May 23, 2008
Vol. VII, Number 18
This
Week in Washington
1. Congressional
Briefing: The Need for a National AIDS Strategy
2.
CHAC Holds Bi-Annual Meeting
3. FY
2009 Budget Resolution Update
Announcements
1. Congress Recesses for Memorial Day Holiday
This Week in Washington
1. Congressional
Briefing: The Need for a National AIDS Strategy
On Tuesday, May 20th,
AIDS Action joined 33 HIV/AIDS Advocacy organizations in hosting a
Congressional Briefing entitled, “It’s Time to End the Epidemic at Home: The
Need for a National AIDS Strategy.” AIDS Action Foundation and Gay Men’s Health
Crisis were key organizers of the briefing, which was co-sponsored by
Representatives Tammy Baldwin (D-WI), Donna Christensen (D-VI), Eliot Engel
(D-NY), Mike Honda (D-CA), Barbara Lee (D-CA), Janice Schakowsky (D-IL), Hilda
Solis (D-CA), Edolphus Towns (D-NY), Maxine Waters (D-CA), and Henry Waxman
(D-CA). Rebecca Haag, Executive Director of AIDS Action, moderated the
briefing.
The briefing
featured expert panelists who called for the development of a comprehensive
National AIDS strategy to fight HIV/AIDS in the United States. They shared their varied perspectives on
why a strategically oriented and results driven strategy is essential to the
elimination of HIV in the United States and must be created now. Speakers included
Dr. David Holtgrave, Department Chair of the Health, Behavior, and Society
Department at Johns Hopkins School of Public Health; Mario Perez, Director,
Office of AIDS Programs and Policy, Los Angeles County Department of Public
Health; Phill Wilson, Executive Director of the Black AIDS Institute; Kathie
Hiers, CEO AIDS Alabama; Terell Halaska, Partner of HCM Strategists; and Dr. Marjorie Hill, Chief
Executive Officer of Gay Men’s Health Crisis. The briefing was attended by 109
guests including 33 bi-partisan Congressional staff.
Dr. Holtgrave, an
accomplished HIV prevention researcher, expressed why he feels a National AIDS
Strategy is necessary from an HIV prevention standpoint. He first gave the
epidemiological rationale for a strategy. He explained that the HIV incidence
rate in the U.S is still 40,000 or higher; with a new infection occurring every
10.5 minutes. There is an AIDS death every 30 minutes in the United States, glaring racial and ethnic disparities
continue to exist, and only half of HIV positive people are receiving the care
and treatment they need. According to Dr. Holtgrave these staggering statistics
are the result of a lack of federal strategic planning and an inadequate
investment in prevention strategies that work. He noted that the Centers for
Disease Control and Prevention’s (CDC) HIV prevention budget has decreased by
19.3% since 2002 after accounting for inflation. He said that a National AIDS
Strategy will help lower HIV rates in the United States, because it will set measurable goals and
accountability standards for achieving them. Lastly, he offered his
recommendations for what the prevention component of a National AIDS Strategy
would look like. It would first set forth ambitious goals and then set the
price tag for reaching them. According to Dr. Holtgrave it would re-establish
the CDC’s 2002 goal of reducing incidence rates by 50% in three years. It would
dedicate policies and resources towards a national education campaign, reducing
stigma, making people aware of their status, and producing an annual report
card. In closing Dr. Holtgrave said, “We have chosen our current reality,
lowering expectations, limiting resources, and not following the science. This
is a matter of National will, not national skill.”
Next, Mario Perez
described his experience managing a local response to HIV/AIDS in Los Angeles. He described the difficulties and financial
complexities of navigating layer upon layer of federal programming with no
clear overall strategy. He said that it is difficult to implement programs at
the local level because of varied and disconnected funding streams from the
federal government. Los Angeles receives federal grants on at least eight different annual funding
cycles, creating an administrative and financial nightmare that hinders the
effectiveness of a local response to the HIV epidemic. Mr. Perez also made
several recommendations for the development of a National AIDS Strategy. It
should: Focus on outcomes, create a single process owner, improve methods for measuring
progress, give a strategic orientation and clear accountability, unify a
disparate system, and involve the private sector and civil society.
