April 9, 2004

This Week In Washington
1. AIDS Action Foundation Launches Connecting to Care: Workbook and Web site in English and Spanish
2. APHA Holds Town Hall to Open National Public Health Week
3. AIDS Action To Join March for Women’s Lives on April 25

In the News
1. New Partnership Could Provide 100 Countries with Affordable ARVs and HIV/AIDS Diagnostics
2. AIDS Drug Assistance Program Subject of Debate Over Access to Care in America

Announcements
1. Southern California’s Altamed Open New Clinic
2. The 2004 Minority Women’s Health Summit To Be Held August 12 - 15
3. APHA Unveils Community Solutions to Health Disparities Database
4. The 2004 Minority Women’s Health Summit To Be Held August 12 - 15
5. Early Registration Period for the Ryan White CARE Act Grantees Conference Ends April 30
6. March for Women’s Lives to Be Held April 25
7. AIDSWatch, to Be Held May 17 to 19

This Week In Washington
1. AIDS Action Foundation Launches Connecting to Care: Workbook and Web site in English and Spanish
The AIDS Action Foundation has released the Connecting to Care workbook and Web site for health care providers working with HIV positive clients. The workbook and Web site feature 17 methodologies that have successfully connected, or reconnected, individuals with "unmet need" to care through medical support services and client-centered approaches.

Unmet Need - as identified by the HIV/AIDS Bureau of the Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services - refers to individuals who are living with HIV and are aware of their HIV status, but are not receiving regular primary medical care.

The featured methodologies or "activities" utilize both traditional and innovative approaches to connect individuals to care despite geographic, economic, cultural and linguistic barriers that hinder long-term engagement. The activities range from "Snapshot Viral Load Testing," which helps clients at health clinics for the homeless obtain a clear picture of their HIV infection, to "Clinicians Reaching Out" that establishes trust and demystifies the role of clinicians through their active participation in the HIV+ community.

Connecting to Care responds to urgent needs created by the HIV epidemic in the United States by providing health care agencies with model activities that can be adapted to their particular demographic settings—both urban and rural.

The Connecting to Care Web site, which offers English and Spanish versions of the workbook, can be accessed through AIDS Action’s homepage at http://www.aidsaction.org.

2. APHA Holds Town Hall to Open National Public Health Week
On Monday, April 5, 2004, the American Public Health Association (APHA) celebrated the beginning of National Public Health Week with A Town Hall on Eliminating Racial and Ethnic Disparities by Moving the Nation from Statistics to Solutions. AIDS Action attended the event, which was held at the Henry J. Kaiser Family Foundation’s Barbara Jordan Conference Center in Washington, D.C.

April 5 to April 11, 2004 marks the fourteenth annual National Public Health Week (NPHW). Each year, NPHW has a different public health-related theme. The theme for 2004 is Eliminating Health Disparities: Communities Moving from Statistics to Solutions. As a project of APHA, National Public Health Week is held in partnership with over 200 national, regional, and local public health organizations, including AIDS Action.

The Town Hall was hosted by Dr. Georges Benjamin, APHA’s executive director. Dr. Benjamin opened the event by welcoming those in attendance and reminding them of the need for programs like NPHW to draw attention to the pressing, health-related challenges that the U.S. faces today. He explained that the theme for this year encourages “moving from statistics to solutions,” noting that, “Now is the time to not just measure the problem, but to do something about it.” This theme was echoed by the morning’s first speaker, Dr. Virginia Caine—the President of APHA. In her remarks, Dr. Caine emphasized the importance of communities working together to ensure that every American has access to the health care they need.

Following these welcoming remarks, the first speaker on the agenda was Dr. Richard Carmona, the U.S. Surgeon General. Dr. Carmona began by describing how his own experiences have taught him the importance of addressing health disparities as part of a broader strategy of prevention. He described how, as a child growing up in Harlem, he was directly impacted by health disparities within his own community and how, as a trauma surgeon, he often saw too late the results of inadequate access to health care.

