May 2, 2008
PROTESTING PUERTO RICO'S CRISIS
AIDS scandal grows
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Activists smile after charges dismissed |
After almost six months and three court appearances, charges against twelve AIDS activistS who blocked traffic in Manhattan to demand federal intervention in Puerto Rico's AIDS crisis have been dismissed. In November the "Broadway 12" lay down on Broadway in lower Manhattan near the Health Resources and Services Administration's New York offices, snarling traffic for almost an hour. On Wednesday, when police officers neglected to show up to in New York Criminal Court, a judge said the group was free to go.
The activists say they are ready to get arrested again to force HRSA to take control of Puerto Rico's Ryan White funds. The mismanagement and fraud of these dollars has gone on for years while people living with HIV/AIDS are denied access to treatment and prevention. This week more information surfaced regarding the commonwealth's AIDS chaos. Puerto Rico's Office of the Controller revealed that it has no record of a Pharmaceutical Benefits Manager (PBM) that was ostensibly managing $78 million in AIDS Drug Assistance Program funds.
Municipalities hire a PBR to control costs of medications. The controller's revelation contradicts information that the the Puerto Rico Department of Health told the President's Advisory Council on HIV/AIDS (PACHA), the U.S. Department of Health and Human Services, Congressional Hispanic Caucus members and the Senate Health Education, Labor and Pension committee that it has a contract with McConnell Valdes, LCC. That contract may violate rules against no-bid contracts and flout a federal drug pricing policy called 340B that gives deep discounts to agencies that purchase medications in bulk. The discounts are supposed to go to help either buy more drugs or improve program infrastructure and are for federal programs. Jorge Delgado Rivas, assistant to Puerto Rico's Secretary of Health would not comment to the Update.
There have been recent glimmers of hope that HRSA will clean up Puerto Rico's mess. Last month HRSA responded to a letter from activist José Colón. The letter from HRSA's Deborah Parham Hopson stated HRSA "understands and shares your deep concern and frustration with the challenges of the care and treatment systems" in Puerto Rico. But she did not recognize advocates' demands that HRSA appoint a third party intermediary to oversee Puerto Rico's federal AIDS funds.
PLANNING TO END AIDS
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Janet Johnson (left) introduced Waters at the AIDS At Home rally |
At AIDSWatch's "AIDS At Home" rally on Tuesday, Rep. Maxine Waters (D-CA) called for a national AIDS strategy to stem the tide of the epidemic in the U.S. The U.S. requires all countries receiving millions from the President's Emergency Plan for AIDS Relief funds to create a national strategy for fighting AIDS, but here at home there are only piecemeal efforts to fight the disease.
"America can—and must—do more to fight this disease and to help those who are living with HIV/AIDS. I agree with those gathered here that we need a comprehensive national strategy to end this epidemic and to address the needs of everyone in America who is affected," Waters said. The rally was sponsored by the National Association of People with AIDS and the Campaign to End AIDS (C2EA). Other speakers included Sen. Dick Durbin (D-IL), Rep. Donna Christian-Christensen (D-VI), POZ editor-in-chief Regan Hoffman, NAPWA executive director Frank Oldham, and C2EA members Greg Fordham and Chakena Conway.
The call for a national AIDS strategy was a running refrain at NAPWA's 16th annual AIDSWatch from April 28 to 30. "We need to stop nickel and diming Congress based on what we need," said HIV-positive C2EA national organizer Larry Bryant.
Despite tornadoes in Virginia, 450 people—80 percent of whom are people living with HIV/AIDS—from almost every state gathered in D.C. to share their voices with legislators. At this AIDSWatch, NAPWA observed the 25th anniversary of its founding in 1983 when the Denver Principles were drafted. The groundbreaking Denver Principles demanded that people living with HIV/AIDS be involved in AIDS policy decision-making and given respect by the government and other institutions. "That was really the beginning of the movement as we know it," said NAPWA board chair David Munar.
