| July
29, 2005
This Week in Washington
1. Post-G8 Briefing: Future Financing to Address the Global HIV
Pandemic
2. African American Men’s Health Briefing on HIV/AIDS
CARE Act in Brief
1. Ryan White CARE Act Health and Medical Care Services
Announcements
1. Training Opportunity for Advocates in Nine States
This Week in Washington
1. Post-G8 Briefing: Future Financing to Address the Global HIV
Pandemic
On July 21, the Henry J. Kaiser Family Foundation, the Center
for Strategic and International Studies (CSIS), and the Council
on Foreign Relations hosted a briefing entitled “Post G8 Briefing:
Future Financing to Address the Global HIV/AIDS Pandemic.” According
to the opening comments of Dr. Michael Sinclair from the Kaiser
Family Foundation, the meeting was held as a follow-up to the
June 30th London “Marlborough House” meeting. Marlborough House
was the site of the meeting where leaders from government, business,
and research discussed the long-term financing of the HIV pandemic.
The agenda and discussion of the post-G8 briefing also reflected
the developments that came out of the recent G8 summit.*
The first panel featured a summary of key issues
from Marlborough House and the G8 summit. The discussion was moderated
by Dr. Michael Sinclair and the panelists were Ms. Jennifer Kates,
Vice President and Director of HIV Policy at the Kaiser Family
Foundation, Dr. Steven Radelet, Senior Fellow at the Center for
Global Development; Ambassador Princeton N. Lyman, Ralph Bunche
Senior Fellow and Director of Africa Policy Studies from the Council
on Foreign Relations; and Ed Scott, Founder and Chairman of Friends
of the Global Fight.
Ms. Kates framed the discussion with a presentation
of data from her recently published report, “Financing the Response
to HIV/AIDS in Low and Middle Income Countries: Funding for HIV/AIDS
from the G7 and the European Commission.”** Ms. Kates’ data showed
that the U.S. is the largest contributor of international HIV
funding. She also stated that most of the other nations featured
in the report made the majority of their contributions through
bilateral funding, not through the Global Fund to Fight AIDS,
Tuberculosis and Malaria, a multilateral funding source.*** She
concluded that, according to current funding and epidemiological
projections, there will be an additional $15.9 billion required
to meet the need for responding to the HIV pandemic in 2008, regardless
of the funding mechanisms utilized.†
In his opening remarks, Dr. Radelet discussed
the need to increase levels of funding for the HIV crisis worldwide.
By spending money more effectively, he explained, organizations
that administer pandemic relief can allay their demand for financial
resources while advertising their programs to donors as worthwhile
investments. Dr. Radelet then acknowledged that impending budgetary
concerns will compete with HIV for federal dollars from the U.S.
government, and therefore proposed shifting some of this burden
to the private sector by offering incentives for businesses to
address the healthcare needs of their own workers.
Turning to methods for more efficient spending,
Dr. Radelet suggested employing a diverse approach toward asset
allocation that crafts strategies to meet every country’s unique
needs and uses governments as coordinators for contractors and
foundations. He also recommended improving evaluation systems
so that funding can be distributed to the most successful programs.
On a final note, Dr. Radelet encouraged wealthy nations to make
advance purchase commitments for potential vaccines, which would
eliminate much of the risk that keeps the pharmaceutical industry
out of the field of HIV research. Under an advance purchase commitment,
the buyer makes a commitment to a distributor to purchase a certain
amount of a product once it is available.
The second panelist, Ambassador Lyman, highlighted
the importance of sustaining public support in the U.S. for HIV
funding. He went on to share the results of several focus groups
on this topic. When focus group members were informed of the pandemic’s
implications in regions outside of Africa, such as in Russia and
Asian countries, the issue resonated more with them. Lyman also
noted that the American public supports funding where the recipient
“carries their share” of the burden. Finally, the research revealed
Americans deeply resent any indication from foreigners that they
are not generous. According to the Ambassador, Americans take
great pride in their generous nature.
Dr. Scott concluded the presentations with a
discussion of the political will needed to confront the HIV crisis,
both in individual countries and on an international scale. Characterizing
the pandemic as a greater concern than terrorism for the global
community, Dr. Scott called on world leaders to collectively sign
a “treaty,” modeled after nuclear proliferation agreements, which
would confirm their commitment to long-term AIDS relief. By placing
this disease within the paradigm of nuclear disarmament, Dr. Scott
asserted, HIV will garner the status it deserves as the gravest
of threats to human life.
