educating traditional, mono-lingual, migrant Latinas living in one of five high-risk zip codes in San Diego, structured to cover a wide spectrum of health issues with the end goal being to de-stigmatize HIV and empower women to take control of their sexual relationships, get tested for HIV, and start making better decisions related to their own overall health and their children’s health.

AIDS United and Johnson & Johnson provided the opportunity to create an innovative program by allowing a formative and pilot phase prior to implementation.  Staff found that in order to address HIV, some basic needs and issues must first be acknowledged.  The curriculum was designed to address the overall encompassing needs of women, and gain trust and confidence before indulging in the taboo subjects of sex, HIV, and communicating with partners and children. The model consists of seven sessions, as follows: 1.Information/Introduction, 2. Gender empowerment, 3. Healthy relationships, 4. Reproductive anatomy, 5. HIV/STI 101, 6. Communication, and 7. Graduation. The three main objectives are 1. Increase self-efficacy and a personal sense of empowerment 2. Improve inter-personal communication skills, and 3. Improve safe sex practices through sexual health knowledge.

In 12 months Chicano Federation has held 63 weekly sessions for 128 women.  Of those 128 Latinas who participated, 112 graduated with 88% having attended all of the seven weekly sessions.  The comparisons of pre- and post- evaluations show statistically significant, positive improvements in all three areas.  More Latinas are getting tested for HIV and using condoms as a result of this intervention. But perhaps the most interesting results come from personal testaments to the impact that this program has had on the individuals.  Many participants have shared stories of how their participation in De Mujer a Mujer has acted as a catalyst for healthier choices in their lives.  The participants start showing positive improvements in their appearances, they share stories of terminating unhealthy relationships, have fun explaining the creative ways they have introduced condoms in their sex lives, and their experiences of communicating about safe sex with their children, to name a few.  The letter below from a De Mujer a Mujer participant explains both the impact and the continued need for this intervention in our community.

“I want to thank the instructors in the De Mujer a Mujer for giving me the opportunity to attend their class…The exercises we did in class were fun and smartly put together and I found myself laughing but at the same time really thinking about the impact it could make in my everyday life.  I was surprised that the Latinas in our community are still not informed about HIV and the myths they still hear.  I believe our culture has a lot to do with it.  I hope De Mujer a Mujer continues and more Latinas are aware of it because it is greatly needed in the Latina community.  I’m definitely telling every Latina in the community I come across about De Mujer a Mujer.” –Adriana Lopez

Two years ago, Chicano Federation went through a change in leadership, something that had not happened in 20 years.  This change, along with the support from AIDS United, has allowed Chicano Federation to invest in innovative projects like De Mujer a Mujer; it has provided the opportunity to bridge the gap between HIV research and the social services it provides to the community.  The creation of the program, not only brought new energy to the organization, but also to the community at large.  Stakeholders and media alike welcome the opportunity to learn more about De Mujer a Mujer, despite the difficult subject, and they are eager to help make this program succeed.  Chicano Federation and this program are being viewed as a model to delivering mission driven services in a relevant and effective way. Chicano Federation now has social services for HIV prevention and has demonstrated success implementing an innovative project.  Thank you AIDS United and Johnson & Johnson for this wonderful journey!

Proposed House Budget Committee’s FY 2013 Budget: Unfair and Unbalanced but a Clear Choice

March 21, 2012 in Policy/Advocacy

by Ronald Johnson, Vice President, Policy and Advocacy

Its déjà vu all over again as House Budget Committee Chairman Paul Ryan (R-WI) released a proposed budget blueprint for FY 2013 and proposed legislative language for a budget resolution.  With some noted variations, the budget proposal is a repeat of the mean-spirited budget that the full House adopted for FY 2012 on a largely party line vote.  Even the name is the same: “Path to Prosperity.”  The recycled title is just as misleading today as it was last year.  Given what is being proposed, a more complete and correct title would be “Path to Further Prosperity for Those who are Already Very Prosperous.”  The subtitle should be changed to “A Blueprint for Misery and Pain for Everyone Else.”  And make no mistake; the “everyone else” includes the majority of people living with HIV/AIDS.

