Why Are Older Adults with HIV at Increased Risk for Multimorbidity

NMAC

 

 

Advocacy and Education Webinar Series
Please join us for our next webinar!
Why Are Older Adults with HIV at Increased Risk for Multimorbidity?
By Dr. Stephen Karpiak
Friday, April 6th, 2018 – 3:00 PM to 4:00 PM EST
Registration URL: https://attendee.gototraining.com/r/1280203559206296322
(After registering you’ll receive a confirmation email with information about joining the training.)
As people living with HIV experience longer lives, healthcare providers are spending less
time managing HIV-related issues and more time managing age-associated illnesses.
Multimorbidity refers to several serious health conditions that cannot be cured to any
great extent, occurring in an older person and engendering functional and/or cognitive
debility. Join us as we explore this topic with national expert on HIV and aging, Dr.
Stephen Karpiak from ACRIA.
Stephen Karpiak PhD is the Senior Director for Research at the ACRIA Center on HIV &
Aging at GMHC, where he launched ROAH, the seminal Research on Older Adults with HIV,
and supervised clinical trials for HIV drugs. He is a member of the Einstein-Rockefeller-Hunter
Center for AIDS Research, Editorial Board HIV-AGE (www.HIV-AGE.org) American Academy of
HIV Medicine, the American Geriatrics Society, and, the UN Aging Committee. Dr. Stephen is on
faculty at NYU and has published over 150 peer reviewed scientific papers.
Website: http://www.SEKPhD.com

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Cuts that Hurt: What the President’s FY18 Budget Proposal Means for HIV services and people of color

 

 

 

 

 

President Trump’s FY18 budget proposal included several cuts that would directly impact people of color (POC) living with or vulnerable to HIV. It is important to remember that the President’s budget recommendations are only the start of the budget process. Congress makes the final decision on funding for the government.

YOU CAN HELP: It is very important that our elected officials hear from us to save our services for HIV prevention and care. Please join us for this year’s HIV/STD Action Day on September 6 2017, the day before the start of the 2017 United States Conference on AIDS, and speak to your Member of Congress directly or organize an effort in your own local district.

Secretary’s Minority AIDS Initiative Fund (SMAIF)

The President’s FY18 budget request eliminates funding at this critical time in the SMAIF’s existence. Each year, the SMAIF provides over $50 million to support a wide range of activities designed to support communities of color (including, but, not limited to projects that: (1) get and keep people of color in care; (2) build leadership among people of color at the local level who are either living with or affected by HIV, and (3) address Hepatitis C in those living with HIV).

  • POC  IMPACT:  The  proposed  elimination  of  the  SMAIF  would  remove  a  key  resource  that promotes innovative and cost-­effective programs specifically tailored for communities of color and that influence HIV related programs across the entire Department of Health and Human Services.

Cuts to the Ryan White HIV/AIDS Program will
↑ Increase health inequities
↓ Reduce support services for persons living with HIV

Although  praised  by  the  Administration,  the  President’s  FY18  budget  request  decreases funding for the Ryan White program by $59 million (eliminating funding for  the  AIDS  Education  and  Training  Centers  (AETC)  which  train  medical  professional and Special Projects of National Significance (SPNS) programs).

  • POC IMPACT: The proposed cuts to the AETCs will reduce access to important training programs that help the healthcare workforce prepare to meet the needs of clients seeking HIV-related services – particularly, people of color.
  • POC IMPACT: The proposed cuts to the SPNS will stall: (1) evaluation of treatment models; (2) dissemination and replication of successful interventions; (3) capacity-­building in the health information technology systems of the Ryan White program.

Cuts to HIV Prevention will likely cause
Community-­Based Organizations (CBOs) near you to lose funding or close
+30,000 more Americans will become HIV-­positive
‐ 1,000,000 fewer HIV tests will be performed

The President’s FY18 budget request reduces the Centers for Disease Control and Prevention (CDC) funding for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Infections and Tuberculosis by $186.1 million. The proposed cuts to CDC would scale-­down local HIV prevention activities  that  have  just  started  to  reach  communities  of  color,  including  support  for  pre-­exposure  prophylaxis (PrEP) as well as efforts around treatment as prevention which would deeply harm the communities most vulnerable to HIV.

