Important Happenings in HIV/Health Policy

Important Happenings in 

HIV/Health Policy

Week Ending: April 20, 2018
By: Matthew Rose & Sable K. Nelson

 

Senate Hearing FY19 HHS Funding Postponed
Health and Human Services (HHS) Secretary Alex Azar was scheduled to testify on HHS’s FY19 budget request at a Senate Labor-HHS Appropriations hearing on Thursday, April 26. However, due to Secretary Azar’s recent hospitalization related to continued complications with a digestive infection, the Senate Labor-HHS Appropriations hearing will be postponed. It is still unclear when Azar will return to Washington. For more information,

READ → https://www.washingtonexaminer.com/policy/healthcare/hhs-secretary-alex-azar-heads-back-to-hospital

HHS Drug Strategy Under Review

On April 17, The Office of Management and Budget began its review of a strategy developed by HHS to lower prescription drug prices and reduce out-of-pocket costs for consumers. On April 26, President Trump plans to announce the steps his Administration will take to fight high drugs costs. According to the Trump Administration’s 2019 Budget Fact Sheet on lowering the price of drugs, pricing policies include changes to Medicare, Medicaid, the 340B drug pricing program that allows safety-net hospitals to get drug discounts, and speeding the development of more affordable generic medications.
For more information,
READ → https://khn.org/morning-breakout/trump-to-give-speech-on-drug-prices-but-no-new-policies-are-expected-to-be-unveiled/

Kaiser Health Network (KHN) ‘What The Health?’ Podcast:
Nothing In Health Care Ever Goes Away
“In this episode of KHN’s ‘What the Health?’ Sarah Jane Tribble of Kaiser Health News, Joanne Kenen of Politico, Margot Sanger-Katz of The New York Times, and Paige Winfield Cunningham of The Washington Post examine how even after Republicans failed to repeal and replace the Affordable Care Act, the health care debate continues to roil politics. They discuss how Republicans in Congress have shifted their ACA messaging and how the Democrats are looking to Medicare expansion. They also discuss state efforts to expand Medicaid and drug pricing. And they spend a moment talking about Congress’ push to do something about the opioid crisis.”

For more information, READ →  https://khn.org/news/podcast-khns-what-the-health-nothing-in-health-care-ever-goes-away/?utm_campaign=KHN%20-%20Weekly%20Edition&utm_source=hs_email&utm_medium=email&utm_content=62270566&_hsenc=p2ANqtz-_LRHkm4pjBS364Kv9GoI5eX2OuBR4QwrHz0aNCNHpnW0zXKKP_WC5O445IKULhM_fCq4i5fQNYorkM-pEFDUukBPAxow&_hsmi=62270566

 

What NMAC is Doing About It

  • NMAC remains vigilant in its advocacy to protect FY19 government funding and the existence of the social safety net.
  • NMAC will continue to meet with congressional staff about the importance of HIV funding.
  • NMAC will continue to discuss how to implement the recommendations from our Biomedical Blueprint.
  • NMAC is planning a face-to-face meeting with the CDC Director and a site visit with colleagues with the Federal AIDS Policy Partnership (FAPP) in May 2018.

 

What You Can Do

FOLLOW CARDI B’S LEAD: In a recent interview with GQ Magazine, Cardi B remarked “I love government. I’m obsessed with presidents. I’m obsessed to know how the system works.” Cardi B went on to say that President Franklin Delano Roosevelt tried to “make America great again for real” by helping old people to receive social security. Even Senator Bernie Sanders (I-VT) cosigned this component of Cardi B’s interview via Twitter:

Components of the social safety net: the Ryan White Program, Food Assistance, Medicaid, Medicare and Social Security are facing possible program changes and funding cuts in FY19. As various proposals are being discussed, we each have the responsibility to educate ourselves about the issues, systems, and decision-makers that impact our daily lives.

 

TAKE ACTION: Speak truth to power by sharing your personal stories with your elected officials. It is vitally important to meet to your federal elected officials when they are home. If we don’t support and advocate for HIV funding and programs, who will? Our movement cannot afford to stand on the sidelines. Your U.S. Senators and U.S. Representatives need to hear from you.

