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APRIL 19, 2013

We at AIDS United want to take this opportunity to express our concern for all those affected by the Boston Marathon bombings and the explosion in West, Texas. You are in our thoughts, and we hope for a speedy recovery.

Alicia Keys, AIDS United, Kaiser Family Foundation Launch EMPOWERED Community Grants Program

In conjunction with Greater Than AIDS, Alicia Keys is spearheading the EMPOWERED Community Grants Program to help advance community-level efforts focused on women and HIV/AIDS. The grants program will be administered by AIDS United, with guidance from the Kaiser Family Foundation.

The EMPOWERED Community Grants Program is part of a broader effort by Ms. Keys to reach women in the United States about HIV/AIDS, including a cross-platform public information campaign developed with Greater Than AIDS, called EMPOWERED. Other elements include targeted media messages and community outreach. Greater Than AIDS is a leading response to the U.S. domestic epidemic led by the Kaiser Family Foundation together with the Black AIDS Institute and supported by a broad coalition of public and private sector partners.

The EMPOWERED Community Grants program looks to play a strategic role in supporting the development of model programs that address the needs of underserved women. The EMPOWERED Community Grants program offers support to the HIV/AIDS community at a critical and historic time – to continue progress of recent decreases in HIV among women.

The number of women with HIV in the United States has grown steadily for the last 30 years. In 1985, only eight percent of new U.S. cases were in women. By 1992, it was 14 percent. Today, women account for at least 27 percent of new U.S. cases. The time is NOW for the EMPOWERED campaign!

The EMPOWERED Community Grants program is supporting innovative programs for marginalized, underserved populations of women that don't have or can't get prevention and care services. To apply for the EMPOWERED Community Grants Program,click here. For more information about the EMPOWERED Community Grants Program, click here.

Ms. Keys’ appearance at the launch of the EMPOWERED Community Grants Program was featured in the Washington Post; the article can be viewed here.

The Next Steps in the Fiscal Year 2014 Budget and Appropriations Process

This week, Department of Health and Human Services (HHS) Secretary Sebelius testified before the House Energy and Commerce Committee on April 18 and before the Senate Finance Committee on April 17 on President Obama’s Fiscal Year 2014 (FY14) budget request. She explained the Administration’s budget priorities for moving the health of America forward. At the Senate hearing she stated, “The Affordable Care Act, signed into law in March of 2010, is already benefiting millions of Americans, and our budget makes sure we can continue to implement the law. By supporting the creation of new health insurance marketplaces, the budget will ensure that starting next January Americans in every state will be able to get quality insurance at an affordable price.”

Next week, she will testify before the House and Senate Appropriations Labor, Health and Human Services subcommittees on April 24 and 25 respectively. She will discuss the Appropriations necessary for FY14 for her department. AIDS United will keep you informed as these hearings progress. AIDS United will continue to advocate for increased funding for the domestic HIV/AIDS funding portfolio.

FY 14 Budget

The House and the Senate passed separate FY14 budgets that are dramatically different. Senate Budget Committee Chair Patty Murray’s (D-WA) budget assumes sequestration is eliminated. House Budget Committee Chair Paul Ryan’s (R-WI) budget assumes sequestration remains in place and cuts spending even further. Currently, there is conversation between the two houses about convening a Budget Conference Committee (Conference) to hash out the differences and pass a joint budget resolution. Given the stark differences between the two budgets, including ideological differences, it is not likely that the Conference will convene, let alone come to agreement on a joint budget.

FY14 Appropriations

Senate Appropriations Chair Barbara Mikulski (D-MD) and House Chair Harold Rogers (R-KY) will begin debate and discussion of their Appropriations bills with vastly different top line discretionary (discretionary and non-defense discretionary) spending totals. Sen. Mikulski wants the committee to write appropriation bills to total $1.058 trillion, which assumes sequestration is replaced. Rep. Rogers wants the House committee to write appropriation bills to total $966 billion, which assumes sequestration remains in place. The difference in the 2 approaches is the sequestration amount of $91 billion. For FY14 going forward to FY 2021, sequestration cuts will be met by lowering annual budgetary caps that were set in law by the Budget and Control Act of 2011. Different from sequestration in FY13, there will not be a need for an across-the-board cut to all programs. Congress will have the opportunity to appropriate funding that meets the caps in a more thoughtful manner, albeit under severely reduced budgetary constraints. There will continue to be separate caps for defense and non-defense discretionary spending, but the House has already stated that they will increase defense spending, thereby increasing the pressure on the non-defense discretionary side of the ledger.

