Monday, October 31, 2005

Katrina Evacuees Get Meds in Texas

In a meeting with staff from the Department of State Health Services today, we learned that the Texas HIV Medication Program currently has 177 clients enrolled under the emergency provisions put in place for Hurricane Katrina evacuees. All of these clients come to Texas from Louisiana. The total expenditures for their medications thus far has been $104,683. All of this will be reimbursed by pharmaceutical manufacturing companies with in-kind donations.

Unfortunately, the agreement under which reimbursement from the manufacturing companies will occur expires today. This means that the cost of these new clients will either be borne by THMP or reimbursed from some other source. The two possible sources of reimbursement seem to be Louisiana's AIDS Drug Assistance Program or FEMA.

If there is no reimbursement and if all of these clients remain in Texas, the cost to the Texas HIV Medication Program will reach nearly $2 million through the biennium (2006-2007) which began on September 1. Since the program is already projecting a $6 million shortfall by the end of FY 2007, the need to find reimbursement becomes even more urgent. As we are fond of telling legislators, 'THMP is not a Cadillac program." Neither is it a fat one.

Colonel Kaspar

It's a sad day in Texas. Dr. Robert Kaspar, who has served as the HIV/STD Medical Consultant for the Texas HIV Medication Program for the past two years, has joined the army. Dr. Kaspar has done much to improve care for people with HIV in Texas. He will be missed.

Friday, October 28, 2005

New Kaletra Formulation

A notice from the FDA . . .

Today (October 28, 2005) the Food and Drug Administration approved a new formulation of Kaletra. Kaletra (lopinavir/ritonavir) is now available as a film coated tablet (200mg/50mg) that provides advantages over the currently marketed capsule formulation for HIV-1 infected patients. Specifically, the tablet formulation:
  • does not require refrigeration,
  • can be administered without regard to meals
  • does not require dose adjustments for concomitant use with certain NNRTIs and PIs in treatment-naive patients
  • has a decreased pill burden compared to the capsule formulation (2 tablets twice daily or 4 tablets once daily in treatment-naive patients only vs 3 capsules twice daily or 6 capsules once daily in treatment-naive patients

. . .

The capsule formulation will be phased out over time by the company.

Kaletra is a product of Abbott Laboratories. The original formulation was approved on September 15, 2000.

More information, including a copy of the new package insert, will be available on the FDA's website.

Thursday, October 27, 2005

The Smith Amendment Fails

Amendment 2259 was offered by Senator Gordon Smith (Oregon) and considered by the Senate on Thursday. The purpose of the amendment was to appropriate an additional $72 million for AIDS Drug Assistance Programs. Unlike the Coburn amendment, this appropriation did not include an offset (taking money from some other program in order to pay for it). That meant that there had to be 60 senators in favor of the amendment's being voted on; otherwise it would be ruled out of order.

The vote was 46 in favor, 50 opposed. The amendment was ruled out of order and, therefore, failed. Texas Senators Hutchison and Cornyn voted "no."

The Texas HIV Medication Program, which would have benefited from the appropriation, still has a waiting list for Fuzeon and may have to use other cost containment measures within the next year or so. One wonders what alternatives Senators Hutchison and Cornyn have to offer.

Wednesday, October 26, 2005

Live Blogging Coburn's Amendment

Well, sorta. The whole thing only had two minutes for debate. Coburn spoke for it; the two senators from Georgia spoke against it; then Senator Harkin popped up to say that this is the wrong way to fund ADAP.

Turns out that Coburn wants to get his $60 million from funding already designated for improving facilities at the Centers for Disease Control (which just happen to be in Georgia). Oopsie! That's definitely not a good choice.

Harkin said that there would be an amendment coming up later to add $72 million to ADAP (an increase of the increase!) which does not take money from the CDC. I'm looking for the amendment to see which one it is.

While waiting for the vote, it's interesting to see CSPAN2 show that the Coburn amendment provides dollars for "construction & renovation of facilities" at CDC. No mention of HIV. Way clue in the public, guys!

Hutchison votes no, Cornyn votes aye.

Ayes: 14

Nays: 85

Coburn amendment fails.

Compassion Fatique

Medscape (sub. req.) posts this article: "Compassion Fatigue: An Expert Interview with Charles Figley, PhD." The Q&A touches on the definition of compassion fatigue, examples, and recent events. While the article's focus is on such events as Hurricane Katrina, there is relevance for AIDS caregivers. It's worth a read.