  • POC IMPACT: The proposed cuts to CDC threaten the existence of CBOs as cuts to their HIV prevention funding would greatly reduce services including testing, linkage services, prevention campaigns, and health education programs. Thousands more people will be unaware of their HIV status and those who need care will not be linked to life‐sustaining services.

Cuts to Medicaid will likely cause Millions to lose their Medicaid Coverage

The President’s FY18 budget request cuts $610 billion (over 10 years) to this joint federal/state program that provides healthcare services for people with limited income and resources. Medicaid remains one of the largest payers of insurance for people living with HIV.

  • The proposed cuts to Medicaid would especially impact communities of color and put their health and well-­being at-­risk since they will lose their access to HIV prevention and treatment services.

Cuts to National Institutes of Health (NIH) will Adversely impact the Office of AIDS Research (OAR)

The President’s FY18 budget request reduces funding by nearly $5.8 million. Such a large cut would likely harm researchers’ ability to find new prevention strategies and to make sure treatment options meet the needs of those on treatment.

  • POC IMPACT: The President’s FY18 budget request proposes the elimination of the Agency for Healthcare Research and Quality (AHRQ). With an emphasis on health disparities experienced by persons of color when they access healthcare services, AHRQ produces the annual National Healthcare Quality and Disparities Report as well as periodic updates on the National Quality Strategy.
  • POC IMPACT: The proposed cuts to NIH greatly undermine current long­‐term research on HIV vaccines and the hunt for a cure for HIV. Both Black and Latinos continue to be disproportionately affected by HIV and in need of HIV-­related services.

Cuts to the Housing Opportunities for Persons with AIDS (HOPWA) Program will likely cause more than 33,000 homeless People Living with HIV (PLWH) to lose housing support services

Despite being praised by the Administration, the President’s FY18 budget request proposes cutting HOPWA by approximately $26 million dollars.

  • POC IMPACT: The proposed cuts to HOPWA would reduce funding to below FY16 levels (although the 2016 levels were deemed inadequate and the HOPWA formula was updated by the Housing Opportunity through Modernization Act (HOTMA) in 2016).
  • POC IMPACT: The proposed cuts to HOPWA would reduce funding to below FY16 levels (although the 2016 levels were deemed inadequate and the HOPWA formula was updated by the Housing Opportunity through Modernization Act (HOTMA) in 2016). Several thousand fewer homes will be available for homeless or housing unstable PLWH.

Cuts to the Substance Abuse and Mental Health Services Administration (SAMHSA) will
‐ Reduce the SAMHSA Minority AIDS Initiative Funds by $17.7 million

The President’s FY18 budget request decreases SAMHSA funding by $374 million.

  • POC IMPACT: The proposed cuts to SAMHSA would directly impact communities of color since, in 2015, 65% of those who identified injection drug use as the mode of HIV transmission were people of color.
    • Specifically, the SAMHSA Minority AIDS Initiative Funds will reduce the resources available for substance use-­related HIV prevention and treatment programs focused on engaging people of color.

GOOD NEWS→

The President’s FY18 budget proposal is just a recommendation to Congress and only the first step in the Federal Budget Process:

Step 1: The President’s Budget Request

  • The President submits a detailed budget request for the coming fiscal year, which begins on October 1.