Dr. Carmona continued by describing how the elimination of health disparities is at the top of his agenda, and how it is also a key priority for the President. He explained that, “America has its own unique disease—we suffer from racial and ethnic disparities in health care.” He then touched on several conditions that have had a disproportionate impact on certain populations, including HIV. In speaking about HIV, Dr. Carmona pointed to the current estimated rate of 40,000 new infections, “70 percent of which are in communities of color,” as unacceptable and emphasized that Congress and the Administration are committed to addressing HIV both in this country and around the world.

Following Dr. Carmona’s remarks, Dr. Benjamin introduced a panel of speakers, each of whom was asked to address the role of community-based programs in eliminating racial and ethnic disparities. The first panelist was Dr. Nathan Stinson, Deputy Assistant Secretary for Minority Health at the Department of Health and Human Services. Dr. Stinson emphasized the importance of factors that influence health, factors such as the availability of housing, concerns regarding the safety of the environment, cultural norms and values, and other community-specific contexts. Thus, he noted, in order to adequately address disparities, you have to start from within the communities themselves; only by “tap[ping] into the genius of the community” can you expect to translate ideas into results.

Dr. Stinson was followed by Dr. Elena Rios, president of the National Hispanic Medical Association. Dr. Rios echoed Dr. Stinson’s comments by emphasizing the importance of community engagement in the public health process. She further noted that, in order for diverse communities to be successful, they need to be prepared to work in coalition and learn from each other what works.

The final panelist was Michael Bird, executive director of the National Native American AIDS Prevention Center. Mr. Bird spoke about the specific experience of Native American communities in the U.S. and the impact that historical injustices have had, and continue to have, on Native Americans today. He emphasized that indigenous values, such as the importance of interconnections and interdependence, are a good model for finding solutions to the problems presented by health disparities, and he went on to describe several models that are working in Native American communities.

Dr. Benjamin concluded the Town Hall by announcing the official launch of APHA’s new Health Disparities Solutions Database (for more information on this project, see item #2 in the Announcement section below). Final closing remarks were offered by APHA Board Chair Dr. Edwin Marshall, who stated that he was “moved to quote the famous Jedi philosopher trainer, Yoda when he said, ‘There is no try, only do.’” He continued, “Collectively, we can do.”

To view a Webcast of the Town Hall, visit: http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=1113

To learn more about National Public Health Week, visit: http://www.apha.org/NPHW/.

3. AIDS Action To Join March for Women’s Lives on April 25
This week AIDS Action signed on as a co-sponsoring organization for the March for Women’s Lives, which will take place in Washington, D.C. on Sunday, April 25. AIDS Action and over 1,000 local, regional, and national organizations are co-sponsoring this important event.

The March for Women’s Lives is a demonstration in support of reproductive freedom and justice for all women. The event is being organized and funded by seven national partners: the American Civil Liberties Union, Black Women's Health Imperative, Feminist Majority, NARAL Pro-Choice America, National Latina Institute for Reproductive Health, National Organization for Women, and Planned Parenthood Federation of America.

The March is intended to focus attention on the importance of maintaining sexual and reproductive health and choice for all women. Awareness and education about HIV and other sexually transmitted diseases—as well as access to treatment and care—are a critical part of sexual and reproductive health care. Although HIV is not one of the seven key themes around which the March is organized (choice, justice, access, health, abortion, global, and family planning) it is relevant to many of these priorities. Intersections between HIV and broader reproductive and sexual health issues can also be seen in each of the key organizing principles of the March (which are explained at the end of this news brief). For example, access to safe, affordable reproductive health is important not only for decisions about reproductive options, but also for assessing protection options for HIV and other sexually transmitted diseases. In addition, many of the factors that impact a woman’s ability to control her reproductive options (such as economic, class, racial/ethnic, and cultural barriers) are the same factors that challenge many individuals and communities who are impacted by HIV. These commonalities make projects like the March for Women’s Lives essential contributions to HIV advocacy. By participating in the March, the HIV/AIDS community can better ensure that everyone has access to adequate safe, affordable health care.

In addition to the March itself, a number of related activities will be taking place across the country in the days and weeks leading up to April 25. AIDS Action will be attending some of these events and will be represented at the March by a delegation of staff members and allies. Look for a full report on these activities in an upcoming issue of The Weekly Update.