Coburn's Amendment to Increase ADAP Funding

In yesterday's Senate session, Senator Coburn of Oklahoma, introduced an amendment to increase funding for AIDS Drug Assistance Programs. Here's what the Congressional Record says about the amendment:

SA 2232. Mr. COBURN submitted an amendment intended to be proposed by him to the bill H.R. 3010, making appropriations for the Departments of Labor, Health and Human Services, and Education, and Related Agencies for the fiscal year ending September 30, 2006, and for other purposes; which was ordered to lie on the table; as follows:

On page 139, line 16, insert after the colon the following: ``Provided further, That in addition to amounts otherwise made available for State AIDS Drug Assistance Programs authorized by such section 2616, the Secretary shall transfer $60,000,000 from the amount appropriated under this Act for the construction and renovation of the facilities of the Centers for Disease Control and Prevention to carry out such Drug Assistance Programs:''.

I couldn't find anything that said that the amendment was tabled because it exceeded budget authority. Amendments that do seem to be withdrawn as often as not.

Earlier, Texas AIDS Network had signed on to a letter being sent to the Senate, urging passage of this amendment. Debate is now on-going on this amendment.

Just as another bit of interest, Senator Rick Santorum of Pennsylvania has submitted the following:

SA 2239. Mr. SANTORUM submitted an amendment intended to be proposed by him to the bill H.R. 3010, making appropriations for the Departments of Labor, Health and Human Services, and Education, and Related Agencies for the fiscal year
ending September 30, 2006, and for other purposes; which was ordered to lie on the table; as follows:

At the appropriate place, insert the following:
SEC. __. The Secretary of Health and Human Services shall use amounts appropriated under title II for the purchase of not less than 1,000,000 rapid oral HIV tests.

I have no background on this.

Tuesday, October 25, 2005

Burn our feed!

I have no idea how I did it, but I (more or less accidentally) just got Texas AIDS Blog established with FeedBurner. Now you, too, can burn our feed, as we say in English, subscribe to this site.

There's a convenient button now in the sidebar for subscribing. The feed is optimized for just about any feed format that you might want (except for your PDA).

So subscribe already! :)

Church Council Opposes Proposed $50 Billion Cuts

Via email:

The National Council of Churches USA, which opposes proposals to cut $50 billion in social programs from the federal budget, praised Congress Thursday for delaying action on the cuts.

The proposed amendments would reduce childcare benefits, Medicaid, Temporary Assistance to Needy Families, student loans and other social programs. The NCC said yesterday in a letter to U.S. senators that the cuts are “inconceivable” at a time when millions of poor people are still dealing with the devastating affects of recent hurricanes.

Congress will take another look at the budget next week before final action is taken.

Signed by NCC President Bishop Thomas L. Hoyt, Jr. along with other leaders representing 17 of NCC’s member denominations, the letter stated, “This
is not the time for the budget reconciliation process to create greater hardships for those who are already experiencing great suffering. To do so is not only unjust; it is a sin.”

The full text of the letter and the list of signatories is available at the link.

Monday, October 24, 2005

Methamphetamine: Important Clinical Guidance for Healthcare Providers

More Medscape (sub. req.) reading, this time about methamphetamine and HIV/AIDS. The article draws the following conclusions:

Clinicians should ask all patients about their current levels of methamphetamine use. The medical consequences of methamphetamine, particularly the neurologic, dental, and dermatologic sequelae, should be discussed in detail. All HIV risk assessments should include an assessment about whether methamphetamine is contributing to high-risk sexual or drug-using behaviors. All methamphetamine users should receive HIV risk-reduction counseling and condoms; frequent STD screening is warranted, including HIV testing among HIV-negative methamphetamine users. A careful assessment of adherence to ART should be conducted, with close attention to the patient's reported pattern of adherence in the setting of methamphetamine binges. Patients should understand the medical consequences of poor adherence to ART that can result from methamphetamine use.

It is imperative that all methamphetamine-using patients be offered treatment for their substance use. If patients initially are unwilling to participate in treatment programs, at subsequent visits clinicians should continue discussions about drug use and offer treatment referrals. Clinicians should familiarize themselves with the treatment resources in their communities, including whether both abstinence-based and harm-reduction approaches are available, as well as the characteristics (gender, sexual orientation, age) of patients served by specific treatment programs. Careful consideration of the patient's current level of methamphetamine use and receptivity to treatment will help determine the optimal treatment strategy. Although relapse rates are high, it is important to remember that duration of treatment for methamphetamine use is strongly correlated with better outcomes.

The literature review surveys information about the effects of methamphetamine on the user, clinical effects, the relationship between meth and sexual risk/HIV transmission, the possible effects on HIV itself, and options for treatment. It's worth a read. Here's at least one reason why:

"Meth mouth" image borrowed from (Google says so), but darned if I can find the exact post.

Friday, October 21, 2005

About Medicare Part D Formularies

I'm still looking for some handy dandy list of the formularies for the various pharmacy providers for the new Medicare Part D prescription drug benefit. So far, the best I have found is a list of providers and a tool for searching for specific drugs. Both are good things to have around, but not exactly what I want so that I can say "This plan has a full range of HIV meds; this one not so much."