Phill Wilson
depicted the realities of HIV/AIDS in Black America stating that the rates in
Black America are despicable for such a wealthy nation. He addressed the social
and biological factors in the epidemic among Black Americans. He said that the
AIDS story in America, and especially in Black America, is due to a failure to lead. He said
that now is the time to deliver by developing a National AIDS strategy that
addresses HIV/AIDS in Black America and as America as a whole. He said, “We must advance to a
new level of commitment with high expectations.”
Kathie Heirs
expressed views on the need for a National AIDS Strategy, from a Southern
perspective. The South, and more specifically her state of Alabama, are disproportionately impacted by
epidemic. She said that while the South has historically done poorly on many
health indicators, HIV rates are particularly grim. The South receives less
HIV/AIDS funding, both federal and private, per person than other regions of
the country. She lamented particularly on the shortage of CDC prevention
funding. She expressed some of the tragic personal stories in Alabama and the barriers to effectively responding
to a rural epidemic. She joked that Alabama
should apply for PEPFAR funding, because the prevalence of the disease in the
high-risk populations of her state “rival those of Africa.”
She said, “We need a plan.”
Terrell Halaska
indicated that the U.S.
government spends roughly the same amount of money on foreign and domestic AIDS
relief but that efforts abroad have been far more successful. She referenced
the website www.AIDS.gov which lists 30 domestic HIV/AIDS programs
housed in six different agencies with multiple coordinating functions. She
called the current domestic response a “Byzantine maze of programs” with no
clear coordinating leadership. She said it’s hard to tell who speaks for the
federal government and that it’s time the United
States takes the same approach domestically
as internationally. According to Ms. Halaska much of PEPFAR’s success has
hinged on a successful domestic plan including protocol for treatment, testing,
and prevention as well as a “connecting of the dots” with regard to existing
programs. She told the audience three things we could learn from PEPFAR and
apply at home: 1. political will and leadership 2. comprehensive strategies,
and 3. collaboration between governmental, including business, education, and
philanthropic sectors.
Finally, Dr. Marjorie Hill explained what advocates calling
for a National AIDS Strategy have achieved so far by working together as a
community. She referenced the collective planning that went into the successful
briefing and the momentum the call for a National AIDS Strategy has gained so
far. Currently over 200 organizations and several hundred of individuals have
endorsed the creation of a National AIDS Strategy. Both Democratic Presidential
candidates Hillary Clinton and Barack Obama have pledged to develop a National
AIDS Strategy if elected president that includes timelines, goals, clear
objectives, accountability, and coordination across federal agencies. The NAS
team continues to contact John McCain’s campaign to seek his support for a
National AIDS Strategy. Dr. Hill closed by saying that for a National AIDS
Strategy to have a tangible impact, the strategy must be owned by the federal
government; Presidential leadership and top level commitment are crucial. But
she also said that Congress’ role is critical. Congress must fund the
development and process of a strategy and hold the next Administration
accountable.
During the question and answer period, Representative Maxine
Waters (D-CA) made an appearance and addressed the audience. She credited the
progress the United States
has made in fighting the HIV/AIDS epidemic to the hard work of the advocates
and activists in the room. But, she said we have a very long way to go. She
congratulated advocates for bringing the persistent, consistent, and hopeful
message to Capitol Hill about the need for a National AIDS strategy. She said
that Members of Congress will take advocates lead in how to go about developing
this strategy. She said, “It’s time for a comprehensive strategy, and it’s time
for Congress to listen.” She said that creating a NAS can be done; we can set
new goals and achieve them.
To learn more about the Call for a
National AIDS Strategy please visit: www.nationalaidsstrategy.org.
2. CHAC Holds Bi-Annual Meeting
On Tuesday, May 20 and Wednesday,
May 21 the Centers for Disease Control and Prevention (CDC)/Health Resources
and Services Administration (HRSA) Advisory Committee on HIV and STD
Prevention and Treatment (CHAC) held their bi-annual meeting in Atlanta,
GA.
CHAC advises HRSA and CDC on activities related to prevention and
treatment of HIV/AIDS and further steps for collaborative action between the
two agencies.
