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FEBRUARY 15, 2013
President Calls for an AIDS Free Generation in State of the Union Address

President Barack Obama’s State of the Union (SOTU) Address, delivered Tuesday, February 12th, was a strong speech, laying out a relatively aggressive program for the administration on health care. The speech mentioned HIV in the context of the U.S.’s foreign policy, stating:

“So the United States will join with our allies to eradicate such extreme poverty in the next two decades by connecting more people to the global economy; by empowering women; by giving our young and brightest minds new opportunities to serve, and helping communities to feed, and power, and educate themselves; by saving the world’s children from preventable deaths; and by realizing the promise of an AIDS-free generation, which is within our reach.” (emphasis added)

The mention is encouraging because it is only the second time (out of four SOTU speeches) that the President has mentioned HIV in a State of the Union address (the first time was in 2010). Generally, the President has used special occasions such as speeches on World AIDS Day or the announcement of the National HIV/AIDS strategy to highlight the issue. The mention is also interesting since it uses the former Secretary of State, Hilary Clinton’s formulation of “an AIDS-free generation” first announced in a speech at the National Institutes of Health in November 2011. The President has also previously adopted the same language, most notably on World AIDS Day 2011 committing the Administration to ending the HIV pandemic by fighting to reduce the disease “to zero.”

For advocates of increasing domestic prevention, treatment, care and research the language is encouraging because it recommits the President in a major public address to focusing on the HIV epidemic and, of course, in order to reach an AIDS-free generation, the United States must also do so at home. To that end a new petition to “Commit Resources to Ensure an AIDS Free Generation,” was authorized by the convening groups of the Federal AIDS Policy Partnership (FAPP) and Global AIDS Policy Partnership (GAPP) on the White House website’s, “We the People” section. (See Announcements below).

In addition to the section highlighting HIV, the President discussed health care in the speech most notably in the opening section discussing the sequester and funding for government. President Obama noted that the “biggest driver of our long-term debt is the rising cost of health care for an aging population.” He then called for modest reforms to Medicare, offering savings at the rate of the “Simpson-Bowles” commission’s plan to cut deficits. It is not clear what the exact amount such a cut would actually entail, although an estimate of the separate parts can be found here. He then defended the Affordable Care Act, noting that it is already helping to slow health care costs and suggested that another way to cut costs was to reduce subsidies to prescription drug companies and wealthy seniors.

The Republicans asked Senator Marco Rubio (R-FL) to deliver their response to the State of the Union, a speech heavily focused on taxes and regulation. The response strongly criticizes “Obamacare” for causing some people to “los[e] the health care they were happy with” and for creating requirements for businesses over 50 people that he deemed to be too expensive causing them to stop or slow hiring.. He additionally says of Medicare:

“I would never support any changes to Medicare that would hurt seniors like my mother. But anyone who is in favor of leaving Medicare exactly the way it is right now, is in favor of bankrupting it.

Republicans have offered a detailed and credible plan that helps save Medicare without hurting today's retirees. Instead of playing politics with Medicare, when is the President going to offer his plan to save it? Tonight would have been a good time for him to do it.”

This section seemed odd to advocates in the health care field since, as noted above, Obama had specifically suggested making cuts at the level of the Simpson-Bowles plan. In any case, it is clear from the dueling speeches that health care will continue to be a major point of disagreement between the parties, a disagreement that will continue to play out as the Affordable Care Act is implemented.

The 2013 State of the Union speech with transcript can be found here.

The 2013 Republican State of the Union Response transcript can be found here.

The Simpson-Bowles Plan can be found here (Medicare savings are generally found on pp. 37-40).

The State of the Union - From the Inside

By Melissa Donze, Zamora Fellow, AIDS United

The first time I went to the White House, I was 11 years old. I was on a family vacation in D.C., and the only thing I can remember is standing outside the North Portico after our tour and my dad taking pictures of my brother and me, which he has since framed and kept in his living room. The second time I went to the White House was just this past week, when I was invited to watch the State of the Union. Not everyone can say they’ve been to the White House, let alone twice. But being invited to the White House to watch the State of the Union? Now that’s something to write about.

