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

Repeal Without Replace: Senate Starts Undoing Obamacare With No Replacement

In the wee hours of the morning on Thursday, the Senate took the important first step toward repealing the Affordable Care Act, narrowly approving a budget resolution that lays the groundwork for the undoing of much of President Obama’s signature health care law. The 51-48 vote fell almost entirely along party lines, with Senator Rand Paul (R-KY) being the only Republican to vote against the resolution and no Democrats voting for it. Having passed in the Senate, the budget resolution has been transferred over to the House where it could be voted on as early as this Friday or later, depending on how successful Speaker Ryan is at bringing together an often-fractured House GOP.

If the House passes the Senate resolution, reconciliation instructions will be sent out to the Senate Finance Committee; the Senate Health, Education, Labor and Pensions Committee; and to the House Ways and Means and Energy and Commerce committees. These instructions are designed to get the committees to report legislation that would reduce the federal deficit by at least $1 billion over the next decade. In practice the legislation will be used to repeal certain aspects of the ACA with only a 51-vote majority in the Senate and without having to face the risk of being filibustered by Democrats. This means that the GOP will be able to repeal major provisions of the ACA that affect the federal budget and will have to introduce other legislation to repeal the other provisions, including those that reform health insurance practices.
For people living with or at risk of contracting HIV, the changes that could be made through this reconciliation process will be immense and potentially deadly. Through reconciliation, Congress will be able to repeal the individual mandate to buy coverage, take away the ACA’s insurance premium subsidies and, perhaps worst of all, roll back Medicaid expansion. Medicaid is the single largest source of insurance coverage for people living with HIV, covering more than 40% of all people with HIV who are in care. Add to that the fact that Medicaid expansion by itself was responsible for putting an addition 14 million Americans on health insurance, and it is not hard to understand just how much of an impact this reconciliation process could have on the HIV community.

The Senate vote on the budget resolution was the climax of nearly 7 hours of rapid-fire voting known as “vote-a-rama”, a tradition whereby Senators—in this case, mostly Democrats—are allowed to propose roll call votes on amendments to a budget resolution in quick succession with the aim of getting their colleagues on the record with votes concerning politically volatile issues. On Wednesday night, Democrats put forth a number of amendments regarding some of the popular aspects of Obamacare as both an act of defiance and a way to put pro-repeal Senators on-the-record for the elimination of well received ACA provisions.

For their part, Republicans in the Senate chose in most instances to vote as a unified block even when such a vote went against the wishes of their constituencies. Over the course of the evening, the Senate rejected 19 different amendments along party lines, many of which would have served to protect access to quality, affordable health care for all Americans. Of particular interest to people living with or at risk for contracting HIV were amendments put forth by Senate Democrats aimed at preventing health insurers from discriminating against people based on pre-existing conditions, allowing children to stay on their parents’ health insurance until the age of 26, prohibiting insurers from denying health insurance or raising rates on women because of their gender, and not making any cuts to Medicaid funding. None of these amendments were accepted, but they did provide good indication of what aspects of the ACA would be vulnerable under a full ACA repeal.

Perhaps the most important vote of the night—aside from the final approval of the budget resolution—was one that didn’t happen at all. An amendment put forth by Senator Bob Corker (R-TN) and four other GOP Senators that would have extended the January 27th deadline to come up with repeal legislation by an additional 5 weeks was withdrawn late on Wednesday night. The amendment was initially brought up by Senator Corker and some of his Republican colleagues in light of legitimate fears that their party would not have a replacement plan in place when they repealed the ACA. And, while nothing happened over the course of the evening that would have given Senator Corker and his amendment’s supporters reason to believe a replacement plan was any nearer than before, they would all go on to vote in favor of the budget resolution at the end of the night, continuing down a path of repeal without replacement.

Most of America had long since gone to sleep and likely won’t remember when or exactly how it happened, but history with certainly note that, if the Affordable Care Act is indeed dismantled, that Congress began to do so when no one was watching.

