| June
9, 2006
This Week in Washington
1. Conference Marks 25th Anniversary of First Known Cases of HIV
2. Labor, Health and Human Services and Education Appropriations
Bill
CARE Act in Brief
1. CARE Act Hearing May be Held the Week of June 19th
This Week in Washington
1. Conference Marks 25th Anniversary of First Known Cases of HIV
On Monday, June 5th the DC Administration for HIV Policy and Programs
hosted a conference at George Washington University entitled,
“HIV in America’s Capital City: A Clinical Update.” The date marked
the 25th Anniversary of the CDC’s first release of mortality rates
of the disease that what would eventually become known as HIV.
Former Executive Director of AIDS Action Marsha Martin moderated
the event where speakers included Dr. Greg Pane of Washington
D.C., Dr. Donna Sweet of Wichita, Kansas, Dr. Howard Grossman
of Washington D.C., Dr. Celia Maxwell of Washington D.C., Dr.
Ligia Peralta of Baltimore, MD, and former Director of the Office
of National AIDS Policy, Dr. Joseph O’Neill.
One of the main focuses of the conference was
the expansion of routine testing and rapid testing for HIV. The
Director of the DC Department of Health Greg Pane opened the conference
by calling for citywide screening for HIV. Only 10% of men and
17% of women receiving a positive test do so as the result of
the suggestion of a health care provider. Expanded testing also
increases the chances that those who have felt singled out or
discriminated against (when asked if they would like to be tested)
will get tested. In addition to more routine testing, rapid testing
can provide accurate results for patients in twenty minutes, according
to Dr. Pane. Noting that 31% of positive HIV tests are never picked
up by the patient, Dr. Donna Sweet described rapid testing as
the “wave of the future” in preventing the transmission of HIV
in terms of testing procedure. The conference ended with an HIV
Rapid Testing Practicum given by Dr. Celia Maxwell.
The conference provided a healthy mix of optimism
and realism after 25 years of HIV. The medical community has made
and is continuing to make tremendous strides by creating medicines
that are improving the lives of people with HIV everyday. The
average amount of time survived after an AIDS diagnosis has been
growing steadily since 1996. Also, treatments that called for
20-50 pills per day in 1997 have led to new classes of drugs that
are making life easier and easier on patients.
Despite this progress, however, the pace of
infections and AIDS cases continues forward at alarming rates.
Since the onset of the virus in 1981, an estimated 38 million
people have died of the disease worldwide. If current rates continue,
75 million people will be infected by 2010. By 2025, 83 million
people will be dead with an additional 89 million infected. According
to Dr. Maxwell, Washington D.C. has the highest rate of new cases
of any city in the country. On a more international note, there
are nine African countries where life expectancy is already less
than 40 years. After 25 years, the need for the commitment of
resources and action remains as urgent as ever.
Dr. Joseph O’Neill closed the speaking with
a plea for more palliative care, or care that concentrates on
lessening the suffering of patients. While medical technology
is the eventual solution to the epidemic of HIV/AIDS, the reality
is that there is no cure. The treatment of a virus that has no
cure demands a unique approach to care. Dr. O’Neill recalled a
gay black military veteran named Stanley who was his first AIDS
patient when he worked at a San Francisco hospital in 1982. Dr.
O’Neill recalled numerous meetings with colleagues at the time
and the helplessness they all felt in attempting to treat Stanley.
Years later he would find out that a drug kept in healthy supply
at the hospital could have almost certainly prolonged Stanley’s
life. Dr. O’Neill concluded by admitting that he does not beat
himself up over Stanley’s death, “a doctor can only work with
the medical knowledge he has available to him at that time in
history, what I could have done was ease his suffering , that
is what I will always regret.”
2. Labor, Health and Human
Services and Education Appropriations Bill
On Wednesday, June 7, 2006 the House Labor, Health and Human Services,
and Education subcommittee of the Appropriations Committee marked
up the Fiscal Year (FY) 2007 Appropriations bill. AIDS Action
Council staff was in attendance and received a copy of the highlights.