Legislators listen
In the spirit of the Denver Principles, the AIDSWatch training sessions were co-led by policy directors and people living with HIV/AIDS. In addition to lobbying for a National AIDS Strategy, the participants demanded their legislators pass the Early Treatment for HIV Act, impose a moratorium on proposed Medicaid changes, pass the Microbidicide Development Act, repeal the HIV entry ban, eliminate funding for abstinence-only education, increase HOPWA housing, and increase funding for HIV/AIDS.
The Illinois contingent met with Durbin, the second highest ranking Democrat in the Senate, who supported all of the above proposals. "It was a fantastic visit and he's absolutely on top of the issues," Munar said. Munar was also impressed by Rep. Bill Foster (D-IL), a rocket scientist by trade and the replacement for former Speaker of the House Dennis Hastert. Foster was supportive of health care reform and the expansion and the preventive benefits of HIV treatment. The AIDSWatch contingent also met with Jan Schakowsky (D-IL), Eleanor Holmes-Norton (D-D.C.) and Ileana Ros-Lehtinen (R-FL).
Also a highlight: Rep. José Serrano's (D-NY) staffer confirmed that the representative will be introducing a bill to lift the federal ban on needle exchange next week.
Sen. Hillary Clinton staffer Ann Gavaghan "knew the issues we had and what we needed," Conway said. Conway visited New York legislators with a group from Gay Men's Health Crisis. "We put out our call to action and a lot of people were listening," she said.
Some office visits weren't quite so successful. Fordham, the C2EA Virginia co-chair, met with Rep. Thelma Drake's staffer, who didn't know about the federal immigration ban in people with HIV. "It was like going to see Alex P. Keaton," Fordham said.
April 25, 2008
HOUSE PROTECTS MEDICAID
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Can this Medicaid-slasher be stopped? |
By a veto-proof margin of 349 to 62, the House of Representatives passed legislation (H.R. 5613) delaying the implementation of regulations by the Centers for Medicare and Medicaid Services (CMS) that would end reimbursements for seven non-medical and preventive services. Every voting Democrat and dozens of Republicans voted to stop implementation of the changes until 2009 so their potential impact can be assessed.
President Bush has threatened to veto the bill. Similar legislation in the Senate hasn't yet moved, and while it is expected to pass, opposition by Senate Finance ranking member Charles Grassley casts doubt on the likelihood of a veto-proof margin.
According to BNA's Health Care Report, Health and Human Services Secretary Mike Leavitt said, “I feel quite confident there will be significant resistance in the Senate,” but later claimed his comments referred only to some Senate Republicans.If implemented, the new CMS regulations would end reimbursement for targeted case management, essential outpatient services such as administration of vaccinations, vision screening and rehabilitation services, and other crucial health benefits. The CMS regulations have been widely opposed by not just Medicaid advocates, but governors from all 50 states who know their states will end up picking up the federal government's slack. The feds pay 57 percent of Medicaid’s cost, an estimated $204 billion in fiscal 2008. The CMS changes would cut $13 billion off of Medicaid spending in the next five months.
"[The governors] know the devastating effects these rules would have on local communities, upon hospitals, and upon vulnerable beneficiaries," Energy and Commerce Committee Chairman John Dingell and the bill's lead sponsor (D-MI), said, according to the Associated Press.
The CMS proposal could have a catastrophic affect on New York State’s system of COBRA case management. COBRA provides essential psychosocial support vital to the survival of low-income people living with HIV/AIDS.
It’s not too late! Contact your Senators and tell them to support delaying the CMS regulations. Call the Capitol Switchboard at (202) 225-3121 and ask to be transferred to your Senator's office. (Don't know who your Senator is? Visit www.senate.gov to find out.).
COLD SHOWER
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Reps. Davis and Waxman |
At the first-ever Congressional hearing about the use of federal funds to support abstinence-only-until marriage sex education on Wednesday, nine of 11 witnesses advocated for comprehensive sex education programs. The testimony came on the heels of studies—including one by the Bush administration—that ab-only education doesn't prevent teen pregnancies or STIs and increasing national talk of "block grants" and "local control" of funding that would let states shift ab-only dollars to comprehensive sex ed.