Last week, I stumbled upon a tweet inviting individuals who actively engage with the White House through social media to apply for a spot at the 2013 State of the Union White House Social, an opportunity to watch an interactive, live-stream of the State of the Union and discuss the address afterwards with White House officials. I often use social media, namely Facebook and Twitter, to share news related to HIV and other issues that are important to me. While I didn’t think I would actually be selected, I applied thinking it was a great opportunity to engage with others who advocate through social media. To my great surprise, I received an email from the White House congratulating me on being selected to attend the State of the Union White House Social!

To read more about Melissa’s experience at the State of the Union White House Social, click here.

Weathering the Funding Storms

This week has seen a flurry of work on funding issues. Last night Majority Leader Reid (D-NV) introduced a plan – American Family Economic Protection Act to avoid the sequester entirely for the rest of Fiscal Year 2013 and the first 3 months of Fiscal Year 2014. The package costs $110 billion and is equally divided between revenue and spending cuts, with the spending cuts of $55 billion equally divided between Defense and Non-Defense Discretionary (NDD) programs. All of the $27.5 billion in cuts (over 10 years) in NDD would come from Agriculture savings from farm subsidies that are paid regardless of the crop yield, prices or farm income, according to a summary of the package released by Majority Leader Reid’s office. Appropriations Chairwoman Barbara Mikulski stated the Defense cuts are also $25.5 billion or 0.5% of defense spending and would not begin until Fiscal Year 2015 after the troops return from Afghanistan.

Minority Leader Mitch McConnell (R-KY) has said the plan with revenue included is not workable on his side of the aisle. He will be putting out an alternative plan. House Speaker John Boehner (R-OH) is open to working with Majority Leader Reid on an alternative to the sequester. However, he wants the Senate to pass the legislation prior to the House taking it up, since he does not want his Caucus to take a difficult vote if the legislation is not truly moving. The speaker did note that a potential difficulty with having the Senate pass a bill first is that according to the Constitution bills raising revenue must originate in the House.

The revenue in the package includes three main points -- Closing an oil tax loophole on tar sands, ending the tax break for companies that send jobs overseas, and ensuring that those with adjusted gross incomes over $1 million pay at least 30% tax on incomes excluding charitable contributions. These tax changes will generate $55 billion in new revenue.

In related news, on February 14th the new Chair of the Senate Appropriations Committee, Barbara Mikulski held a hearing on the impact of sequestration on agencies throughout the federal government. A particular goal was to highlight the impact on the non-defense discretionary agencies. Although Secretary of Health and Human Services, Kathleen Sebelius did not testify, she sent a letter to the committee via e-mail. The letter highlights HIV/AIDS issues, stating:

“Sequestration would impair the Department's ability to prevent and treat HIV/AIDS. The cuts to the Centers for Disease Control and Prevention (CDC) translate into approximately 424,000 fewer HIV tests conducted by CDC's health department grantees. The Health Resources and Services Administration estimates that 7,400 fewer patients would have access to life-saving HIV medications through the AIDS Drug Assistance Program (ADAP). This would cause delays in service and drug provision to people living with HIV and potentially lead to ADAP wait lists for HIV medications.”

Additionally, Secretary of Housing and Urban Development Arne Duncan highlighted cuts that could also impact people living with HIV. In particular he noted that as many as 7,300 households would lose assistance under the Housing Opportunities for Persons with AIDS (HOPWA) Program. He also noted the potential loss of 125,000 housing choice vouchers. HIV advocates pointed out that these cuts also might affect people living with HIV since approximately half of the holders of vouchers under this program are disabled or elderly and that 100,000 homeless or formerly homeless would lose support and risk return to homelessness.

