What’s Missing from the Budget Discussions?

October 11, 2013 in Budget and Appropriations, Policy/Advocacy

Donna_Crews_2013_webby Donna Crews, Director of Government Affairs

There sure is a lot of conversation going on in Washington these days.  Government shutdown.  Economic shutdown. Repeal of delay of the Affordable Care Act.  A major topic of discussion seems to be getting lost in this mix, though: avoiding additional sequestration cuts come January 2014 if the Budget Control Act law is not revised.  We at AIDS United encourage our colleagues to continue to contact Congress to eliminate sequestration with a balanced approach to federal deficit reduction (federal cuts and revenue increases), to reopen the government, and avoid a federal default. The total spending amount ($986 Billion) being used in the proposed short-term Continuing Resolution (CR) for the discretionary portion of the bill assumes that sequestration continues. Continuing to use that total number, without repealing the sequester will trigger another round of automatic cuts in January. Sequestration must be repealed to ensure non-defense discretionary programs have the necessary funding to meet the growing needs in public health, education, and nutrition programs.

Last week, Minority Leader Nancy Pelosi said at a press conference after a meeting of the four leaders at the White House, “We’ll take your number to keep government open. Give us a chance to vote for it.”  However, AIDS United believes that the spending total should only be used for the short term CR.  The cuts have already cost way too much for the community-based member organizations of AIDS United’s Public Policy Committee (PPC). Congress must restore funding by utilizing the higher Senate number of $1.058 trillion for the long-term solution to Fiscal Year 2014 and replacing sequestration.  Some of our PPC member agencies have seen anywhere from five to 15 layoffs — including both medical doctors and lawyers.  Some have not filled as many as eight positions lost in attrition; are experiencing anywhere from 30 to 100 increased caseloads for case managers; and having to make drastic cuts to hot meal availability.  Waiting lists have been implemented for AIDS Drug Assistance Program (ADAP) medication and for medical treatment slots after an HIV positive initial diagnosis.  As one of our PPC members, Carole Treston of the Association of Nurses in AIDS Care (ANAC) stated, “A waiting list for care is not just an inconvenience; it is a critical time to engage a person in treatment.”  If that patient have to wait six weeks for an appointment it could diminish  motivation to engage in care and further deteriorate their health and the HIV status of his or her partner –  and possibly their community.

The impact of the sequester on HIV prevention programs are just as severe.  One of our PPC members closed their HIV prevention center serving men who have sex with men age 13 to 35, one of the populations most impacted by HIV.  While in one of our jurisdictions the cuts from the Centers for Disease Control and Prevention (CDC) were absorbed by the state, enabling their prevention programs to continue unscathed, the  majority of our PPC member organizations have been faced with dire prevention cuts, forcing reduction in HIV testing and prevention messages to the high-risk HIV-negative population.

HIV-focused trainings and workforce development have also been cut by more than ten percent due to rescissions and sequestration, just when the healthcare workforce — which needs HIV training — will increase with the expansion of the Affordable Care Act.  It is more important than ever to increase our training capacity as more healthcare professionals will interact with HIV-positive individuals across the healthcare spectrum.

At a time when we have the scientific prevention and treatment tools to begin to end the AIDS epidemic in the United States, it would be immoral to allow funding cuts due to sequestration to divert us from this worthy mission.  Congress must find a balanced solution to end the stalemate and – permanently eliminate the sequester; reopen the government; avoid an economic shutdown.  It is too important to the health and well-being of our nation.

It’s Not a Past-time, It’s a Duty

September 27, 2013 in HIV/AIDS Awareness Days, m2mPower

kenny_palmer_webby Kenny Palmer,  AIDS United Public Policy Assistant

I find it rather fitting that National Gay Men’s HIV/AIDS Awareness Day coincides with the end of my first week with AIDS United. This first week has really opened my eyes to the vast amount of individuals around the country who have dedicated their lives to defeating to this disease, and also to the great amount of work that remains to be done. The battle against HIV/AIDS is one in which I have a personal stake. As an African American and a gay male, I belong to two communities that are disproportionately affected by this disease. For me, combating this disease is not a past-time, it’s a duty.

