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July 2004 Health Disparity Explored in NORA Meeting On Monday, July 12, the National Organizations Responding to AIDS (NORA) coalition, for which AIDS Action serves as the convener, held its monthly meeting. The meeting featured Dr. Georges Benjamin, executive director of the American Public Health Association, speaking on health disparities and HIV. Preceding Dr. Benjamin’s presentation, coalition members heard a legislative update from NORA Executive Committee member Donna Crews, government affairs director of AIDS Action, and a care and treatment update from Jim Harvey, executive director of the HIV Community Coalition and a member of NORA’s Executive Committee. Ms. Crews started by noting the recent meeting of the President’s Advisory Council on HIV and AIDS (PACHA) on June 28 and 29. She then reported on remarks delivered by President Bush while in Philadelphia on June 23. During his remarks, the President announced an infusion of $20 million dollars into the AIDS Drug Assistance Program (ADAP) to end its existing waiting lists; support for the reauthorization of the Ryan White CARE Act “based upon the principles of focusing federal resources on life-extending care; ensuring flexibility to target resources to address areas of greatest need; and ensuring results”; the second distribution of funding to the focus countries of the President’s Emergency Plan for AIDS Relief (PEPFAR); and the naming of Vietnam as a fifteenth focus country for PEPFAR. She observed that media coverage of President Bush’s remarks highlighted the international elements, particularly Vietnam, while little attention was paid to the release of $20 million dollars for HIV treatment in the U.S. This difference revealed the media’s flagging interest in the domestic epidemic, she added. Ms. Crews concluded her presentations with a brief update regarding the subcommittee markup of the Labor, Health and Human Services, and Education appropriations bill, which took place on June 8. The appropriations were passed in the subcommittee with all HIV related programs receiving flat funding except for a $35 million increase in ADAP. Jim Harvey then outlined the impact that the release of incarcerated ex-offenders into metropolitan communities has on the HIV epidemic. Mr. Harvey provided an epidemiological view of incarceration and HIV rates in the District of Columbia. In 2002, the incarceration rate in the District was 50% higher than most rates, and the District’s inmate population had the greatest seroprevalence when compared to other jurisdictions. The high rate of HIV among D.C.’s incarcerated populations has significant implications for the prevalence rates within the city, as these prisoners are often released without health education or access to the community resources they need to stay healthy; for example, housing, transportation, and medical services. He assessed the HIV-related needs of previously incarcerated individuals as a “public health crisis.” After these reports, Jim Harvey introduced Dr. Georges Benjamin. Dr. Benjamin began his presentation, entitled “The Changing Face of AIDS: Eliminating Disparities,” by defining the term health care disparity. According to the Institute of Medicine, a health disparity is “a racial or ethnic difference in the quality of health care which is not attributed to access-related factors.” Disparities arise when access is equal but treatment is not. He stressed that income is not the issue. Within the HIV epidemic, there are glaring racial and geographic disparities that cut across the economic spectrum. To illustrate these disparities, Dr. Benjamin presented slides with statistics by race, which illustrated the striking differences in the number of HIV cases, the use of health services, the reasons for postponing care, and insurance coverage. After sharing these statistics, Dr. Benjamin offered reasons as to why minority groups are suffering from health care disparities. He explained that the reasons can be separated into two discreet categories: patient factors and provider factors. Patient factors contributing to differences in HIV incidence and use of medical care include fear of diagnosis, a sense of fatalism, lack of trust in their providers, fear of research, health literacy barriers, stigma, and the cost of care. Among the provider factors that contributing to disparities are a lack of cultural competence, a dysfunctional health care system, and a lack of measured practice outcomes. Dr. Benjamin then described the main federal HIV funding mechanisms, emphasizing that an increase in cost drivers and tax cuts, along with a decrease in budget spending, lead to the inadequacy of these funding mechanisms. At the conclusion of the presentation, NORA members had the opportunity to ask questions and engage in dialogue with Dr. Benjamin about health disparities and HIV. Many of the questions presented by the audience focused on the limited availability of physicians in high need areas. Dr. Benjamin commented on the large number of physicians leaving the field of medicine due to rising malpractice costs, especially in obstetrics. When asked about new initiatives to entice doctors to work in low income rural or urban settings, Dr. Benjamin spoke of Title VII of the Public Health Service Act which provides scholarship programs for physicians to work in rural community health centers. Also discussed was the fear and suspicion around medical research in some communities. Dr. Benjamin explained that questions remain about the long-term efficacy and safety of HIV treatments. As a result, many of the current treatment options are, in some ways, still experimental. This has becomes a barrier to care for many people within minority populations, because there is heightened fear and suspicion of individuals being used in medical experimentation without their knowledge or consent. For more information about NORA, e-mail Jessica Tytel at jtytel@aidsaction.org. |