Also, MAKE SURE THAT YOU ARE REGISTERED TO VOTE in time for the primary and general elections happening this year:

Nebraska

 4/30/2018
Mississippi 5/7/2018
Montana 5/7/2018
New Mexico 5/8/2018
South Carolina 5/14/2018
New Jersey 5/15/2018
Nevada 5/15/2018
Alabama 5/21/2018
South Dakota 5/21/2018
California 5/21/2018
Virginia 5/21/2018
Maine 5/22/2018
Iowa 5/25/2018
Utah 5/27/2018
District of Columbia 5/29/2018

For more information, VISIT→ https://www.eac.gov/voters/register-and-vote-in-your-state/

Finally, PARTICIPATE IN THE PRIMARY ELECTION(S) in your state:

Indiana 5/8/2018
Ohio 5/8/2018
North Carolina 5/8/2018
West Virginia 5/8/2018
Pennsylvania 5/15/2018
Idaho 5/15/2018
Oregon 5/15/2018
Nebraska 5/15/2018
Arkansas 5/22/2018
Georgia 5/22/2018
Kentucky 5/22/2018

For more information, VISIT→ http://www.ncsl.org/research/elections-and-campaigns/2018-state-primary-election-dates.aspx

USCA Special Announcement: Larry Kramer to Speak to USCA

 

In our fight, Larry Kramer is mythic. As a young queen who was overwhelmed by the loss of so many friends, I found inspiration and courage from Larry’s iconic piece in the New York Native. NMAC is pleased to announce that Larry Kramer will present the opening keynote at this year’s United States Conference on AIDS on Thursday, September 6th in Orlando.

There is a whole generation of activists who have never heard Larry speak. The conference is pleased to give him this platform as we talk about what it means to be over 50 and living with HIV. There was a time when the idea of aging with HIV seemed impossible. Now it’s a reality for most – but not all – PLWH.  As our movement ages, far too many people are living in isolation and depression. Given the trauma associated with HIV, this shouldn’t be a surprise. A better understanding of this trauma may be how we fight for health equity for all communities highly impacted by HIV.

Our incentive to insure access to healthcare, medications, and wrap-around services has never been greater. Not only is there great benefit to the individuals, but there is also a prevention factor. Ending this epidemic requires leaders from communities living with HIV and people who are sexually active or use needles to work together. We have the science to create real pathways to end HIV. What would Larry say if we wasted this opportunity?

If you’ve never heard Larry speak, then buckle your seatbelts. Larry speaks his truth. In 1993 NMAC hosted a dinner at the Library of Congress for the new Secretary of HHS, Donna Shalala. Larry took over the dinner and proceeded to explain to the new Secretary that not enough was being done to fight AIDS. When I say I’ve been protested by the best, I mean it. It took Donna three years to forgive me for that dinner.

Our movement owes a huge debt to all the leaders who spoke truth to power. It may seem unbelievable now, but there truly was a time… I’m going to leave that story for Larry to share. Join us as we sit at the feet of one of our movement’s elders. Space will be limited and NMAC may need to adjust seating arrangements so that everyone will fit.
Paul Kawata
Executive Director

April is Minority Health Month

by NMAC Policy Analyst, Sable K. Nelson

April is National Minority Health Month.
Per Matthew Y.C. Lin, MD, the Deputy Assistant Secretary for Minority Health and Director of the Office of Minority Health, the theme for 2018 is Partnering for Health Equity which highlights partnerships at the federal, state, local, tribal and territorial levels that help reduce disparities in health and health care. 