What I did run across was Medicare's position paper (PDF) on what should be in a formulary.

Why is CMS requiring “all or substantially all” of the drugs in the antidepressant, antipsychotic, anticonvulsant, anticancer, immunosuppressant and HIV/AIDS categories?

CMS has a responsibility under the Medicare Modernization Act (MMA) to make sure beneficiaries receive clinically appropriate medications so that formularies are not discriminatory. In our final formulary guidance for 2006, we noted that a majority of drugs in these categories would have to be on plan formularies and that beneficiaries should have uninterrupted access to all drugs in that class. In addition, our formulary guidance explicitly stated that we would encourage the use of formularies that have been demonstrated to be effective by their widespread use today for millions of seniors and people with disabilities. In the process of reviewing the practices of other Federal programs for comparable populations such as the Federal Employees Health Benefit Program (FEHB) and Medicaid, we learned that formulary inclusion rather than an exceptions process is an appropriate standard in certain circumstances.

The remainder of the paper elaborates on each of those points and discusses HIV/AIDS treatments quite specifically, asserting that there should be no interruption in therapy. On its surface, this should mean that almost all of the plans available for Texas should have what people need for HAART, and there shouldn't be any hassles with prior authorization and such.

However, there are a couple of caveats already apparent. Fuzeon was specifically singled out as being required for a plan's formulary, but it was also allowed to be set for prior authorization. There was also some mention of drugs that will not have been approved by the FDA prior to January 1, 2006, having to go through a formal review process for inclusion on a plan's formulary. And there was an indication that the requirements regarding HIV/AIDS drugs and the others covered by this paper would be reviewed once experience with the program had been gained. All of these are indicators that, at the very least, Medicare requirements will continue to need monitoring.

But I'm still looking for a spreadsheet . . .

Thursday, October 20, 2005

Legal Services for Rita, Katrina Survivors

Here's a new legal service geared to help people sort through legal problems created by losing papers, being moved to another state and depending on the Federal Emergency Management Agency for help.

The new service is called the Texas Legal Services Center Disaster Assistance Legal Hotline.

At no cost to those affected by Hurricanes Katrina and Rita, the Disaster Assistance Legal Hotline will offer assistance and advice about Louisiana and Texas law. A lawyer and an evacuee from New Orleans, Ms. Peggy Fuller, has been hired to staff the hotline. She is ready to help evacuees appeal FEMA denials, and resolve problems with landlords, creditors, insurance companies, government and private assistance programs, family law, pensions and taxes and utilities.

For additional information contact Ms. Fuller at 800-622-2520 or call the Texas Legal Services Center at 512-477-6000.

Wednesday, October 19, 2005

Medicare Part D: Texas Stand-Alone PDPs

October 15 was Medicare's target date for announcing the Prescription Drug Plan for the various states. A PDF file listing the Prescription Drug Plans approved for Texas as of October 10 can be found at:

What the PDP table shows is that there are 20 different providers offering a total of 47 different plans for Texas. Premiums range from a low of $10.31 (Humana) to a high of $59.51 (Silverscript). Somewhat less than half of the plans show that there will be "no premium with full low income subsidy."

Somewhat more than half show that there will be no deductible charges. Three have a reduced deductible; the remainder will charge the standard $250 deductible. Almost all will have a tiered co-pay for drugs (e.g., a lower co-pay for generic drugs).

Six will have some sort of additional coverage during the "doughnut hole" (coverage gap). Offering generics only will be:
  • AETNA Medicare Rx Plus
  • AETNA Medicare Rx Premium
  • CIGNATURE Rx Complete Plan
  • Pacificare Comprehensive Plan
  • Medicare Rx Rewards Premier

Humana PDP Complete S5884-050 will offer both generics and brand drugs in the coverage gap. All six of these plans have comparatively higher premiums, but not necessarily the highest.

All but Community Care Rx offer mail order delivery.

There is also a column which indicates how many of the "top 100" drugs are on the plan's formulary, but I'm not seeing that as a useful bit of information right now.

Multi-Drug Resistant HIV

After watching an alarming episode of Law & Order: SVU last night, I was a wee bit disconcerted to see a similar alarm raised in Dr. Jeffrey Laurence's article in Medscape (registration required) concerning multi-drug resistant HIV. Turns out, Dr. Laurence wasn't writing about the scary "superbug" hyped on one of my favorite TV shows (it was one documented case, guys!!!), but about the very real problem of drug resistance, its causes and effects. While Dr. Laurence supports his own alarm with some disturbing reports of increasingly risky behaviors in the "age of HAART," his conclusions make good sense:

One group of investigators concluded, "While the prospects for maintaining viral suppression in people starting [antiretroviral therapy] remain good over the first 5 to 10 years, the longer-term prospects for continued viral suppression may increasingly depend on development of new antiretroviral drugs."[4] They are right.

