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MARCH 15, 2013
Fiscal Year 2014 House and Senate Budgets

Earlier this week, both Representative Paul Ryan (R-WI), Chair of the House Budget Committee, and Senator Patty Murray (D-WA), Chair of the Senate Budget Committee, released their respective budgets for Fiscal Year (FY) 2014. To no one’s surprise, the budgets have little in common and approach the issue of deficit reduction in very different ways. A House/Senate conferenced budget is not expected to emerge from this process.

Rep. Ryan’s budget, “The Path to Prosperity: A Responsible, Balanced Budget,” promises to balance the budget in ten years by achieving $4.6 trillion in cuts. To achieve a balanced budget in this short amount of time (even shorter than the drastic 20 year goal he proposed in last year’s budget), Rep. Ryan’s budget slashes spending for health care and for programs that benefit low-income and vulnerable Americans while lowering the tax rate for the wealthiest Americans.

Rep. Ryan proposes cutting the top individual tax rate to 25% from its current 39.6% as well as eliminating the Alternative Minimum Tax and suggests that such cuts will not add to the deficit. However, when Rep. Ryan proposed cutting the top individual and corporate income tax rates from 35% to 25% in his FY 2013 budget, the Tax Policy Center estimated that such cuts would cost more than $4 trillion over ten years.

Furthermore, Rep. Ryan’s budget assumes the repeal of the Affordable Care Act (ACA), which is on the verge of celebrating its third anniversary (March 23, 2013). On top of the repeal of the ACA, the budget will cut Medicaid by $756 billion converting it into a block grant program administered by the states. This change will likely increase states’ healthcare costs. Although calling for repeal of the ACA, the budget plan maintains the projected $716 billion in Medicare savings that are included in the ACA. The budget plan also cuts Medicare by $356 billion and proposes a voucher-like system for all beneficiaries beginning in 2024. This would affect people born in or after 1959. The proposal would ultimately raise the cost of out-of-pocket care for Medicare beneficiaries. These budget proposals would deny health coverage to millions of Americans, including thousands of people living with HIV. This means that many people living with HIV would not be eligible for Medicaid or would lose eligibility. Many of those who would remain eligible would no longer have access to robust medical care or the drug formulary needed to remain healthy.

Furthermore, those who became ineligible for Medicaid or health exchanges would also find that non-defense discretionary safety net funding for HIV treatment and care such as the Ryan White Program would receive drastic cuts. Measuring from post-sequestration funding levels, Rep. Ryan’s budget cuts non-defense discretionary (NDD) programs by an additional $700 billion. However, as both parties seek to replace sequestration, it is important to measure Rep. Ryan’s budget from pre-sequestration levels of funding. When measuring from these levels of funding, the proposed budget cuts non-defense discretionary spending by more than $1 trillion. These proposed cuts are vague and unspecified and reduce NDD spending to its lowest level on record as a share of the economy, according to data that goes back to 1962. Such cuts are detrimental to the progress of the latest HIV/AIDS research, which shows that people living with HIV who through consistent treatment and care are able to reduce their viral load to undetectable levels also curtail their likelihood of transmitting the disease. As such, losing access to needed treatment and care not only will reverse the gains in lives and health of people living with HIV but will increase the number of new infections.

Additionally this budget will strongly curtail direct spending on HIV/AIDS prevention programs and other programs that provide health care, food and nutrition, housing, and other support services that are vital to the health and well being of many people including those living with HIV/AIDS. Rep. Ryan’s budget proposes $800 billion in cuts to mandatory programs over ten years, 70% of which benefit the most disadvantaged Americans. Those programs subject to such cuts include Pell Grants, school lunches and child nutrition programs, Temporary Assistance for Needy Families (TANF), the Supplemental Nutrition Assistance Program (SNAP), the Supplemental Security Income (SSI) program, and the Earned Income Tax Credit program.

Representative Hal Rogers (R-KY), Chair of the House Appropriations Committee, has stated that the budget proposed by Rep. Ryan cuts too much, especially given the amount of discretionary spending cuts that Republicans have made in the past few years. He will, however, reluctantly vote in favor of the budget. The Center on Budget and Policy Priorities has also published an analysis of Rep. Ryan's budget, which can be viewed here. AIDS United has written a letter strongly urging Members of the House of Representatives to vote “No” on Rep. Ryan’s FY 2014 budget resolution, stating that this budget is unacceptable and must be rejected. A sound federal budget is crucial to the national response to HIV. Achieving such a response must occur through a gradual, balanced approach that includes revenue and does not harm vulnerable populations or destroy the safety net of programs for health care and economic security.