For more information about the March, and/or to find out how you can be involved, please visit http://www.marchforwomen.org...

March for Women’s Lives: We March to Uphold

• Choice: To ensure that all women have the right to choose to have or not to have children, with reproductive health options that are safe, affordable and accessible.
• Justice: To promote true reproductive justice that recognizes women must have the right to have, or not have, children. To realize these rights, all women must address poverty, racism, xenophobia, trafficking, homophobia, incarceration, and sexism, as well as resist all population control strategies that attack women’s right to bodily self-determination.
• Access: To ensure the availability of contraceptive services, family planning, and abortion services to all women regardless of geographic location or income.
• Health: To address disturbing statistics that indicate widespread disparate treatment options offered to women due to race, income, and age, to help women protect their lives from breast cancer, over-use of hormone replacement therapies, medical abuses, and other issues that threaten women’s health.
• Abortion: To uphold the fundamental right of women to control their lives through safe and legal abortion.
• Global: To establish the connection between foreign and domestic policies that harm women worldwide and to assert reproductive freedom as a basic human right.
• Family Planning: To demand access to a range of safe and affordable family planning options, including the right to accurate and effective sex education and safe and effective contraceptive development and testing. Women deserve the right to full disclosure of information about new reproductive technologies and the race, class, and gender implications of such technologies, including our opposition to bio-engineering and genome research that particularly place low-income women and women of color at risk.
  Source: http://www,marchforwomen.org

In the News
1. New Partnership Could Provide 100 Countries with Affordable ARVs and HIV/AIDS Diagnostics
On Tuesday, four organizations that have committed to efforts against HIV in developing countries—the World Bank, UNICEF, the Global Fund to Fight AIDS Tuberculosis and Malaria, and the William J. Clinton Presidential Foundation—announced plans to combine forces for an initiative that would make it possible for more than 100 developing countries to purchase high-quality medications and diagnostics for HIV “at the lowest available prices,” a World Bank press release reported.

World Bank President James Wolfensohn said of the announcement, “We regard AIDS as being the single most important issue at the moment in Africa because of the devastating effect that it has had throughout the Continent, and it is not something that is deferrable to discussions of economic or other issues. The epidemic in Asia, Europe, and Central Asia, and the Caribbean is also a tremendous concern.”

According to the World Bank, the joint initiative builds on the work of the Clinton Foundation which secured an agreement, announced in October 2003 and January 2004 ) to provide HIV/AIDS diagnostics and generic drugs to sixteen countries in Africa and the Caribbean at drastically reduced prices. (For further details, see the 11/23/ 03 and 1/16/04 issues of The Weekly Update, found respectively at http://www.aidsaction.org/communications/weekly_updates/102303.htm and http://www.aidsaction.org/communications/weekly_updates/011604.htm.) This agreement, made with five manufacturers of antiretrovirals (ARV) and five manufacturers of HIV diagnostic tests, was designed to reduce the costs associated with ARVs and diagnostic equipment by more than 50 percent in many cases.

The new joint initiative intends to extend such reductions to recipients of World Bank, Global Fund or UNICEF funding, the Sunday Times further noted. While the Clinton Foundation has been charged with negotiating drug prices, UNICEF will employ its procurement capacity, and the Global Fund and World Bank will provide the funding for this new initiative.

“This new partnership works to break down some of the barriers—such as price, supply and demand—that are impeding access to life-saving AIDS medicines and diagnostics in developing countries,” explained Carol Bellamy, director of UNICEF.

However, a New York Times article on April 6 suggested that it was still unclear “whether the ambitious plan would be realized.” According to the article, “The drug and diagnostics companies named in the deal have not all agreed to sell their products at the low prices they offered to a few African and Caribbean countries under two other deals brokered by the Clinton Foundation last year.”

A Global Fund executive quoted in The New York Times called Tuesday’s announcement “a mistake on our part,” since the suppliers’ agreement had not yet been assured. Under the initiative, the World Bank press release announced, the companies named as providers of discounted ARVs included Aspen Pharmacare Holdings in South Africa; and Cipla, Hetero Drugs Limited, Ranbaxy Laboratories, and Matrix Laboratories—all of India. Beckman Coulter, Inc., Befton Dickinson and Company (BD), Bayer Diagnostics, Roche Diagnostics, and bioMerieux were named as suppliers of HIV/AIDS diagnostics, including CD4 tests and viral load tests.