Experts Support Use of PrEP Despite New HIV Infection Reported in Adherent PrEP User

 

A second case of HIV transmission to a person who was adherent to Pre-Exposure Prophylaxis (PrEP) protocols was announced at the HIV Research for Prevention conference. A previous case was reported in February. In both cases, testing revealed that the strain of HIV acquired was resistant to Truvada, the FDA’s only approved drug for PrEP. Despite these two widely reported cases, this mutation is rare and Truvada continues to be highly effective at preventing HIV infection.

HIV infection while PrEP adherent is most likely to occur due to exposure of an HIV strain resistant to tenofovir or emtricitabine, the component drugs in Truvada. This drug resistance occurs most often when a person living with HIV is not consistent with their treatment protocol. HIV has the highest mutation rate of any biological substance ever recorded, meaning that it rapidly transforms its structure, defenses, and identity. Missing doses of antiretroviral therapy (ART) allows the virus to replicate in presence of ART, increasing the likelihood the it will adapt and develop resistance. With this new resistance, the virus could replicate unchecked, becoming amplified and dominant. Individuals adherent to Truvada may not be protected if they are exposed to a strain of HIV that is already resistant to tenofovir or emtricitabine. Experts have tried to be clear that PrEP is not 100% effective as shown by these two cases. For this reason, the Centers for Disease Control and Prevention (CDC) recommends that PrEP be combined with the use of condoms. At the same time, most experts acknowledge that these cases are extremely rare and continue to support the use of PrEP in populations at risk for HIV infection.

AIDS United’s position statement on PrEP supports nationwide implementation of CDC guidelines on PrEP as an effective prevention strategy for men and women at risk for HIV. We continue to follow the research regarding PrEP including new cases of HIV transmission, despite PrEP adherence. However, it is important not to overreact to these cases as well. Since 2012, more than 79,000 people have taken Truvada as a PrEP in the United States, and yet there have only been just two cases of HIV transmission among those adherent. PrEP remains a highly effective method of HIV prevention.

As PrEP continues to be implemented in the U.S., another lesson is that the field must continue to combat drug resistance. One way to address drug resistance is to support treatment adherence among people with HIV. Similarly we should provide tools to people who are taking PrEP so that they can adhere to their regimen as well.

We also should note that these cases reinforce the need for regular (quarterly) STI screenings including for HIV for people who take PrEP. Early discovery of any new HIV infection leads to faster treatment with the benefits of a longer, healthier life as well as reducing the likelihood of future transmission through viral suppression. Finally, we hope that HIV providers and educators will continue to help people to understand the benefits and value of PrEP so that individuals can make informed decisions about deciding to take PrEP.

Serious Infections Tied to Suicide Risk

Study suggests biological basis for suicide among those with serious infections.

People hospitalized for serious infections may face an increased risk of dying by suicide, and researchers suspect there’s a biological reason for it.

In a study of over 7 million people, Danish researchers found that those who’d been hospitalized for infections were 42 percent more likely to die of suicide compared to people with no history of serious infection.

People hospitalized for HIV/AIDS or the liver infection hepatitis showed the highest risk — more than twice that of people without those diseases, the study found.

Although the study couldn’t prove a cause-and-effect link, the study authors and at least one other brain health expert think the increased risk of suicide after infection might not simply reflect the psychological impact of serious illness. Instead, infections might directly contribute to suicide risk by causing inflammation in the brain.

“We know that inflammation can cause depression symptoms,” said Dr. Lena Brundin. She’s an associate professor at the Van Andel Research Institute’s Center for Neurodegenerative Science in Grand Rapids, Mich.

That, she said, is based on evidence from both animals and humans. For example, the drug interferon revs up the immune system’s inflammatory response, and up to 45 percent of patients develop depression during treatment, according to Brundin. Interferon is used to treat certain infections and some cancers, according to the U.S. Food and Drug Administration.

The new study is important, in part, because it’s huge, according to Brundin. She said it strengthens the case that smaller studies have made: Depression, and suicidal behavior, may be inflammatory disorders to some degree.

Brundin wrote an editorial published with the findings Aug. 10 in JAMA Psychiatry.
For the study, researchers used Denmark’s system of national registries to comb through data on over 7 million people who lived in the country between 1980 and 2011. During that time, over 800,000 — or 11 percent — were hospitalized for an infection, including HIV, hepatitis or infections of the lungs, digestive system, skin or blood.

