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

March 25, 2011 in Policy/Advocacy

By James Schneidewind, Public Policy Associate

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

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

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

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

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

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

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

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

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

The Time is Now

March 21, 2011 in Access2Care

by Will Rutland, Montgomery AIDS Outreach

It is a bittersweet thing to leave an environment so charged with hope in order to carry that hope into the world.  And yet, today, that is what we did: today we left the comforting confines of the Pere Marquette convening space. Today we began the task of translating our respective aspirations into action beyond the walls of our hotel meeting room, appropriately called “Storyville III.”

Fortunately, AIDS United sent us out well-armed.  In addition to the powerful programs and presentations given over the last few days (and let’s be fair, the St. Patty’s revelry down Rue Bourbon was a whimper in comparison to the thunderous message of  WORLD  founder Rebecca Denison’s moving film about her beloved HIV doctor), we concluded the convening with small group conversations focused on: evaluation, the peer model, and social networking.

After digging into our respective areas of interest, we reconvened in front of our able captains from AIDS United, Maura Riordan and Suzanne Kinsky, and continued a dialogue regarding how best to stay connected as we embark on our shared, separate adventures.  Having collectively determined that: (1) too many emails are bad for the soul, and (2) we really should more seriously consider a convening in Hawaii, the time had come to say goodbye.

For our Montgomery group, that means the time is *now* to begin the work of bringing crucial care to those outside the practical boundaries of the traditional model; the time is now to begin reaching the previously unreachable; the time is now to begin amplifying the impact of our efforts through technology.  The time is now to do more.

And so, with heartfelt hugs, vigorous handshakes, and one or two quickly-covered sniffles, we bid each other farewell – parting company a little more certain that after this hopeful (if trepidation-tinged) week, we can do this. Together, we can do this.

And so we begin . . .

California Dreaming

March 18, 2011 in Access2Care

by Liz Brosnan, Executive Director, Christie’s Place, San Diego, CA

As I read my colleague’s wonderful blog yesterday citing her “enthusiastic trepidation,” Michael Jackson’s song “You Are Not Alone” rang through my head. A moment later I envisioned all 80 convening participants covering that song as a Glee spoof.  Naturally, I was leading the chorus as Glee’s substitute teacher Holly Holliday, so adeptly played by Gwyneth Paltrow.  While I’m a far cry from Gwyneth, a girl can dream . . . heck, a girl should dream.

The convening commenced with welcoming remarks from AIDS United President & CEO Mark Ishaug.  His energy and enthusiasm quickly became contagious and light surfaced at the end of the ominous match tunnel.  Day one built solidarity amongst grantees as well as bridged communities from across the country through networking, sharing best practices and strategies. The richness of experience and expertise is best expressed via an excerpt from a poem written by a positive man shared in a documentary this afternoon: “Are you inspired?  You should be.”

As we roll up our sleeves even more on day two of the convening, there are a few things that resonate most with me.  Rebecca Denison, WORLD Founder, discussed the ingredients that help keep people in care in her talk entitled “The Art of Keeping People in Care.” In a nutshell, that is the essence of this ambitious Access to Care Initiative (A2C).  She emphasized the power of the peer, a strategy that is pervasive amongst grantees.  I found myself surprisingly excited about evaluation (please don’t stop reading here – it’s really not a dirty word).  The national evaluation, an effort led by John Hopkins University, will lift up our work by measuring our collective impact on individuals, systems and communities.  Finally, as we embark on the era of healthcare reform, we are uniquely positioned to lead the way.  We are pioneers transforming healthcare through this initiative.

A2C represents the power to ignite change through innovation.  As we create new pathways to care and strengthen existing ones, it is clear to me that this work will not only build healthier communities, it will also produce models that will be replicated in other sectors.

As a Walmart and Social Innovation Fund (SIF) grantee from San Diego, CA, this initiative has been a game changer for Christie’s Place – and that’s putting it mildly.  In San Diego County an alarming 69% of HIV+ women who know their status are not in care.  With A2C support we now have the resources to reach those women as well as engage and retain them in care with cutting-edge strategies and by improving our service delivery system.  Up until six months ago, I could only dream about having the resources to be able to address and reduce the unmet need that exists for women.  SIF is about dreaming, dreaming big.  More than that, it’s about turning those dreams into reality.  It is turning our “what if” into our “what is.”  After all, a girl can dream . . . a girl should dream.

Opportunity – and transformation – knocking!

March 17, 2011 in Access2Care

by Cheryl Roberts Oliver, Executive Director, Saint Louis Effort for AIDS

At 2 this morning, the words “opportunity and transformation” were not on my mind, but after the first day of the AIDS United Access to Care Initiative Grantee Convening, they are at the top of my mind.  The sleepless night (one of many) caused by the daunting task of raising funds to match the Social Innovation Funds just granted to Saint Louis Effort for AIDS has also been experienced by representatives of the other nine agencies that were awarded SIF grants.  Today I learned that AIDS United must raise $3.6 million matching funds by August, and that none of us are alone in our challenges or our incredible enthusiasm to create innovative programs that will truly transform healthcare models, not just as they relate to HIV/AIDS, but how we approach chronic diseases among vulnerable populations across the country.

Being with my colleagues and sharing information has raised my awareness and my spirits.  The “opportunity” is that this is the first time there is a significant chunk of non-HIV money going into the HIV community, and each of the grantees can leverage each federal dollar so that in the end we are tripling the amount.  More importantly, the projects that we are implementing will change systems and provide new answers to old problems.  I suspect that I may wake up again at 2 a.m. tomorrow, but feel confident now that I will focus on how the work of these public/private partnerships will help us tackle the real causes of illness in our communities.

The convening in New Orleans is the biggest and most complex for AIDS United because it includes the 10 SIF grantees, plus the Positive Charge and Wal-Mart grantees.  The messages that come out of this meeting will help shape our communication about how we will get PLWHA into care.  Urban, suburban and rural initiatives will be implemented over the next twelve months.  At the end, instead of saying “what the heck have we gotten ourselves into” we will be realizing the benefits of having moved HIV/AIDS thinking out of silos and into a learning community.  Enthusiastic trepidation, matched by so many caring and creative minds, is bound to be transformative.

Why the Latest Sex Survey Isn’t Surprising…

March 14, 2011 in Policy/Advocacy

…and How it Offers an Argument for Comprehensive Sexuality Education

by Julia Cheng, AIDS United Zamora Fellow

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

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

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

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

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

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

All We Are Sayin’ is Give Female Condoms a Chance

in Policy/Advocacy

by Jessica Terlikowski, Director of Regional Organizing

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

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

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

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

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

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