No piece of testimony during the House Committee on Oversight and Government Reform was more compelling than that given by Max Siegel, an HIV-positive policy associate at AIDS Alliance for Children, Youth and Families.
"When I was 17, I began seeing someone six years older than me. The first time we had sex, I took out a condom, but he ignored it. I did not know how to assert myself further. I knew enough to suggest a condom, but I didn't adequately understand the importance of using one, and even if I did, I had no idea how to discuss condoms with my partner. The abstinence-only message did not prepare me for life, and I contracted HIV from the first person with whom I consented to having unprotected sex. I was still in high school," Siegel told Congress during the three panel, four hour hearing. He also noted that as a gay man, his ab-only education didn't address the fact that it is not legally possible for him to wait until marriage to have sex.
Siegel's testimony clearly moved Rep. Chris Shays (R-CT). Shays admonished Stanley Mooney, director of the Institute for Research and Evaluation, who provided unconfirmed evidence in defense of what Mooney described as "abstinence-centered education" that does not teach about contraceptives.
"You object to young people having the armor they need. If you abstain, you're protected. If you do anything else you're on your own," Shays said. "The young man on your left [Siegel] dealing with HIV is one of the outcomes, and that's tragic. I just don't get it." According to one expert witness, Harvey Feinberg, president of the Institute of Medicine, out of 13 studies examining abstinence-only programs, none showed "an enduring effect" on teens' sexual behavior.
But it's not all about science...
While this politically charged issue isn't likely to be resolved any time soon, there is increasing talk of letting states have more control over sex-ed funding. The committee chair Rep. Henry Waxman (D-CA) favors block grants that would allow individual jurisdictions more flexibility in spending their dollars. Seventeen states have rejected federal funding for abstinence-only education.
"If communities are deciding for themselves, many of those communities will choose comprehensive sex education," Diana Bruce, Director of Policy and Government Affairs for the AIDS Alliance for Children, Youth and Families told the Update.
During the last ten years, the federal government has provided $1.3 billion for abstinence-only education and no funding for comprehensive sex education, despite the fact that 95 percent of Americans have sex before marriage. The Democrat-controlled Congress has continued to fund abstinence-only education, and even increased funding for Community-Based Abstinence Education (CBAE), in hopes of scaring up enough Republican votes to avoid a presidential veto on the House Appropriations budget. Their master plan failed, and Bush still vetoed the budget.
Funding for the Title V Abstinence Education Grant program, created in the 1996 welfare reform law, is the second largest source of ab-only funding. At $50 million a year, Title V is tied to the Temporary Medical Assistance program that allows those leaving welfare to qualify for Medicaid. When Democrats tried to delink the funding last year, Republicans balked. The ongoing, uncomfortable marriage makes it unlikely that Title V will be completely gutted in the near future. Both programs are up for review on June 30.
April 11, 2008
THE LETTER AND THE LAW
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HRSA still needs to take control |
A letter from a high-level Health Resources and Services Administration (HRSA) official to Puerto Rican AIDS activist José Colón signifies HRSA's strongest language yet regarding San Juan and Puerto Rico's mismanagement of federal Ryan White dollars.
In response to Colón's letter detailing the failings of Puerto Rico's AIDS infrastructure to Health and Human Services (HHS) Secretary Michael Leavitt, Assistant Surgeon General Deborah Parham Hopson replied last week by outlining the steps that HRSA, a branch of HHS, is taking to address the crisis. Hopson told Colon that HRSA "understands and shares your deep concern and frustration with the challenges of the care and treatment systems" in Puerto Rico. But she stopped short of recognizing advocates' demands that HRSA appoint a third party intermediary to oversee Puerto Rico's $53 million a year in federal AIDS funds.
"Jose Colón wrote a poignant and piercing letter to the U.S. Secretary of Health related to the HIV/AIDS crisis in Puerto Rico. Deborah Parham confirmed what the HIV/AIDS community in Puerto Rico has been saying for nearly two years," said Dennis deLeon, executive director of the Latino Commission on AIDS.
