Pneumocystis Pneumonia -“The first five”reported/documented

In the period October 1980-May 1981, 5 young men, all active homosexuals, were treated for biopsy-confirmed Pneumocystis cariniipneumonia at 3 different hospitals in Los Angeles, California. Two of the patients died. All 5 patients had laboratory-confirmed previous or current cytomegalovirus (CMV) infection and candidal mucosal infection. Case reports of these patients follow.

Patient 1: A previously healthy 33-year-old man developed P. carinii pneumonia and oral mucosal candidiasis in March 1981 after a 2-month history of fever associated with elevated liver enzymes, leukopenia, and CMV viruria. The serum complement-fixation CMV titer in October 1980 was 256; in may 1981 it was 32.* The patient’s condition deteriorated despite courses of treatment with trimethoprim-sulfamethoxazole (TMP/SMX), pentamidine, and acyclovir. He died May 3, and postmortem examination showed residual P. carinii and CMV pneumonia, but no evidence of neoplasia.

Patient 2: A previously healthy 30-year-old man developed p. carinii pneumonia in April 1981 after a 5-month history of fever each day and of elevated liver-function tests, CMV viruria, and documented seroconversion to CMV, i.e., an acute-phase titer of 16 and a convalescent-phase titer of 28* in anticomplement immunofluorescence tests. Other features of his illness included leukopenia and mucosal candidiasis. His pneumonia responded to a course of intravenous TMP/.SMX, but, as of the latest reports, he continues to have a fever each day.

Patient 3: A 30-year-old man was well until January 1981 when he developed esophageal and oral candidiasis that responded to Amphotericin B treatment. He was hospitalized in February 1981 for P. carinii pneumonia that responded to TMP/SMX. His esophageal candidiasis recurred after the pneumonia was diagnosed, and he was again given Amphotericin B. The CMV complement-fixation titer in March 1981 was 8. Material from an esophageal biopsy was positive for CMV.

Patient 4: A 29-year-old man developed P. carinii pneumonia in February 1981. He had had Hodgkins disease 3 years earlier, but had been successfully treated with radiation therapy alone. He did not improve after being given intravenous TMP/SMX and corticosteroids and died in March. Postmortem examination showed no evidence of Hodgkins disease, but P. carinii and CMV were found in lung tissue.

Patient 5: A previously healthy 36-year-old man with clinically diagnosed CMV infection in September 1980 was seen in April 1981 because of a 4-month history of fever, dyspnea, and cough. On admission he was found to have P. carinii pneumonia, oral candidiasis, and CMV retinitis. A complement-fixation CMV titer in April 1981 was 128. The patient has been treated with 2 short courses of TMP/SMX that have been limited because of a sulfa-induced neutropenia. He is being treated for candidiasis with topical nystatin.

The diagnosis of Pneumocystis pneumonia was confirmed for all 5 patients antemortem by closed or open lung biopsy. The patients did not know each other and had no known common contacts or knowledge of sexual partners who had had similar illnesses. Two of the 5 reported having frequent homosexual contacts with various partners. All 5 reported using inhalant drugs, and 1 reported parenteral drug abuse. Three patients had profoundly depressed in vitro proliferative responses to mitogens and antigens. Lymphocyte studies were not performed on the other 2 patients.

Reported by MS Gottlieb, MD, HM Schanker, MD, PT Fan, MD, A Saxon, MD, JD Weisman, DO, Div of Clinical Immunology-Allergy; Dept of Medicine, UCLA School of Medicine; I Pozalski, MD, Cedars-Mt. Siani Hospital, Los Angeles; Field services Div, Epidemiology Program Office, CDC.