Several of the companies in question offered either conditional or qualified assurance. According to The New York Times, Cipla Chairman Dr. Yusef K. Hamied commented, ‘That doesn’t mean I don’t intend to participate. I want to know more.” Through its vice president for trade development, Aspen Pharmacare said that, although it would sell its first-line combination of drugs through the Clinton Foundation for about $140, it would only do so in Africa. And a chief executive of Matrix told the newspaper that his company only supplied raw material but would be willing to expand its capacity.

In addition, The New York Times reported that a Ranbaxy spokesman said that the official who worked with the Clinton Foundation could not yet confirm whether the company would participate.

To view the press release and articles on which this news brief is based, go to
http://web.worldbank.org/WBSITE/EXTERNAL/NEWS/0,,contentMDK:20188898~menuPK:34463~pagePK:64003015~piPK:64003012~theSitePK:4607,00.html for the World Bank press release; http://www.sundaytimes.co.za/zones/sundaytimes/newsst/newsst1081227199.asp for the Sunday Times article; and http://www.nytimes.com/2004/04/06/health/policy/06AIDS.html?ex=1081828800&en=345302b18cbcaf45&ei=5062&partner=GOOGLE for The New York Times article.

2. AIDS Drug Assistance Program Subject of Debate Over Access to Care in America
Even as the Administration debates whether or not to allow funds from the President’s Emergency Plan for AIDS Relief (PEPFAR) to purchase generic drugs for HIV patients overseas, a related debate about access to life-saving HIV medications, including antiretroviral therapy, in the United States is being conducted. As reported by Reuters on Tuesday, April 7, the increasing cost of HIV drugs, as well as tight state budgets, has squeezed the AIDS Drugs Assistance Program (ADAP), which provides HIV treatment domestically to HIV positive people of low income or who are uninsured, or underinsured.

Reuters reported further that “physicians and activists” are concerned about the health of ADAP. What they find particularly troublesome is the growing number of individuals who are eligible for treatment through ADAP, but remain on waiting lists because the programs are filled to capacity. ‘We’re about to fall into a major crisis,’ maintains Jose Zuniga, president and CEO of the International Association of Physicians in AIDS Care, Reuters reported.

In a press release on Thursday, April 8, the National Alliance of State and Territorial AIDS Directors (NASTAD), which regularly monitors ADAP, indicated that, as of this month, there are 1,263 people on ADAP waiting lists. NASTAD also noted that sixteen states have closed ADAP enrollment, or have limited access to medications available through ADAP, and eleven more states anticipate implementing such restrictions as well.

Although any ADAP waiting list, regardless of size, is a concern to health advocates, it is difficult to ascertain the extent to which people are being denied HIV treatment because of waiting lists. According to some of these advocates, this difficulty is attributed, in part, to the decision by certain states to close their ADAP enrollment instead of setting up waiting lists. Consequently, once these states have reached their ADAP enrollment limits, they do not track the number of eligible individuals who are turned away from their programs. Other advocates maintain that some HIV positive individuals who are denied access to ADAP manage to receive HIV treatment through an alternative mechanism. For these reasons, the extent of the ADAP problem is difficult to quantify accurately.

However, as Dr. Franklyn Judson, director of the Denver Public Health Department and a member of the President’s Advisory Council on HIV/AIDS asserted at a recent meeting of the Council, the existence of ADAP waiting lists make it apparent that the federal program needs a critical review. In addition, he pointed out that ADAP contains inconsistencies between states. For instance, in some states, ADAP pays for medications used to treat the side effects of HIV drugs and/or opportunistic infections that stem from HIV disease; whereas other state ADAPs only cover medications for the treatment of HIV. Additionally, while certain states cover most or all types of HIV medications, other states only pay for the most affordable drugs.