HHS policy states that "if a recipient fails to comply with the terms and conditions of an award" Leavitt has the power to temporarily withhold cash payments, withhold awards or "take any other remedies legally available." Such withholding is exactly what happened in the case of Baltimore, Washington, D.C. and other eligible metropolitan areas that ceded control of federal Ryan White dollars to HHS. But this might be trickier when it comes to Puerto Rico.
"Because of the legacy of colonialism, it seems like HHS treats Puerto Rico differently than other EMAs," Colón said, although he is clear that he thinks the only way the mismanagement of funds will improve is for HRSA to take over. Colón, an HIV-positive activist who lives in Puerto Rico briefly went on a medication strike in May to protest the AIDS Drug Assistance Program waiting list on the island.
The crisis goes on
Puerto Rico receives more than $53 million in Ryan White Care Act funds but activists have documented numerous cases of people living with HIV/AIDS who are unable to access medication. The commonwealth still offers no prevention programs for IV drug users, who account for a majority of new infections, and community-groups still wait for desperately needed funding. In December 2006, the FBI raided four San Juan Health Department offices, seizing 400 boxes of documents in a criminal investigation into possible misuse of Ryan White grants.
The lack of a centralized reporting system in Puerto Rico makes it impossible to know the true number of yearly infections. But according to the Kaiser Family Foundation, more than 30,000 people in Puerto Rico have HIV/AIDS, and more than 19,000 Puerto Ricans have died from AIDS. And despite intense media coverage that led in August to a much-touted appointment of Jorge Delgado Rivas as an assistant to Puerto Rico's Secretary of Health and a yet-to-be implemented 11 point plan, advocates on the ground report no improvements.
According to Hopson's letter, and the Update's additional follow-up with HRSA, some of the steps HRSA has taken to address the crisis are:
- "Restricted drawdown procedures" for both Puerto Rico and San Juan. This means instead of delivering the funding in a lump sum, both EMAs are monitored each month before funding is sent through.
- Recommending that both San Juan and Puerto Rico employ a contracted fiscal intermediary to supervise funds. San Juan has refused the recommendation, but Puerto Rico "has indicated that it is considering the use of a Pharmacy Benefits Manager to oversee the management of its pharmaceutical services."
- Providing "conference call and technical assistance" to grantees, as well as an on-site visit.
While these steps should be applauded in theory, it's unclear if HRSA's actions will amount to anything real.
"This letter is positive. It means that HRSA has paid attention, at least partially, to the voices of the activists demanding better administration of funds. But HRSA needs to do more. I believe the crisis remains the status quo," said New York City Issues Organizer and Policy Analyst Tamara Oyola-Santiago. "As long as Municipality of San Juan refuses to name a third party, corruption will continue."
James Albino, who recently left the National Minority Council on AIDS and is continuing to advocate on behalf of Puerto Ricans with AIDS, agreed. "Restrictive draw down, program monitoring and technical assistance for the last two years have done little to address the most critical of issues," Albino said. "What is the status of patient care? How many patients are not getting service? Why does Puerto Rico continue to outpace most of the of the country in incidence and mortality? After 20 years of operating an ADAP program why is there no protocol for qualifying patients, for providing insurance co-pays or for accurately assessing and forecasting the number of patients that go without medication? How long can the community based organizations, the heart of the healthcare delivery system survive without a reliable reimbursement system?"
While the media is focusing on the 19 indictments facing Puerto Rican governor Anibal Acevedo Vila, Colón doesn't think the scandal will necessarily affect the efforts of the commonwealth's AIDS advocates. "There's always something going on," he said.
April 4, 2008
TRACKING CHANGES
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Even this dude would have been confused by the CDC's new data |
The 2006 HIV/AIDS Surveillance Report released by the Centers for Disease Control and Prevention last week caused confusion and frantic press releases. It's no wonder: The report stated that newly reported infections in the U.S. rose dramatically from 35,537 in 2005 to 52,878 in 2006.
The rise was cause for concern—and not. On the one hand, the numbers rose because California, Delaware, Illinois, Maine and Washington switched over to a names-based reporting system—the only system the CDC tracks. On the other hand, in the 33 states and five territories that have used the CDC-approved confidential names-based reporting system since at least 2003, newly diagnosed infections have remained relatively stable, though there has been a slight increase in certain subgroups.
