September 8, 2006

This Week in Washington
1. Ryan White Care Act Update
2. HIV/AIDS Braintrust at the Congressional Black Caucus Foundation 36th Annual Legislative Conference
3. The Stop AIDS in Prison Act of 2006 Introduced by Representative Maxine Waters

Continuing Coverage of the International AIDS Conference
1. Kaiser hosts “Post AIDS 2006” Briefing on the International AIDS Conference
2. AIDS Action Members Host Satellite Session at the International AIDS Conference

Announcements
1. Mark B. McClellan Announces Resignation

This Week in Washington
1. Ryan White Care Act Update
The Bi-partisan Bi-cameral committee leadership of reauthorizing the Ryan White Care Act released a draft bill on Thursday September 7, 2006. A stakeholder’s meeting of community providers to discuss the latest draft bill is scheduled to take place on Monday September 11, 2006. AIDS Action will be in attendance and will provide a more detailed update on the status of the bill in next week’s Weekly Update.

2. HIV/AIDS Braintrust at the Congressional Black Caucus Foundation 36th Annual Legislative Conference
The Congressional Black Caucus Foundation held its 36th Annual Legislative Conference at the Washington Convention Center from September 6-9, 2006. On September 7, 2006 The Congressional Black Caucus Foundation held an HIV/AIDS Braintrust entitled, “HIV/AIDS at 25: A Generation of Unmet Challenges.” The braintrust was organized by Representatives Barbara Lee (D-CA) and Donna Christensen (D-VI) to explore the successes, issues, and current challenges in the fight against HIV/AIDS in the African American community that have emerged over the past twenty-five years. Bernard J. Tyson, Senior Vice President of Health Plan/Hospitals Operations for Kaiser Foundation Health Plan, Inc. and Kaiser Foundation Hospitals moderated the discussion. The brain trust featured four distinguished panelists in addition to Representatives Lee and Christensen. The panelists included Cornelius Baker, National Policy Advisor, National Black Gay Men’s Advocacy Coalition, Kwame Roberts, Administrator Regional Addiction Prevention, Chris Collins, of Open Society Institute and author of HIV/AIDS Policy in the United States: Monitoring the UNGASS Declaration of Commitment on HIV/AIDS, and Bishop Zachary Jones of the United Fellowship Church in Brooklyn.

Congresswoman Barbara Lee opened the session by asking, “Why is it that 25 years into the epidemic African Americans represent 50% of new HIV cases?” She went on to ask why African American women are 23 times more likely to have an AIDS diagnosis than their white counterparts and why is AIDS the leading cause of death in African American women ages 25-34. She explained that with Representatives Donna Christensen and Maxine Waters (D-CA), she signed a National Call to Action and Declaration of Commitment to end AIDS in the black community at the IVX International AIDS Conference in Toronto. She offered the need of a national action plan as the theme of the braintrust, with the first step to be to stop the silence about how HIV/AIDS is impacting the black community.

After Representative Lee’s remarks, Bernard Tyson spoke briefly before introducing the panelist speakers. He said, “The health care disparities African Americans are facing is the unfinished business of the civil rights movement.” He gave several statistics to highlight the race disparities in HIV/AIDS. 1996 was the first time more African Americans died of AIDS than whites. African Americans are seven times more likely to die of AIDS than whites after diagnosis. And, while African Americans make up only 13% of the American population, they represent 50% of new HIV cases. He spoke on the 5 reasons HIV in African Americans is out of control in the United States. These 5 reasons came from the ABC Primetime special, “Out of Control: AIDS in Black America” which aired on August 24, 2006. The five reasons are ignorance, government failure, sex and sexual behavior, being black and gay, and a failure of leadership in the black community. As Mr. Tyson turned the conversation over to the featured speakers he asked them to touch on those five points.