Editorial Note: Pneumocystis pneumonia in the United States is almost exclusively limited to severely immunosuppressed patients (1). The occurrence of pneumocystosis in these 5 previously healthy individuals without a clinically apparent underlying immunodeficiency is unusual. The fact that these patients were all homosexuals suggests an association between some aspect of a homosexual lifestyle or disease acquired through sexual contact and Pneumocystis pneumonia in this population. All 5 patients described in this report had laboratory-confirmed CMV disease or virus shedding within 5 months of the diagnosis of Pneumocystis pneumonia. CMV infection has been shown to induce transient abnormalities of in vitro cellular-immune function in otherwise healthy human hosts (2,3). Although all 3 patients tested had abnormal cellular-immune function, no definitive conclusion regarding the role of CMV infection in these 5 cases can be reached because of the lack of published data on cellular-immune function in healthy homosexual males with and without CMV antibody. In 1 report, 7 (3.6%) of 194 patients with pneumocystosis also had CMV infection’ 40 (21%) of the same group had at least 1 other major concurrent infection (1). A high prevalence of CMV infections among homosexual males was recently reported: 179 (94%) had CMV viruria; rates for 101 controls of similar age who were reported to be exclusively heterosexual were 54% for seropositivity and zero fro viruria (4). In another study of 64 males, 4 (6.3%) had positive tests for CMV in semen, but none had CMV recovered from urine. Two of the 4 reported recent homosexual contacts. These findings suggest not only that virus shedding may be more readily detected in seminal fluid than urine, but also that seminal fluid may be an important vehicle of CMV transmission (5).

All the above observations suggest the possibility of a cellular-immune dysfunction related to a common exposure that predisposes individuals to opportunistic infections such as pneumocystosis and candidiasis. Although the role of CMV infection in the pathogenesis of pneumocystosis remains unknown, the possibility of P. carinii infection must be carefully considered in a differential diagnosis for previously healthy homosexual males with dyspnea and pneumonia.

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Suicide rates rise sharply across the United States, new report shows

Suicide rates rise sharply across the United States, new report shows

  •  Health Blog •

This article was originally published by The Washington Post.

This post has been updated.

Suicide rates rose in all but one state between 1999 and 2016, with increases seen across age, gender, race and ethnicity, according to a reportreleased Thursday by the Centers for Disease Control and Prevention. In more than half of all deaths in 27 states, the people had no known mental health condition when they ended their lives.

In North Dakota, the rate jumped more than 57 percent. In the most recent period studied (2014 to 2016), the rate was highest in Montana, at 29.2 per 100,000 residents, compared with the national average of 13.4 per 100,000.

Only Nevada recorded a decline — of 1 percent — for the overall period, although its rate remained higher than the national average.

Increasingly, suicide is being viewed not only as a mental health problem but a public health one. Nearly 45,000 suicides occurred in the United States in 2016 — more than twice the number of homicides — making it the 10th-leading cause of death. Among people ages 15 to 34, suicide is the second-leading cause of death.

The most common method used across all groups was firearms.

“The data are disturbing,” said Anne Schuchat, the CDC’s principal deputy director. “The widespread nature of the increase, in every state but one, really suggests that this is a national problem hitting most communities.”

It is hitting many places especially hard. In half of the states, suicide among people age 10 and older increased more than 30 percent.

Percent change in annual suicide rate* by state, from 1999-2001 to 2014-2016 (Centers for Disease Control and Prevention)

“At what point is it a crisis?” asked Nadine Kaslow, a past president of the American Psychological Association. “Suicide is a public health crisis when you look at the numbers, and they keep going up. It’s up everywhere. And we know that the rates are actually higher than what’s reported. But homicides still get more attention.”

One factor in the rising rate, say mental health professionals as well as economists, sociologists and epidemiologists, is the Great Recession that hit 10 years ago. A 2017 study in the journal Social Science and Medicine showed evidence that a rise in the foreclosure rate during that concussive downturn was associated with an overall, though marginal, increase in suicide rates. The increase was higher for white males than any other race or gender group, however.

“Research for many years and across social and health science fields has demonstrated a strong relationship between economic downturns and an increase in deaths due to suicide,” Sarah Burgard an associate professor of sociology at the University of Michigan, explained in an email on Thursday.