 In the House, Appropriations Chair Representative Harold Rogers (R-KY) announced a plan to introduce legislation to pass a 6 month Continuing Resolution (CR)  that would maintain the current CR limits onFY 13 spending at $1.043 trillion, as specified in the Budget Control Act.  Chairman Rogers expects that if automatic spending cuts (sequestration) go into effect, the FY 13 spending limit will be lowered to about $974 billion. The automatic spending cuts in FY 13 could be averted by changing the March 1 starting date of sequestration, as proposed in the Senate Democrats’ plan.

Finally, on Tuesday, February 12 and Wednesday, February 13, the Senate Budget Committee held its first two hearings of the 113th Congress. As part of Chairman Patty Murray’s (D-WA) continued efforts to make sure the values and priorities of families across the country are heard in the budget process, members of the public appeared as witnesses before the committee to talk about the impact of budget decisions made in Washington, D.C. on their families and communities. The testimonies of the witnesses were compelling and emphasized the importance of maintaining federal funds for safety net programs like the Supplemental Nutrition Assistance Program (SNAP) and the Women, Infants and Children (WIC) Program. Mrs. Tara Marks, a witness at the hearing, stated the following in her testimony:

“In conclusion, I am very thankful that SNAP was there for us. I urge the Committee –and the Congress – to take stories like mine into account as you put together your budget. I ask that Congress continue to invest in life-saving programs so that families like mine - all across the country - can get the support they need to get back on their feet, back on track, and back into a job. They were there for me when I needed it most, and they shouldn’t be cut now when so many others are struggling in this tough economy.”

Many people living with HIV/AIDS are in similar situations and rely on these programs. Unfortunately, Mrs. Marks’ struggle is not unique; it is a story that many Americans share. We cannot allow Congress to make cuts to programs that save the lives of Americans without also increasing methods of revenue.

Two-Spirit and Transgender Communities Present for the First Time at 50th PACHA Meeting

For the first time in the history of the Presidential Advisory Council on HIV/AIDS (PACHA), the Two-Spirit and Transgender (aka “Trans”) communities were invited to present on the impact of HIV on their respective communities on February 7, 2013. Each of these compelling presentations revealed some key factors from their respective communities that have resulted in alarmingly high rates of HIV infection.

Speaking on behalf of the Two-Spirit community was Harlan Pruden of First Nations Cree and Dr. Karina Walters of the Choctaw Nation of Oklahoma. Both identify as Two-Spirit. The American Indian/Alaska Native population has traditionally held the Two-Spirit gender identity in high esteem; many Two-Spirit people were given the most important roles during ceremonies and celebrations. While the American Indian/Alaska Native population as a whole faces extreme barriers to quality health, the Two-Spirit population faces additional challenges that increase risk for HIV as well as other health issues. “ The HONOR Project” was a five-year, multi-site Two-Spirit health study that took place from 2002-2007 and revealed a combination of trauma (historical, childhood and microaggressions); mental health issues; physical health and health risk behaviors; and culturally specific practices that have contributed to high rates of HIV among the Two-Spirit population. Twenty-two percent of the Two-Spirit individuals surveyed in this project self-reported being HIV positive; 73% of HIV infections among the American Indian/Alaska Native population are found in MSM. Perhaps most distressing is that HIV diagnoses among the American Indian/Alaska Native population have increased despite an overall population decrease, signifying the necessity of more research and resource commitment to fighting HIV in the American Indian/Alaska Native population.