Following opening remarks by the two CHAC Co-chairs, Dr.
Edward Hooks and Dr. Donna Sweet, Dr. Kevin Fenton, Director of the National
Center for HIV/AIDS, Viral Hepatitis, STD,
and TB Prevention (NCHHSTP), presented on recent developments within CDC. Dr. Fenton noted the March 5, 2008 testimony of CDC
Director Dr. Julie Gerberding before the House Committee on Appropriations’
Subcommittee on Labor, Health and Human Services, Education and Related
Agencies in which she described CDC’s leadership and efforts to move the United
States to become one of the world’s
healthiest nations. He also noted the
rotational approach being taken to fill temporarily the position of Director of
the Division of HIV/AIDS Prevention (DHAP), following the departure of Dr. Rob
Janssen on May 2. Dr. Rich Wolitski, the
DHAP Deputy Director for Behavioral and Social Science will serve as Acting
Director for six months. If a permanent
replacement has not been found, Janet Cleveland, DHAP Deputy for Prevention
Programs will serve as Acting Director.
Dr. Fenton also noted the Latino/Hispanic consultation on HIV/AIDS that
was held in April and the upcoming community mobilization meeting for the
Heightened National Response to the HIV/AIDS Crisis in the African American
Community.
In his update, Dr. Fenton made no mention of the release of
the long awaited revised CDC estimate of the annual number of new HIV
infections (HIV incidence estimate). In
response to a question from a CHAC member as to when the new estimate would be released,
Dr. Fenton replied, “In due course.”
During the discussion CHAC members also commented on the critical need
for improved HIV surveillance, the erosion of prevention and surveillance
resources in the FY 2008 appropriation and the President’s FY 2009 Budget
Request, and the potential impact of proposed Medicaid cuts. Members also
discussed the need for an infusion of funds for primary care to ensure that the
increased number of individuals newly diagnosed with HIV as a result of
increased testing initiatives are linked to care. In response to a question as
to when HIV data from all 50 states and the District of
Columbia will be released, Dr. Fenton noted the
maturation time frame for HIV reporting systems. He said that comprehensive data from all 50
states would be available in five years, which will be the year 2013.
The HRSA update was presented by Deborah Parham Hopson, HRSA
Associate Administrator and head of the HIV/AIDS Bureau (HAB). Ms. Hopson highlighted HAB’s efforts to
implement the 2006 reauthorization of the Ryan White CARE
Act, noting in particular the status of the FY 2008 grant awards and policy
studies underway. Among the policy
studies is a core medical services examination of the impact of the core
medical services provision on grantees’ service system and whether there are
disruptions in the continuity of care that impede the ability to respond to
clients’ needs and the effects of the provision on the diversity of the
provider community. There is also a
policy study assessing the impact of funding shifts on grantee care delivery
systems. Ms. Hopson also noted a study
being conducted by the Government Accountability Office (GAO) of the Minority
HIV/AIDS Initiative (MAI) as required by the
2006 reauthorization.
Ms. Hopson noted that HAB is preparing for the transition to
a new administration the 2009 reauthorization of the Ryan White HIV/AIDS
Program. HAB is also conducting an HIV workforce analysis.
During the question and answer discussion that followed her
update, Dr. Hopson clarified that the policy studies are being conducted by
non-HRSA personnel.
A major agenda item of the meeting was a discussion of the
next reauthorization of the Ryan White HIV/AIDS Program. There was general agreement that the CHAC
should not repeat the process of holding community forums around the country
that was done for the 2006 reauthorization of the CARE
Act. There was also general agreement
that given the need for a larger, more extended debate on health care reform,
the Ryan White HIV/AIDS Program should be reauthorized for three or four years
with minimal changes. There was an
acknowledgement that there will be many interpretations of what constitutes
“minimal change.”
Public comment was provided on Wednesday, May 21 by Ronald
Johnson of AIDS Action Council and Ann Lefert of the National Alliance of State
and Territorial AIDS Directors (NASTAD).