In observance of National Minority Health Month, NMAC, along with several national, state and local organizations converged on Capitol Hill on Tuesday, April 17,2018 to educate staffers and members about the soon-to-be introduced Health Equity and Accountability Act (HEAA). HEAA is the only legislation that holistically addresses health inequalities, their intersections with immigration status, age, disability, sex, gender, sexual orientation, gender identity and expression, language, and socio-economic status, along with obstacles associated with historical and contemporary injustices. HEAA is comprehensive, bipartisan legislation that provides policy solutions to address a wide spectrum of health equity concerns:

  • Title I: Data Collection and Reporting—Seeks to increase the precision, accuracy, and number of resources for the collection and reporting of health data.
  • Title II: Culturally and Linguistically Appropriate Health Care—Ensures patient access to high quality care by enhancing language access services and culturally competent care in the health care delivery system.
  • Title III: Health Workforce Diversity—Aims to create a pipeline and training opportunities for professional and allied health care workers that will allow them to more effectively serve communities of color.
  • Title IV: Improvement of Health Care Services—Removes harmful barriers to health insurance coverage while maximizing the positive impact of federal health care investments in communities of color.
  • Title V: Improving Health Outcomes for Women, Children, and Families—Addresses certain health disparities faced by women and children, and promotes programs supporting healthy family formation.
  • Title VI: Mental Health—Incorporates strategies to address mental and behavioral health issues affecting communities of color.
  • Title VII: Addressing High Impact Minority Diseases—Proposes focused approaches to combat diseases and conditions that have a disparate impact on racial and ethnic minorities, such as cancer, diabetes, and HIV/ AIDS.
  • Title VIII: Health Information Technology—Ensures that underserved communities and communities of color benefit from rapid advances in health information technology (HIT) and new investments in HIT infrastructure that serve as the foundation for improving quality, efficiency, and outcomes as our health care system advances.
  • Title IX: Accountability and Evaluation—Strengthens HHS oversight to ensure programs continue to reduce health disparities.
  • Title X: Addressing Social Determinants and Improving Environmental Justice—Builds upon the ACA’s historic investments in prevention to bolster primary and secondary prevention efforts and dedicates resources to communities striving to overcome negative social determinants.

NMAC was involved in the development of the content for Title VII (Addressing High Impact Minority Diseases; specifically, the subtitle on HIV/AIDS) and Title IV (Accountability and Evaluation). Personally, I must say that it was been an honor and a privilege to represent NMAC on the HEAA Community Working group. It was humbling and awe-inspiring to work collaboratively with countless advocates from across the country who are passionate and determined to eliminate racial and ethnic health disparities. Collaboratively, we uplifted the voices, challenges and solutions gathered from the lived experiences of our various constituencies.

Since 2007, HEAA has been introduced by the Congressional Tri-Caucus, comprised of the Congressional Asian Pacific American Caucus (CAPAC), the Congressional Black Caucus (CBC), and the Congressional Hispanic Caucus (CHC). In total, 158 different members of Congress have cosponsored HEAA in a bipartisan way throughout previous years. In the 115th Congress, Senator Mazie Hirono and Representative Barbara Lee are the lead sponsors of HEAA. NMAC applauds the Congressional Tri-Caucus for its leadership and hard work. NMAC will keep you posted about the introduction of HEAA in the upcoming weeks and actions the HIV can take to support this piece of legislation going forward.

Addressing the racial and ethnic disparities that exist in HIV prevention and treatment contributes to the realization of health equity. As people living with and affected by HIV, we MUST keep raising our voices and telling our stories about the importance of racial justice and health equity in HIV prevention and treatment. Population-specific disparities exist in HIV prevention and treatment which disproportionately and adversely impact women, people of color, people living with disabilities, and Lesbian, Gay, Bisexual, Transgender, and Queer individuals.

You will have the opportunity to share your story about the importance of racial justice and health equity in HIV prevention and treatment during the Partnering for Health Equity Twitter Chat hosted by the Office of Minority Health on April 25, 2018 at 2p ET For more details visit: https://minorityhealth.hhs.gov/nmhm18/#events

NMAC Connection Special: Why I Wrote an Open Letter to the Director of the CDC

Why I Wrote an Open Letter to the Director of the CDC

For the first time in the epidemic’s history, the Director of the Centers for Disease Control and Prevention (CDC) believes we can end the HIV epidemic in America.  At Dr. Redfield’s first address to CDC staff, not only did he articulate this vision, but also the possibility that it can be done within three to seven years. NMAC does not agree with the new director on all the issues, but we are committed to working with CDC to make this dream real.