Technically, the new numbers don't indicate a rise in newly reported infections or diagnoses, as the Director of the Division of HIV/AIDS Prevention for the CDC Robert Janssen, M.D. said in a statement and Dear Colleague letter issued on March 28 and meant to address the confusion. But then again, this report blows apart the widely cited CDC figure of 40,000 new infections per year, a statistic that hasn't been updated since 2001, and was derived using an indirect method based on now outdated surveillance data.
Guessing game
The confusion over the 2006 Surveillance report was so great that the Federal AIDS Policy Partnership (FAPP) has scheduled a special meeting on Monday, April 14 to clarify the report's results. The scramble to grasp the data also overshadowed another, smaller more troubling report the CDC released on March 11: HIV/AIDS Surveillance in Men Who Have Sex with Men (MSM) shows a more than a 65 percent increase in the number of newly reported HIV cases among MSM ages 13 to 24 from 2001 to 2005 , and an even starker 74 percent increase in the number of new cases for blacks in that cohort.
One reason the 2006 Surveillance Report created chaos on AIDS listservs and organization releases is that some people confused it with recent news stories that the CDC is expected to announce a new national estimate of how many Americans are infected with HIV each year.
That estimate,based on better technological data, will probably be released this summer, and is expected to be much higher than dusty statistic that there are 40,000 new HIV infections a year. That number was last revised in 2001, and was always meant to be a "back of the envelope" estimate. But the new estimate may not be much more accurate. "Even if the number comes out saying there are 50,000 infections a year, this will just be a new benchmark instead of the old one. We need at least two years to see what the trend is," said Walt Senterfitt, an epidemiologist who works for Community HIV/AIDS Mobilization Project.
The adjusted data won't automatically affect funding, but as those involved with the 2006 Ryan White CARE Act Reauthorization process know all too well, if the data shows a huge shift among regions, this will probably affect the way the pie is divided within states during the 2009 reauthorization.
Although this week's newly released data is a bizarre patchwork of numbers, two things are clear. One: We still don't have close-to-accurate data about yearly new infections. "What we've had are suboptimal annual incidence rates," said Judy Auerbach, deputy executive director of science and public policy for the San Francisco AIDS Foundation. "We need to know who and where people are affected. Are we doing the right things? Are we reaching the right people? It matters what that number is." Two: HIV infections are not going down. "Even if the data in the Surveillance Report ultimately shows incidence is flat rather than going up, this still means shows we haven't put enough money in prevention to bring it down," Senterfitt said. "That funding is reduced every year is a crisis and an anomaly."Here's what we CAN learn from the study:
In the 33 states and five territories where HIV infection trends can be accurately measured, HIV infections have remained relatively stable, with infections down 6.5 percent for women and up five percent for men from 2003 to 2006. During that same period, the number of new HIV/AIDS cases increased by seven percent among whites and 17 percent Asians/Pacific Islanders, remained stable among blacks and Hispanics, and fluctuated among American Indians/Alaska Natives. African-Americans still remain grossly over-represented in the epidemic, accounting for 49 percent of new infections, even though they represent only 12.5 percent of the U.S. population. The HIV/AIDS Surveillance in Men Who Have Sex with Men (MSM) showed that young MSM have seen increases in infections among all races, but disastrously so among black men. New infections increased from 928 cases in 2001 to 1,618 cases in 2005—a more than 74 percent jump.
March 21, 2008
BYE-BYE BAN?
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Kerry, we salute your bill repealing the HIV immigration ban |
When the House Foreign Service Committee signed off on $50 billion for the reauthorization of The President's Emergency Plan for AIDS Relief (PEPFAR) on March 13, a happy addition included attaching Sen. John Kerry (D-MA)'s HIV Nondiscrimination in Travel and Immigration Act to the global AIDS legislation. Kerry's provision would repeal the 1993 Congressional provision in the Immigration and Nationality Act banning HIV-positive travelers and immigrants from entering the U.S.