The Trans panel consisted of Trans individuals as well as advocates for the Trans community. Unfortunately, more gaps exist than actual research on Trans health issues, but what research is available highlights the extreme disparities in HIV infection. A 2008 study revealed that while 12% of Trans women reported HIV positive, 28% actually tested positive for HIV. Among Trans men, 0-3% reported being HIV positive and 2% actually tested positive for HIV. The factors driving such high rates of HIV among Trans individuals include: social stigma (lack of family/peer support), employment discrimination, survival sex work, multiple injection risks, culturally incompetent prevention methods, and gender identity validation through sex. Furthermore, Trans people are more likely to face barriers to quality health care, and high rates of depressive symptoms predict both high-risk sexual behavior and HIV infection. The combination of multiple discriminations and high-risk behaviors has contributed to such high rates of HIV infection among Trans individuals, and it is clear from this presentation that further research is necessary to fully understand HIV as well as other health disparities among the Trans community. AIDS United recently awarded a Retention in Care grant to the Mazzoni Center in Philadelphia, PA, for an intensive retention initiative targeted exclusively to transgender women that includes a drop-in center where clients can receive wrap-around services.

PACHA passed resolutions to address HIV/AIDS in both transgender populations as well as Two-Spirit communities.

PACHA also passed the HIV criminalization resolution that was sent back to the disparities subcommittee at the conclusion of the previous PACHA meeting in October 2012. Among other items PACHA recommended that the Department of Justice (DOJ) and the Department of Health and Human Services (HHS)/CDC complete a written review finding opportunities to create incentives to eliminate HIV-specific criminal laws. They also recommended current criminal laws be modernized to eliminate HIV-specific statutes consistent with current medical and scientific knowledge and accepted human rights-based approaches to disease control and prevention, and finally to avoid imposition of unwarranted punishment based on health and disability status. This resolution was first presented in October by Catherine Hanssens, the Executive Director of the Center for HIV Law and Policy, on behalf of the Positive Justice Project’s Federal Advocacy Work Group (AIDS United’s Political Director, William McColl, serves as a co-chair of the PJP and helped draft early versions of the resolution).

To learn more about PACHA, click here.

Announcements

AIDSWatch is 10 Days Away! Register TODAY!

AIDSWatch 2013 is just 10 DAYS AWAY, but there’s still time to register! Join the Treatment Access Expansion Project, AIDS United and the 200+ people who have already registered! On February 25-26, 2013, in Washington, D.C., YOU can make your voice heard with your Members of Congress about HIV and health-related policy! For more information about AIDSWatch and how to register, please click here.


Upcoming HIV/AIDS Awareness Days

Mark your calendars now! March 10, 2013 is National Women and Girls HIV/AIDS Awareness Day and March 20, 2013 is National Native HIV/AIDS Awareness Day. To learn more about these and other HIV/AIDS Awareness Days throughout the year, click here.

The 24th National Week of Prayer for the Healing of AIDS will take place March 3-9, 2013. This is an annual HIV awareness campaign that mobilizes faith communities and highlights the contributions and impact congregations are making in areas of HIV prevention, testing, direct service, advocacy and community engagement. To learn more, visit their website by clicking here.


AIDS United President and CEO Michael Kaplan Featured in Huffington Post

This week, AIDS United President and CEO Michael Kaplan wrote a compelling piece for the Huffington Post regarding coming out about HIV status. To read his blog, click here.


Petition to the Obama Administration to Commit Resources to Ensure an AIDS Free Generation

On the heels of President Obama’s State of the Union Speech and in advance of the release of the Administration’s budget, the convening groups of the Federal AIDS Policy Partnership (FAPP) and the Global AIDS Policy Partnership (GAPP) posted a petition to the White House website’s “We the People” section. The petition calls on President Obama to fully support funding for an AIDS-free generation. We have 30 days to get 100,000 signatures to garner a response from the White House!

We ask that you share the petition with your organizations, supporters and grassroots. 100,000 may seem like a daunting goal but with the weight of these communities behind it we should be able to reach and exceed it.

Some in the community are using the hashtags #endaids, #aidsfreegeneration, and #dontcutnow in social media, and we ask that as you push the petition over your own social media channels you consider doing the same.

You can sign the petition here! Please share this with everyone you know so we can reach 100,000 signatures!

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