Six Reasons the Republican Budget is a Potential Disaster for People Living with HIV

April 21, 2011 in Policy/Advocacy

Bill McCollby William McColl, Director, Political Affairs

On Friday, April 15th the House passed Rep. Paul Ryan’s (R-WI) Fiscal Year 2012 (FY12) budget on a near party line vote of 235 to 193.  The Democrats voted unanimously against the bill while four Republicans switched sides to vote against it.  They were right to vote against it.  This budget has the potential to leave many people living with HIV/AIDS without any sure way of accessing treatment.

6 Major Issues for People Affected by HIV
What would the Ryan Budget mean for people living with HIV/AIDS or at risk of being infected?  After careful review here are six things AIDS United is most concerned about.  The Republican plan would:

1. Create block grants to the States for Medicaid reducing federal support by about 33% (or $1.4 trillion).

  • Few federal standards could survive and services would become available on a state by state basis more than ever before.  States that have expressed stigma towards people living with HIV could easily roll back funding for services for PLWHs.
  • Even states with waivers that currently provide services to people who are HIV-positive but not diagnosed with AIDS would have to find ways to cut back – many states could choose to limit this care.
  • Medicaid services would have to be cut to a barebones minimum – it would be hard to find a doctor or get an appointment, drug formularies would have to be limited.

2. “Privatize Medicare” is privatized as a voucher program to buy services from private health insurers for all people beginning in 2022.  This means anyone under 55 years old now would be impacted by this change.

The vouchers will not increase in value as fast as medical costs, so they are unlikely to cover the rates of purchasing insurance for people living with HIV.  A lot of people living with HIV would likely move from Medicare to Medicaid if services were available at all.

3. Repeal and defund the Affordable Care Act resulting in:

  • An end to prohibition of lifetime and annual insurance caps.
  • An end to pre-existing condition clauses.
  • Loss of Medicaid eligibility for many PLWH’s with incomes below 133% of the federal poverty level.
  • High out of pocket costs for drugs for people with access to Medicare to pay.
  • Potential loss of the Prevention and Public Health Awareness Fund.
  • Loss of coverage for young adults.

4. Result in potential loss of funding for the Ryan White CARE Act – non-defense funding for health care would be cut to below FY 2008 levels and would be capped for five years. Even though the CARE Act has enjoyed strong bipartisan support, such a funding reduction would mean that none of the parts would be able to keep up with the need – in fact the need would grow as people who had been accessing Medicaid and Medicare turn to the CARE Act for help. This might cause:

  • Likely increases in HIV ADAP waiting lists.
  • Increases and wait lists for access to doctor visits.
  • Cutbacks on supportive services such as case management, transportation, help with translation needs, food and nutrition services and more.

5. A potential loss of funding for the HIV prevention – likely to be cut to FY 2003 or even lower levels and then capped.

  • The overall Centers for Disease Control and Prevention budget was cut to 2003 level for the remainder of FY ‘11.  It is likely they would remain a target for even further cutbacks in resources and virtually certain that they would not be raised.
  • 6. A potential loss of funding for the Housing Opportunities for People with AIDS (HOPWA) program and other housing programs.

    • Although HOPWA only received a 0.2% rescission for FY’11, the rest of the housing budget was cut by billions of dollars.

    All of this plus cuts to education and other programs would amount to about $4.3 trillion in cuts.  In the meantime the budget would give tax cuts of $4.2 million to the wealthiest people in America.

    Sorry, AIDS United can’t buy this.  We’re opposing the changes of the Republican plan that would hurt people living with HIV plan including the drastic cuts to Medicare and Medicaid that would threaten the main sources of treatment and care for people living with HIV.  So what can you do?

    What to do?
    The bright side of this issue is that this budget is not binding.  The President laid out a budget plan that accepts the need to find ways to cut overall spending levels, but which clearly maintains Medicare and similar priorities.  New Members of Congress do not understand the importance of these programs to people in their districts and State.  It’s not too late to stop the erosion of health care in this country.  We urge advocates to plan meetings when your Representative and Senators are in town during their recesses (or to attend local town hall meetings which are generally held during the recesses).  Tell them:

    • That you oppose the Ryan budget and any other budget that will make it harder for people living with HIV to get access to Medicare and Medicaid for treatment
    • That cutting health care programs like HIV/AIDS treatment programs while giving huge tax breaks to people earning more than $250,000 is wrong and that you oppose it.

    AIDS United can help you plan your meeting with your Members of Congress when they are in town. Click here for a tip sheet for planning and implementing your meeting, or email jschneidewind@aidsunited.org with questions.  The current recess is now-May 1. The House of Representatives is also out May 16-22 and June 6-12 while the Senate recess is July 4-10.  Keep an eye out for an AIDS United webinar in May that addresses the Ryan budget, cuts to HIV and how to talk with your Representatives.

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

    April 19, 2011 in Policy/Advocacy

    julia_chengBy Julia Cheng, Zamora Fellow, AIDS United

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

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

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

    FY 11 Budget: The Impact on HIV/AIDS

    April 15, 2011 in Policy/Advocacy

    Donna Crewsby Donna Crews, AIDS United Government Affairs Director

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

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

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

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

    Playing Defense and Offense

    April 13, 2011 in President's Message

    by Mark Ishaug, President and CEO
    AIDS United

    Can you walk a tightrope while preparing for the fight of your life? Sometimes you simply have no choice. In just the last month, AIDS United has had to become even more politically agile while making ourselves programmatically stronger. While the HIV/AIDS epidemic continues to rage on in our country, impacting our nation’s most vulnerable communities, we are working in overdrive to prevent devastating budget cuts that would dismantle health care reform, eliminate signatures programs like AmeriCorps and the Social Innovation Fund, and reinstate the ban on federally-funded syringe exchange programs. And the budget talks for FY 2012 are only just beginning to heat up.