But we also need to increase prevention education and maintenance. In addition, strategies to conserve treatment options, including delaying HAART until the CD4+ cell count predicts an unacceptable risk of opportunistic infections and malignancy, selecting regimens that preserve recourse to active drugs in case of treatment failure, individualizing regimens to account for the convenience of patients and their susceptibility to certain side effects, use of therapeutic drug monitoring, and design of clinical trials to assess the level of virologic failure that must trigger a change in HAART, should be considered.[12]

They got one thing right on SVU last night: Meth is death.

Tuesday, October 18, 2005

A few bad apples

Today's big AIDS story is about the settlement and fine of Serono Labs for fraudulent marketing of Serostim. The AP and Reuters reports seem to provide the basis for everyone else's story, although there is some variation among the reports. Here's a sample:

AIDS Drug Maker to Pay $704M in Settlement (ABC News)
Firm admits AIDS-drug fraud (Billings Gazette)
U.S. Says Serono to Plead Guilty, Pay $704 Mln (Reuters)
AIDS Drug Maker to Pay $700M in Settlement (Associated Press via Yahoo)
Drugmaker to pay $704M fine in health care fraud (USA Today)
Swiss firm to plead guilty in AIDS case (CNN Money)
Settlement in Marketing of a Drug for AIDS (New York Times)
U.S.: Serono 'guilty' on AIDS drug (CNN World Business)
Maker of AIDS Drug Fined for Kickbacks (Washington Post)

There are, no doubt, more stories, but you get the picture. It's either the second or third largest (depending on your source) case of its type ever prosecuted. It's a whistleblower case, so five whistleblowers get to divvy up a $51 (or $52) million reward.

It's also about kickbacks and making deals with doctors to prescribe the drug unnecessarily in return for a trip to France. It's about creating a medical device that never got any review by the FDA (to prove that it worked) to "diagnose" AIDS wasting in people who didn't need the drug.

Some former company executives have been indicted, the company has paid both civil and criminal fines, but the U. S. Attorney in the case has not revealed whether he will be pursuing indictments of the doctors who falsely prescribed the drug. Serostim and all other Serono products will stay on the market, but one branch of Serono (not the whole company) will be barred from participating in federal programs for five years.

Serostim is not on the formulary for the Texas HIV Medication Program. It is, however, on the Texas Medicaid formulary. At the time it was added to Medicaid, Serostim was listed as a drug that required prior authorization because of its expense and the rarity with which it was expected to be needed. There is no information about whether any Texas doctors or sales reps were involved in the scam.

Serono blames the whole thing on a few bad apples.

Monday, October 17, 2005

Congressional Districts and Maps

Sometimes I just can't help myself. I start at one link and then find another, and before I know it, I've followed another rabbit trail. Something sent me over to Wikipedia this morning and a look at one of Texas' much gerrymandered congressional districts. That led me to the National Atlas and this list of maps for each of those congressional districts.

The National Atlas has a number of maps that make it worth a stay at that site long enough to sample a few. At the very least, you might save a copy of the map of your own congressional district. This becomes useful when you want to identify other folks who might live in your district so that you can work together to contact your congressperson or--here's a thought--visit his/her district office.

Did I mention that I was checking out a congressional district on Wikipedia? Seems they have at least as stub for each district but, in other cases, history and voting information. This list seems to be a portal to get you to all of the districts. It's worth a look, just in case your district is one of the ones that has some historical information for you. This might help you understand your congressperson and the various pressures he/she faces before applying your own.

Another source that popped up in my rabbiting around is the American Community Survey. This list is a nice portal for information about the demographics, economic, social, and housing characteristics of each congressional district (and some cities and counties as well). The information can be useful when you need some additional facts and figures to buttress your arguments to your representatives (both state and national in this case).

Thursday, October 13, 2005

Home Test for HIV

Spent the day in a meeting with the Texas AIDS Health Fraud Information Network. One of the things that we are constantly looking at through the task force is home testing kits for HIV that are outright frauds. HomeAccess is FDA-approved, but it requires that the blood sample collected at home be sent to a lab for testing. Right now there simply is no other test that you can take at home and get the results from at home without sending a blood sample to a lab. Anybody who says they have such a test are scamming you.

That may change.

The FDA will look at the matter of allowing OraSure to be used as a home HIV test on November 3. If approved, this will open the door for individuals to perform a simple oral swab, wait a few minutes, and know their status. In a perfect world, that would mean that everyone who is positive would now have the chance for truly anonymous testing and could begin immediately to notify their sexual partners to get tested and and themselves start practicing safer sex. Reality being what it is, this will also mean a nice bundle of profits for the manufacturers from sales to the worried well. [shrug] That doesn't bother me as much as some other elements of reality.