Like most documents dealing with the federal budget, Chairman’s Ryan’s proposal for FY 2013 is a mass of numbers and projections.  The proposed budget can, however, be boiled down to a few key elements, most dusted off from last year’s proposal:

  • The budget proposal sets the overall discretionary federal spending level at $1.028 trillion. This is $19 billion below the FY ’13 level called for in the Budget Control Act (BCA) and represents a disturbing break with the bipartisan agreement that was forged last summer to avoid the country defaulting on its debt.
  • Defense discretionary spending would increase by $8 billion while non-defense discretionary spending would be reduced by over 5%. Non-defense spending includes health care and HIV/AIDS programs and already has been cut by nearly $1 trillion over 10 years under the BCA.
  • The budget proposal assumes repeal of the Affordable Care Act, including of course Medicaid expansion in 2014 to individuals whose income is at or below 133% of the federal poverty level (FPL).  This alone would mean that the large number of people living with HIV who have low incomes and are currently uninsured would continue to have limited or no access to the care and treatment that can save their lives. The impact on people living in the South could be especially dire.
  • The plan calls for a fundamental and drastic restructuring of Medicaid and Medicare.  The entitlement nature of both programs essentially would be eliminated and federal support slashed.  Much of the costs would be shifted to the states, in the case of Medicaid, and to the individual, in the case of Medicare.  Together, the programs are the top two providers of health care coverage for the overwhelming majority of people living with HIV and AIDS.
  • Existing tax breaks that benefit the wealthiest individuals and many corporations would be maintained and new tax cuts created.  The cost, estimated to be over $3 trillion over 10 years would be paid for by higher taxes for middle class individuals and families and deep cuts in spending for programs that benefit the “99%.”
  • The proposed budget shreds the intricate web of safety nets not only for low-income individuals and vulnerable populations but for middle class people as well.  Funding for food stamps and other programs that provide direct assistance would be reduced significantly. Equally draconian would be the cuts to investing in education, the country’s infrastructure, and to public health.

In many ways, the proposed FY 2013 plan is less a budgetary document and more a political manifesto.  Chairman Ryan himself sees the proposed budget as setting a clear difference with President Obama over the role and function of government.  It is also a clear difference between a fair and balanced approach, with shared responsibility, to reducing the federal deficit and achieving fiscal stability and a one-sided approach that destroys the social compact, stresses austerity for the many, and awards huge benefits for the very few.  The Ryan budget is one more indicator of how important the upcoming November elections are.  This election year will provide us with a clear choice.  We can choose a path that leads to a true American renewal that can include an end to the AIDS epidemic or we can choose a path that adds to more inequality, more health disparities, and more social and economic injustice.  If we can recognize and rise up to meet this challenge, maybe the recycled Ryan budget will have been a service after all.

A Fire in the House: HIV/AIDS in the Deep South

March 20, 2012 in Access2Care

by Maura Riordan
Vice President, Access & Innovation

I’ve never blogged before. Having been active in the fight against HIV/AIDS for the past 25+ years, I’ve seen plenty of life that is unfair, unjust, and painful. I grew up in a sense, in the AIDS epidemic. I began this work when I was in my 20’s . . . when my gay male friends starting getting sick, and dying. I did not understand what was happening around me. As more people became sick, and quickly died during the early years of AIDS in the US, I did know one thing – I wanted to be able to tell my future children that I did something to help – that I did not stand by while human beings died without a loving hand to hold, without hope, without respect. I wanted them to know that while some reacted with bigotry and hatred, so many stepped forward with a sense of community and a remarkable human spirit.