Last week NMAC released Blueprint II: Policies to bring biomedical HIV prevention to all the communities highly impacted by HIV. This document can be downloaded for free here. Like Dr. Redfield, NMAC is a big believer in PrEP, PEP, U=U, and TasP. This is the science needed to bend the curve of new infections, support the health of People Living with HIV (PLWH), and end the epidemic. However, it can only happen with leadership, planning, and money. NMAC strategy is to ask for all three. We plan to use Dr. Redfield’s vision as the justification to ask Congress for more HIV funding, for HHS to put together a federal biomedical HIV prevention plan to end the epidemic, and everyone’s leadership to make that a reality.

In a world that is so divided, it will be interesting to see if we can put aside differences to end an epidemic. I have my doubts, but this is the best opportunity we have to move forward. If we don’t make an effort to grab this moment, our movement will be stuck with level funding, 38,000 new cases a year, and no clear federal pathway for ending the epidemic.

NMAC gave an olive branch to the new Director when we invited him to the National Biomedical HIV Prevention Summit. We chose the Summit over the United States Conference on AIDS because we believe it is the place where we have the most agreement. NMAC spoke to Dr. Redfield prior to his appointment and heard directly about his belief in biomedical HIV prevention. We are going to use part of USCA to put together a strategy for the Summit, to listen and talk with constituents about the right messages, practices, funding, and collaboration to end the epidemic.  ore communication will follow.

We can’t do this alone. It’s going to take a movement to make this work. This is the first bridge we’ve had to an administration that has many of us concerned. Deciding to cross the bridge is a test of our leadership. For some it will be impossible. For others it will be impossible not to. There is no clear right answer, but NMAC has always been committed to working with the federal government regardless of the administration. This is also our test.

NMAC will cross the bridge leading with race. We believe in biomedical HIV prevention; however, we are very concerned that it is not equivalently reaching all the communities highly impacted by HIV. The majority of people living with HIV are people of color and the majority of new infections happen to people of color, yet the vast majority of people on PrEP are white, we have a problem.

This is a real test of our movement’s leadership. Where is the line? What are we willing to do to ensure healthcare, medications, and wrap around services for all people living with HIV? What are we willing to do to end an epidemic?  That’s why I wrote the letter to Dr. Redfield. I will keep you informed when/if I hear back from him.

Yours in the struggle,

Paul Kawata
Executive Director

NMAC Connection: National Transgender HIV Testing Day

National Transgender HIV Testing Day is April 18
By Marissa Miller, NMAC Program Coordinator
April 18 marks the second annual National Transgender HIV Testing Day (NTHTD), a national initiative to increase HIV screening, prevention, and treatment among transgender people. HIV screening is an important step in HIV prevention and the first step in the HIV Care Continuum, the recommended treatment plan for people living with HIV. As simple as getting tested might seem, transgender people still encounter many barriers to screening. NTHTD aims to facilitate screening and prevention among transgender individuals by actively engaging them in their sexual health and wellness and empowering them to take charge over their health and wellness.

Read the full story.

50+ Strong & Health Grantees Impacting Their Communities
The HIV 50+ Mini Grant Program supports our HIV50+ Strong & Healthy Scholars to become involved in their communities and develop and implement projects to educate and engage people living and aging with HIV to connect with other peers. Here are several of those projects:

  • Eric Jannke of Palm Springs is developing an educational manual addressing the needs of long-term survivors and others aging with HIV.
  • Bryan Jones of Cleveland is working on all-day training for PLWH to become leaders in their community.
  • Jennifer Chang of Los Angeles is organizing a meet-and-greet and dog-walking event for 50+ survivors of HIV/AIDS.
  • Rob Quinn of Boston will facilitate a Health and Wellness Day for HIV 50+ and Long-Term Survivors on April 21.
  • Michael G. Smith of Santa Fe is working to assist PLWH on disability to return to work and educate about benefits and financial planning.

To find out more about the Mini Grant Program and see other grantee projects, please visit our website.

NMAC’s Next Community Spotlight Webinar is April 24
Join us for our next Community Spotlight webinar on April 24 at 3:00 PM EST. This month’s focus will be on Youth and HIV and feature voices from NMAC’s Youth Initiative program, which trains future leaders in the fight against the HIV epidemic.