The big argument against true home testing in the past was a mental health issue. The shock of being diagnosed with a life-threatening disease is pretty major. In the case of a disease that also turns you into a social pariah and can lead to a hard death, the temptation to opt out sooner rather than later could be tempting. Advocates in Texas and elsewhere, spoke against unregulated home testing because of concerns about suicide.

That, however, was not the only concern. The current testing system, including the home test that requires that blood samples be sent to a lab, includes several important elements.

Epidemiology is nothing to sneer at. It's more than simply counting cases. It's a means of tracking the disease demographically, geographically, and behaviorally. It's also a means of planning both prevention and treatment. If we know how the epidemic is progressing, then we know more about how to work to prevent its spread. If we know how the epidemic is progressing, then we can better predict the scale of resources that will be needed for treatment. Yes, it's numbers, but it's no game.

The current system, in Texas, requires both pre- and post-test counseling. That requirement is sometimes the victim of various shortcuts, but it's there for a reason. Before a test is administered, the individual can be counseled about risky behavior and advised about ways to reduce the risk. Since many people who are tested do not return for their test results, that is a critical opportunity for counseling. The post-test counseling is an opportunity to link the person who tests positive to a support network at the same time there can be a frank discussion about preventing the further spread of the disease. Pre- and post-test counseling matters--it's a significant component of prevention.

There is yet another element that folks don't always like to think about, but partner notification is extremely important. It's tough enough to go tell someone, "Hey, honey, we have the clap; you should maybe see a doctor." It's much harder to deal with the matter of notifying one's partner(s) about HIV. The current system allows for the public health system to step in for the follow up, both in terms of contact tracing and partner notification.

On the other hand, a large percentage of folks who are positive do not know that they are. A home test might encourage them to test themselves and adopt safer behaviors.

I'd like to be optimistic about this, but I am at least ambivalent. What do you think?

Wednesday, October 12, 2005

DSHS HIV Stakeholder Meetings

The Texas Department of State Health Services (DSHS), HIV and STD Program is planning to hold a series of stakeholder meetings throughout the state this fall and winter. The purpose of these meetings is to:
  • Discuss the implications of decreased federal funding
  • Discuss HRSA guidance and related challenges
  • Solicit stakeholders' thoughts and ideas on how to best address the two issues above.
The meetings will include a brief presentation by DSHS staff and round table discussions addressing the following questions:
  • What can be done to simplify local administration and reduce costs?
  • What can be done to simplify local planning and reduce costs?
  • What changes to services and/or planning boundaries are needed to simplify activities and reduce cost?

Below is a schedule of the meeting dates, times and locations. Please invite other stakeholders who may be interested in participating. If you have questions regarding the meeting, please contact Jenny McFarlane at 512-533-3094.


October 24, 2005, 1-4pm
Austin State Hospital, 4110 Guadalupe
Building 636, Room 1102

October 27, 2005, 1-4pm
DSHS Region 2/3 Office
Bank One Building, 1301 South Bowen Road Suite 200, Conference Room 2210

November 3, 2005, 1-4pm
DSHS Region 11 Office
601 West Sesame Drive, Rockport Room

November 15, 2005, 1-4pm
Harris County Public Health and Environmental Services - Main Office
2223 West Loop South
Fifth Floor Auditorium, Room 532
Parking: Parking is free in the parking garage located behind and attached to office complex. The building is located on Loop 610 near the Galleria area, on the north bound feeder road between Westheimer and San Felipe.

December 8, 1-4pm
DSHS Region 9/10
2301 N. Big Spring St., Suite 300 (Conference Room)

Tuesday, October 11, 2005

Disability Funders Network Looks at Disaster Relief

An estimated 20 percent of the United States population has a disability making this the largest minority group in the nation. People with disabilities have the highest rate of poverty of any minority group in the United States. Geographically, nearly 40 percent of people reporting a disability live in the South-twice the percentage of people with disabilities in the other regions of the country.

"People with disabilities, including older adults, face a vast range of barriers to safety and survival during disasters that are often overlooked by rescue and recovery efforts," said Jeanne Argoff, executive director of Disability Funders Network (DFN). "Our goal is to raise grantmakers' awareness of not only the importance of including the disability community in their disaster preparedness, rescue and recovery efforts, but also to increase their understanding of the disability community's needs following a crisis."

Among the last to be rescued following Hurricane Katrina, people with disabilities faced difficulties in making their presence known, resulting in unnecessary deaths. Those rescued were forced to evacuate leaving behind necessities such as life-saving medications, equipment, aids and service animals. Often, they were sent to places unable and sometimes unwilling to meet their needs.

The disability community's needs following Katrina and Rita are far reaching-from assistive technology such as teletypewriters, signaling devices and hearing/speech amplification devices, to durable medical products like wheelchairs, walkers, canes and adaptive accessories. Medical supplies-including oxygen, hospital beds and transfer lifts are also in high demand.

Conventional relief groups have not consistently demonstrated that they understand how to assist disaster survivors with disabilities.