Cornelius Baker spoke first. To lay out a perspective of the impact HIV is having on African Americans, he shared the fact that 40 million people are infected with HIV around the world, and African Americans are the majority of those infected in all of those places. He said, “The African American community is struggling to stay alive.” Cornelius stressed that this struggle was not a new phenomenon. As early as 1983, 29% of HIV cases in Washington DC were in black men. He believes we must address this history of disparity instead of noticing changes in the face of the epidemic. He discussed two previous studies conducted by the Centers for Disease Control (CDC). A five city surveillance study looking at HIV rates in black men who have sex with men (MSM) came out in June of 2005. You can read the results of this study at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5424a2.htm. This study found that the average rate of infection in Black msm is 46%. The second study he highlighted was a study done over two years ago looking at an HIV outbreak in a small rural college in North Carolina. Results of this study can be found at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5332a1.htm. This study showed the need for HIV education in rural communities and promotion of healthy sexual relationships. Mr. Baker stated, “These studies are the proof, but we can’t do anything with them without the proper government and community leadership. We need to step up leadership as a black community.”

Kwame Roberts followed Mr. Baker’s remarks. He spoke on the unique issues of HIV/AIDS in the incarcerated population. He explained why there is so much blame put on the prison system. African Americans compose 45-60% of the population in prisons. Mr. Roberts described prisons as cocoons for HIV infection because of the sexual behavior, sexual assaults, injection drug use, and tattooing that rampantly occurs. He stated that it is critical to be aware of the fact that 96% of inmates eventually go back to their communities. It is estimated that 7-10% of those individuals leave jail infected with HIV. When they do re-enter their homes, families, and communities, they are totally disconnected from society with no social supports. Mr. Roberts went on to explain the policy implications of these findings. He thinks we must reform the “war on drugs” and stop incarcerating people for non-violent crimes. There needs to be harm reduction methods such as condoms and clean needles in prisons. Funding for the Minority AIDS Initiative of the RWCA must be increased. Mr. Roberts said, “Inmates can no longer return home without being tested or treated for HIV, and we must commit to eliminating barriers for these individuals once they are released back into society.”

Chris Collins spoke next. He focused on US policy failures in the prevention and treatment of HIV/AIDS in the black community. He noted that from 2002-2004 the death rate from AIDS decreased 19% in whites, but only 7% in African Americans. He explained that inequities in addressing the epidemic in the black community have been evident since the beginning of HIV, but the current administration has exacerbated those inequities by flat funding the RWCA and not using a comprehensive prevention approach. Mr. Collins proposed three top priorities for future HIV policy making. The first is to establish a national AIDS strategy with concrete goals and outcomes. He said, “We are a nation with no plan of action, no goals, and no accountability. We need clear roles, responsibilities, and timelines. We need to focus on results and design policies with the complete involvement of civil society.” He explained that a national strategy plan in the form of a piece of legislation would be inexpensive and its targets could be used as a tool for advocates and the media. It would serve as a measure of progress and send a message of governmental failures to congress. His second proposed priority is an expanded effort to address racial disparities in health. He said, “We need a President’s Emergency Plan for AIDS Relief (PEPFAR) for the United States.” Lastly, we need increased resources. These resources need to be spent on comprehensive sexuality education, and tools like vaccines, microbicides, and pre-exposure prophylaxis. We also need a comprehensive assessment and evaluation of what CDC has done with the resources it has. Chris Collin’s report, HIV/AIDS Policy in the United States, can be found at: http://www.soros.org/initiatives/health/focus/phw/articles_publications/publications/hivaids_20060523.

Next Bishop Zachary Jones shared his thoughts on the role of black churches in curbing the HIV epidemic. He stated that black preachers are currently echoing the words of white evangelicals, not recognizing the important role of black gay men in families and the community. Black churches are not offering a welcoming environment for black gay men, adding to the stigmatization that they face. This stigmatization leads to the lack of open conversation and education about HIV which the church should be facilitating.

Representative Donna Christensen concluded the panel discussion. She strongly said, “It is time to confront the crisis. African Americans must own it and confront it.” She reminded the audience that is has been eight years since the Minority AIDS Initiative was launched, and we are 25 years into the epidemic. Yet, black people are still being so disproportionately affected, with Washington, DC leading the pack. She renewed the call for a State of Emergency in communities of color. “We must be stronger and much firmer in our advocacy for the RWCA, MAI funding, needle exchange, and comprehensive prevention. Now is not the time for small incremental change. We must go for what we really need and the Congressional Black Caucus must be instrumental in that change.”

