Re-Entry, HIV Linkage, and Overdose Prevention Webinar

 

 

 

Re-Entry, HIV Linkage, and Overdose Prevention

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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

END THE EPIDEMIC / DIGITAL

End the Epidemic, In Part by Digital Communication

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

Florida Phasing Out Project AIDS Care, Other Medicaid Waivers

Thousands of Floridians living with AIDS could be losing financial assistance they say is essential to living a normal life, and some AIDS groups are worried the state won’t carry through on its promises.

On a recent Tuesday morning, Brandi Geoit sits at a conference table at the West Coast Aids Foundation headquarters. Across from her in the small New Port Richey office with butter-yellow walls is Dwight Pollard, a 61-year-old man living with AIDS.

Geoit tells him a new Florida law means patients like him could lose some of the financial help they’re getting through Medicaid.

“We’re not sure if you would keep your Medicaid because you’re still pending for your social security. And you haven’t qualified for Medicare yet because you’re still not old enough,” Geoit said.

Pollard no longer works, and depends on a special Medicaid waiver to cover his health care costs. Medication alone can cost $15,000 a month.

His partner, Ed Glorius, was sitting next to Pollard as he heard the news.

“It just doesn’t make sense,” Glorius said. “It doesn’t make sense to put people’s lives in turmoil. We’re better off than most and I’m freaking out. I’m waking up first thing in the morning thinking about this every day.”

Pollard is one of about 8,000 Floridians with AIDS who get help paying for doctor visits, medications and various home health services through this Medicaid waiver fund, which is called Project AIDS Care. Last month, Gov. Rick Scott signed a bill formally eliminating this waiver for AIDS, along with waivers for cystic fibrosis, developmental disabilities and elder care.

Florida’s Agency for Health Care Administration said while the waiver is going away, AIDS patients in Florida will not see a loss or gap in services. The agency declined repeated requests for interviews, but issued a written statement, explaining transition into a Medicaid Managed Medical Assistance plan.

“We will continue to provide the same services through the same providers for these individuals. The PAC (Project AIDS Care) waiver is essentially a waiver that expanded Medicaid eligibility to those diagnosed with HIV/AIDS and allowed the recipients to access needed medical services (e.g., physician services) and drugs. Given the advances in pharmaceuticals available to treat HIV/AIDS, most PAC recipients in the waiver only need those medical services and case management. With this transition, their eligibility will be maintained and they will continue to have access to the medical services, drugs and case management under the MMA waiver through the health plans. They will see no reduction in services and will be able to continue to see the medical professional they always have.”

The agency said patients will go into the Medicaid Long Term Care program starting this month. Everyone will be transitioned into it by Jan. 1, 2018.

But Geoit estimates 90 percent of her clients will not meet the requirements for long term care, which normally applies to people needing round the clock nursing.

She said her clients will definitely lose certain services that Medicaid doesn’t cover. Massages for those with neuropathy? Gone. Pest control? Gone. And services that are currently covered – like delivered meals, adult diapers and wheelchair ramps – could be lost, too.

So, she’s asked the state to clarify how it’s now different.

“When we asked them, they said, ‘Don’t worry. Reassure your client that they’ll be taken care of.’ And when we asked them point-blank what happened, you know, we were under the impression that a single adult still does not qualify for Medicaid. Has this changed? And they ended the conference call,” Geoit said.

Her program – a non-profit – exists only to manage the Project Aids Care waiver money for 325 clients in seven counties including Pasco, Pinellas and Hillsborough. With the new law, Geoit said her foundation will shut its doors by the end of the year.

For Dwight Pollard and his partner, the State Agency for Health Care Administration’s lack of answers is a concern.

“You don’t need the stress of how you’re going to pay or how you’re going to do this,” Pollard said.

But that’s his reality. And Pollard said until the state agency can give clear answers, he’ll keep searching for other programs that can help pay for his life saving medications.

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