According to Zuniga, as quoted in Reuters, if we are to address these concerns, “We need to look at a mixed basket of solutions.” In the Reuters article, he tried to keep from pointing fingers at drug companies for their pricing of medications and instead looked to elected officials for guidance. Politicians “are not paying attention anymore,” he asserted. Meanwhile, William Arnold, of the ADAP Working Group cautioned in the same article that if the problems of ADAP are not addressed soon, “a whole bunch of people are not going to be treated.”

NASTAD’s Web site contains a report called the “ADAP Funding Watch” at http://www.nastad.org.
To read the Reuters article mentioned in this report, link to
http://www.reuters.com/newsArticle.jhtml?type=topNews&storyID=4776399.

Announcements
1. Southern California’s Altamed Open New Clinic
AltaMed, an organization in Southern California with a bilingual, bicultural, and professional staff that provides a fully integrated system of quality care, including HIV/AIDS services, has opened a new clinic in East Los Angeles. The clinic will offer medical services such as dental, OB-GYN, and pediatric care to residents with low income.

The new clinic is in a building formerly occupied by the Community Healthcare Foundation, which was closed in 2002. That year, the Los Angeles County Board of Supervisors and Department of Health Services (LADHS) approved the closure of 11 community health clinics due to a $600 million deficit. The closures left approximately 40,000 Angelenos without access to care, while the closing of the Community Heatlhcare Foundation had a particularly hard impact on Latinos since East Los Angeles is home to many Latinos.

With these closures in mind, Cástulo de la Rocha, AltaMed’s president and CEO, commented about the new clinic in La Opinión, a Spanish-language paper, and a translation of his statement is provided here: “Today, we have returned. We have come to serve our community and to offer low-cost medical services that will be determined by the client’s income and number of dependents.”

For more information about Altamed and the services it provides, link to http://www.altamed.org/.

2. APHA Unveils Community Solutions to Health Disparities Database
As part of the activities for National Public Health Week, April 5 to 11, 2004 (for more information, see APHA Holds Town Hall to Open National Public Health Week in the This Week in Washington section), the American Public Health Association has unveiled the Community Solutions to Health Disparities Database. This new tool enables members of the public health community to search for information about programs and interventions that have succeeded in addressing different forms of health disparities in communities across the country.

This searchable database, which is accessible for free via the APHA Web site, consists of the descriptions of programs and initiative that have been submitted for inclusion by APHA members and partners. Individuals looking for information can search the database by keyword, state, and target population (with search options for gender, race/ethnicity, and age). At the present time, the database contains over 500 entries with more being submitted every day. The database will continue to be available after National Public Health Week, and members of the community are encouraged to continue submitting their programs for inclusion.

To access the Community Solutions to Health Disparities Database, visit http://www.apha.org/nphw/solutions/.

To learn more about National Public Health Week, visit http://www.apha.org/NPHW/.

3. Guide to Social Security Benefits for People Living with HIV/AIDS
The Social Security Administration (SSA), has released a new document: Social Security Benefits for People Living with HIV/AIDS, which describes how people living with HIV can apply for benefits under two SSA programs: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). In addition, the document covers the following topics: eligibility for benefits; disability definitions; how to file for benefits; questions asked during the eligibility process; how eligibility determinations are made; how to expedite processing of claims; and what happens if recipients return to work. This document serves as a replacement for the discontinued A Guide to Social Security and SSI Disability Benefits for People with HIV Infection," which is no longer available.

To view Social Security Benefits for People Living with HIV/AIDS, go to
http://www.ssa.gov/pubs/10019.pdf.

4. The 2004 Minority Women’s Health Summit To Be Held August 12 - 15
The 2004 Minority Women's Health Summit will be held in Washington, DC over a four-day period from Thursday, August 12 to Sunday, August 15. With its theme, Women of Color, Taking Action for a Healthier Life: Progress, Partnerships & Possibilities, the summit will build on the outcomes of the 1997 National Conference Bridging the Gap: Enhancing Partnerships to Improve Minority Women's Health. Among the key women’s health issues that will be highlighted are HIV/AIDS, cardiovascular disease, cancer, and diabetes. The summit’s objectives are below:

• Explore current prevention strategies that work in various communities, both urban and rural.
• Promote dialogue among policy makers, service providers, community women, academia and other stakeholders to address current health care issues for women of color.
• Recommend action-oriented strategies to increase positive health outcomes for women of color across the lifespan, from rural and urban communities.
• Foster community partnerships to identify and implement best practices that target prevention, diagnosis and treatment of diseases that disproportionately affect women of color.
• Promote strategies to diversify leadership in health sciences, education, research and policy.
• Ensure health issues of women of color remain at the forefront of national, state and local health policy agendas.
  