"Disability Funders Network (DFN) is instituting a 'Rapid Response Fund'--effective October 4, 2005 --to make grants to nonprofit organizations providing direct relief to people with disabilities in the affected regions," announced Sylvia Clark, chair of Disability Funders Network and executive director of NEC Foundation of America. And to best prepare for future crises, Disability Funders Network (DFN) has an ongoing initiative, "Emergency Preparedness for People with Disabilities and Older Adults: What Grantmakers Need to Know."

Monday, October 10, 2005

"I gave her AIDS"

TheWisconsin legislature has just appropriated a half million dollars in new funding for HIV in that state and named the fund for Michael Johnson, a positive advocate who has spent many years talking to youth about HIV and the need to get tested. The Wisconsin State Journal story highlights Johnson's contribution to HIV prevention in his home state and his recent health struggles. Johnson himself regrets that he has not been well enough recently to carry on the fight:

Johnson says he'd like to return to the school circuit. He feels he let the parents of Wisconsin down during the years he was too sick to speak.

He wants to tell teenagers that they and their sex partners need to get tested. If that doesn't seem romantic, tough.

"I gave her AIDS," Johnson said, nodding at his wife, Sherie. "and I love her more than anyone in the world. Why? Because I didn't know."

If Johnson's story persuaded kids a decade ago, it's even more poignant now that he's come back from his deathbed to tell it once again.

A few years ago, the theme for World AIDS Day referred to men and their role in prevention. I was asked to speak at an appreciation event held at a local CBO on that day and had to come up with something to say that fit the theme. My first response was pretty snarky: Well, men are the problem, aren't they? But I eventually settled down to the task and thought it through.

I remembered an old poster that used to be available in Texas. It was in Spanish, which I don't read, so I asked someone to interpret it for me. The graphics showed a man standing in front of a woman and a couple of children, presumably his family, fighting off a many-headed monster. The caption was translated as "To be a man." In essence the poster talked about the role of a man in protecting his loved ones from danger--including HIV.

I used that thought in my talk on that World AIDS Day. I talked about the ways in which we traditionally thought of men as protectors and looked at how they should be protecting themselves and those that they loved from the spread of HIV.

It seems that Michael Johnson has been talking about this for a lot longer. Let's hope that his work can continue.

Love and Condoms

The Fall 2005 issue of Mental Health AIDS includes an article review that discusses adolescent condom use relative to the degree of commitment in a relationship: the more commitment (and love and trust), the less likely condoms are to be used.

The article reviewed is:

Bauman, L.J., & Berman, R. (2005). Adolescent relationships and condom use: Trust, love and commitment. AIDS & Behavior, 9(2), 211-222.

Friday, October 07, 2005

Congress May Cut Funding to Vital Services Soon

The Coalition for Human Needs has issued the following Action Alert.


Congress has a serious priorities problem - and it will mean less food and health care for people in need if you don't set them straight.

It's unthinkable that Congress might cut Medicaid, Food Stamps, TANF and other vital services for people in need - whose numbers have shot up because of the hurricanes. But these cuts are now scheduled for action in Congress starting the week of October 17.

Its even more unthinkable that Congress may cut even more deeply! Reacting to the cost of Katrina recovery, powerful voices in Congress are now calling for deeper cuts across domestic programs. But they have not stopped the plans for still more tax breaks to the well-off. These are dangerous choices.


For a PDF flier with this information, click here:

For background on cuts, click here:


Step 1: On October 17 or 18, call 1-800-426-8073 to be connected toll-free to the Capitol Switchboard. Ask to speak to one of the senators from your state.

Step 2: When the senators phone is answered, say:

My name is ___________ and I live in [your town/city]. I would like Senator [name] to oppose $35 billion in cuts to Medicaid, Food Stamps and other vital services, and to oppose $70 billion in more tax cuts.

The right priorities are protecting people from sickness and hardship, investing in
housing, jobs, and other services that families need not squandering billions on tax cuts for the well-connected.

Step 3: Use the toll-free number in step 1 and call your other senator and your representative. If the lines are busy, please be patient and try again. Or, dial their direct lines (not toll-free) - find the numbers at and

If you do not know who your (Texas) representatives are in Congress, a handy tool for locating them can be found at

What Marsha Says

Marsha Martin was the Executive Director of AIDS Action Council until a few weeks ago. Now she's the new AIDS Director for Washington, DC. DC's poor response to HIV has been repaid by one of the nation's highest prevalence rates. Marting has wasted no time in suggesting a couple of solutions:

Marsha Martin, the newly appointed director of the District of Columbia’s HIV/AIDS Administration, is calling for the availability of condoms in schools and the establishment of needle-exchange programs in Washington to combat the spread of HIV, the Washington Examiner reports. “We want condoms everywhere,” she said at a panel discussion on Monday. “We have already had conversations with the public schools. I want them everywhere."