On Wednesday, March 13, a day after Rep. Ryan revealed his budget proposal, Sen. Patty Murray unveiled “Foundation for Growth: Restoring the Promise of American Opportunity,” the Senate Budget Committee’s proposal for FY 2014. Sen. Murray’s proposal does not balance the budget in ten years, as Rep. Ryan’s budget does, but it does achieve $1.85 trillion in savings in addition to the $2.5 trillion in deficit reduction already passed by Congress.

Sen. Murray’s budget is a balanced approach that calls for $975 billion in savings from ending tax expenditures and closing loopholes. It maintains tax rates for middle and lower class Americans, but does not exclude the possibility of raising taxes for the wealthiest Americans higher than those negotiated in the fiscal cliff deal at the beginning of this year.

Sen. Murray’s budget replaces the across-the-board cuts of the sequester that were enacted on March 1. The budget calls for $493 billion in domestic cuts, including $275 billion from health care savings that will only impact providers, not beneficiaries. It also includes $240 billion in defense spending cuts and $242 billion in reduced interest payments. Finally, the budget sets aside a $100 billion economic stimulus measure, which includes investments in infrastructure and worker training. Our colleagues at the National Priorities Project have produced a side-by-side comparison of the Ryan, Murray and Congressional Progressive Caucus budgets, as well as public opinion measures, that can be viewed here. Both the Senate and House Budget Committees have passed their respective budgets, and they will be brought to their respective floors next week.

Throughout the fiscal cliff crisis and the sequester, AIDS United has advocated for a balanced approach to deficit reduction that includes spending cuts as well as measures to increase revenue. Given the nature of these two drastically different budget proposals, AIDS United continues to advocate for a balanced approach that protects vital health care and public health programs relevant to people living with HIV/AIDS.

Finishing Fiscal Year 2013 Appropriations Process

Senator Tom Harkin (D-IA), Chair of the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies, introduced an amendment on March 12 to the Continuing Appropriations Act of 2013. This amendment proposed increased funding for the AIDS Drug Assistance Program (ADAP), NIH, child care and education while maintaining the current budget parameters. The FY 2013 Continuing Resolution (CR)/omnibus spending package offered by Senator Barbara Mikulski (D-MD), Chair of the Senate Appropriations Committee, provides flat-funding for nearly all agencies with a few exceptions. In addition to this flat funding, the sequester will cut about 5% from most agencies and programs. The Harkin Amendment would add the Labor-HHS-Education and Related Agencies budget to the list of budgets with prioritized funding figures. Specifically, the amendment increases the Ryan White Program AIDS Drug Assistance Program (ADAP) from $933 million to $962 million. The amendment was put to vote Thursday, March 14; although it received a majority vote (54 Yeas), Senate rules require a 3/5 majority vote (60 Yeas), and, therefore, the amendment was rejected. AIDS United continues to advocate funding for such programs that are crucial for people living with and affected by HIV/AIDS.

District of Columbia Police Department Clarifies Condom Policy

In July 2012, just prior to the International AIDS Conference hosted by Washington, D.C., Human Rights Watch released “Sex Workers at Risk: Condoms as Evidence of Prostitution in Four US Cities.” The report details concerns that police, with the support of prosecutors, were using condoms to justify the stop, search, and arrest of sex workers on prostitution charges. Using condoms as evidence creates incentives for people who may be highly at risk for HIV to abandon condoms and regular condom use. From a health policy perspective, such an outcome is disastrous since it increases the likelihood of new infections. Although some of the city’s officials protested the findings, stating that such arrests were against policy, Human Rights Watch interviewed 40 people and received numerous reports that condoms were being used in this way.

