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DECEMBER 7, 2012
Reflections on World AIDS Day in D.C.

By Melissa Donze, Zamora Fellow

On the evening before World AIDS Day, I took a walk down to the White House after work. As a recent transplant to D.C., the sight of the White House, the Washington Monument, and the Capitol still make me smile like a tourist. But this time, as I turned the corner and crossed through Lafayette Square, the sight of the White House took my breath away.

Draped across the North Portico was a big, red ribbon. It stood out so vividly against the white backdrop, and for a moment I stood there, frozen, completely entranced. It was an incredibly beautiful sight.

It’s been seven years since I first became actively involved in the fight against HIV/AIDS; seven years since I first started informing my high school peers about HIV; seven years since I found out that most people in my small hometown didn’t want to talk about sex or drugs or race or poverty because HIV “didn’t affect them.”

Click here to read Melissa’s entire blog about World AIDS Day.

Lame Duck Session Update

At the end of the second full week of the lame duck session of the 112th Congress there seemed to be no substantive progress on a proposal on the various issues that make up the “fiscal cliff,” which includes the automatic spending cuts known as sequestration and the expiration of the Bush-era tax cuts. There were signs, however, that some Congressional Republicans reluctantly are accepting the idea that tax rates will have to increase for the top 2% of taxpayers. President Obama has maintained an unwavering stance on the need for the tax cuts to be extended for all but wealthier individuals and families. Polling data shows overwhelming support from the public that taxes for rich people need to increase as part of any balanced plan to reduce the federal deficit. Polls also show that the majority of Americans will blame Republicans if there is a failure to reach an agreement to avoid the fiscal cliff.

Advocates, including we at AIDS United, are maintaining close attention to the fiscal cliff issues in the lame duck session. Over 200 advocates for non-defense discretionary (NDD) programs attended an NDD Town Hall Meeting on Tuesday, Dec. 4. A keynote speaker was Senator Patty Murray (D-WA). Senator Murray called for continued solidarity in the NDD community and noted that a “bad deal” should not be accepted, saying “But taking an even worse deal [than sequestration] simply for the sake of getting a deal would be deeply irresponsible, and it would hurt families far more than sequestration in the long run.”

A key message from the Town Hall Meeting was that spending for NDD programs has already been cut deeply as a result of the Budget Control Act of 2011. These cuts total nearly $1.5 trillion over 10 years. Any balanced approach to deficit reduction must include the NDD spending cuts already enacted and should not include further NDD spending cuts. NDD programs include all domestic HIV programs such as the Ryan White Program, HIV prevention, HOPWA (Housing Opportunities for Persons with AIDS), and HIV/AIDS research. An NDD Day of Action has been planned for Monday, Dec. 10. Advocates are urged to make calls, visits, send e-mails, letters, and Tweets to Members of Congress. A suggested “ask” for HIV advocates is:

We urge you to support a balanced approach to deficit reduction that does not include further cuts to non-defense discretionary (NDD) programs such as the Ryan White Program and HIV prevention [other HIV priorities can be substituted or added]. These programs already have contributed to deficit reduction through the bipartisan Budget Control Act (BCA) and prior spending cuts.

Click here to read Senator Murray’s remarks at the NDD Town Hall Meeting.

For more information on the NDD Day of Action, click here.

Prevalence of HIV Criminalization Perpetuates Stigma and Inhibits Disclosure and Testing, According to U.S. National Dialogue

On December 4, the United Nations Development Programme (UNDP), Center for HIV Law and Policy, and the National Alliance for State and Territorial AIDS Directors (NASTAD), in conjunction with Representative Barbara Lee (D-CA), hosted “The United States National Dialogue on the Criminalization of HIV Transmission, Exposure and Non-disclosure: The Role of States and the Federal Government." The landmark event brought together 40 civil society representatives, people living with HIV, and other experts to discuss how to lessen criminalization laws and how to enhance peoples’ ability to disclose their status. Representative Barbara Lee (D-CA) highlighted her work as the U.S. Representative to the Global Commission on HIV and the Law. She noted the surprising number of prosecutions of people living with HIV for failing to disclose their status despite lack of actual transmission, or evidence of intent to transmit. Rep. Lee also indicated that there is clear evidence showing that these prosecutions make it more difficult for people to get tested and treatment. Many criminalization laws were passed before the advent of anti-retroviral therapy and are based on a long-outdated understanding of HIV.

Panelists from UNDP highlighted a July 2012 report by the Global Commission called “Risks, Rights and Health” that served as the background for the presentation. The report and accompanying materials can be found here.

