AIDS United’s Statement on President Trump’s Budget for FY 2018

AIDS United is shocked by President Trump’s Fiscal Year 2018 budget request released today. It threatens to roll back the progress in the fight against the domestic HIV epidemic. Now more than ever we must maintain and strengthen our progress towards our 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.

The deep proposed cuts to domestic HIV and STD prevention cannot be reconciled with the goal of preventing new HIV transmissions and the rising rates of STDs. The proposed $59 million cut to the Ryan White HIV/AIDS Program, coupled with a fundamental restructuring of the Medicaid program capping federal spending for the first time to the tune of a $610 million funding reduction over the next decade, diminishes every community’s ability to deliver quality health care to people living with HIV by eliminating AIDS Education and Training Centers and Special Programs of National Significance (SPNS).

“AIDS Education and Training Centers (AETCs) are essential to the HIV care continuum and the success of the national goals and priorities to end the epidemic,” said AIDS United President & CEO Jesse Milan, Jr. “AETCs assure that providers know and apply the best standards of care for people living with and at risk for HIV.”

Further, AIDS United is particularly concerned that the President’s budget eliminates SPNS and reduces funding for Minority AIDS Initiative (MAI) programs. SPNS and MAI programs address the HIV epidemic by developing targeted, innovative approaches to reach chronically underserved people.

“Investment in targeted approaches are effective and save money, at a time when 1 in 2 and 1 in 4 Black and Latino gay and bisexual men respectively are at substantial risk for HIV infection in their lifetime. How can we reduce funding to programs that address these disparities? The President’s budget isn’t just a set of numbers, it’s a disturbing statement of values. Every voter must send their own message to Congress to express that they value the health of our people,” said Milan.

AIDS United urges Congress to reject the draconian cuts proposed in the President’s budget request and support funding for Medicaid, HIV programs, and STD prevention. Congress cannot idly allow the return of reduced, sequester discretionary spending caps for fiscal year 2018. These restrictive caps must be raised so that non-defense discretionary programs, which include HIV programs, can be adequately funded in fiscal year 2018. A bipartisan budget agreement that provides relief from the sequester spending caps while preserving parity between defense and non-defense discretionary programs must be achieved for 2018.

“The president’s budget would turn back the clock for years and years on progress to end the HIV epidemic. We call on Congress to keep the country moving forward,” said Milan.

The facts are in – TrumpCare is dangerous and destructive

The Congressional Budget Office (CBO) has finally released their report on TrumpCare, the bill that passed out of the U.S. House of Representatives on May 4. Yeah. You read that right. The U.S. House passed TrumpCare before they knew what it cost or how it would affect health insurance.

And now we know why. The facts are clear. The American Health Care Act is dangerous and destructive.

The CBO tells us that the bill will strip 23 million people of their health insurance. We already knew that the bill completely guts protections for people with pre-existing conditions and makes devastating cuts to Medicaid. All while providing massive tax cuts to the wealthy and giant corporations.

But the fight is not over. The Senate now has to pass a bill, and it will then likely have to go to back to the House for a final vote.

WE CAN STILL STOP THIS.

Here are three things you can do NOW to make your voice heard:

Call Gov. Rauner at 312-814-2121 and demand that he publicly oppose the American Health Care Act, which will cost Illinois billions of dollars in Medicaid funding and thousands of jobs.
Call your member of Congress at 1-866-877-3303 and demand that they publicly oppose the American Health Care Act.
Forward this immediately to 10 friends and family members in Illinois, especially if they live outside of Chicago. You can also share these steps on social media using #ilsaveaca
We have asked a lot of you, but it is only because you are making a difference. Your Member of Congress is crucial in this fight and they need to hear from you again!