Register now.

The Importance of National Transgender HIV Testing Day

April 18 marks the second annual National Transgender HIV Testing Day (NTHTD), a national initiative to increase HIV screening, prevention, and treatment among transgender people. HIV screening is an important step in HIV prevention and the first step in the HIV Care Continuum, the recommended treatment plan for people living with HIV. As simple as getting tested might seem, transgender people still encounter many barriers to screening. NTHTD aims to facilitate screening and prevention among transgender individuals by actively engaging them in their sexual health and wellness and empowering them to take charge over their health and wellness (UCSF, 2018).

Each year, community-based organizations, local health agencies, and social service agencies specializing in gender affirming care focus on strategies to raise HIV status awareness among trans and gender non-binary persons.  By utilizing innovative approaches to reduce HIV and its related health disparities among transgender women the organizations seek to engage the trans community in conversation about culturally tailored HIV screening and treatment in the US.

These efforts have never been more important, as the transgender community is increasing in visibility and new policies threaten the livelihood and well-being of transpeople across the country. The fact remains: HIV continues to be a crisis for transgender Americans.

HIV infection rates are two times higher in transgender people than in sexual gender minorities, including lesbian, gay, and bisexual persons (CDC, 2015; Institute of Medicine, 2011). About 1.4 million or 28 percent of all trans women in the United States are living with HIV (Flores, Herman, Gates, & Brown, 2016). Rates of new HIV infection among Black transgender people is 24.9 percent compared to 0.6 percent in the general United States population (Human Rights Campaign, 2016). Moreover, Black transgender women are more likely to be living with HIV (56 percent) than are White (17 percent) and Hispanic/Latina (16 percent) transgender women (CDC, 2015). Transgender women, especially those of color, are disproportionately affected by HIV infection in the United States (Centers for Disease Control and Prevention [CDC], 2015; White House Office of National AIDS Policy, 2015).

But why are the numbers among transgender people so high? And what can we do about it? First, there is a lack of comprehensive care and approaches to health, a lack of affirming places of care and multi-layered transgender stigma and discrimination that collectively discourage transgender and gender non-binary people from seeking HIV screening and treatment. Second, there is a lack of medical models that support trans-specific care. Third, on a national level, there is a lack of clinicians who are adequately trained to provide transgender health care services.

To increase HIV screening and address the HIV epidemic in transgender and gender non-binary people, we must have safe entries to care, build networks of clinicians and care providers who are representative of the community, and adapt or develop models of inclusive care.

As we commemorate National Transgender HIV Testing Day and mobilize our efforts in working towards advocating for policies that support health equity and parity for this population of men and women may we be reminded of a quote from Sir Williams Dean, former Governor General of Australia, “The ultimate test of our worth as individuals and countries is how we treat the most vulnerable and disadvantaged.”

 

References:

Centers for Disease Control and Prevention. (2015). HIV among transgender people. Retrieved from http://www.cdc.gov/hiv/risk/transgender/

University of California San Francisco, Trans HIV Testing Toolkit Overview: National Transgender HIV Testing Day. Retrieved 4/9/2018 via: http://transhealth.ucsf.edu/pdf/NTHTD/Overview_cd.pdf

Institute of Medicine. (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Retrieved from https://www.nap.edu/read/13128/chapter/1

Flores, A. R., Herman, J.L., Gates, G.J., & Brown, T.N.T. (2016). How many adults identity as transgender in the United States? Retrieved from https://williamsinstitute.law.ucla.edu/research/how-many-adults-identify-as-transgenderin-the-united-states/.

Hines, D. D., Draucker, C. B., & Habermann, B. (2017). HIV Testing and Entry to Care Among Trans Women in Indiana. Journal of the Association of Nurses in AIDS Care, 28(5), 723-736.

Human Rights Campaign. (2016). Transgender people and HIV: What we know. Retrieved from http://www.hrc.org/resources/transgender-people-and-hiv-what-we-know. Original dataset: https://bedbible.com/transgender-statistics/

White House Office of National AIDS Policy. (2015). National HIV/AIDS strategy for the United States: Updated to 2020.