Randy Mayer, AIDS Director for the Iowa Department of Health, and Iowa State Senator Matthew McCoy (D), discussed actions being taken at the state level. Iowa has one of the harshest HIV criminalization laws in the U.S., requiring sentences of people living with HIV to more than 25 years in prison whether or not transmission actually took place or the person took efforts to minimize the possibility of transmission. Iowa’s law also requires the person register as a sex offender. Senator McCoy has introduced legislation to: 1) amend that state’s HIV statute to limit it to cases of malicious intent to harm someone, 2) change the penalty based on actual transmission, and 3) remove the registration requirement. Mayer has also worked to educate lawmakers about more effective ways to address the issue of transmission. NASTAD has created guidelines for state directors in helping to deal with this issue, which can be found here. Senator McCoy indicated he did not believe the issue broke down around partisan lines as much as around lines of the “informed and uninformed.” According to Senator McCoy, it is important that everyone understands the benefits of ending outdated criminalization laws.

Lisa Fager-Bediako from the Congressional Black Caucus Foundation’s Act Against AIDS Project moderated a discussion among the civil society representatives and audience about the risks and consequences of HIV transmission, HIV in hard-hit U.S. communities, HIV prosecutions and disclosure, promotion of safe and voluntary HIV disclosure and the identification of solutions and next steps. Participants in the room agreed to keep working to change laws and planned to create additional spaces for future discussions of HIV criminalization.

Seminar on "New Responses to the D.C. HIV/AIDS Epidemic": D.C. Gentrification an Independent Risk Factor for City's Vulnerable Populations

On Monday, December 3, the D.C. Developmental Center for AIDS Research (D-CFAR) hosted a seminar with Dr. Gregory Pappas, Senior Deputy Director of the HIV/AIDS, Hepatitis, STD and TB Administration at the D.C. Department of Health. Entitled “New Responses to the D.C. HIV/AIDS Epidemic," Dr. Pappas’s presentation focused on trends in D.C.’s HIV/AIDS epidemic, including current systems of health and care and major policy approaches.

According to Dr. Pappas, D.C. has eliminated many of the traditional barriers to care and treatment, including lack of transportation and cost of medicine. It has the second highest rate of insurance coverage in the nation after Massachusetts due in part to early implementation of the Affordable Care Act. He highlighted the correlation between the increased number of clean needles distributed since local funding for syringe exchange was legalized in 2007 along with the decreased number of cases of HIV transmission through needle sharing. Despite many successful programs, HIV prevalence in D.C. remains high at 2.7%, and only 29% of those who are HIV positive have maintained viral suppression. Because of stigma, African-American men who have sex with men (MSM) are less likely to be tested, get into treatment, and be virally suppressed; in fact, 25% of African-American MSM in D.C. are HIV positive.

One of the most interesting aspects of Dr. Pappas’ presentation was his discussion of gentrification in D.C. as an independent risk factor for HIV for vulnerable populations, as these populations’ social capital is strained and displaced by the disruption of social networks due to the effects of renovation and restoration. In fact, he tracked rates of HIV incidence and gentrification and found that 55% of the variance in case rate distribution of HIV can be explained by gentrification alone.

In terms of policy approaches, Dr. Pappas suggested the idea of a “domestic PEPFAR,” a kind of program that would invest large amounts of money into prevention, treatment and care with coordination across the federal and jurisdiction levels. He also discussed the importance of HIV medical homes, which could be used as the national model for patient-centered medical homes for people living with chronic diseases once the Affordable Care Act is implemented. In February, his office will be hosting a training focusing on achieving coordination between community based organizations and clinical caregivers to ensure the highest quality of care and support for people living with HIV.

Many of the points that Dr. Pappas discussed, while specific to D.C., can be adapted and applied to regions across the country. For example, his data on the correlation between syringe exchange programs and decreased rates of HIV transmission should serve as evidence for a greater number of these programs. His focus on policies like gentrification at the micro-level has proven to be extremely valuable, and we must consider how social structures and programs around the country have an effect on HIV. As Dr. Pappas and his office continue to build policy that ensures the greatest quality of care and support for people living with HIV across the country, we should look to D.C. to learn valuable lessons about our own programs and policies.

To learn more about the DC D-CFAR, you can visit their website by clicking here.

Senate Fails to Pass Convention on the Rights of Persons with Disabilities

On December 4, the Senate failed to pass the Convention on the Rights of Persons with Disabilities, a treaty of the United Nations, by 5 votes. The Convention was created to develop and carry out policies, laws and administrative measures for securing the rights for people living with disabilities and abolish laws, regulations, customs and practices that constitute discrimination. The U.S. International Council on Disabilities released a statement following the vote in support of those Senators who voted to pass the treaty:

“The American disability and veteran community applauds the 61 courageous senators who stood up for the rights of their citizens. The Democrats and Independents were unified in their support for the treaty. We sincerely thank those Republicans who stood with us for their courage: Senators McCain, Barrasso, Brown, Collins, Ayotte, Snowe, Murkowski, and Lugar. As for the other 38 senators, who abandoned the very principles and values that this country was built upon by blocking the Convention on the Rights of Persons with Disabilities - we will not let you forget this vote. Countless Americans with disabilities came together across the United States to support the cause of U.S. ratification of the CRPD.”