The total appropriation bill will be $141.9 billion with $454.6
billion in mandatory spending. Mandatory spending is down $5.4
billion from last year with a less than 1 percent total increase
over FY 2006. The House Appropriations bill is a $4.136 billion
increase over President Bush’s FY 2007 request of $137.794
The Ryan White CARE Act has been appropriated
a total of $2.1 billion in funding. The bill includes President
Bush’s proposed increase of $70 million for the Ryan White CARE
Act which President Bush had stated was to be used for medications.
However the $70 million increase was placed in the Title II base
funds which will be allocated to states based on a formula. According
to the Committee highlights of the bill the $70 million “will
permit States to provide needed medications for those with the
greatest need. The $25 million President Bush proposed for Title
III community and faith based programs was not included in the
bill.
The Centers for Disease Control and Prevention
(CDC) has been appropriated $63 million “for a new testing initiative
at the CDC to help stop the spread of this disease through increased
levels of testing”, according to the Committee highlights. This
is $30 million below the President’s request for this program.
The bill provides funding of $113 million for
community based abstinence education programs $91 million below
the President’s FY 2007 request. The House Appropriators continue
to work toward completion of all appropriations bills prior to
the 4th of July recess.
CARE Act in Brief
1. CARE Act Markup May be Held the Week of June 19th
After returning from Congress’s Memorial Day recess on June 5th,
Senate and House Democrats and Republicans again began to negotiate
the final outlines of the Ryan White CARE Act. The negotiations
became particularly difficult during this week and threatened
to bog down over several issues. Although committee members had
earlier in the week proposed to have a markup of the CARE Act
bill in the House Energy and Commerce Full committee on Tuesday,
June 13th, members of the negotiating team decided late on Friday
to wait at least one more week. The negotiating team has agreed
to continue to work within the bicameral, bipartisan process to
make sure that they can create a bill that will receive near unanimous
approval from members of the Senate and House of Representatives.
The negotiators are now hoping to mark up the bill as early as
Tuesday, June 20th and possibly take it to the House floor on
Thursday. The week of June 19th is “Health Week” in the House.
A particularly difficult issue for the negotiators
has been to determine how best to distribute CARE Act funding
for Titles I and II. A version of the bill marked up by the Senate
Health, Education, Labor and Pensions (HELP) committee in May
would require that all formula allocations be based on Centers
for Disease Control and Prevention (CDC) accepted HIV rates for
each state except for those states which have not yet switched
to an HIV reporting system. States that had not yet received CDC
approval would be granted a proxy number to estimate HIV certified
by the CDC. The proposed proxy number was a ratio of 9 HIV cases
to every 10 AIDS cases or 0.9. This immediately created concerns
among states which have switched to a CDC certified position but
which have lower reported rates of HIV than the proposed proxy.
The negotiators now seem to have a number of
proposals that they are considering. Although it appears that
they will seek to avoid using a proxy altogether, they also seem
to be committed to trying to move to the use of HIV data in some
manner. Negotiators recognize that this is problematic for some
states that do not yet have CDC accepted data or a mature HIV
reporting system. They are working to solve that issue.
Another hot discussion has been whether or not
to include additional services under the definition of Core Medical
Services. AIDS Action staff members have been told that the definition
may change to include Medical Nutrition Therapy, but that is the
only item negotiators are willing to discuss and that it is likely
that little else will change from the previous Senate bill. In
addition, AIDS Action staffers have also been told that negotiators
are considering provisions regarding the testing of pregnant women
and infants although it is not yet clear what the outcome of that
discussion is.
AIDS Action staffers have been told by
sources on Capitol Hill that negotiations have reached the stage
of sorting out “must have” from “nice to have.” This means that
the success or lack of success, of the negotiations are likely
to occur within the next week or two. AIDS Action will be certain
to let readers know when an agreement on these issues is reached.
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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