As a result of the report, AIDS United and AIDS United grantees HIPS andThe Women’s Collective, along with Human Rights Watch, DC Appleseed and the DC Trans Coalition, met with several city officials, including Deputy Mayor for Public Safety and Justice, Paul Quander; Chief of Police of the Metropolitan Police Department (MPD), Cathy Lanier; and Dr. Gregory Pappas, Senior Deputy Director at the DC Department of Health, who is responsible for HIV/AIDS issues in the city. As a result of the meeting and in order to clarify Washington, D.C.’s policy on condoms, Chief Lanier agreed to distribute cards that note MPD’s support for the distribution of condoms to prevent HIV, that people may carry as many condoms as they want and that possession of condoms is not a reason to conduct a search. Advocates were extremely pleased by this clarification of policy and issued a press release detailing the change. In addition, MPD has announced the use of the cards during their morning roll calls.

The cards, which feature a row of colorful condoms and the MPD logo are an attractive and innovative way of spreading the news to both individual police officers and members of the community that condoms may not be used as grounds for a search. They additionally provide information about how to make a complaint if there is a violation of this rule. The coalition thanked the officials involved for their willingness to clarify the policy and will continue to seek improvements in HIV prevention for sex workers and others in Washington, DC, and elsewhere.

The card issued by the MPD can be viewed here.

Dr. Myron Cohen: "We are at the Beginning of the End of this Disease"

The DC Developmental Center for AIDS Research (DC D-CFAR) hosted a seminar with Dr. Myron Cohen on Wednesday, March 13, on “HIV Transmission and Prevention of Transmission: Working Toward the End of the AIDS Pandemic.” Dr. Cohen is the J. Herbert Bate Distinguished Professor of Medicine, Microbiology and Immunology and Public Health at the University of North Carolina at Chapel Hill. He also serves as chief of infectious disease medicine, director of the Institute for Global Health & Infectious Diseases, and Associate Vice Chancellor for Global Health at UNC.

Dr. Cohen's research focuses on the transmission and prevention of HIV. For his work developing laboratory methods to measure HIV in genital secretions, Dr. Cohen has received 30 years of continuous funding from the National Institutes of Health (NIH). Dr. Cohen is the architect and principal investigator of the multinational HPTN 052 trial, which demonstrated that antiretroviral treatment (ART) prevents the sexual transmission of HIV-1. This work was recognized by Science Magazine as the "Breakthrough of the Year" in 2011.

Dr. Cohen’s seminar focused on many of the breakthroughs and scientific discoveries currently propelling HIV/AIDS research. One of the most significant topics was acute HIV infection (AHI), the period of infection immediately after exposure. He believes that most new HIV infections are due to exposure with someone who has AHI, yet there are few resources available to allow for widespread detection of patients with AHI. Patients with AHI are unlikely to be aware of their infection, as many symptoms that may occur are nonspecific to HIV. He also emphasized the role that STD/STI coinfection plays in amplifying transmission of HIV; any STD/STI coinfection leads to a greater concentration of HIV in genital secretions. For example, an HIV positive patient who contracts gonorrhea will have eight times the amount of HIV in their genital secretions.

Dr. Cohen also touched on the potential for an HIV vaccine and the next generation of pre-exposure prophylaxis (PrEP). Traditional viral vaccines allow infection to occur in the patient, but prevent symptoms and, therefore, prevent disease. However, this is not possible with HIV. An HIV vaccine will require broadly neutralizing antibodies for all strains of HIV, and due to the variety of strains that can occur, is proving difficult. Despite this difficulty, there are multiple methods of PrEP being researched and tested in addition to the pill Truvada, including shots and gene therapy.

Dr. Cohen stated that this is a time to be optimistic in the field of HIV transmission and prevention. Given the many recent scientific advancements, he believes that we are at the beginning of the end of this disease, and at this critical point, we must redouble our investments in research and science to achieve an AIDS-free generation.

A Story in Pictures: AIDSWatch 2013

If a picture is worth a thousand words, then almost 200 pictures should certainly tell a full story! And what a story is told by the pictures taken of AIDSWatch 2013 by photographer Khalid Naji-Allah! AIDSWatch 2013 took place February 25-26, when more than 170 participants came to Washington, D.C., to make their voice heard with their Members of Congress about HIV/AIDS-related issues impacting them and their communities. After a day of training on the issues and on the specifics of meeting with lawmakers, as well as a reception honoring leaders in the positive organizing movement, AIDSWatch participants collectively attended nearly 200 congressional meetings to help advance HIV policy in their respective congressional districts. Click here to review Khalid’s photos of AIDSWatch 2013. And mark your calendars NOW for AIDSWatch 2014, scheduled for April 28-29, 2014!