Based on death certificates, nearly 32,700 people died of suicide during the 32-year study period. Almost one-quarter of them had ever been hospitalized for an infection, the study showed.

When the researchers dug further, they found that people hospitalized for most kinds of infection had an elevated rate of suicide — pregnancy-related infections being the only exception.

And the more infections people had contracted, or the longer their treatment course, the higher their suicide risk.

“There are many potential mechanisms that might link infections to death by suicide,” said lead researcher Helene Lund-Sorensen. She’s from the Mental Health Center Copenhagen in Denmark.

Lund-Sorensen said her team tried to account for as many as possible — including whether people with infections had additional health conditions, were lower-income or had ever been diagnosed with depression or substance abuse.

Even then, there was a statistical link between infections and increased suicide risk. That, according to Lund-Sorensen, implies that psychiatric disorders “may only explain parts of the association.”
She agreed that there could be a biological connection between serious infections and suicide, including the effects of inflammation.

Inflammation is part of the immune system’s response to injury and infection. But when those inflammatory chemicals build up, there can be negative effects, too. If they infiltrate the central nervous system, there can be “profound effects on brain chemistry,” Brundin said.

Studies have found that people who are clinically depressed or have attempted suicide tend to have heightened levels of inflammatory immune-system chemicals in their blood, spinal fluid and brain, according to Brundin.

Still, none of that proves that infections, or inflammation, directly contribute to suicide. Brundin said more definitive evidence could come from treatment trials testing the effects of anti-inflammatory medications.

There are already such studies underway, she noted.

One trial is looking at whether adding an anti-inflammatory drug called sirukumab to antidepressant treatment helps ease symptoms of major depression.

Lund-Sorensen said her team is also planning to study whether less-serious infections are related to suicide risk, too.

“Our research, [along with] others’, will hopefully in time clarify the role of infections and inflammatory diseases in suicide,” Lund-Sorensen said.

If infections do raise suicide risk, she said, “we believe that early identification and treatment of infections could be explored as a public health measure for suicide prevention.”

In this study, Lund-Sorensen’s team said, about 10 percent of suicides could be attributed to severe infections.

For people living with chronic infections such as HIV or hepatitis C, Brundin said she thinks there is some positive news in the findings.

If they do suffer from depression, she said, there is mounting evidence that there could be a “biological basis” for it.

“And it’s possible that in the near future, we’ll have better treatments for it,” Brundin said.

SOURCES: Helene Lund-Sorensen, B.M., Mental Health Center Copenhagen, Denmark; Lena Brundin, M.D., Ph.D., associate professor, Center for Neurodegenerative Science, Van Andel Research Institute, Grand Rapids, Mich.; Aug. 10, 2016, JAMA Psychiatry, online

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More funding desperately needed for Ryan White Program

, by Emily Newman

funding moneyTwenty-six years ago, on August 18, 1990, the Ryan White Program was established in the U.S. to fund programs and services for people living with HIV. Since that time, it has been—and continues to be—and important safety net for people living with HIV who either don’t have insurance or have inadequate insurance coverage. Although there’s little risk of seeing the Ryan White Program go away any time soon, experts say that even more funding will be needed now and in the coming years to truly meet the needs of a growing caseload.

Currently, over half of all people living with HIV in the U.S. (600,000 people) are supported by the Ryan White Program in some way. Ryan White funds go to things such as the AIDS Drug Assistance Program (ADAP), which helps people afford medications, to health centers who care for people living with HIV, and for services such as case management, transportation and housing support for people living with HIV.

Who is Ryan White? In the late 1980s, young man named Ryan White became an HIV advocate for the rights of people living with HIV and AIDS after being expelled from his school in Indiana because of his infection. Ryan was diagnosed with AIDS when he was 13 after a blood transfusion in the early 80s. Ryan passed away in April of 1990—only a few months before Congress passed the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act.

Sean Cahill, PhD, director of health policy research at Fenway Health, said that funding for the Ryan White Program has not increased significantly since the early 2000s, although the number of people in HIV care has risen. Over the next ten years, the number of people living with HIV is expected to increase by more than 25%.