In Texas, current law says that condoms cannot be distributed in schools in the context of a presentation on how to use them or their effectiveness. It still doesn't, as far as I can see, prohibit condom distribution. That doesn't mean that others see it that way, or, if they do, that condoms are distributed.

Are condoms available in your local school district? Community college? University?

Thursday, October 06, 2005

Abstinence Educator Gets Laid

That's the shorter version of the SFWeekly's "What Part of "Wait Until Marriage" Don't You Understand!" subtitled "Infiltrator goes to a teen abstinence educators' conference -- and gets laid!" Harmon Leon details his adventures at a conference to train abstinence educators and his decision to become a born-again virgin--for the duration of the conference at least.

Leon describes several of the arguments and techniques used in abstinence education, interjects more than enough satire to keep the story rolling, and makes some very telling points regarding the purpose of abstinence education. A few excerpts:

We're sitting in a conference room eating $15 box lunches (turkey with mayo on white bread, of course), engaging in shop talk. One topic: All Web sites should refer to the failure rate of condoms, rather than to their effectiveness. Another: Should extremely graphic slides be used when speaking to students about STDs (which condoms don't prevent)?

. . .

Abstinence Fun Fact!

Why not tell kids to try to abstain, but if they are going to have sex, use a condom? That's an easy question to answer. Saying, "If you must, use a condom," is like saying, "Don't drink and drive, but if you do drink and drive, make sure you wear a seat belt." Or saying, "Don't go and shoot a cop, but if you are going to shoot a cop, make sure to wear safety goggles and earplugs." So when we say it's OK for a teen to use a condom, it's like saying it's OK to shoot a cop!

. . .

Then comes a series of TV commercials produced by his foundation, to be aired during Oregon State Beaver football games, showing the consequences of not practicing abstinence. "This ad changes the English language by changing the view. We need to see the woman as a hero for bringing a baby to term."

The first commercial -- called Night -- Abortion Changes Everything. Think About It -- shows a hot-looking, blond female firefighter (you see them all over the place) saving a tiny baby from a burning building. She mentions that her mother, who almost had an abortion, would be very proud today that her decision saved more than one life. "When you work with women coming to your clinic, they're heroes!"

"The next commercial deals with selling abortion to blacks in inner cities," the gray-suit man dryly explains. "They [the blacks] usually have their first child, so we put the child in the ad." The ad has the feel of a Folgers coffee commercial. We see a smiling, well-adjusted black woman in a middle-class house; she has a small child. With a huge, satisfied smile, she says she's decided to have her next baby as well!

There's more. A 17-year-old white girl is jogging in a nice running outfit. "You can't run away from your problems," she says. "I'm keeping it." She jogs off (I would guess back to her middle-class home).

But a question pops into my mind: Where's the TV commercial with the woman (or hero) who's been raped by her alcoholic stepfather and the words "Abortion -- let's not have two victims!

. . .

The Case for Marriage

"What we think of marriage is not what the world around us thinks of marriage," the bubbly woman from earlier tells the room, which is 90 percent full of gray-haired ladies; they are attending the workshop "The Case for Marriage." "This is the will of God that you should abstain from sexual immorality. We believe that human sexuality is a divine gift, a primal dimension of each person.

"No question about that. God is pretty clear where he stands on that!"

I realize, now, that abstinence education goes deeper than telling high school kids not to have sex. It's the exportation of a code of conduct into our public schools directly from the Bible.

. . .

[After detailed description of skits promoting abstinence and virginity pledges,] According to the Journal of Adolescent Health, teens who take virginity pledges often remain technical virgins by engaging in oral and booty sex. It makes sense: If they're trying to preserve their virginity, oral and anal sex fit under the definition of not having sex.

. . .

Abstinence Fun Fact!

I don't want kids thinking they'll be protected by condoms, because it won't protect the most important body part of all -- the heart. And isn't that the area of the body most susceptible to raging gonorrhea?

. . .

I look again at the slide of Holly and Steve hugging, holding flowers. What went wrong? They look so happy. To think, it was all because of birth control.

We go next to the Bible, specifically Genesis 38:10, in which Onan spills his seed on the ground and is struck dead by God. The soft-spoken director questions the appropriateness of married couples using contraceptives. "That's our objective: understand God's plan for marriage and families," she says. "The purpose of sex is procreation."

Once we separate sex from creating children, she says, the door is open to a whole (pardon my French) hell of a lot of trouble: "Protestant Church tolerance of birth control paved the way to the legalization of homosexuality, sodomy. And you know where we are today with gay marriage."

. . .

Now I fully understand why abstinence educators tell kids that condoms are ineffective. It's not a scientific or logistical issue; it's completely a moral issue for these folks. They think birth control correlates to something in the Bible (my favorite work of fiction next to Battlefield Earth). They're not thinking of kids' health; they have a moral agenda. It's like teaching creationism over evolution in the classrooms. It's religion over science, except here it's religion over the health of kids.