3. The Stop AIDS in Prison Act of 2006 Introduced by Representative Maxine Waters
H.R. 6038, The Stop AIDS in Prison Act of 2006, was introduced on September 6, 2006 by Representative Maxine Waters (D-CA). This bill was created to provide an effective HIV/AIDS Program in Federal Prisons to stop the spread of HIV/AIDS among inmates and protect prison guards and other personnel from HIV/AIDS infection.

The key elements of this bill center on HIV testing procedures in federal prisons, HIV/AIDS prevention education, and comprehensive medical treatment for all inmates who test positive for HIV/AIDS.

The bill states that medical personnel shall provide routine HIV/AIDS testing to all inmates as part of a comprehensive medical examination immediately following admission to a facility and prior to their release and reentry into the community. All inmates have the option to opt-out of routine HIV/AIDS testing. Their refusal will not be considered a violation of prison rules. Inmates shall be allowed to obtain HIV/AIDS tests upon request once per year or whenever an inmate has a reason to believe he/she may have been exposed to HIV/AIDS. According to the bill, post-test counseling must be provided to all inmates who test positive for HIV/AIDS. The bill requires the Bureau of Prisons to develop procedures for HIV tests that ensure inmate confidentiality. If an inmate tests HIV positive, the bill states that medical personnel must provide comprehensive medical treatment to that individual as well as confidential counseling on managing their medical condition and preventing its transmission to others.

Continuing Coverage of the International AIDS Conference
1. Kaiser hosts “Post AIDS 2006” Briefing on the International AIDS Conference
On September 6, 2006 The Kaiser Family Foundation in partnership with the Center for Strategic and International Studies sponsored a briefing titled: “Reflections on the XVI International AIDS Conference in Toronto- Moving Forward from Time to Deliver.” Jennifer Kates, Vice President and Director of HIV Policy at the Kaiser Family Foundation moderated the conference. Panelists Helene Gayle, International AIDS Conference (IAC) co-chair and President and CEO of CARE USA, Todd Summers, Senior Policy Officer for Global Health of the Bill & Melinda Gates Foundation, and J. Stephen Morrison, Executive Director of HIV/AIDS Task Force and Director, Africa Program, Center for Strategic and International Studies, all shared their thoughts on the outcomes of the IAC and their strategies for moving forward.

Jennifer Kates offered opening remarks and introductions. The goal of the briefing was to reflect on the conference while providing an opportunity to address the conference’s implication for the future. She stated that the IAC can no longer be looked at as a single isolated event, but it is critical in the process of moving forward. She felt as though the 16th IAC was different and more visible than prior conferences with a clear elevation of prevention on the agenda. Women, gender inequalities, and the discussion of accountability were also emergent themes of the conference according to Ms. Kates. She then introduced the panelists. After her introductions a she showed a video presentation featuring snapshots of the speeches and sessions at the conference.

Ms. Gayle spoke first. Throughout Helene’s speech, she emphasized that the conference is part of a process, not a piece in time, and it is meant to continue momentum in the fight against AIDS. As the conference co-chair she spoke first about planning the conference. There was a great deal of thought debate on naming the conference “Time to Deliver.” By deciding on that theme, it was Helene’s hope that accountability would pervade the conference. She said, “We have more of what it takes. We have 8.5 billion dollars, more government commitments we never had, and more knowledge, but we are not giving it our all. We still aren’t moving forward like we should.” She went on to say that the key of the IAC is to pull together information, facilitate information sharing, bring together diverse communities, and renew commitment. She feels those goals were met at the AIDS 2006 conference.