The second panel featured Dr. Mark Dybul, Deputy
U.S. Global AIDS Coordinator and Chief Medical Officer, Office
of the U.S. Global AIDS Coordinator; Allen Moore, Senior Fellow,
Global Health Council; and Dr. Stephen J. Morrison, Executive
Director, CSIS HIV/AIDS Task Force and Director, CSIS Africa Program.
The panel discussion was focused specifically on the role of the
U.S. in the global response to HIV, as was pointed out by panel
moderator Dr. Debrework Zewdie, Director of the Global HIV/AIDS
Program of the Human Development Network, World Bank.
Dr. Mark Dybul’s comments addressed the significance
of the President’s Emergency Plan for AIDS Relief (PEPFAR) – especially
in comparison to contributions from other G8 nations. PEPFAR is
implemented by the Office of the Global AIDS Coordinator at the
U.S. State Department, the coordinating office for the U.S. government’s
response to HIV internationally. Dr. Dybul stated that the U.S.
funds over 50% of the international response to HIV. He went on
to say that the President had hoped that the passage and funding
of PEPFAR would have motivated other G8 countries to increase
their contribution to the HIV response in a similar manner. According
to Dybul, President Bush was disappointed when the dramatic increases
in funding from the other countries did not materialize.
Allen Moore shared his unique perspective as
a former staff member to Senator Bill Frist (R-TN), Senate majority
leader. Mr. Moore shared with the audience what he saw as the
point-of-view of Senators and Representatives, critical decision
makers in the debate over how much U.S. funding should be distributed
to HIV prevention and treatment overseas. Mr. Moore explained
that federal elected officials must always weigh international
needs against the needs of their constituents back home. He then
used as an example Tennessee’s “Tenncare problem.” State officials
in Tennessee are in the process of cutting the enrollment in Tenncare
(Tennessee’s Medicaid program) by approximately 300,000 people.
Referencing this dismal situation, he shared that Senator Frist,
a strong proponent of international HIV assistance, was constantly
faced with the difficult question from constituents: Why are you
improving healthcare overseas and not at home? While this question
remained unanswered during Mr. Moore’s comments, it helped to
explain the dilemma that elected officials face when making foreign
aid decisions.
Dr. Stephen Morrison opened his comments with
his observation that it is a “remarkable moment” for foreign aid.
There is currently a significant focus – from governments and
the public alike – on foreign aid, and there are many new mechanisms
through which the U.S. is contributing resources to other countries.
However, he noted, there is widespread skepticism among the general
public and non-U.S. governments about the intentions of the U.S.
in making these contributions. He characterized this skepticism
as culminating in a “cultural war” of sorts – and asserted that
we must move beyond it in order to effectively respond to the
epidemic. In closing, he noted that the “logic of mobilization
around alarm and emergency [for HIV] is losing its effectiveness”
and a new logic needs to be developed to garner increased support.
* The G8, or “Group of 8”, is a collection
of eight countries representing the wealthy, industrialized world;
this year their annual summit focused on Africa. The countries
are: the United States, France, Britain, Germany, Japan, Italy,
Canada, and Russia.
** The report does not include the contributions of Russia, which
was the eighth country to be added to the G8.
*** Bilateral funding refers to one nation funding another nation.
Multilateral funding refers to the contributions of more than
two nations.
† A full copy of the report is available at http://www.kff.org/hivaids/7344.cfm.
2. African American Men’s Health Briefing on
HIV/AIDS
On Thursday, July 21, 2005 AIDS Action’s Government Affairs Director,
Donna Crews, participated in a panel discussion entitled “African
American Men’s Health Briefing on HIV/AIDS”. Other panelists were
Dr. Ronald Simmons, President of Us Helping Us and Jennifer Kates,
Vice President and Director of HIV Policy for Kaiser Family Foundation.
Dr. Simmons was the first presenter; he discussed HIV infection
rates among Black Gay men in the United States. He called on the
federal government to allocate more federal resources to reduce
the “unacceptable” rate of HIV infection in this population.