I grew up in South Carolina and attended undergrad at Furman University. During my academic career, I undertook several internships and fellowships. It was during this time that I began my first Congressional internship in Washington, DC. Working on the Hill allowed me to observe the legislative process first hand, but it was living in DC that really opened my eyes to several issues that existed within the LGBT community; issues that I’d never been fully exposed to while living in the South. Sure I knew about the vast discrimination that existed, but that was just the tip of the iceberg. It was then that I decided that I wanted to be more active in both the LGBT community and the African-American community.

I look forward to working with the team at AIDS United to meet those individuals who are on the front lines of this battle and personally know the needs of individuals living with HIV/AIDS in their perspective areas. The opportunity to meet such icons as AU President/CEO President Michael Kaplan, Rep. Barbara Lee and others still has me star-struck. Furthermore, the chance to become extremely knowledgeable in healthcare and budgetary policy really excites me. I hope to accomplish a lot during my time here but above all, I would like to see a firm partnership emerge between the African-American and LGBT community, especially in the battle against HIV/AIDS.

 

 

Lost and Found

September 6, 2013 in Access2Care

Author-webBy Nucrisha Stone Plowden
Health Navigator,  Amida Care

I was recently asked to write about my experiences as a Health Navigator for Amida Care.  Amida Care, a grantee of AIDS United’s Access to Care Initiative, is a Medicaid health plan specifically designed for people living with HIV/AIDS in Manhattan, Brooklyn, the Bronx, and Staten Island, New York.  Amida Care’s “Live Life Plus” mission is to provide access to comprehensive care and coordinated services that facilitate positive health outcomes and general well-being for its members.

The Health Navigator is a key component of Amida Care’s access to care work.   Because of the success of our Health Navigator Program, we have been able to expand the number of Health Navigators from three to seven, giving us even greater capacity to help our members get reconnected to the care they need.  This can still be a bit of a challenge, though, as shown through a recent experience with one of our members.

First appearing on my “lost-to-care”  list (meaning I had to search for him), this member was a young man of 22 who had little knowledge of the HIV virus that he had been infected with. Having been diagnosed at age 15, he admitted he had never taken any of the medications prescribed. Because of the resistance he was developing to treatment, he began to experience early stages of renal disease, along with a low CD4 count and high viral load.  He had only kept a few appointments throughout the year, but not enough to maintain his health. I educated him on some basic facts about disease and treatment and explained how crucial it was for him to visit with his doctor regularly and to take his medication.  He expressed he wasn’t sure if he wanted to get care in a hospital because the setting was so overwhelming to him. He felt he wanted to experience something new, maybe some place smaller. I asked him to revisit the clinic and assured him that I would escort him and advocate for him. I just wanted him to be sure of any decision that he made.

Access-to-Care-Team--NYC-webThe clinic staff was surprised to see him return for an appointment, as this patient has been hard to engage. Fortunately, as a Navigator, I had the time to look for him. Not only did I have the time, but I refused to give up.  After a few more visits he made up his mind to transfer his care to another facility. He wanted to see what it would be like to have care in a private setting as opposed to a large hospital.  He made the decision and I was proud that he was being accountable for his health care.

My intention is to do what is best for the patients, and to respect their wishes.  We work to empower our members — mentally, emotionally and physically — to educate them about their health and all available health services and connect them with community services to enhance their overall functioning.

In the end, this member learned self-preservation, obtained a greater sense of self-esteem and was able to tap into personal strengths that he had been unaware of. He took charge of his health and is taking his medication as prescribed daily and is working on getting his renal disease under control.

Many times I feel like I’m chasing ghosts and I beat myself up when I can’t find people, but cases like this make it all worth it and I am reminded that the work we do is impacting lives.

 Amida Care is a grantee of AIDS United’s Access to Care (A2C) Initiative

 

One City, Two Access to Care Interventions

August 9, 2013 in Access2Care

BrianRisley-webBy Brian Risley, 
Manager, Treatment Education Program
AIDS Project Los Angeles

People living with HIV/AIDS in Los Angeles can face numerous barriers – including systems, structural and social barriers — to accessing the life-saving, HIV-focused care they need. Some may lead to people already falling through cracks in the system, and some may inhibit people from seeking care at all. AIDS Project Los Angeles (APLA), with support of AIDS United’s Access to Care (A2C) initiative, has set out to tackle these barriers by creating the Care & Access Network. The Care and Access Network is a partnership with Northeast Valley Health Corporation, REACH LA and the Los Angeles County Division of HIV & STD Programs, and uses a variety of intervention protocols to get HIV-positive Los Angeles area residents into care and to keep them there.