For bureaucratic and political reasons, a reversal of the travel ban wasn't included in the House version of the PEPFAR bill but as the Washington Blade reported, Rep. Barbara Lee (D-CA) said she is committed to include it when Congress conferences the bill upon its return April 1.
Some House Dems were hesitant to draw attention to lifting the travel ban out of concern that attention would bring opposition, and asked advocates to keep the provision's introduction hush-hush. "They were worried it would become an 'election year issue,'" said Nathan Schaefer, director of public policy at the Gay Men's Health Crisis. But the tune has changed since the Senate bill has received a warm reception from the public and, more importantly, the White House.
"The President has a strong interest in the passage of PEPFAR as part of his legacy, and it's a symbolic move to put the immigration ban repeal in PEPFAR," said Immigration Equality Legal Director Victoria Neilson. "It's a national embarrassment that we're taking the lead on fighting HIV/AIDS around the world and have an antiquated policy in our own law."
Even if Kerry's provision sails through during the PEPFAR reauthorization—and the chances look pretty good that it will—it would mean that the Department of Health and Human Services (HHS) is allowed to lift the travel and immigration ban, not that it has to do so. HHS instated the ban in 1987, but when HHS reversed its position in 1991 and tried to overturn the ban, Congress stepped in and made it law.
"Everyone's so focused on step one, but HHS is an executive agency, so it takes a wait-and-see attitude right now," Neilson said, noting that the head of HHS is appointed by the president. On World AIDS Day 2006, Bush hinted that there was at least some room for improvement in the HIV/AIDS travel ban, and proposed a "categorical waiver" to allow HIV-positive people to enter the U.S. on a short-term basis (but said nothing about HIV-positive immigrants). Bush's waiver earned near-universal jeers from AIDS advocates during a comment period because of restrictions that it imposed. The Department of Homeland Security hasn't released the final regulation.
According to AIDSVote.org Sens. Barack Obama and Hillary Clinton support lifting the ban, and Sen. John McCain's position is unknown.
"We're actively targeting Congressional targets, and our highest hope is that the President will have a bill for his signature in early July," said Schaefer, who is leading GMHC's involvement in the Coalition to Lift the Bar since the departure of Nancy Ordover from GMHC last month. "It's so encouraging that among Congressional leadership there's enough knowledge and background that they're willing to commit to this. It's been years of grassroots efforts and hard work."
Additional PEPFAR notes...
Despite the good news on the ban, the Senate bill gave the shaft to HIV prevention for women and girls, following in the cowardly footsteps of the House. It requires that PEPFAR country coordinators report to Congress if less than 50 percent of funding to prevent sexual transmission of HIV goes toward abstinence and fidelity programs. Organizations receiving U.S. global AIDS funding must also have a policy explicitly opposing prostitution and sex trafficking, a policy that, at least among U.S. organizations, is in the courts because of a violation of free speech. Unlike the House bill, that only allows groups that meet the requirements of the Mexico City Policy to receive PEPFAR funds for HIV/AIDS testing, counseling, and education services, the Senate remained silent on the issue of family planning.
For side-by-side comparison of the House and Senate PEFAR bills and the 2003 version click here. To read an in-depth critique of how "the PEPFAR reauthorization legislation is a sell-out" click here.
CALLING ON CONGRESS
ETHA demonstration project moves forward
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Housing Works staff Susan Miles and Beverly Sutton explain the importance of ADHCs as Clinton staffer Ann Gavaghan takes notes |
Five Housing Works clients and staff went to Washington, D.C., this week to prod New York's Congressional delegation to sign a letter urging the Centers for Medicare and Medicaid Services (CMS) to match New York State's $1.4 million rate increase for AIDS Adult Day Health Care (ADHC) programs with $1.4 million in federal dollars.
The staff at each one of the 14 offices visited said they supported the increase and many agreed to sign on to the letter—though all were hesitant to take the lead.