Fiscal Year 2013 AIDS Drug Assistance Program/Part C Transfers

AIDS United continues to discuss the importance of the transfer of funding at HHS for the AIDS Drug Assistance Program (ADAP) and Part C World AIDS Day funding. This funding is on the ground now and needs to continue with the Ryan White ADAP 2013 funding. Staff from the Office of Management and Budget has informed us that they are aware of the funding problem and are working diligently to solve the issue. It is always difficult to transfer funding from one program to another, but this year it will be even more difficult since programs are being cut approximately 5% due to sequestration implementation as well as the small percentage cut from the legislation passed in January to delay the start of sequestration until March 1.

Prevention and Public Health Fund Fiscal Year 2013 Allocations

The Department of Health and Humans Services (HHS) has made the 2013 Prevention and Public Health Fund Allocations available to the public. The Affordable Care Act established the Prevention and Public Health Fund to provide expanded and sustained national investments in prevention and public health, to improve health outcomes, and to enhance health care quality through investments in a range of activities, including community and clinical prevention initiatives; research, surveillance and tracking; public health infrastructure; and immunizations and screenings.

This release is the first place we see the real impact of sequestration on this program. The Fund was scheduled to be allocated at $1 billion. The announced allocations total $949 million, which reflects the 5% cut ($51 million) from sequestration. Though 5% sounds like a manageable amount, when you are dealing with a $1 billion program, 5% is real money. We will continue to work with our colleagues to inform Members of Congress about these impacts, but we also urge you to continue to catalog stories that we can use here in Washington, D.C. You can tell your Members in their district offices that sequestration is cutting important programs in all of our communities. You can view the 2013 allocations here.

Analysis of Kaiser Family Foundation's Report on Key Issues for the Ryan White Program

On April 1, the Kaiser Family Foundation (KFF) released a report by Jeffrey Crowley from the O’Neill Institute for National and Global Health Law at Georgetown University and Jen Kates, Vice President and Director of HIV Policy at Kaiser Family Foundation. Mr. Crowley, of course, is well known as the former Director of the Office of National AIDS Policy in the Obama Administration and Ms. Kates is a well known researcher with a reputation for independence who has served on numerous Institute of Medicine panels regarding HIV. The report is likely to be important not only because Mr. Crowley continues to have ties to the Obama Administration, giving hints at how current officials may view the future of the Ryan White Program (RWP), but also because the report continues to reflect the strong evolution of thinking about the early provision of treatment and care in the United States.

As such, the report in many ways is a continuation of the National HIV/AIDS Strategy (NHAS), which was released in July of 2010 after passage of the Affordable Care Act (ACA) while Mr. Crowley was the Director of ONAP. The NHAS called for reducing HIV incidence, increasing treatment efforts and focusing on health outcomes, reducing health disparities in the HIV field and for integrating the response to HIV of various government agencies. The report explicitly cites three trends since the previous reauthorization of the RWP in 2009, including scientific evidence that viral suppression not only helps individual patients but reduces the risk of HIV transmission, passage of the ACA and introduction of the NHAS as reasons to contemplate some change to the program. The authors acknowledge that questions about the timing of reauthorization have been raised, particularly in that the far reaching ACA changes in 2014 remain unpredictable since some states will not expand Medicaid.

The new report suggests key issues and potential strategies for policymakers to consider that are strongly suggestive of the NHAS. The four issues are:

  • Supporting people with HIV at each stage of the Treatment Cascade from diagnosis to viral suppression
  • Building HIV care networks in underserved communities
  • Integrating HIV care expertise into the mainstream health system, and
  • Effectively and fairly allocating Ryan White Program resources.

Several key issues in the report bear further thought. Among them is linking the RWP to the steps of the well known HIV treatment cascade. In a series of steps (diagnosis, linkage to HIV care, retention in care, on anti-retroviral therapy, suppression of viral load), the cascade shows that over three quarters of people living with HIV in the U.S. are not achieving sustained viral suppression. The report suggests using the cascade specifically for measuring clinical and HIV indicators and potentially updating rules about the provision of core and supplementary medical services that might interfere with providing support along the cascade.