Baby Steps

One intervention example in which we are starting to see success involves a culture change — not a seismic shift, but a discernible change — in the way one Ryan White-funded HIV care clinic in the Los Angeles County – University of Southern California medical system now addresses systems barriers. The catalyst occurred once our County patient navigators (NAVS) went to work in the clinic to help reach a long list of patients who had fallen out of care. The NAVs locate and contact out of care patients though multiple people-finding resources, and upon consent, work with the client using to address barriers to care and connect them back into HIV care. The County NAVs have gradually assimilated into the clinic culture and have been resourceful enough to try to amend some of the structural barriers they faced: out-of-date patient contact information, expired medical consents, insufficient reminder calls to patients by clinic staff, no electronic medical record keeping and limited access to computers and databases. To date, the County NAVs have been providing helpful feedback to the Medical Director or the head administrative RN, who then have taken appropriate action to resolve the issues. The result has been improved documentation of new patient contact information, increased appointment reminders to patients from clinic staff, and more mindful attention to create patient-centered conversations.

APLA-CAN-blog-photo-web

The Care & Access Network team discusses strategies for keeping a client in care.

Safe Spaces

Another example of early success involves a newly diagnosed client who came into the other arm of the Care & Access Network, located at APLA’s Geffen Center, through a support group of newly-diagnosed HIV-positive people. The client became comfortable enough to disclose that he recently relocated to Los Angeles and learned through an emergency room visit that he was HIV-positive. His viral load was sky high, (over a million copies/ml), he had no HIV
medical care outside the ER, and no health insurance. Because he was employed by the adult film and escort industry, he was fearful production companies and clients would shun him if they found out about his HIV diagnosis. Uninsured and depressed, the client was happy to receive help. APLA’s patient navigator linked the client to a Ryan White-funded HIV clinic, and he became virally undetectable within eight weeks on antiretroviral treatment. He also gained skills about disclosure and negotiating boundaries, which would come in helpful when faced with the lure of lots of money to engage in risky sex practices. The client’s most pointed crisis was to risk telling employers about his HIV status and suffer a major loss of income, especially when living in a new city with no family or friends. Together, navigator and client addressed the fear of loss of health, income and stigma and found a talent manager who works with other HIV-positive adult film stars. The client signed with the manager and met others who were going through similar health challenges. Today, the client is starring in a new DVD release where his knowledge of treatment as prevention, condom use and boundary negotiation has brought back real confidence. He sort of has a boyfriend, has cut down on his “overnights” to attend his support group meetings and doctor appointments, and is grateful for
the advice and safety of the Care & Access Network.

APLA is a grantee of AIDS United’s Social Innovation Fund-supported Access to Care Initiative

What the Supreme Court’s Decision in Shelby Means for Voting Rights

July 12, 2013 in Uncategorized

Wade Henderson

By Wade Henderson, President and CEO of the Leadership Conference on Civil and Human Rights

The Supreme Court’s decision on June 25 in Shelby County v. Holder will have a real and detrimental impact on the voting rights of Americans. The Court dealt a significant blow to civil and human rights. As such, all Americans should be concerned about what this means for the continued health of our democracy.

The Voting Rights Act (VRA) has long been considered the most successful civil rights law Congress ever passed. Section 5 of the VRA played a critical role for decades in stopping voting discrimination against racial minorities.

Shelby County, Alabama, challenged Section 5 of the Voting Rights Act (VRA), which requires state and local jurisdictions with a history and ongoing record of voting discrimination to receive preclearance from the Department of Justice or a federal court in Washington, D.C., before any voting-related change can take effect. The Court did not rule on the constitutionality of Section 5. Instead, the 5-4 majority ruled that Section 4a, which determines which jurisdictions are covered under Section 5, was unconstitutional. The decision effectively shuts down Section 5 until Congress creates a new formula for deciding which parts of the country are subject to preclearance.