Dr. Simmons explained that just last month after
the Centers for Disease Control and Prevention’s (CDC) National
HIV Prevention Conference, a group of 12 Black gay activists convened
to craft a response to the data heard at the conference. One study
on seroprevalence reported that in five urban cities 46% of the
black gay men recruited for the study tested positive for HIV.
Two-thirds of those who tested HIV-positive were not previously
aware of their HIV serostatus. The group of activists determined
that it was important for the Department of Health and Human Services
(DHHS) to “take action.” They developed the following 10 recommendations
for DHHS that responded to the newly released data:
- At the national, state and local level,
assess and evaluate federal efforts to reduce HIV infection
among Black gay and bisexual men.
- Increase efforts to reach Black gay
and bisexual men through HIV testing, STD screening, primary
medical care and behavioral interventions.
- Increase the research for effective
HIV prevention strategies and behavioral interventions, and
increase the effort to adapt and tailor current evidence-based
interventions for Black gay and bisexual men.
- Enhance the access for Black gay/bisexual
men to primary medical care, STD treatment, and hepatitis A
and B vaccinations.
- Increase access to substance abuse treatment
and mental health services for Black gay and bisexual men, regardless
of their HIV status.
- Increase leadership opportunities for
and community engagement efforts with, Black gay men on the
federal, state and local level.
- Fund demonstration projects to address
the intersection of substance abuse, mental health and HIV risk
behavior among Black gay and bisexual men.
- Develop and implement strategies to
address the stigma associated with homosexuality in the Black
community.
- Implement HIV treatment models tailored
for HIV-positive Black gay and bisexual men so that they can
make informed decisions about their treatment options.
- The issue of Black men who may have
engaged in consensual, or non-consensual, homosexuality while
incarcerated. Some of these men may be HIV-positive as a result
of their prison experience. Discharge planning is crucial so
that HIV-positive men who are released from prison are counseled
about risk reduction behavior and ways to protect their sexual
partners.
Next on the panel was Donna Crews who discussed
the important role advocacy has played in the history of the HIV
epidemic in the U.S. She explained that the Minority AIDS Initiative
began in a very similar manner to the meeting Dr. Simmons had
described. In March of 1998, a group of African American HIV service
providers met in Atlanta and were informed by the CDC of the newly
released statistics on African Americans living with HIV and AIDS
in the United States. These service providers subsequently met
with members of the Congressional Black Caucus and advocated for
additional federal funding to be targeted toward HIV prevention
and treatment in minority communities. Ms. Crews explained the
importance of coming to Washington and meeting with the staff
of Members of Congress. The staff person is likely to follow an
issue closely and needs to have contacts for particular issues
that are trusted and reliable within their constituent communities.
A Congressional staffer needs to be able to brief the Member on
the specifics of the HIV epidemic within their particular jurisdiction.
Ms. Crews shared her opinion that “people who
are involved in HIV advocacy owe it to the one million people
living with HIV in the United States to take every opportunity
to educate all elected and appointed officials about what it is
like to live with HIV in the United States.”
Jennifer Kates was the final speaker and gave
an overview of the current data from the CDC which estimates that
1,039,000 – 1,185,000 people are living with HIV and AIDS in the
United States. This is an increase of over 50,000 from the CDC’s
previous estimate. The next set of data, which she admitted was
very difficult to find on CDCs public website, reported that in
1989 African American men made up 26.1 % of the AIDS cases and
in 2003 they comprised 41.3% of the AIDS cases in the United States.
Ms. Kates then went on to discuss the important
work the Kaiser Family Foundation is doing in collaboration with
the entertainment industry. The Foundation has met with different
television producers and has been able to secure storylines about
HIV into several television shows. As an illustration, she showed
a video clip of an episode of the program Eve. In this episode
the entire cast goes to get an HIV test. The testing counselor
is an actual HIV positive African American man from Detroit who
the producers met through Kaiser and asked him to portray himself
on the program.
CARE Act in Brief:
a frequently occurring series on the Ryan White CARE Act
1. Ryan White CARE Act Health and Medical Care
Services
Over the last three weeks, this section
has compared and highlighted recommendations from national organizations
about the AIDS Drug Assistance Program (ADAP) found in Title II
of the Ryan White CARE Act (see Weekly Updates, July 8, 15 and
22 available at www.aidsaction.org).