The lobbyists-for-two-days visited the offices of New York City Congressional Reps. Carolyn Maloney, Charles Rangel, Vito Fossella, Nydia Velazquez, Edolphus Towns, Joseph Crowley, Gregory Meeks, Yvette Clarke, Jerrold Nadler, Jose Serrano, Anthony Weiner, and Eliot Engel and Sens. Hillary Clinton and Charles Schumer. While all Congressional staffers voiced their support for a CMS rate increase and most said they would sign onto a letter, only Schumer's office has already written one.
AIDS Day Health Care (ADHC) programs are a critical point of access to cost-effective services for more than 1,700 people living with HIV/AIDS in New York State. ADHCs provide a "one-stop-shop" array of programs, including medication management, health care monitoring, case management, mental health and substance abuse services, nutritional services, and health education.
CMS' refusal to match New York state comes despite its approval of the increase under the state Medicaid plan in 1996. CMS is now asking New York to apply for a federal waiver—which could mean two more years before funds are approved. ADHCs might not have that long: Eight of the nine ADHC programs lost money last year, an average of $19 a day, for total losses of $510,000 of program revenues on average. In January, the Long Island at Catholic charities ADHC closed, and others could succumb to the same fate. On the state level, all one-house budgets allow for the release of $1.4 million to cover the state's share.
"Being an ADHC client taught me about taking my medication and what I need to do to stay healthy. That allowed me to go into the Housing Works Job Training Program. Soon I'll be working and paying taxes," said Housing Works ADHC client Nelson Alston, who told his story to Congressional staffers.
Meanwhile in D.C...
A modified Sen. Gordon Smith/Sen. Hillary Clinton Early Treatment for HIV Act (ETHA) demonstration project amendment was accepted by the U.S. Senate March 13 as part of the Senate Budget Resolution. The $500 million set-aside for the project was removed, but the removal conforms with many of the other reserve funds included in the bill. The AIDS Institute's Director of Federal Affairs Carl Schmid said the change isn't a reason to be nervous. However, it's not a reason to get excited either, since advocates seem resigned that the ETHA demonstration project isn't in the cards for this Congress. "If we can't pass SCHIP (the State Children's Health Insurance Program), how are we going to pass the demonstration project?" Schmid said. "It's more just to keep ETHA on the radar."
The project is the first step on the road to ETHA itself, which would allow states to extend Medicaid coverage to low-income people with HIV before they became disabled by AIDS, something that current Medicaid eligibility requires.
March 14, 2008
ACTION ALERT: ASK YOUR REPS TO BOOST HOPWA FUNDING!
living with HIV/AIDS
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Tell your rep to follow Nadler's leader! |
"Patron saint of HOPWA" Representative Jerrold Nadler (D-NY) and Joseph Crowley (D-NY) released a programmatic sign-on letter on March 4 to the Chair and Ranking Member of the House THUD Appropriations Subcommittee requesting $470 million for the Housing Opportunities for Persons With AIDS (HOPWA) program for FY2009—the amount required to provide housing assistance to an additional 40,000 low-income people with HIV/AIDS and their families.
The President included a recommendation of $300 million for HOPWA in his FY2009 budget representing flat funding from the current fiscal year, which is not enough to make a real dent in fighting homelessness among people with HIV/AIDS.
Here is the challenge: Sign-ons from members of Congress are urgently needed! The deadline for your member to sign on to this critical letter urging the Chair and Ranking members of the House THUD Appropriations Subcommittee to fund HOPWA at $470 million is Wednesday, March 19.
Follow these easy steps to request that your Representative sign on:
1. Call the Capitol Switchboard at (202) 225-3121 and ask to be transferred to your Representative's office. (Don't know who your rep is? Visit www.house.gov to find out.)
2. Ask to speak to the staffer in your representative's office that handles housing funding issues.
3. Tell the staffer that you are a constituent, that HOPWA is important to your community, and that you urge the representative to sign on to Nadler and Crowley's letter to the Appropriators asking for $470 million dollars for the HOPWA program in FY2009. He or she can sign on by contacting Jillian Youngblood in Nadler's office or Kevin Casey in Crowley's office.