“The federal government has really prioritized trying to find everyone with HIV in the U.S. and get them connected to treatment,” said Cahill. “We know that the number of people living with HIV who’ve been coming into Ryan White care has grown a lot in the last 15 years. The HIV caseload has more than doubled at this point, but the funding has basically been flat and has actually declined by about 20% in inflation-adjusted dollars.”

The budget for the Ryan White Program was 2.323 billion in 2016. Cahill shared that a 6% increase, of $142 million, would be appropriate to keep pace with the growing number of people in HIV care and to adjust for inflation. This increase, to $2.465 billion, was the request made by the AIDS Budget and Appropriations Coalition for the 2017 fiscal year.

“This [increase] is pretty modest, but it would really go a long way to address unmet needs,” said Cahill.

Even the expansion of healthcare access, through Medicaid and the Affordable Care Act, will not be enough to meet the needs of many people living with HIV, said Cahill.

“There are gaps,” he said. “People living with HIV are now getting private insurance because of the end of discrimination on the basis of having a preexisting condition, but this insurance doesn’t cover all of their medical needs. It certainly doesn’t cover all of the support services that people need, in addition to medical care.”

People who receive Ryan White Program-funded care have documented better health outcomes compared to people living with HIV who receive care elsewhere. People in Ryan White-funded care are more likely to be in continuous care and more likely to have suppressed viral loads. That’s because, compared to other HIV care providers, Ryan White-funded care facilities are more likely to provide other support services that help people with complicated health and medical needs—such as mental health concerns and substance use.

“People getting Ryan White services may have really complex health care needs,” said Cahill. “That includes medical needs but also behavioral health needs and socioeconomic drivers of vulnerability. The Ryan White Program can assist with those as well. Like housing support, meals, and legal assistance to help with an eviction. It’s really successful at treating people who have a lot of challenges in their lives, and that’s a great record of achievement to point to. If the program has more resources, I think it it’s logical to assume that we would expect it to improve the HIV care continuum.”

More information about Ryan White HIV/AIDS Services, Medicaid expansion, and fact sheets on policies affecting people living with HIV are available from the Federal AIDS Policy Partnership here and here.

National Black HIV/AIDS Awareness Day (NBHAAD)

In the face of recent racially driven conversations approaching this Black History month, February 7th, 2016 will mark the 17th observance of the National Black HIV/AIDS Awareness Day (NBHAAD) in the United States. In 1999, NBHAAD was created to raise national awareness of the impact of HIV in the Black community in the United States, and to mobilize efforts around the world to eradicate the virus. In a recent study, the Centers for Disease Control and Prevention states that, although Black Americans represent 12% of the U.S. Population, they account for 44% of new HIV infections and an estimated 44% of people living with HIV. Even more alarming, the rate of infection within the Black community is nearly eight times that of whites and more than twice that of Latinos. Based on these numbers, we must normalize discussions on race, and effectively bend the curve of new HIV infections. Such drastic differences enforce a need for NBHAAD’s Pillars: to Educate, Test, Involve, and Treat.

In 2014 NBHAAD National Coordinator LaMont “Montee” Evans shared, “Regardless of where we stand on sexual orientation, religious beliefs/values, age, income, education or otherwise, Black Life is worth saving and working for the betterment of our survival has to become our paramount objective and goal. It is time for us to end AIDS in Black communities by making sure those living with HIV or AIDS take care of themselves. We stand on some strong shoulders that intended for us to survive.” Two years later this sentiment remains the same.

It is sobering to know that HIV was the 5th and 7th leading cause of death for Black men and women, respectively, ages 25-44 in 2010 – higher than any other racial/ethnic group. Your race should not be the determining factor for your risk of HIV infection. NMAC’s Leading with Race initiative aims to significantly reduce new infections that are disproportionately affecting communities of color. NMAC is committed to staying the course of fighting for racial justice and health equity by partnering with NBHAAD’s national coordinating organizations and stakeholders within government and the private sector. Through all of this, we unapologetically continue to share the dream that together we will forge our own future and end HIV once and for all.

ADAP PREMIUM PLUS PRESENTATION 11/24/2015

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