The dramatic rise in opioid addiction also can’t be overlooked, experts say, though untangling accidental from intentional deaths by overdose can be difficult. The CDC has calculated that suicides from opioid overdoses nearly doubled between 1999 and 2014, and data from a 2014 national survey showed that individuals addicted to prescription opioids had a 40 percent to 60 percent higher risk of suicidal ideation. Habitual users of opioids were twice as likely to attempt suicide as people who did not use them.

High suicide numbers in the United States are not a new phenomenon. In 1999, then-Surgeon General David Satcher issued a report on the state of mental health in the country and called suicide “a significant public health problem.” The latest data at that time showed about 30,000 suicides a year.

Kaslow is particularly concerned about what has emerged with suicide among women. The report’s findings came just two days after 55-year-old fashion designer Kate Spade took her own life in New York — action her husband attributed to the severe depression she had been battling.

“Historically, men had higher death rates than women,” Kaslow noted. “That’s equalizing not because men are [committing suicide] less but women are doing it more. That is very, very troublesome.”

Among the stark numbers in the CDC report was the one signaling a high number of suicides among people with no diagnosed  mental health condition. In the 27 states that use the National Violent Death Reporting System, 54 percent of suicides fell into this category.

But Joshua Gordon, director of the National Institute of Mental Health, said that statistic must be viewed in context.

“When you do a psychological autopsy and go and look carefully at medical records and talk to family members of the victims,” he said, “90 percent will have evidence of a mental health condition.” That indicates a large portion weren’t diagnosed, “which suggests to me that they’re not getting the help they need,” he said.

Cultural attitudes may play a part. Those without a known mental health condition, according to the report, were more likely to be male and belong to a racial or ethnic minority.

“The data supports what we know about that notion,” Gordon said. “Men and Hispanics especially are less likely to seek help.”

The problems most frequently associated with suicide, according to the study, are strained relationships; life stressors, often involving work or finances; substance use problems; physical health conditions; and recent or impending crises. The most important takeaway, mental health professionals say, is that suicide is an issue not only for the mentally ill but for anyone struggling with serious lifestyle problems.

“I think this gets back to what do we need to be teaching people — how to manage breakups, job stresses,” said Christine Moutier, medical director of the American Foundation for Suicide Prevention. “What are we doing as a nation to help people to manage these things? Because anybody can experience those stresses. Anybody.”

The rates of suicide for all states and the District of Columbia were calculated using data from the National Vital Statistics System. Information about contributing circumstances for those who died by suicide was obtained via the National Violent Death Reporting System, which is relatively new and in place in only 27 states.

“If you think of [suicide] as other leading causes of death, like AIDS and cancer, with the public health approach, mortality rates decline,” Moutier said. “We know that same approach can work with suicide.”

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Elevating Trans Voices

I am Joi-Elle White, and I work at Positive Impact Health Centers (PIHC). I am an HIV Educator and soon will become a Prevention Specialist. I’ve been at PIHC for a year but have been in this field for 16 years. I started out as an outreach volunteer for Hudson Pride Connections in New Jersey when I was going to their transgender group called G.L.I.T.Z. (Girls Living in the Trans Zone).

My lived experiences got me involved in this work. I faced rejection, discrimination, sexual and physical assault, homelessness, and other bumps in my journey. And some of my experiences I would not wish on anyone, let alone the younger generation. I can’t stop any of that from happening and we all will have to come across them. So my plan was to learn a way to help the youth through whatever life can throw at us.

I was so excited to be put on the Transgender Leadership Initiative project at PIHC, where I was part of creating applications, policies, and curriculums, as well as facilitating an eleven-session leadership program called TRANSitioning to Leaders Academy (T2L). I was part of recruiting twelve transgender ladies to compete the academy.

T2L’s goal was to help bring the leadership skills out in these ladies so the transgender community can have a voice on the HIV planning council and anywhere else their voices can be heard. T2L was unique because it was “for us, by us.” Three transgender women and a cisgender woman created the curriculums and facilitated the sessions.