A second point of interest is that the Affordable Care Act should not supplant Ryan White Services but rather discusses the many ways that the Ryan White Program will likely be needed to supplement the increased health coverage and access after the introduction of health exchanges and Medicaid expansion in January 2014. An interesting point made in the report is that this is already the role that the RWP plays. In fact, 70% of Ryan White Program clients today have insurance coverage of some type. The authors write that, “This suggests that insurance coverage, on its own, is often insufficient to protect against the high cost of HIV care or to provide the range of services needed to keep people with HIV engaged in care and on treatment. In fact the authors note that the demand for Ryan White Services could actually increase and require additional resources going to the Ryan White Program to better achieve the goals of reducing incidence and maintaining people in treatment and care.

Another strong point is the desire to retool the Ryan White Program to better reach the most marginalized populations. The authors strongly note that one success of the RWP is that it is grounded in community response and that some core aspects of the response should be retained. Among these roles is building and sustaining HIV care networks in underserved communities. The authors suggest that three programs, the Minority AIDS Initiative, the Part D program and the AIDS Education and Training Centers (AETCs) have the potential to provide collaborative roles in developing “evidence based models for intervening to improve outcomes for targeted populations.” The authors suggest strengthening the focus on gay and bisexual men, particularly young and racial and ethnic minority men who are at significant risk of infection. They also suggest considering focused programs for high-cost cases and especially vulnerable populations. One issue that comes up but is not resolved is the role of Community Based Organizations (CBOs); it is suggested that CBOs will need assistance in adapting to changing roles and suggest that in some cases consolidation will be needed.

There are several points of contention. Among them are calls for a reconsideration of funding formulas for Parts A and B, review of assertions that Part D is more generously funded than Part C and modifications to the SPNS program and potential changes to how planning is done at the local community including planning councils. These controversies are likely to be at least somewhat balanced by calls for greater transparency, greater integration and reductions of administrative burden.

Ultimately the report is likely to be a useful tool for new ideas and helping to guide administrative and legislative changes as the Ryan White Program continues its mission of care completion in the age of expanded health care coverage under the Affordable Care Act.

The Choreography of Silence

By Charles Stephens, AIDS United Southern Regional Organizer

Through Facebook, over a series of messages back and forth, his sister told me it was a “rare blood condition.” He wasn’t yet 30, about 26 at the time, and had been found in his apartment. Found. Unconscious. A mutual friend was the one that told me he was in the hospital.

He was living in Washington, D.C., by this point. I reached out to his sister on Facebook to find out what was going on, and she told me it was a “rare blood condition.” She didn’t say much more about his condition. I didn’t ask.

Charles and I met when he was a senior in high school and I was a sophomore at Morehouse College. He started attending a young black gay men’s discussion group that I facilitated at the time. This was around 2000. He was ambitious, articulate, thoughtful, but very introverted. We hit it off immediately.

To read more of Charles’ piece, click here.

Announcements

AIDS United Needs Your Help!

AIDS United wants to hear YOUR story about the impacts of sequestration and the $1.5 trillion in cuts already enacted by Congress! We are currently compiling stories about the real effects that drastic budget cuts and the sequester have had on people living with and affected by HIV/AIDS. Members of Congress need to know that the decisions they make have real, drastic impacts! Please use the following questions to frame your story:

  • What has life been like for you/your organization/your community before these budget cuts?
  • What are the indicators that sequestration may already be having an effect on you/your organization/your community?
  • What will the results be for you/your organization/your community if sequestration is fully realized?
  • What will you/your organization/your community do if the drastic budget cuts enacted in the sequester are not replaced with a more responsible and balanced solution?

You can send your stories to policy@aidsunited.org. Please keep stories to 500 words, and include a headshot if possible!


Technical Assistance: Foundations of Grant Writing

Interested in learning the basics of federal grants and federal grant writing? Join The Office of Minority Health Resource Center (OMHRC) on April 25, 2013 for the Capacity Building Webinar, Technical Assistance: Foundations of Grant Writing. Organizations will learn how to write a strong federal grant proposal during this webinar, led by Michelle Loosli, Director, and Margaret Korto, Capacity Building Senior Program Analyst, of the Office of Minority Health Resource Center.

Webinar Objectives:

• Identify key steps to apply for federal grants
• Review the critical elements of proposals
• Provide guidance for internal evaluations of proposals

The webinar will take place Thursday, April 25, 2013 from 4:00 PM - 5:30 PM EST. To register for the webinar, click here.