In Congress, Obamacare Replacement Plans Start To Emerge

 

Just twenty-five days into the 115th Congress, the Republican congressional majority has made significant steps to make good on campaign promises to repeal the ACA and setup President Trump for swift action on his other top priorities. Republicans kicked off a policy retreat in Philadelphia Wednesday that extends through Friday evening where they hope to hash out how to repeal and replace Obamacare.
While Republicans have had the last six years, and five-dozen attempts to overturn the ACA and plot a replacement, no clear consensus has risen on what to do following repeal. Adding to the uncertainty of how they might repeal and replace Obama’s signature law, is the assertion by President Trump that he will send his own plan to Congress, once his Health and Human Services (HHS) Secretary nominee, Tom Price is confirmed. The notion of the White House sending legislation to Congress is unnerving for many lawmakers and calls into question the separation of powers. Senator Rand Paul M.D. (R-KY), who introduced The Obamacare Replacement Act (S.222) this week, said in a statement that, “Sometimes you get ideas from the White House,” which underscores the atypical nature of President Trumps desired path toward repeal.

The Paul Replacement 

Sen. Paul’s bill has several provisions including an immediate repeal of the individual and employer mandates, the essential health benefits requirement, and other insurance mandates. Further the bill would allow unlimited deposits into Health Savings Accounts and broaden options for using those funds; allow the purchasing of insurance across state lines; and create voluntary associations for insurance pooling.

Cassidy-Collins replacement 

Sens. Bill Cassidy (R-LA) and Susan Collins (R-ME) held a press conference Monday to propose three options states could consider moving forward with health care coverage. States could either keep the Affordable Care Act (ACA) but with reduced federal funding for subsidies, switch to a different system to purchase insurance coverage, again with reduced subsidies , or go forward with an alternate plan that does not include federal assistance. The Cassidy-Collins proposal is in direct contrast to plans discussed by House and Senate leadership, which would not let the ACA continue in any form. Cassidy notes that this proposal serves as a middle-way approach that could potentially bridge Democrats’ and Republicans’ concerns. However, the Cassidy-Collins one-page compromise still needs legislative language.

Cassidy noted:
“At some point in this process, we will need a bill that can get to 60 votes. Now you can say to a blue-state senator who is invested in supporting Obamacare, ‘You can keep it, but why force it on us?’” Collins, affirms saying, “I believe most states would embrace this option, which allows states to cover the uninsured by providing a standard plan that has a high-deductible, basic pharmaceutical coverage, some preventive care and free immunizations.”

The question is, what does the rest of Congress think?

Senate Minority Leader Chuck Schumer (D-NY) described the proposal as “an empty facade that would create chaos.” Schumer wasn’t the only Democrat that predicted insurmountable challenges in the Cassidy-Collins proposal. Democratic leadership call into question the idea of giving some states the option to dismantle the current health care law and replace it with something else or nothing at all, for that matter. Conversely, Republican leadership hasn’t publicly commented much on the generality of the bill. Furthermore, Republicans have persistently supported the dismantling of the current health care law’s taxes and fees.

Presidential Executive Order 

As one of his first actions last Friday, Trump signed an executive order intended to minimize the economic burden of the ACA, pending its repeal. The order allows the U.S. Department of Health and Human Services (HHS) and other federal agencies to use their existing powers “to the maximum extent permitted by law” to weaken the ACA. HHS and agencies such as the IRS “were given vast discretion over key parts of the law including the individual and employer mandates,” per Pro Health Care’s Brianna Ehley. What this could mean is that it is possible to stop the individual mandate from being enforced.

In addition to President Trump’s actions, there was a congressional hearing, at which Republican members sought to expose what they perceive to be a decrease in marketplace competition and affordability. The hearing examined the “Failures of Obamacare.” There was also a hearing on theACA Individual Mandate. The hearing on the Price Nomination for HHS Secretary was also a forum for Republican senators to air their ACA-related grievances.

As HIV advocates we remain vigilant in the changing landscape and continue to seek intelligence and influence the proposed changes to our health care systems. It is imperative that the ACA not be repealed without a replacement that protects the expanded access the law has brought. We must insure vulnerable population, including people living with or at risk for HIV, are provided the access to care they deserve.