 

NMAC Connection Special: An Open Letter to CDC Director Dr. Robert Redfield

An Open Letter to Dr. Robert Redfield
Director, Centers for Disease Control

Dear Dr. Redfield,
Congratulations on your appointment as the new Director of the Centers for Disease Control and Prevention. It was especially heartening that, at your first meeting with CDC staff, you said it’s possible to end the HIV epidemic in America. Your ambitious goal of ending it within the next three to seven years was music to our ears. You are the first CDC director to have this vision and NMAC wants to work with you to make it a reality.

We have a mutual belief that biomedical HIV prevention is key to bending the curve of new HIV infections. Attached is the latest Blueprint from NMAC that shares policy recommendations on ways to expand access to PrEP and U=U/Treatment as Prevention. This document highlights the unique challenges people of color face in HIV prevention, care, and treatment. It gives ways to improve outreach to gay men of color, women of color, and the transgender community.

NMAC would like to formally invite you to attend this year’s National Biomedical HIV Prevention Summit on December 3-4, 2018. The meeting will be an opportunity to dialogue directly with community, share your vision for ending the epidemic, and discuss CDC’s plans to fully implement biomedical HIV prevention.

Ending AIDS must be more than a slogan; it takes planning, collaboration, and funding to make it real. Over the past five years, significant achievements have been made. Despite these successes, our gains have not been realized equally.  Your vision to end the HIV epidemic within our lifetime can only happen when we work together. We may not agree on everything, but NMAC can definitely support, collaborate, and work to end the epidemic with CDC.

Yours in the struggle,


Paul Kawata
Executive Director

NMAC Connection: Scholarship Applications Open

More Federal Funds for Opioid-Related Infections is Good – But More is NeededFive of the nation’s leading organizations focused on ending the HIV, STD, and hepatitis epidemics in the United States – AIDS United, NASTAD, the National Coalition of STD Directors, NMAC, and The AIDS Institute – applaud Congress and the Administration for restoring critical funding for HIV and STDs and bolstering hepatitis programs. The Fiscal Year 2018 Omnibus Appropriations represents a down payment on shoring up the nation’s public health infrastructure, but it also falls short on necessary resources to combat the nation’s opioid crisis and associated infectious diseases.

Read the full statement.

 

April 10 is National Youth HIV & AIDS Awareness Day
From time to time, we will feature voices from NMAC program participants to talk about their communities and their work. This week, in honor of National Youth HIV & AIDS Awareness Day, we’re featuring Joe Gray, a participant in our Youth Initiative.

This is such an overwhelming feeling and such an honor to get to serve my Tribe, the HIV Community. I am a young man from very humble beginnings and this is my truth. I have gone from a hopeless Addict to an HIV Activist. April 10, 2015, National Youth HIV & AIDS Awareness Day, is the day I got clean and moved into a 90 day homeless shelter for persons living with HIV here in Sacramento. I have done a lot of work on self over the years to be where I am and I strive daily to be the person I needed when I was that young kinder-queer and newly diagnosed person living with HIV.
Read the rest of Joe’s story.

Still Time to Apply for NMAC’s Youth Initiative

There’s still time to apply for the eighth cycle of NMAC’s Youth Initiative program to train future leaders in the fight against the HIV epidemic. The seven-month program is open to applicants ages 18-25. Youth living with HIV or on PrEP, LGBTQ, youth of color, and young cis & trans women are particularly encouraged to apply. For more information or to apply, visit the NMAC website.

 

Applications are due by April 10.

NMAC’s Next Community Spotlight Webinar April 24

Join us for our next Community Spotlight webinar on April 24 at 3:00 PM EST. This month’s focus will be on Youth and HIV and will feature voices from NMAC’s Youth Initiative program, which trains future leaders in the fight against the HIV epidemic.

Register now!

We’re Hiring!

NMAC is hiring! If you’d like to come work with us, please check out our latest job opportunities.

Why Are Older Adults with HIV at Increased Risk for Multimorbidity?