We need as many voices and people as possible to help us get rid of the stigma, myths, discrimination, lack of Medicaid coverage, and, last but not least, lack of education. Those are a few of the barriers we face. It’s important for us to keep talking about HIV to educate society. I would like people to get tested and learn their status. Knowing your status is the first step towards reducing the risk of spreading HIV. G.I. Joe said it best: “Knowing is half the battle.”

Additionally, we need to create our own platforms, forums, and panels all over on TV screens, radios, and magazines. It’s also important for organizations to hire transgender people. Not only will it give the transgender community a friendly face of someone who has walked in their shoes, it also gives us an opportunity to be part of the change we want to see.

I believe what keeps me motivated is every time I hear or see a law that has changed to benefit the transgender community and seeing more transgender people joining the fight. Hearing a transgender male or female say to me, “I am working,” or “I got my keys to my apartment,” knowing that they reached their goal – that motivates me.

Joi-Elle White is an HIV Health Educator in Atlanta, Georgia. Through Positive Impact Health Centers, a grantee of AIDS United’s Transgender Leadership Initiative, Joi-Elle and her colleagues created a leadership course for transgender individuals to increase participants’ HIV knowledge and to improve HIV service delivery, health and social justice outcomes for their peers. Joi-Elle has been doing HIV work for over fifteen years. 

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Congress Passes Fiscal Year 2018 Budget…3 months into 2019

 

It took six months, five continuing resolutions and two government shutdowns, but Congress finally passed its Fiscal Year 2018 funding early on Friday morning. After pleading with Senator Rand Paul (R-KY) not to send the U.S. government into another brief shutdown in his quixotic quest to stop what he considers to be profligate federal spending, Senate Majority Leader Mitch McConnell succeeded in bringing the House-passed omnibus bill to a vote shortly after midnight. Ultimately, the bill squeaked through the Senate by a vote of 65 to 32, with the bulk of the nays being constituted by a number of more conservative Republicans and a smattering of Democrats.

The $1.3 trillion spending package was a bit of a mixed bag for HIV advocates. Once again, the Ryan White program was flat-funded from the previous year, but given the fact that both President Trump’s budget and the House’s initial FY18 appropriations zeroed out vital programs like the Secretary’s Minority AIDS Initiative Fund, the AIDS Education Training Centers, and the Special Projects of National Significance, it can be viewed as a net positive this year. At the same time, funding for the Housing Opportunities for People with AIDS program was raised to $375 million in the FY18 spending deal, an increase of $19 million over last year.

Encouragingly, the FY18 spending bill dedicated $3.3 billion to curbing the opioid epidemic, with a substantial portion of that money—about $2.8 billion—going to treatment, prevention and research. Among other things, the spending package doubles funding for state and tribal grants created under the 21st Century Cures Act to $1 billion, provides $415 million to HRSA to expand access to substance use treatment in rural and community health care settings and a $1.3 billion increase for the Substance Abuse and Mental Health Administration. This new funding is a good start in the federal government’s efforts to stem the tide of the opioid epidemic, but it is still not nearly enough.

There was also plenty that this spending deal did not do that both parties were lobbying intensely for over the past few months. Much to the chagrin of hardline conservatives, there were no funding exclusions for Planned Parenthood as was floated in negotiations earlier this month and there were no provisions defunding sanctuary cities. Similarly, Congress shut down President Trump’s hopes for seeing his much-ballyhooed border wall come to fruition anytime soon, only allotting $641 million for new border fencing (not walls, but see-through fencing) and not providing any new money for more ICE agents or beds to hold undocumented immigrants. The omnibus also did not provide any protections for the more than 700,000 Dreamers who are at risk for deportation and did not include any measures designed to stabilize the Affordable Care Act.

Early Friday morning, President Trump threatened not to sign the omnibus over the lack of funding from Congress for his border wall. “I am considering a VETO of the Omnibus Spending Bill based on the fact that the 800,000 plus DACA recipients have been abandoned by the Democrats (not even mentioned in Bill) and the BORDER WALL, which is desperately needed for our National Defense, is not fully funded”, Trump tweeted. It is yet to be seen if this will be an idle threat or if this could cause yet another government shutdown.