For more information on the summit, link to http://www.4woman.gov/mwhs/ or contact one of the following people:

• Elizabeth David at (202) 205-0571,
• Adrienne Smith at (202) 690-5884, or
• Frances Ashe-Goins at (202) 690-6373.

5. Early Registration Period for the Ryan White CARE Act Grantees Conference Ends April 30
The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act 2004 Grantees Conference, We CARE. We Act: Putting It All Together, which is sponsored by the Health Resources and Services Administration (HRSA) and its HIV/AIDS Bureau (HAB), will convene for four days, Monday, August 23 to Thursday, August 26, 2004, at the Marriott Wardman Park Hotel in Washington D.C.

Developed under six broad tracks, including 1) Access to Care; 2) Quality; 3) Program Development; 4) Coordination and Linkages; 5) Administration: Fiscal and Program Management; and 6) Data, Evaluation, and Outcomes, the conference aims to provide a rewarding and productive exchange of valuable training and technical assistance that focus on four objectives. They are as follows: 1) Identify strategies to improve systems of care for people living with HIV; 2) Increase grantees' knowledge of programmatic and administrative requirements; 3) Enable grantees to share models of care; and 4) Encourage collaboration and networking among grantees.

All participants and presenters are responsible for their own travel, hotel, and registration fees which should come from CARE Act grants. Early registration fee is $375 through April 30, 2004. The regular fee is $475 and onsite registration is $525. Registration fees will cover the costs that cannot be covered by the HIV/AIDS Bureau such as meals, breaks, and other conference materials.

What’s more, this annual conference for CARE Act grantees will be held for the second time in conjunction with the CARE Act Clinical Conference, which is now in its seventh year.

The goal of the Clinical Conference is to provide a comprehensive overview of current clinical issues in HIV management and current strategies in HIV care for practitioners in RWCA Title I, II, III, and IV funded programs. This continuing medical education (CME) program will include didactic lectures and interactive workshops.

Further information on these conferences, including registration forms, is available online at http://www.psava.com/rwca2004/general.asp.

6. March for Women’s Lives to Be Held April 25
On Sunday April 25, 2004, advocates from across the country will meet in Washington, DC for the March for Women’s Lives, a demonstration in support of reproductive freedom and justice for all women. The event is being organized by the American Civil Liberties Union, Black Women's Health Imperative, Feminist Majority, NARAL Pro-Choice America, National Latina Institute for Reproductive Health, National Organization for Women, and Planned Parenthood Federation of America, and by nearly 1,000 local organizations who have signed up as co-sponsors for the event.

For more information about the March and to find out how your organization can become involved, visit: www.marchforwomen.org.

7. AIDSWatch, to Be Held May 17 to 19
AIDSWatch, an annual advocacy event organized by National Association of People With AIDS (NAPWA), will be held this year from May 17 to May 19 in Washington, DC. As a sponsor of the event, AIDS Action encourages its members to come to the capital and participate in AIDSWatch activities. AIDSWatch brings together advocates from across the country and provides them with the training and information they need to have successful meetings with legislators and their staff members and to persuade these policymakers to support domestic and global HIV/AIDS programs. In order to ensure this success, AIDSWatch will provide participants with a full day of hands-on advocacy training, which will include an update on federal HIV/AIDS policy and funding. Participants will then meet with their elected representatives, along with other AIDSWatch participants. In addition, some AIDSWatch groups will be joined by staff and board members from national HIV/AIDS organizations.

Registration for the event is free, and any information you include on your registration will be kept confidential. To register, link to http://www.napwa.org/AIDSWatchsub.html.

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