Posted By: AIDS United, Policy Department – Friday, January 27, 2017

AIDS United: A Harm Reduction Compendium

 

As a result of the opioid epidemic, the concept of harm reduction has come into increasing prominence in the United States. Harm reduction is a strategy designed to reduce harmful consequences of drugs, sex, or other risky behavior by focusing specifically on reducing the harms associated with that behavior rather than focusing on the risk or illegality of the behavior. AIDS United has long advocated for harm reduction policies such as legalizing and funding syringe services programs (SSPs) and allowing or even requiring that condoms be available in prison. With the 11th National Harm Reduction Conference hosted by the Harm Reduction Coalition in sunny San Diego just around the corner, this seems like a good time to provide an overview of some of AIDS United’s current harm reduction activities.

Harm Reduction Conference

AIDS United is participating heavily in this year’s National Harm Reduction Conference as a sponsor, as presenters and exhibitors, and as participants. AIDS United staff are leading several pre-conference workshops designed to help syringe service organizations and harm reduction organizers expand their capacity and increase their sustainability in an era of federal funding for syringe services. AIDS United is participating in a host of workshops throughout the conference – including a funders’ roundtable and a session diving into the federal implementation of syringe services funding – as well as tabling in the exhibitor hall for the duration. We will also be offering on-site technical assistance for any programs looking to apply for – or assist their health department in applying for – federal funding for SSPs.

Federal Funding Implementation

AIDS United has continued to monitor the implementation of federal funding for SSPs, and has produced a variety of resources for advocates and CBOs over the last year. In June, we released a webinar explaining the various implementation guidance documents released by the Department of Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC), Health Resources and Services Administration (HRSA), and Substance Abuse and Mental Health Services Administration (SAMHSA) as well as the role Community Based Organizations (CBOs) could play in guiding their jurisdiction’s “Determination of Need” process. A follow-up webinar, examining what we’ve learned over the first year of federal funding availability, can be expected in the new calendar year. This fall, we released a series of fact sheets, including an SSP-101 and fact sheets aimed at CBOs and SSP advocates. We continue to offer capacity building and technical assistance for programs interested in expanding services using federal funds through our CDC-funded capacity building program Getting to Zero and our policy department. Finally, we continue to work with our partners within the Coalition for Syringe Access to build upon the victories won in late 2015.

Funding

The Syringe Access Fund (SAF) is a funding collaborative of Elton John AIDS Foundation, Irene Diamond Fund, Levi Strauss Foundation, Open Society Foundations, and AIDS United. It is the largest private funding collaborative for syringe access in the United States. The Fund is currently in the first year of its 9th funding round, with grantees across the country continuing to offer lifesaving services and critical policy advocacy on behalf of people who inject drugs. The Round 10 RFA, covering 2018-2019, is expected to be released in Fall, 2017. To date, the Syringe Access Fund has provided more than $17 million in grants to syringe services programs.

Policy Advocacy

AIDS United continues to support harm reduction policy responses to substance use, and in July became the first national HIV advocacy organization to publicly endorse Supervised Injection Facilities as an HIV/HCV prevention strategy for people who inject drugs, alongside expanded access to Medication Assisted Treatment, layperson-naloxone distribution, Good Samaritan protections, syringe services programs, and non-abstinence based housing first permanent supportive housing programs. This endorsement, supported by our Public Policy Committee, firmly centers harm reduction approaches to HIV prevention for people who inject drugs. With the opioid epidemic continuing to rage, AIDS United expects to only deepen our commitment to advancing harm reduction responses to this public health crisis.

Posted By: AIDS United, Policy Department – Friday, October 28, 2016

As STD Rates Soar, Prevention Spending Cuts Continue to Loom Large

 

Infectious diseases don’t take breaks. Humanity has plenty of advantages over communicable diseases, but by and large, policy makers and the public have a disconcerting tendency to only pay attention to public health in times of crisis. In the midst of an outbreak, we are prone to take swift and demonstrative action to address whatever problems face us. However, as soon as that outbreak subsides, our reaction is too often to take our foot off the gas and refocus our energy on issues that suddenly seem more pressing.