Re-Entry, HIV Linkage, and Overdose Prevention Webinar

 

 

 

Re-Entry, HIV Linkage, and Overdose Prevention

Honoring National Black HIV/AIDS Awareness Day

 

 

The Fight Is Not Over: Celebrating and Honoring National Black HIV/AIDS Awareness Day

HIV/AIDS remains a significant problem and continues to disproportionately impact the African diaspora. Black people living in US southern states – those infamous localities for the involuntary servitude of Africans, the lynching of Black bodies, and Jim Crow laws restricting Black opportunity and advancement – make up 44% of people living with HIV and 54% of those newly infected. When the President of the United States (allegedly) labels the ancestral homes of Black people as “shit-hole countries” and declares that all Haitians “have AIDS,” the directive of the 2018 NBHAAD theme is clear: “Stay the Course, the Fight is Not Over!”

HIV Prevention and Treatment as a Right for Black People and Others

Throughout the US, there has been greater attention placed on the lived experiences of African Americans, Afro-Latinos and other Africans living in the United states, especially in our pursuits of justice related to police violence and interactions; educational and workforce opportunities; access to health care; and citizenship. Our organizing and mobilization with Black Lives Matter, the Women’s March and the March for Science allows us to publicly speak against these injustices and nurture efforts that assert HIV prevention and treatment as a right.

Expanding the Fight

In fact, all HIV/AIDS, civil rights, and justice organizations must assert that Black people have the right to “life, liberty and the pursuit of happiness”, along with living HIV free. This requires a collective will that is able to recognize root injustices and engage in sustained dialogue and actions that interrupt the status quo. No longer can this fight be viewed as the sole responsibility of local health departments, community organizations and people living with HIV. Public and private schools, religious institutions, business leaders and other influencers must learn, promote, and, if applicable, use the latest advancements in HIV prevention and treatment, including PrEP for HIV-negative individuals and the gospel of Undetectable = Untransmittable. Highlighting individuals and organizations operating in these spaces of engagement will help inform cross-sector partnerships that equip communities with the tools and resources to do this work effectively and efficiently.

Nurture the Frontline

As with any campaign for justice, it is important to nurture those individuals and organizations on the frontline – including those living with HIV, those in communities disproportionately affected by it, and those organizations that use their resources to fight against it.  By keeping these individuals and organizations healthy, they are in ready-position to provide support. National organizations can set an example for local organizations by addressing racial and gender equity and developing campaigns that identify and highlight the needs of front line staff workers – whether it is guidance for employers to maximize employee assistance benefits, saving and investing in retirement accounts, or ensuring avenues for skill development in transferrable areas (e.g. medical coding, data collection, or phlebotomy). Black unemployment, especially when compared to White unemployment, is unacceptably high.

Measure our Performance

Knowing if our efforts are making a difference is important for designing strategies to end HIV and promote justice in Black communities. The National HIV/AIDS Strategy (NHAS) offers a data-guided approach for key actions and measuring impact in the local and national context. The NHAS milestones and indicators can also inspire our tracking of other indicators and data points that describe mobilization efforts, membership dynamics, and engagement around policy. By participating in these activities, we are better able to identify collective approaches that successfully work in Black communities. Occupying this space also allows UCHAPS and others to sustain their operations, resources and passion to do even more.

Stay the Course, the Fight is Not Over

In 1926, Carter G. Woodson started Negro History Week, which is now celebrated throughout the entire month of February (and yearly for some). It’s a reminder of the great contributions and struggles faced by Black people in the US and throughout the world. Similarly, NBHAAD provides an opportunity to unite our contemporary fight against HIV within this rich historical legacy for recognition, freedom and liberation. Today, UCHAPS encourages everyone to expand the fight, nurture the frontline and measure our performance to help end HIV, protect Dreamers and DACA, fight against police brutality, create Black wealth, and achieve political liberation.

Stay the course. The fight is not over.

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

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