She then touched on what she saw as the emerging themes of the conference. She said that that prevention was now being heard loud and clear. The Gates helped put it on the map. In his speech at the conference Bill Clinton said, “Treatment must reinforce prevention efforts.” Ms. Gayle said, “It was wonderful to hear that treatment supports prevention.” The second theme was Women. She pointed out that we have been negligent in providing for the needs of women in two categories: prevention tools for women and addressing the broader underlying vulnerabilities of women such as gender inequality, poverty, and food security. She also thought treatment continued to be a highlight of the conference. “There is no turning back on Universal Treatment,” she said. She continued, “We need to make sure people have access. It must continue to be a world priority.”

She also commented on vaccines. While there continues to be scientific advancement in vaccine research, there is still little hope for a vaccine in the near future. There is forward movement but little clarity on how long it will take and whether it will be a preventative or therapeutic vaccine. She expressed that this gives priority to the advances like microbicides which should be available sooner. She said, “The world cannot give up on vaccines, but must accept the pace of science. We need to be comfortable with incremental advances, not huge breakthroughs.”

Todd Summers spoke next and also noted that there were no big scientific breakthroughs at this conference. Todd went on to explain the Gates Foundations top priorities for the conference. The first is that HIV prevention is a focus of the global response. The Foundation wants a balance of prevention and treatment. Their second priority is women. Bill and Melinda Gates both strongly believe in an increased investment in microbicides and methods women can control until a vaccine is developed.

The secondary goals of the Gates Foundation at the conference were to give the Global Fund a strong push. Gates recently gave the Global Fund a $500 million dollar contribution. He sees it as a critical fund worthy of other donors. The Foundation also wanted to portray its strong interest in HIV prevention technologies and reaffirm their commitment to vaccines. The Foundation’s last objective at the conference was to emphasize the impact PEPFAR has had, despite its prevention challenges. Mr. Summers said, “We must realize that PEPFAR has changed the landscape of treatment from millions to billions.” Mr. Summers concluded by noting that because of the United State’s immigration ban on people with HIV, we could never have a conference in the United States. “We need an effort to overcome that ban,” he said.

Stephen Morrison followed Mr. Summers. He believes that with a little leadership in Congress, a measure to change the HIV Visa ban could be accomplished with very little cost. Mr. Morrison thinks it would bolster Congress and the Administration’s global credibility if the conference could be held in the United States. Mr. Morrison focused his remarks on the paradox between United States leadership in HIV/AIDS and our lack of global credibility. “There is tremendous stigma around US leadership and PEPFAR including very real policy debates on ABC, abstinence only prevention and the prostitution pledge,” he said. Mr. Morrison believes these policy debates are prone to distortion, causing the bigger picture of the overall US contribution to be lost. According to him, this decreases public acknowledgement and support, hampering efforts for increased funding. If we can talk more openly about these debates, the successes of United States leadership will be less obscured. By focusing on the reality of the impact the funding is having on the ground in PEPFAR countries, we can increase American support for future appropriations.

Mr. Morrison recognized the extreme polarization surrounding prevention, its high cost, moral ideology, and scientific evidence. He said there seems to be optimism around microbicides and the scientific prevention agenda. He suggests we merge the optimism and polarization to allow for a change in prevention, secure higher level resources, and manage these resources carefully and sensibly. He went on to say that not only is there a lack of support of American leadership, but there is also a huge leadership gap in impacted countries. The leaders of those developing countries need to be at the table to move forward from the conference.

A question and answer session followed the panelist’s speeches. A complete webcast of the briefing as well as the video snapshots can be viewed at www.kaisernetwork.org/healthcast/kff/06sep06.

2. AIDS Action Members Host Satellite Session at IAC
On Tuesday, August 15, 2006, two AIDS Action members, the District of Columbia Department of Health, Administration for HIV Policy and Programs (AHPP) and the Urban Coalition for HIV Prevention Services (UCHAPS) presented a breakfast satellite session, attended by 75 people, at the XVI International AIDS Conference in Toronto, Canada. The session entitled “Municipal Government Action on HIV”, focused on the leadership role that city health departments, local and national governments, and community stakeholders play and/or assume in the global response to HIV. Charles Sessoms, Community Liaison from AHPP and a UCHAPS member, moderated the session.