Step 2: The Congressional Budget Resolution

  • Congress usually holds hearings to question Administration officials about federal agency funding requests
  • Congress usually holds hearings to question Administration officials about federal agency funding requests
  • The federal House and Senate Budget Committees then develops its own budget resolution (which are supposed to be filed by April 15th)
  • The full House and Senate then vote on its own budget plan (only a majority vote is required to pass)

Step 3: Enacting Budget Legislation

  • The federal House and Senate Appropriations Committees determine program-­by-­program funding levels in 12 separate bills
  • The federal House and Senate Appropriations Committees determine program-­by-­program funding levels in 12 separate bills
  • Most HIV related programing is determined in the Labor­-Health and Human Services­-Education and Related Agencies appropriations bill

TAKE HOME MESSAGE→ The final distribution of funds is ENTIRELY in the hands of Congress

HIV TESTING IMPROVE

Frequency of HIV Testing and Time from Infection to Diagnosis Improve

 


 

HIV and Our Youth

KEY FINDINGS

1. HIV hits close to home for many young people of color.

Due to a combination of social inequities and where the disease initially took hold, HIV has disproportionately affected Black and Latino populations. The uneven impact of HIV is reflected in the starkly differing views and experiences reported by those of different races.

About three times as many Blacks and Latinos, as whites, say HIV today is a “very serious” issue for people they know.

National Survey of Young Adults on HIV/AIDS chart: How serious of a concern is HIV for people you know?

Almost twice as many Blacks, as whites or Latinos, say they know someone living with or who has died of HIV. One in five Blacks have a family member or close friend affected by HIV.

National Survey of Young Adults on HIV/AIDS 15

About a third of Black and Latino young people say they worry about getting HIV; approximately half as many whites express concern about their own risk.

National Survey of Young Adults on HIV/AIDS 16

2. Many are not aware of advances in HIV prevention and treatment.

In the five years since PrEP, the pill to protect against HIV, was approved by the Food & Drug Administration, only about one in ten young adults know about the prevention option.

When taken as prescribed, PrEP is highly effective in protecting against HIV. PrEP is also a significant advance in that it provides women with the first HIV prevention tool that they can control themselves.

National Survey of Young Adults on HIV/AIDS 17

There are also gaps in understanding of how the medications used to treat HIV work. While most young adults are generally aware of the health benefits of antiretrovirals (or ARVs), many understate their effectiveness and few know they also prevent the spread of the virus.

ARVs work to reduce the viral load to levels undetectable by standard lab tests. Studies show that when the viral load is less than 200 copies of virus per milliliter of blood, long-term health is greatly improved and sexual transmission of the virus is extremely unlikely, if not impossible.

National Survey of Young Adults on HIV/AIDS chart: How effective are current HIV treatment options

3. Stigma and misperceptions about HIV persist.

Most young people today say they would be comfortable having people with HIV as friends or work colleagues, but when it comes to other situations, the stigma of the disease is evident.

National Survey of Young Adults on HIV/AIDS chart: How comfortable would you be

Providing insight into what may be behind the stigma, the survey also reveals a lack of understanding among some about how HIV is and is not transmitted.

National Survey of Young Adults on HIV/AIDS 20

4. HIV testing is occurring less than generally recommended. 

The CDC recommends HIV testing as part of routine health care, yet more than half of young adults say they have never been tested.

Black young adults are more likely – and more recently – to report having gotten an HIV test.

National Survey of Young Adults on HIV/AIDS chart: Have you ever been tested for HIV

5. The Internet is a go-to resource for HIV information.

After school, searching online is one of the most often named sources of HIV information by young adults (multiple responses possible). Almost as many cite some form of media as doctors for at least “some” information.

National Survey of Young Adults on HIV/AIDS chart: How much information about HIV have you gotten from

Four in ten say they would like more information about at least one basic HIV topic asked about. More Black and Latino young people indicate they want to know more about HIV, across all topics, as compared to whites.

National Survey of Young Adults on HIV/AIDS 24

National Men’s HIV/AIDS Awareness Day

HIV.gov Shares Communication Tools for Gay

AIDS United Responds to Fiscal Year 2017 Omnibus Appropriations Bil

 

AIDS United acknowledges that the Fiscal Year 2017 omnibus appropriations bill, released last night, provides continuity of HIV funding for most domestic programs. This is an important development for maintaining our progress towards the national goals and priorities of reducing new HIV infections, increasing access to care and improving health outcomes for people living with HIV, and reducing HIV-related health disparities.