For over a decade, funding to combat sexually transmitted diseases (STD) has been given the short shrift by Congress and state legislatures that is all too common with regards to health issues. Since 2003, Congress has not provided a single funding increase for STD programs, while, simultaneously, more than half of all state and local STD programs have undergone large budget cuts.

The result of this institutionalized neglect of STD prevention and treatment has been a startling, but not altogether surprising, resurgence in STD rates, with the recent release of a Centers for Disease Control and Prevention’s (CDC) report showing the highest number of combined cases of chlamydia, gonorrhea, and syphilis ever recorded in the United States. Between 2014 and 2015, the number of cases of primary and secondary syphilis, congenital syphilis, gonorrhea, and chlamydia rose by 19 percent, 6 percent, 13 percent, and 6 percent respectively, but those numbers only tell part of the story.

This sharp spike in STD rates over the past year is just the most recent and most pronounced manifestation of a disturbing epidemiological trend that shows no signs of stopping any time soon. Between 2003–the last year that Congress provided a funding increase for STD programs–and 2015, the recorded number of cases of primary and secondary syphilis increased by a staggering 333 percent. During the same period, the number of reported cases of chlamydia rose by 174 percent. The number of reported cases of gonorrhea have gone up by a comparatively low 18 percent, but this modest increase is countered by the severity of antibiotic resistant strains that are becoming increasingly prevalent.

It is not a coincidence that this surge in STD cases has come at a time when the budgets of state and local STD programs are being slashed. Much like our aging roads and bridges, America’s public health infrastructure is woefully underfunded and is being pushed to its breaking point. As Bill Smith, the former executive director of the National Coalition of STD Directors, put it at a congressional briefing on STD prevention back in April, “Our mantra has been to ‘do more with less,’ but now we’re doing less with less. The public’s health is in danger.”

At that same congressional briefing, Dr. Gail Bolan, the CDC’s director of STD Prevention, gave a dour diagnosis for the trajectory of STD infection in the United States if state and local STD programs continue to be underfunded or abandoned. “For those of you who are not clinicians, in most people’s assessment, congenital syphilis is a sentinel event.” Bolan said. “It is a failure of the health care system and it is a failure of the public health system. And in a society that invests as much as we do in our health care and in our public health we should not be seeing this number of congenital syphilis cases in the United States.”

One would think that Congress would immediately react to such a dire warning and would circle the wagons and work to nip this burgeoning STD crisis in the bud. Unfortunately, with the lame duck session quickly approaching, Congress may decide to double down on its neglect of the nation’s sexual health. In the Senate’s current Labor, Health and Human Services and Education Appropriations bill for FY2017, there is a proposed $5 million cut to the CDC’s Division of STD Prevention, while the House version merely continues the flat funding that has led to a 40% reduction in the Division of STD Prevention’s buying power since 2003.

Out of sight, out of mind, is not an acceptable approach for Congress or state and local governments to take regarding any public health issue, much less one with the destructive personal and financial implications of sexually transmitted disease. For the millions of Americans who contract STDs each year, and particularly for populations like men who have sex with men who bear a disproportionate brunt of this burden, what do these proposed cuts in funding say about the government’s opinion of them and their wellbeing? It is hard to interpret a call to slash STD program funding in the wake of this recently released CDC data as anything other than a disregard by elected officials for the health of their constituents and it cannot be allowed to stand. As Congress completes its funding of federal programs for the fiscal year that began Oct. 1, AIDS United will join other advocates in demanding increased funding for STD prevention. The latest surveillance data call for no less from us.

Posted By: AIDS United, Policy Department – Friday, October 28, 2016

Celebrating the Legacy of AmeriCorps

This summer, the AIDS United AmeriCorps program drew to a close after 22 years. Over the years, the program trained and placed over 800 AmeriCorps Members in HIV-focused community-based organizations, where they gained frontline experience in the fight against HIV. I consider myself fortunate to have been one of these Members.