This week, this section compares and contrasts the principal recommendations
of seven national organizations. These recommendations address
the question of whether or not the CARE Act reauthorization legislation
should specifically state which health and medical care services
can be performed with CARE Act funding. Recommendations on this
question have been made by the American Academy of HIV Medicine
(AAHIVM) partnered with the HIV Medicine Association (HIVMA),
the AIDS Healthcare Foundation, The AIDS Institute, the CDC/HRSA
Advisory Committee on HIV and STD Prevention and Treatment (CHAC),
the National Alliance of State and Territorial AIDS Directors
(NASTAD), and the Title II Community AIDS National Network (TIICANN).
These recommendations are presented below.
The American Academy of HIV Medicine and
the HIV Medicine Association
The American Academy of HIV Medicine (AAHIVM)
and the HIV Medicine Association (HIVMA) call for prioritizing
medical care in the Ryan White CARE Act. Both organizations believe
that “the core function of the CARE Act is to address the gaps
in coverage of primary medical care and basic medical services
for people with HIV/AIDS.” They recommend that Title I and II
grantees should devote at least 25 percent of funds to the following
“primary medical care” services:
- Physician and other medical provider visits,
including adherence services;
- Subspecialty care related to HIV and/or
HIV treatments or that plays an integral role in the success
of HIV treatment with a specific population, such as obstetric
and gynecological services and pediatric HIV specialists;
- Medically necessary medications, including
all approved anti-retroviral medications;
- Laboratory tests to monitor the effectiveness
and safety of treatment, including HIV viral load, CD4+ T-cell
testing, and appropriate resistance tests; and,
- Clinical pharmacology consultation and services.
In addition they recommend that another 25 percent
of CARE Act funding (again for Title I and Title II grantees)
should go to the following “basic medical services”:
- Medically necessary oral health services;
- Mental health services;
- Substance abuse treatment;
- Prevention counseling in HIV clinical settings;
- Nutrition Counseling; and,
- Hospice.
AAHIVM and HIVMA recommend continuing the provision
of “social services.” These social services include transportation,
housing assistance, food, child care, emergency financial assistance,
respite care services, case management, client advocacy services,
and health insurance co-payments and deductibles.
The AIDS Healthcare Foundation
The AIDS Healthcare Foundation made recommendations
in a press release on June 20th.
In particular the AIDS Healthcare Foundation recommends that cities
spend a minimum of 65 percent of CARE Act funds on “primary HIV
medical care.” They did not specifically define “primary medical
care.” However, the Foundation notes that the original structure
of the CARE Act is nearly 15 years old and reflects a time in
which individuals diagnosed with HIV often had very little time
to live. Consequently, funding was needed for “non-medical support
services” for those individuals. They state that the situation
has changed and that HIV should now be considered a chronic disease
(a prolonged illness rarely cured completely). Since individuals
with HIV are often healthier and live longer than in the first
decade of the epidemic, they require more medical care than social
and support care than at the time the CARE Act was first created.
Consequently, they believe that providing 65 percent of care as
primary medical care will “ensure adequate access to treatment,
while simultaneously providing cities enough budgetary flexibility
to meet other non-medical HIV needs.”
The AIDS Institute
The AIDS Institute is in general agreement with
the recommendations of AAHIVM and HIVMA. They recommend that a
set of minimum services should be available through the CARE Act
to all persons eligible for CARE Act services. The AIDS Institute
states that these services should include as a minimum: primary
medical care, medications, laboratory services, oral health services,
mental health services, substance abuse treatment, case management,
hospice and such medical setting counseling as adherence, nutritional,
prevention and wellness counseling. They state that primary HIV
medical care must include access to specialty care.
CDC/HRSA Advisory Committee on HIV and
STD Prevention and Treatment (CHAC)
The CDC/HRSA Advisory Committee on HIV and STD
Prevention and Treatment (CHAC) adopted recommendations related
to medical services on November 30, 2003. These recommendations,
titled “Priority to Core Services and Linkages to Health Care”
call for the CARE Act to require grantees and planning bodies
to give the highest priority to the provision of health care services
and medications. However, they state that these needs must be
appropriate for the local community that the grantee serves. The
advisory committee notes that support services play a significant
role in supporting access to healthcare. Consequently they recommend
that CARE Act funds should not be restricted to a “narrow range”
of direct medical services.