The session included an overview of Washington DC’s innovative HIV screening campaign entitled “Come Together DC – Get Screened DC”, presented by AHPP Prevention Bureau Chief Leo Rennie as an example of a municipal government and community collaboration. UCHAPS members Scott Kellerman, MD, (New York City) responded by sharing New York’s experience expanding routine HIV screening and routinizing it in hospital emergency rooms in New York City. Michael Milsap (Philadelphia) added examples of how Philadelphia’s Community HIV prevention planning processes had been reviewed and assessed to reflect current realities and emerging needs, resulting in new priorities for funding. Jeffrey Bailey (Los Angeles) also shared Los Angeles County’s experience with special populations in unique venues and settings and how targeted prevention services can be effective in controlling a local epidemic. Steven Tierney, PhD, (San Francisco) summarized the presentations, acknowledging the importance of UCHAPS and its peer-to-peer technical assistance and best practices. Jim Harvey (Washington, DC) reiterated the importance of sharing experiences across jurisdictions and called on Dr. Marsha Martin to introduce and discuss City AIDS, a global network of municipal responses to HIV.

In her remarks, Dr. Martin stated, “In countries around the globe, municipal governments are at the forefront of the community's response to health challenges, including HIV. Municipal governments, in most cases working with national governments, private sector resources, and community leaders help to develop and implement local and national health programs, including policies for preventing and controlling HIV. Examples here at home include the CAEAR Coalition, an organization designed to represent partnership between government and community; NASTAD, an organization designed to represent state government responses; and PACHA, a national/federal advisory body.” After a brief overview of the program, Dr. Martin introduced Luc Constantin of UNAIDS. He presented a model of municipal collaboration, designed to increase AIDS competence through knowledge exchange and collaborative facilitation. Dr. Martin announced plans to invite the City AIDS representative to the fall UCHAPS meeting and announced the formation of City AIDS – North America.

In addition to hosting a satellite session, AHPP also escorted a delegation of 25 people from Washington, DC to the conference. The delegation consisted of AHPP staff members, including AIDS Action Council board members Paul Cunningham and Gunther Freehill, leadership from the local Ryan White Planning Council, HIV Prevention Community Planning group, HIV/AIDS Drug Advisory Committee, and the Mayor’s Task Force on HIV.

Announcements
1. Mark B. McClellan Announces Resignation
Centers for Medicare and Medicaid Services (CMS) Administrator Mark B. McClellan announced on Tuesday September 5, 2006 that he plans to step down from his post by early October. The resignation of the head of the Centers for Medicare and Medicaid Services creates a critical vacancy as the Bush administration enters its final two years.

The CMS administrator oversees Medicare, Medicaid and the federally subsidized State Children's Health Insurance Program (SCHIP), which together serve about 90 million Americans and account for more than $535 billion a year in federal spending. During his time as chief of Medicare, McClellan took charge of implementation of the program’s new prescription drug benefit, known as Part D.

McClellan, who has run the agency since March 2004, earlier served as commissioner of the Food and Drug Administration and as a member of Bush’s White House Council of Economic Advisers. He also served in the Treasury Department during the Clinton Administration. He told agency employees in an e-mail Tuesday that he is leaving to spend more time with his family. Its is speculation that McClellan, 43, is contemplating a return to academia or a position in a Washington think tank such as the Brookings Institute or the American Enterprise Institute.

Department of Health and Human Services Secretary Michael O. Leavitt issued a statement after McClellan’s announcement saying, “His energy and commitment have been vital to the accomplishments of this department and administration.”

Speculation about a successor to Mark B. McClellan centered on some of his underlings at the agency. Possible successors, at least on an interim basis, include Leslie V. Norwalk, the deputy administrator of CMS; Herb Kuhn, director of the agency's Center for Medicare Management; and Julie Goon, a special assistant to Bush and formerly the director of Medicare outreach at the Department of Health and Human Services.

The AIDS Action Weekly Update
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