My experience in the AIDS United AmeriCorps program was formative. In addition to developing my understanding of the HIV epidemic and its surrounding stigmas and disparities, the program was the start of my career in public health and the beginning of lifelong friendships. More recently, as the manager of this program, I had the privilege to meet and learn from dozens of passionate people united to make a difference in the HIV epidemic.

The legacy of the AIDS United AmeriCorps program demonstrates that anyone can make change. Seemingly small actions like taking extra the time during a counseling session to answer questions, organizing a community cleanup, or simply lending an ear can have a profound effect on both AmeriCorps members and the people and community they serve. Multiply this by almost one thousand members over 20+ years and these individual actions have created a movement.

A look back at what has been accomplished is monumental. In 20+ years over 800 members:

  • served over 1.4 million service hours,
  • conducted over 100,000 HIV tests, and
  • reached almost 500,000 people through education and outreach.

Each number represents a life changed. It’s people seeking HIV treatment for the first time, learning their HIV status, or being linked to supportive services.

Even after they complete their service, a majority of program alumni work in community-based organizations, medicine, and social services agencies. Many, specifically work in HIV. Their contributions to the fight against HIV are critical. We have the tools to end the epidemic, but it will take persistent work to counter the stigma and disparities that fuel this epidemic. Knowing there is a cohort of AmeriCorps alumni engaged in the movement makes me hopeful that we will get there.

Race for the White House: HIV is Invisible but Election Outcome will be Real

 

As many people cast their ballots in the closing days of this seemingly endless presidential campaign, we can reflect on what the elections mean for the nation’s response to the HIV epidemic. HIV as an issue, and as a day-to-day reality for more than 1 million individuals in the United States was virtually invisible in this year’s election campaign. Indeed, health care overall had a low profile in the campaign. However, elections do have consequences, even on issues hidden throughout the campaigns. The decision on who sits in the Oval Office for the next four years will be consequential for people living with or affected by HIV. We should cast our votes with this potential fallout on our minds.

Given the stark differences between the two major presidential candidates on health care, it is ironic that the issue has been so low key. In the latest Kaiser Health Tracking Poll, nearly three-fourths of those polled felt that the health care views of Hillary Clinton and Donald Trump are very different:

 For people living with or affected by HIV, the differences can be very impactful. Mrs. Clinton has a stated strategy for addressing HIV/AIDS. Mr. Trump has articulated no policy or made any statements that address HIV or AIDS. On the Affordable Care Act (ACA), Mrs. Clinton supports defending and expanding health care reform, including expanding Medicaid in the remaining states that have not done so. Mr. Trump favors complete repeal of the ACA, encourages the use of Health Savings Accounts, and supports the purchase of health plans across state lines.

The candidates also differ sharply on Medicaid, beyond their differences on Medicaid expansion. Clinton supports maintaining the current financing structure for Medicaid while Trump favors transforming Medicaid into a block grant program. On Medicare, Mrs. Clinton supports allowing people 55-64 years of age to buy into the program and supports allowing the Centers for Medicare & Medicaid Services (CMS) to negotiate on drug prices. Mr. Trump’s campaign is silent on Medicare. These are critical issues to people living with HIV. Together, these programs provide health coverage to more than 65% of people living with HIV. The importance of Medicare will only increase as the number of people living with HIV continue to age into the program.

While AIDS United, as a not-for-profit organization governed by U.S. tax laws, cannot support or oppose any candidate or political party. We do vigorously support voters being aware of the issues, being engaged in the voting process, and being mindful of the consequences of their votes. We know that voting is a form of HIV advocacy. 

HIV and health care may not have been visible campaign issues, but the health and wellness of people living with and affected by HIV are real and very visible. Each of you will need to decide which candidate will better protect and advance your health and wellness and that of your community. But please, do not be complacent. The differences between the candidates are real and so will be the consequences of this election. It’s your life and it’s your vote. Use it as if your life depended on it, because it may. 

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