National Alliance of State and Territorial
AIDS Directors (NASTAD)
The National Alliance of State and Territorial
AIDS Directors (NASTAD) recommends that the CARE Act programs
continue to be able to provide “supportive services” within the
CARE Act. Supportive services according to NASTAD are essential
to ensure access to, and retention in, care and treatment. These
supportive services include: case management, transportation assistance,
benefits counseling, housing referrals and supportive services
for women, children and families. They note that because the CARE
act is a “patchwork” of funding, supportive services are particularly
important to help individuals navigate the requirements of different
programs of the CARE Act.
Title II Community AIDS National Network
(TIICANN)
Finally, the Title II Community AIDS National
Network (TIICANN) recommends “guaranteeing” benefits to eligible
enrollees in the CARE Act. The benefits that must be guaranteed
include: primary care and intervention services, Highly Active
Anti-Retroviral Therapy (HAART)*, HIV case management, obstetric
and gynecological services, and mental health and substance abuse
services. TIICANN recommends providing these services through
“Centers of Excellence in HIV Care.” A “Centers of Excellence”
model generally seeks to bring together expertise, technology
and financial resources to create innovative treatment in a health
care setting. TIICANN believes that the creation of Centers of
Excellence devoted to HIV would result in the best possible care
at the lowest cost. Finally TIICANN believes that guaranteeing
benefits would prevent disability (resulting in saved lives),
save money and reduce new HIV infections.
This completes this week’s review of recommendations
related to defining medical services within the CARE Act. Future
articles in this section of The Weekly Update will continue to
explore reauthorization recommendations from a variety of other
organizations and perspectives.
*HAART, the current standard of HIV treatment,
uses a combination of between two and five anti-retroviral medications
to inhibit replication of HIV in the body.
To link to the organizations on which this CARE
Act in Brief series is based, click on the following:
AIDS Healthcare Foundation
http://www.aidshealth.org/newsroom/mediareleases05/mediarelease22.htm
The AIDS Institute
http://www.theaidsinstitute.org/downloads/TAIreauthrecs505.pdf
The American Academy of HIV Medicine
(AAHIVM) and the HIV Medicine Association (HIVMA)
http://aahivm.org/rw2_0308.pdf
CDC/HRSA Advisory Committee on HIV
and STD Prevention and Treatment (CHAC)
http://www.nastad.org/documents/public/reauth_watch/RWCA%20RECOMMENDATIONS%20--%20FINAL%20Dec%202003%20Plus%20MembersFINAL%20(2).doc
The National Alliance of State and
Territorial AIDS Directors (NASTAD)
http://www.nastad.org/documents/public/ReauthorizationIssuePaperv6_6-13-05.pdf
Title II Community AIDS National Network
(TIICANN)
http://www.tiicann.org/bmx3/reauthtiicann.pdf
Announcements
1. Training Opportunity for Advocates in
Nine States
A new program managed by Collaborative Solutions—an organization
based in Birmingham, AL that is specifically focused on the continuation
and development of supportive housing for special needs populations—is
recruiting 18 key leaders in targeted states where access to HIV
care and treatment is limited due to funding limitations. The
program, called Access Advocates Program, will accept two advocates
from the nine states: Arkansas, Iowa, Louisiana, Mississippi,
North Carolina, South Carolina, Tennessee, Texas, and West Virginia.
All “Access Advocates” will become familiar with the fundamentals
of a statewide advocacy campaign. They will also receive the following:
- Support and direction to successfully design
their own statewide campaigns
- Materials necessary to support the approach
of each recruit
- One-to-one support to make their state's
design a reality
Applications are due Wednesday, August
3 and require three letters of recommendation. Applications
and further information are available at www.collaborative-solutions.net.
Instructions, program details, and a guide for required references
are all available at the Web site as well.
The AIDS Action Weekly Update
The Weekly Update is written with
a mind toward the interests of our members. If you are interested
in membership with AIDS Action, we invite you to contact members@aidsaction.org.
AIDS Action works
to end the HIV epidemic by advancing public policies that
prevent new infections, provide care for people living with
HIV, and support the search for a cure. AIDS Action serves
as the national voice for people living with HIV and represents
AIDS service organizations, health departments, and a diverse
network of community-based organizations across the country. |
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