The following representatives have already signed on:
Steve Cohen (D-TN)
Joe Courtney (D-CT)
Joseph Crowley (D-NY)
Keith Ellison (D-MN)
Sam Farr (D-CA)
Al Green (D-TX)
Maurice Hinchey (D-NY)
Carolyn Maloney (D-NY)
Jim McDermott (D-WA)
George Miller (D-CA)
Jan Schakowsky (D-IL)
Bobby Scott (D-VA)
Carol Shea-Porter (D-NH)
Chris Van Hollen (D-MD)
Henry Waxman (D-CA)
Robert Wexler (D-FL)
If your representative is on the list, feel free to still call his or her office and give a hearty thanks! But if not, tell your rep to get a move on! (Afterwards, please e-mail the National AIDS Housing Coalition at latoya@nationalaidshousing.org to let them know your success.
March 7, 2008
STUDIES SHOW...HOUSING WORKS!
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CHHP participant Mary Pelts at the conference. Her uplifting story is recounted in the Wall Street Journal |
On the second day of the National Housing and HIV/AIDS Research Summit, investigators from two major multi-year studies released preliminary data showing that providing housing for homeless people living with HIV/AIDS improves health outcomes and saves millions in medical costs. The Housing Research Summit is convened by the National AIDS Housing Coalition in collaboration with the Johns Hopkins Bloomberg School of Public Health.
The four-year Chicago Housing for Health Partnership (CHHP) study, the subject of an article in Thursday's Wall Street Journal, followed 407 chronically ill homeless people, more than a third of whom had HIV. Half of the study participants were placed in housing with case management, while the other half relied on Chicago's existing network of services. The group that received case management and housing assistance spent significantly less time in hospitals, emergency rooms and nursing homes and experienced improved health.
After 18 months, 55 percent of CHHP-assisted participants with HIV had "intact immune systems" compared to only 34 percent of people in "usual care." Researchers estimate that the improved medical outcomes for all study participants saved approximately $1.5 million in emergency room, hospital and nursing home costs, after taking into account the costs of the housing and case management.
The other major study presented today came from researchers who worked on the five-year Centers for Disease Control and Prevention (CDC) Housing and Health Study, which followed 630 unstably housed people living with HIV/AIDS. Half of the participants received enhanced housing and medical assistance while the other half depended on usual AIDS services networks.
Preliminary data showed that receipt of a housing voucher enabled 82 percent of participants to secure and maintain stable housing. Housing participants who secured housing had significantly fewer overnight hospitalizations, emergency room visits and opportunistic infections, and significant improvements in medication adherence and mental health. The study also showed a 40 percent reduction in the number of people who traded sex for shelter—a significant prevention problem among homeless people living with HIV.
The CDC study also showed some of the unexpected challenges of trying to conduct research on homelessness and HIV. For example, some participants were unable to use housing vouchers to get stable housing because of a lack of affordable housing in their communities.
"The results of the CHHP and CDC studies as well as the numerous other studies presented at the conference this week are inspiring," said David Holtgrave, PhD, chair of the Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School, who worked on the CDC study. "Not only do these studies show that there is a really good scientific basis to the argument that housing is health care, they show that we can save lives and save money at the same time by providing people with housing."
More than 200 researchers, service providers and people living with HIV from all over the world are in Baltimore from March 5 to 7 for the third-annual National Housing and HIV/AIDS Research Summit sponsored by the National AIDS Housing Coalition (NAHC). Researchers presented groundbreaking research on housing and HIV. Highlights included:
- A study from India that showed that sex workers "housed" in brothels were able to form support networks that led to widespread condom use versus so-called "flying" or unhoused sex workers.
- Homeless youth are four to five times more likely to engage in high-risk drug use than youth in housing with some adult supervision and over twice as likely to engage in high-risk sex.
- Among poor women, there is a strong connection between housing instability, HIV risk and violence.
The past two National Housing and HIV/AIDS Research Summits provided the basis for the development of the NAHC Policy Tool Kit (http://www.nationalaidshousing.org/policytoolkit.htm). Summit Series convening researchers also worked closely with the NAHC on a special "Housing and HIV" issue of the journal AIDS and Behavior released last fall (Volume 11, Supplement 2/November, 2007).