What’s most alarming about this decision is the fact that a narrow majority of the Court substituted its political judgment for that of Congress, which in 2006, during the last reauthorization of the VRA, held extensive hearings and gathered mountains of evidence in determining that the coverage formula in Section 4 remained essential. Congress conducted more than 20 hearings, heard from more than 50 expert witnesses, and collected more than 17,000 pages of testimony. A coalition of civil and human rights groups, RenewtheVRA.org (which included my organization, The Leadership Conference on Civil and Human Rights), commissioned and submitted for the congressional record reports that detailed the continued voting discrimination in all of the states covered by Section 5 .

Without Section 5 in effect, we have lost an important tool in stopping voting discrimination against racial minorities before it happens. While the VRA still stands, the only way to combat voting discrimination now is to file a lawsuit after the damage has already been done. This is costly and doesn’t actually do what the VRA was always intended to do – deter bad actors from discriminating against minority voters.

Just last year alone, Section 5 blocked discriminatory voter ID laws in Texas and South Carolina, and prevented Texas from drawing political boundaries that discriminated against African-American and Latino voters.

Our fears about a nation without an operational Section 5 have already proven true. The decision isn’t even a month old and we’re already seeing states like North Carolina introduce voter ID bills that will disproportionately keep minorities from being able to cast a ballot for their candidate of choice and curtailing early
voting. Within hours of the Court’s decision Texas’s attorney general announced that the discriminatory ID law that had been blocked by Section 5 would take effect immediately.

The danger is real. But Congress can – and must — act. The Court put the ball in our federal legislators’ hands to come up with a new formula. And while it’s true that Congress is bitterly divided along party lines, the VRA has always enjoyed broad bipartisan support. In 2006, the VRA reauthorization passed with sweeping, bipartisan majorities in both houses of Congress and was signed into law by a Republican president.

So it can be done. And it’s our job as citizens to push Congress to respond in an urgent, responsible, and bipartisan manner to protect voters from discrimination at the polls.

Voting is the language of democracy. Without a vote, citizens have no say in the government that is supposed to protect and serve them. Without the ability to cast a ballot, citizens have no way to ensure that government is responsive to their needs on every issue of importance from health care to education and national security.

Join the movement at RestoreVotingRights.org


Wade Henderson is the president and CEO of The Leadership Conference on Civil and Human Rights, the nation’s premier civil and human rights coalition consisting of more than 200 national organizations working to build an America as good as its ideals.

The Telemedicine Link to HIV Care

July 9, 2013 in Access2Care

by Sandra Percival, Program Director, Telemedicine and Distance Learning Initiatives
Medical AIDS Outreach of Alabama

Reashanda's-photo - MAOReashanda White, access and retention liaison for Medical AIDS Outreach of Alabama, Inc., makes frequent trips to Selma, where more than 39% of residents live below the federal poverty line.  Reashanda (pictured right) recently visited a drug treatment center there that serves young adults.  Because the center’s clients are considered at increased risk of HIV infection, Reashanda wanted to raise awareness of HIV/AIDS and the services MAO provides.

This initial visit led to a partnership with the treatment facility that enables Reashanda to give bi-monthly presentations to these high-risk individuals.  At her first presentation, she was pulled aside by the center director who had several questions about how to get a new resident, who is HIV positive, into treatment.

Thanks to the Social Innovation Fund grant from AIDS United, Reashanda was able to direct him to MAO’s ground-breaking telemedicine clinic in Selma, just around the corner from the drug treatment center. Without the telemedicine clinic, this resident would have had to drive more than an hour away to get to MAO’s Montgomery clinic, or worse,  risk falling out of care.  Thanks to the telemedicine clinic, the Selma patient has a local, full-service treatment center.

Thanks to Reashanda’s proactive approach to outreach, the Selma drug rehabilitation center now refers its residents needing HIV care to the telemedicine clinic.

In rural areas like Selma, poverty and transportation are the two biggest barriers to care for persons living with HIV/AIDS.  Without personal vehicles, many PLWH/A risk disclosing their status in order to find a ride to a treatment center in an urban area.

Telemedicine allows doctors to see patients without the need for travel.  It’s just like being in the room with the provider, but at a much lower cost.

Today, the drug treatment center’s HIV-positive resident is enrolled in care and, with telemedicine, he does not have to travel to Montgomery for his appointments.