AIDS Action’s public comments follow:
CDC/HRSA Advisory Committee on
HIV and STD Prevention and Treatment
May 20-21, 2008
Atlanta, GA
Public Comments:
Ronald Johnson
AIDS Action Council
Good morning. My name is Ronald Johnson. I am the Deputy Executive Director of AIDS
Action Council. Formed in 1984, AIDS
Action Council is a national membership organization devoted to the development
of and advocacy for sound and effective federal policies and programs that are
responsive to the needs of all people living with and affected by HIV/AIDS and
the organizations that serve them.
AIDS Action commends the CHAC for beginning to focus on the
next reauthorization of the Ryan White HIV/AIDS Program. The CARE
Act has and continues to be essential to the lives of hundreds of thousands of
people and must continue beyond September 2009.
AIDS Action and its sister national organizations are
working together to forge a common, unified reauthorization agenda. We are working through the Ryan White CARE
Act Reauthorization Workgroup, which is a working group of the Federal AIDS
Advocacy Partnership (FAPP). Included in
the workgroup are the AIDS Alliance for Children, Youth and Families, NASTAD,
NAPWA, the National Minority AIDS Council (NMAC), the CAEAR Coalition, and The
AIDS Institute. AIDS Action has the
privilege to chair the workgroup and a co-chair will be named soon. In a meeting last week (May 14), the national
Executive Directors reaffirmed the workgroup as the primary vehicle for
developing a set of principles and positions to guide our collective, community
advocacy on Ryan White reauthorization.
While no firm positions have been set, there is a growing
agreement around to reauthorize the current program with some small
changes. As CHAC members mentioned
yesterday, there will be considerable debate as to what constitutes a “small
change.” One group’s “tweak” can be
another group’s major change. Also
consistent with views expressed in the CHAC discussion, several of the national
organizations also feel that a larger rethinking of HIV care should be done in
the context of the debate on health care reform.
AIDS Action and many other organizations also have joined
the Call for Action for a National AIDS Strategy. Any major restructuring of the Ryan White
program should be in the context of developing a National AIDS Strategy for the
United States’
HIV/AIDS epidemic. I note that yesterday
(May 20), a Congressional briefing on the need for a National AIDS Strategy was
held in Washington, D.C.
with a Standing Room Only audience of over 100 people, including staff of
several Members of Congress.
While we work towards a National AIDS Strategy and health
care reform, we should “tweak” and continue the Ryan White program. The Ryan White CARE
Act Reauthorization Workgroup would welcome the opportunity to present its
thinking to and dialogue with CHAC members at the next CHAC meeting.
Thank you very much.
3. FY 2009 Budget Resolution
Update
On Tuesday, May 20th, House and Senate Budget
conferees agreed upon a Fiscal Year (FY) 2009 Budget resolution, S. Con. Res.
70. The House and Senate will vote to
adopt the FY 2009 Budget conference in early June. The Budget Resolution
conference agreement total for non-defense discretionary spending is $21
billion higher than the President’s Budget request. Within that, the Function
550 received a total of $59.7 billion, a figure $5.2 billion higher than the
President’s Budget. The Function 550
covers most health spending except Medicare, including spending on health
services, research and training, and consumer and occupational safety. The
Health community had requested at least $58.556 billion for the Function 550.
After Congress adopts the budget resolution, the FY 2009 appropriations process
will begin.
Announcements
1. Congress Recesses for Memorial Day Holiday
Both the House and Senate break for a one week recess
in honor of the Memorial Day holiday. Congress will reconvene on Monday, June 9th.
During this time, please visit your Senator’s District offices and urge them to
support passage of S.2731, The Tom Lantos/Henry Hyde HIV/AIDS Tuberculosis and
Malaria Reauthorization Act of 2008 (PEPFAR Reauthorization). Tell them to urge
Majority Leader Harry Reid (D-NV) to make PEPFAR Reauthorization a priority by
scheduling a floor vote and ensuring passage of this crucial and life saving
legislation.
The
AIDS Action Weekly Update
The Weekly Update is written with the
interests of our members in mind. If you are interested in membership with AIDS
Action, we invite you to contact aford@aidsaction.org.
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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 AIDS service organizations, health departments, and
a diverse network of community-based organizations across the country,
working with and for people living with and affected by HIV.
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