Since those early days, I have stayed in the field of HIV/AIDS.  And in that time I have seen the epidemic change in so many ways. We have treatment options that make HIV/AIDS a chronic, manageable disease.   Not easy, but with access to care and treatment, manageable.  The populations most impacted have changed.  Or more accurately, and more sadly, expanded.   White, gay men were hit first (and continue to be), but now people of color living in poverty are the forefront of those disproportionately impacted. The African American community is at the epicenter of the epidemic, with a particularly devastating impact on men who have sex with men (MSM), and women.

Many of us who have worked in this field long-term have grown accustomed to fewer deaths and a system of care that was built as a result of activism, spurred by the stigma, homophobia, and lack of mediations that killed so many HIV-positive Americans in the beginning.  The creation of the Ryan White Care Act, the formalization of support services that grew out of grassroots efforts to care for the dying, and the availability of life-saving medications have all fundamentally changed what was once widely considered by much of the general public, a top tier public health crisis.

Don’t get me wrong – there have always been unmet needs and deep injustices toward people living with HIV/AIDS in the US, but it is fair to say that overall, things got better in the late 1990’s.

And then I went to Alabama. I went as part of a small delegation of private sector funders to see the impact of HIV on the region, and to learn more about the innovative responses to epidemic that our grantees and stakeholderse have developed with AIDS United support.

I have known for some time that the South is the home of disproportionate HIV infections, poverty, lack of access to care, stigma, and poor health outcomes.  Somehow though, in more than 25 years of working in HIV,  I had managed to miss a visit to Alabama. It is hard to put into words what this trip, and the people I met and listened to, has meant to me. I have come away with a renewed sense of urgency in my work, because what I have seen and heard is far too reminiscent of my early days in this fight. The fear that many people in the South living with HIV/AIDS have at the possibility of others finding out about there HIV status, is palpable. Disclosures  have resulted for many in the loss of employment, the severing of relationships by friends and family, and a spiral into substance use, deeper poverty and marginalization.

I was initially shocked at the difficulty we had finding HIV-positive Alabamians to talk with our group about living with HIV in the South, but it became abundantly clear that stigma and its dangerous ripple effects, are simply intolerable for people living with HIV in the South, in addition to dealing with poverty and racism.

HIV’s ravaging of the Deep South represents a fire in our collective house in the United States.  The HIV/AIDS epidemic there is comparable with many of the countries that we assist in our global response to it. This is unacceptable, and presents a pivotal opportunity for those among us who believe in righting historical wrongs. Our first evening on the Alabama trip began in the Civil Rights Memorial Center, in Montgomery, Alabama. Walking through this space, and seeing the powerful images of the historical fight against injustice, it was clear that the current day fight against HIV/AIDS stigma and resource deprivation in the South is part of the same march for human rights.

The HIV/AIDS epidemic in the South cannot be seen as an isolated reality, separate from the larger civil and human rights movement. Poverty, racism, and ignorance fuel the HIV/AIDS epidemic in South and beyond. If we have learned anything from those who went before us, those who put their lives on the line for justice and human rights, it is that change will not come easily. Do we sit by while an entire population of Americans living in the Deep South face an epidemic proportional to that in developing countries? Do we demand that federal resources be allocated in a way that is reflective of the Southern reality? Do we host an International AIDS Conference in Washington DC this July, and not acknowledge that there is a fire in our own home?

For the first time in years, I feel a fire in my belly. It is a message that I cannot ignore. Many years ago, I promised myself that I would be able to tell my children that I did the right thing.  So I joined the fight. I now know that the fight looks different.  And though it may not be the neighbor I know that is dying, it is still my neighbor, my community member, my fellow American. It is time to stop the complacency, to step out of the comfort zone we have settled into in the US – there is a fire in our house. Will you join the fight this time? Will you someday be able to tell your children, your nieces and nephews, your grandchildren, that you did something to stop injustice and inequality? It is time to step up, and right another wrong.  Let’s put this fire out.