While most HIV programs will see level funding in the budget, AIDS United is concerned that a $4 million cut to Ryan White HIV/AIDS Program Part C clinical providers and a $5 million cut affecting the budget to fight sexually transmitted infections will diminish our response to HIV and health care, particularly given the increasing cases of sexually transmitted infections, such as syphilis, among men who have sex with men.

“Knowing that Congress plans to keep funding intact for most HIV efforts is reassuring, but we urge Congress to also ensure that Part C clinical providers and our response to sexually transmitted infections are fully funded,” said AIDS United President & CEO Jesse Milan, Jr.

AIDS United is particularly appreciative that Congress listened to the voices of people living with and affected by HIV in increasing funding for the Housing Opportunities for People With AIDS (HOPWA) program by $21 million. “Housing is fundamental to ensuring that people living with HIV live longer and healthier lives and we thank Congress for recognizing the importance of this program by securing its current stability,” said Milan.


About AIDS United: AIDS United’s mission is to end the AIDS epidemic in the U.S., through strategic grant-making, capacity building, formative research and policy. AIDS United works to ensure access to life-saving HIV/AIDS care and prevention services and to advance sound HIV/AIDS-related policy for U.S. populations and communities most impacted by the epidemic. To date, our strategic grant-making initiatives have directly funded more than $104 million to local communities, and have leveraged more than $117 million in additional investments for programs that include, but are not limited to HIV prevention, access to care, capacity building, harm reduction and advocacy. aidsunited.org

House and the Administration Begin to Show Their Hands

February 23, 2017

House Republicans Unveil a Health Care “Policy Menu”; Trump Department of Health and Human Services Proposes First Major Health Care Regulation

 

Although there is still no specific ACA repeal and replace proposal from the hill, both Congressional Republicans and the Trump Administration released documents last week articulating their approach to replacing the ACA and addressing concerns with the Marketplaces in the meantime. Congressional Republicans released a Health Care Policy Brief that is intended to serve as a menu of potential elements for a forthcoming ACA replacement bill. This Brief includes elements that have been found in previous ACA replacement proposals and that present concerns for access to care. Further, the Department of Health and Human Services (HHS) released a proposed rule entitled “Patient Protection and Affordable Care Act; Market Stabilization” (proposed rule), which is intended to help stabilize the Marketplaces until an ACA replacement is completed. Unfortunately, some of its changes may limit access to care for vulnerable individuals and make the Marketplaces less friendly to those living with chronic illnesses and disabilities. Advocates should be sure to understand both documents as well as send comments on the proposed rule to HHS by March 7, 2017.

Advocates Should:

1. Review the Health Care Policy Brief released by House Republicans last week to better understand which ideas are popular among Congressional Republicans and likely to make it into any ACA repeal and replace proposal.

2. Understand the proposed Market Stabilization regulation released by the Department of Health and Human Services and how it will impact access to care in the 2018 qualified health plans.

3. Submit comments on the proposed rule to HHS urging them to consider the impact the proposed regulations will have on access to care for vulnerable individuals.

House Republicans Unveil Health Care Policy Brief

On February 16, 2017, after a closed-door meeting, House Republicans unveiled a policy brief and resource document to explain major elements of their plan to repeal and replace key programs and protections of the ACA. House Leadership is terming this strategy “repeal plus.” The policy brief should not be considered an actual legislative proposal but rather a “menu” of replacement ideas such as tax credits for purchasing health care, health savings accounts, and high risk pools. Part of the intention of this document is to encourage Congressional Republicans, who have found it difficult to coalesce around a health care policy strategy, to find consensus on these issues. Unfortunately, many of the components of this “repeal plus” strategy would curb access to care for vulnerable individuals, including those living with chronic illnesses and disabilities.