AIDS Coordinating Committee of the American Bar Association Presents “HIV Criminalization, Immigration and Domestic and Sexual Violence” Teleconference

The AIDS Coordinating Committee of the American Bar Association is hosting a bi-monthly teleconference series on Woman and HIV/AIDS throughout 2013 and will present on “HIV Criminalization, Immigration and Domestic and Sexual Violence” on Friday, April 26, 2013. Speakers include Catherine Hannssens, Founder and Executive Director of the Center for HIV Law and Policy; Allison Nichol, Special Counsel in the Office of the Associate Attorney General at the US Department of Justice; and Leslye Orloff, Director of the National Immigrant Women’s Advocacy Project (NIWAP).

The teleconference will take place on Friday, April 26, 2013, from 12:00-1:00pm EST. The dial-in number for the event is (877)317-0419, and the access code is 265 842 38.


Congressional Briefing on Untreatable Gonorrhea

The National Coalition of STD Directors (NCSD) is partnering with the following organizations to present a Congressional Briefing on “Untreatable Gonorrhea? What Public Health Needs for an Effective Response”:

Advocates for Youth; AIDS United; American Sexual Health Association; Association of State and Territorial Health Officials; Infectious Diseases Society of America; Georgia AIDS Coalition; National Alliance of State and Territorial AIDS Directors; National Association of County and City Health Officials; National Family Planning and Reproductive Health Association; Sexuality Information and Education Council of the United States (SIECUS)

In cooperation with the offices of Senator Blumenthal (D-CT) and Representative Schakowsky (D-IL), there will be two briefings held on Friday, April 26, 2013: the first, from 10:00-11:30am in 485 Russell Senate Office Building and the second, from 2:00-3:30pm in 2103 Rayburn House Office Building.

Given the current trajectory of this disease, the question is not if gonorrhea will develop resistance to all drugs designed to treat it, but when. The current public health infrastructure has been continually strained and is currently unable to prepare as necessary for the arrival of untreatable gonorrhea additional funding is desperately needed. Attend this briefing to learn more about the impacts of untreatable gonorrhea and what investments in our public health system are needed to effectively respond to this growing public health emergency.

For more information or to RSVP, please contact Stephanie Arnold Pang at NCSD at sarnold@ncsddc.org or 202-842-4660.

When sending in an RSVP for this event, please specify which briefing you plan to attend.


2013 Johnson & Johnson /UCLA Healthcare Executive Program Now Accepting Applications

The UCLA/Johnson & Johnson Health Care Executive Program (HCEP) is a management and leadership development program for executive directors and leaders of Community Health Centers (CHCs) and AIDS Service Organizations (ASOs). The HCEP is especially designed and valuable for ASOs and CHCs that need to prepare for and adapt to the changes in service delivery and healthcare financing related to the Affordable Care Act (ACA) as well as how the ACA will impact the future of traditional AIDS service funding mechanism like the Ryan White Care Act. The program will take place July 7-17, 2013, and the deadline to submit an application is 5:00pm PT on May 15, 2013.

You can learn more about the program, upcoming informational calls, and application directions by clicking here.


2013 National Transgender Health Summit

Cosponsored by the UCSF Center of Excellence for Transgender Health and the World Professional Association for Transgender Health, the National Transgender Health Summit aims to provide a multidisciplinary program presenting cutting edge research in transgender health and evidence-based clinical training curricula for healthcare providers of all backgrounds.

The National Transgender Health Summit will take place May 17-18, 2013, at the Oakland Marriott City Center in Oakland, California, and will feature programming by world-renowned experts in the field of transgender health on a variety of tracks. For more information, email transhealthsummit@ucsf.edu.

To register, click here.


Federal AIDS Policy Partnership Seeking Respondents for Housing Work Group Survey

The Federal AIDS Policy Partnership Housing Work Group survey is seeking respondents! Please take a few minutes to answer some questions about how HIV/AIDS housing programs are working in your community and how you’re preparing for the potential changes in federal funding. This will help the group as they chart their course for the coming year. You can take the survey here.

If you have questions, please contact Jason Wise of AIDS Project Los Angeles at jwise@apla.org.


Centers for Disease Control and Prevention (CDC) Launches New National Hepatitis Testing Day Website

May 19, 2013, is the second national Hepatitis Testing Day, and in order to support and promote the events and activities surrounding the day, the CDC has launched a new national Hepatitis Testing Day webpage. The new website allows people to search for Hepatitis Testing Day events near them during the month of May, which is also Hepatitis Awareness Month.

Hepatitis Testing Day is a day for people at risk to be tested, and for health care providers to educate patients about chronic viral hepatitis and testing. Millions of Americans have chronic hepatitis; most of them do not know they are infected.

You can read more about the initiative here.

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