Announcements

Upcoming HIV/AIDS Awareness Days

March 20, 2013 is National Native HIV/AIDS Awareness Day! To learn more about National Native HIV/AIDS Awareness Day and how you can get involved, click here.

The first ever National Youth HIV & AIDS Awareness Day is taking place on April 10, 2013! AIDS United is a founding partner of the awareness day, which is aimed at youth ages 13-24, a population that increasingly accounts for rising numbers of HIV incidence. You can learn more by clicking here.


HRSA’s New Affordable Care Act Webpage

The Health Resource Services Administration’s HIV/AIDS Bureau (HRSA/HAB) has created Ryan White and the Affordable Care Act: What you Need to Know, a website meant to provide guidance on the key provisions of the ACA for the Ryan White Program. The page is intended to grow as a resource guide as more information becomes available.


UCHAPS Launches Search for New Board Members

The Board of Directors of the Urban Coalition for HIV/AIDS Prevention Services (UCHAPS) is launching the search for new Board candidates. They ask for your assistance in distributing this Call for Nominations package widely around your professional network and sphere of influence. The information provided includes the nomination process, nomination form, and details about Board Member responsibilities.

The deadline to submit the nomination application is March 31, 2013. If you or anyone interested in a Board position has a question, please contact Kirby Reed directly (kirby@uchaps.org), who will forward the inquiry to the Nominations Committee.

Thank you, and UCHAPS appreciates your help in sharing this Call for Nominations around the community.


Health and Human Services Seeking Nominations to the Presidential Advisory Council on HIV/AIDS

The office of Dr. Howard Koh, Assistant Secretary for Health, is seeking nominations of qualified individuals to be considered for appointment as members of the Presidential Advisory Council on HIV/AIDS (PACHA). PACHA is a federal advisory committee within the Department of Health and Human Services (HHS). The Council was established to provide advice, information, and recommendations to the Secretary regarding programs and policies intended to promote effective prevention of HIV and AIDS. The functions of the Council are solely advisory in nature.

For more information, click here.


The Substance Abuse and Mental Health Services Administration Accepting Applications for TCE-HIV: Minority Woman Grants

The Substance Abuse and Mental Health Services Administration (SAMHSA) is accepting applications for up to nearly $54.6 million for Targeted Capacity Expansion grants for providing substance abuse treatment to minority women at high risk for HIV/AIDS (TCE-HIV: Minority Women grants). The grant program will expand substance abuse treatment and HIV services for African American, Hispanic/Latina, and other racial/ethnic minority woman ages 18 and older. People benefiting from these expanded services will include heterosexual, lesbian, bisexual, and previously incarcerated women who have substance use or co-occurring substance use and mental disorders and are living with or at risk for HIV/AIDS. The services will also be provided to the women’s significant others.

SAMHSA expects that awards of up to $520,000 per year will be provided to up to 35 selected grantees for up to three years. The actual award amounts may vary, depending on the availability of funds. Applications are due by 11:59 PM Eastern on May 14, 2013, and all required documents can be downloaded here. You can also request a complete application package for RFA number TI-13-011 from SAMHSA at 1-877-SAMHSA7 [TDD: 1-800-487-4889].

For questions about program issues, contact David C. Thompson at (240) 276-1623 or david.thompson@samhsa.hhs.gov .

For questions on grants management and budget issues, contact Eileen Bermudez at (240) 276-1412 or Eileen.bermudez@samhsa.hhs.gov .


The American Public Health Association (APHA) Calls for Applications for the APHA Public Health Fellowship in Government

APHA is looking for candidates with strong public health credentials who wish to spend one-year in Washington, D.C., working in a congressional office on legislative and policy issues such as health, environment, and other public health concerns. There is a critical need for public health professionals, including practitioners and researchers, to engage in the federal policy process. The fellows will have the opportunity to see firsthand how public policy impacts public health and to offer their public health expertise to policymakers. These hands-on experiences will be invaluable to the field of public health, policymakers, and the public health fellow.

Fellows will spend one year working in Washington, D.C., on legislative, regulatory, and policy issues that would benefit from the input of a public health professional. The fellow will have the option of serving on the staff of a member of Congress or a congressional committee.

Applications must be received by April 8, 2013. For more information on how to apply, click here.

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