HIV-positive individuals are protected under the Americans with Disabilities Act, and the passing of this treaty would have been an even greater step towards ensuring that the inherent dignity of people living with HIV is respected and maintained. AIDS United hopes that this treaty will be passed to ensure the rights of all people with disabilities, including those living with HIV, are protected and respected.

To read more about HIV and the Americans with Disabilities Act, click here.

To read more about the U.S. International Council on Disabilities, click here.

Announcements

Show Support for HIV Testing Recommendation!

On November 19, 2012, the United States Preventative Services Task Force issued a draft recommendation in strong support of routine HIV testing for all adolescents and adults ages 15 through 65, pregnant women, and others at increased risk for HIV younger than 15 and older than 65. This recommendation was assigned a Grade "A" rating. This is a monumental change for the USPSTF which in the past recommended testing only for people who are “at risk” for HIV and pregnant women. The Grade “A” grade is merely a draft and is now subject to a 30-day public comment period before it can be finalized.

Click here to read a sign-on letter authored by the HIV Testing Reimbursement Subcommittee of the Federal AIDS Policy Partnership (FAPP) in strong support of the draft recommendation. If you or your organization would like to sign it, please go to: http://www.surveymonkey.com/s/H6CVJNJ

The deadline to sign-on to the letter is 12 noon ET, Friday, December 14th.

Should you have any questions or comments on the letter, please feel free to contact Subcommittee Co-Chairs Carl Schmid at cschmid@theaidsinstitute.org or Holly Kilness at holly@aahivm.org.

Finalization of this recommendation can have a substantial impact on bringing more people into care and treatment, and decreasing new HIV infections. It will also have implications on coverage of HIV testing as USPSTF grades guide reimbursement requirements for private insurers, Medicare and Medicaid.

To read the draft recommendation or if you would like to submit your own comments (individual comments are due by December 17, 2012) go to: http://www.uspreventiveservicestaskforce.org/draftrec.htm.


Urge the USPSTF to Change Its Hepatitis C Testing Recommendation!

On November 27, 2012, the U.S. Preventive Services Task Force issued a draft recommendation statement on screening for Hepatitis C. The statement recommends “screening for hepatitis C virus infection in adults at high risk, including those with any history of intravenous drug use and blood transfusions before 1992” and gives this recommendation a Grade B rating, meaning that screening for these populations has much more potential benefits than harm. The statement also recommends that “clinicians consider offering Hepatitis C infection screening in adults born between 1945 and 1965” and gives this a Grade C rating, meaning it has at least a small overall benefit.

AIDS United is concerned that this recommendation does not follow the guidelines from the Department of Health and Human Services (HHS) report, COMBATING THE SILENT EPIDEMIC of VIRAL HEPATITIS Action Plan for the Prevention, Care & Treatment of Viral Hepatitis, which is to implement routine viral hepatitis testing as part of the standard of care in a reformed health-care system.

The Task Force’s recommendation is open for public comments until December 24, 2012. Until then, you can show your support for changing the recommendation to a Grade B rating! You can read the draft recommendation and add your comments by clicking here.


Survey Regarding Safe and Appropriate Access to PrEP for Women in the U.S.

Earlier this year, SisterLove, a reproductive justice organization for women that focuses on HIV/AIDS and based in Atlanta, met with a group of women advocates from across the U.S. to talk about how to make PrEP (Pre-Exposure Prophylaxis) safely and appropriately accessible to women in the U.S. who want to use it. They have developed this survey to make sure that the views of transgender women, sex workers and active drug users are represented in their discussions.

We invite any and all eligible individuals to complete this survey by January 1, 2013. Your input is greatly appreciated and will assist SisterLove in this important discussion about the role of PrEP in the lives of women in the U.S. Feel free to pass this survey along to whatever lists, friends or colleagues you think are appropriate.

For more information, please contact Anna Forbes (annaforbes@earthlink.net or (301) 946-4269/(610) 662-1261).


National Latino AIDS Action Network Seeking Intern to Support Program and Policy Activities

The National Latino AIDS Action Network (NLAAN) is seeking a qualified intern to help support program and policy activities. NLAAN is a national coalition of community-based and national organizations, state and local health departments, researchers and concerned individuals working to address the disproportionate impact of HIV/AIDS in Latino/Hispanic communities. It works to mobilize, educate, and advocate on national, state and local levels in collaboration with Latino-serving organizations and communities to prevent HIV infection, increase access to care and treatment, and inform research efforts that address the needs of diverse Latino communities.

Qualified candidates should apply by e-mail only to nlaan411@gmail.com. Please list INTERN, NLAAN in subject line and attach a cover letter and resume.

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