    Hundreds of millions of dollars for critical domestic HIV/AIDS programs are at risk at a time when we can afford no losses. More important, the lives of the people we serve are at risk. We must fight for the full implementation of the Affordable Care Act. We must step up our efforts to ensure the success of the National HIV/AIDS strategy. And we must develop new public-private partnerships that will help us reduce HIV infections, increase access to care and eliminate health disparities.

    AIDS United is playing defense and offense, and maximizing all of our organizational strengths and skills to be the leanest, smartest and strongest asset we can be in the fight to end AIDS in America. We are adapting, changing, and honing every day.

    • At its first official meeting since becoming AIDS United, the Board of Trustees embarked on the development of a three-year strategic plan, which will align AIDS United’s goals with those of the National HIV/AIDS Strategy.
    • We unveiled a new Community Partnership model at the 2011 annual meeting, which will support community-based programs to (1) strengthen systems, (2) seed and measure innovation, and (3) organize and lead policy/advocacy efforts. We asked Community Partners to join with us in thinking even more creatively and strategically about how we might break down HIV/AIDS silos. We began to expand our ideas of how we can more effectively help the people we serve by focusing on the myriad of co-existing conditions that contribute to HIV’s transmission.
    • At the first Access to Care grantee convening, AIDS United mobilized grantees supported by Bristol-Myers Squibb, Walmart and the Social Innovation Fund, providing them with the educational and skills-building opportunities they need to advance successfully to the next phase of their respective projects. Grantees rolled up their sleeves for substantive, productive and sometimes difficult discussions about participant recruitment, evaluation, and fundraising.
    • AIDS United awarded $1.4 million dollars to 29 organizations to promote the development and expansion of local advocacy networks in nine Southern states – one of the regions in our country hardest hit by the epidemic.

    So will we defend programs that work and save lives? Yes we will! Will we fight for new public and private resources for innovative, evidence-based projects? Absolutely! And will we succeed? We have no choice. And we can only do all this and more with you. So join us today! Donate to AIDS United, call your legislators, sign up for action alerts, friend us on Facebook, follow us on Twitter. AIDS United, and people living with and affected by HIV/AIDS, are counting on you.

    A Call For Collaboration and Advocacy: the Community Partnership Model Evolves

    April 4, 2011 in Community Partnerships

    Christine Wasikby Christine Wasik
    Community AIDS Partnership of the Capital Region
    Albany, NY

    Another wonderful AIDS United Community Partnership Meeting!  Thanks so much to AIDS United and the AIDS Foundation of Chicago for their hospitality.  It is so helpful to get together with other Partnerships and find out the new and innovative things people are doing as well as share with each other the similar challenges we are facing.  We are all struggling with decreases in funding and donor fatigue, especially in the area of HIV/AIDS.  People have been working so hard for so many years to end AIDS in their communities and it seems that it is harder and harder to get people’s attention about the issue.

    Over the past two years AU has been stressing the importance of collaboration and advocacy.   After last week’s meeting I believe we have some clear direction to begin discussing and implementing much needed changes to our Partnership.   I now feel prepared to take some of the concepts we have been discussing for the past two years and strategize ways to make them work locally.   The support from AU has always been top notch but after this meeting I am especially confident to tackle a new partnership model.  AU seems to understand that, as they are, the Partnerships are finding their way through this process.  It is evident that AU is prepared to support us patiently along the way and assist us in achieving shared goals even if we all get there on slightly different paths.

    Thanks so much again for a great meeting!

    Love Me Tender: Team NOLA Flirts with Bondage

    in AmeriCorps

    Having already walked dogs at the animal rescue, weeded a sculpture garden, and repaired a house destroyed by Hurricane Katrina, Team NOLA next decided to volunteer at a bondage education night. On February 16th, Team NOLA volunteered at the New Orleans Gay Men’s Wellness Center’s inaugural event– “Love Me Tender: Flirting with Bondage the Proper Way”.

    The Wellness Center is a project of the Louisiana Office of Public Health which focuses on promoting health in all aspects of the body, mind, and spirit. Team NOLA member Brandon, who serves as an Americorps member at the Wellness Center, planned and organized “Love Me Tender”. At this event, attendees were educated on safe bondage practices as well as offered free, rapid HIV testing.

    The event took place on the second floor of John Paul’s, a gay bar located in a beautiful house in the Marigny neighborhood of New Orleans. Team NOLA arrived an hour early to help set up the event.

    Brandon opened the event with an exercise to break the ice. A volunteer stood with his/her back to the audience. Then Brandon held up a word and the audience gave clues to the volunteer to help him/her guess the word. All volunteers were awarded prizes, such as condoms or a copy of Rough Trade, an anthology of gay S&M erotica.

    Next, local masseuse and bondage expert Patrick Tyrus gave a talk about safe bondage practices. Some of the topics he covered were the best knots and ropes to use, basic safety rules, and the importance of communication.

    After a short break, Tyrus gave a live demonstration of all the topics he had just discussed. He tied up a woman who had previously arranged to volunteer and demonstrated different ways to use spanking, chopsticks, and clothespins in one’s bondage practice. After some Q&A, the event was over. Some audience members took the opportunity to have Tyrus demonstrate a few rope ties on them.

    The event was a success. The small room was bursting with about 35 attendees, 3 of whom were tested for HIV and all of whom were educated on safe bondage practices.