And then he left the conference and then he got laid (by a former abstinence educator). She brought the condoms.

Wednesday, October 05, 2005

Updated Guidelines for Post Exposure Prophylaxis

Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis

Centers for Disease Control and Prevention. MMWR 2005;54(No. RR-9).

This report updates U.S. Public Health Service recommendations for the management of health-care personnel (HCP) with occupational exposure to blood and other body fluids that might contain human immunodeficiency virus (HIV). This report emphasizes adherence to postexposure prophylaxis (PEP) regimens when indicated, expert consultation in managing exposures, follow-up to improve HCP adherence to PEP, and monitoring for adverse events, including seroconversion. Clinicians should consider occupational exposures as urgent medical concerns.

Tuesday, October 04, 2005

KFF Webcast on Medicare Part D

LIVE Webcast - Ask the Experts: Medicare Part D

On Thursday, October 6, a panel of experts will answer questions about the Medicare Part D implementation during a live webcast of "Ask the Experts," a program. Send questions in advance of the live program to .

WHAT: With sign ups for the Medicare Prescription Drug Benefit less then two months away, this live webcast will address how implementation of Medicare Part D is proceeding. The discussion will be moderated by Kaiser Family Foundation Vice President and Editor-in-Chief Larry Levitt.

WHO: The panel of experts:
  • Leslie Norwalk, Esq., deputy administrator, Centers for Medicare and Medicaid Services
  • Tricia Neuman, Sc.D., vice president, Kaiser Family Foundation and director, Medicare Policy Project
  • Aileen Harper, executive director, Center for Health Care Rights
WHEN: Thursday, October 6 at 2:00 p.m. ET

WHERE: Watch the live webcast on

HOW: The panel of experts will take your phone calls and emails. Send questions in advance to or call 1-888-524-7378 during the live broadcast.

Please note: The toll-free phone number will function only during the live program and is for submitting questions only. The program is accessible via webcast on the Internet and not via teleconference. If you have never viewed a webcast before, please test your media player in advance of the live webcast at

Webcast on HIV Screening

Webcast - Revised Recommendations for HIV Screening of Adults, Adolescents, and Pregnant Women in Health Care Settings

Thursday, November 17, 2005, 12:00 to 2:00 p.m.

This program will be available for viewing at

This live web cast will provide information regarding the rationale for expanded HIV screening in health-care settings, alternative procedures for normalizing screening in various health care settings, and practices that facilitate routine screening. Interviews and strategies at public and private health-care settings will be included. A panel of experts will answer viewers' questions, which can be sent via fax during the broadcast.

  • Rashad Burgess, Team Leader, Prevention Programs Branch, Division of HIV/AIDS Prevention (DHAP), CDC
  • Eileen Couture, DO, FACEP, RN, MS, Clinical Chair, Emergency Department, Oak Forest Hospital of Cook County, Chicago, Illinois
  • Donna Futterman, MD, Professor of Clinical Pediatrics and Director, Adolescent AIDS Program, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
  • Bernard Branson, MD, Associate Director for Laboratory Diagnostics, DHAP, CDC
  • Robert T. Maupin, Associate Professor, Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, New Orleans, Louisiana

Target Audience: Persons who administer, deliver or plan the care and treatment of adults and adolescents in public and private health-care settings, particularly prenatal care, STD treatment and prevention, emergency care, and primary care.

Continuing Education Information: CE credit is not planned for this webcast.

Webcast sponsor: Division of HIV/AIDS Prevention (CDC) and the Public Health Training Network

Webcast website:

Please note: This program will also be broadcast via satellite. DSHS does not have plans to host a site to view this program.

Change to comments

I've made a change in the comments. Anyone can still comment; you just need to be human to do it. To prove your humanity, word identification is now in place. This will, I hope, stop the computer spam that has started to creep into the site. Unfortunately, I know that the spam is there (I get notice via email when someone comments on the site), but I haven't found it yet. When I do, I will delete it. If it (the spam) is offensive, please accept my apologies. If word identification is a problem, you can send email to tan AT texasaids DOT net and let me know.

After a hiatus on the blog, I will be back posting significant items that cropped up in the past three months. I won't, however, give you the gory details of relocating the office, setting up the computers all over again, or two hurricanes.

Monday, October 03, 2005

Ryan White funding for urban areas shouldn't be cut

In an editorial, the Rochester (NY) Democrat & Chronicle opines that funding for rural areas and states with comparatively fewer cases of AIDS should not come at the expense of states like California and New York. Rather overall funding for the Ryan White CARE Act should be increased to make sure that all of the states have the level of funding that they need.

A bigger pie. We can live with that!

HOPWA deadline extended

From the National AIDS Housing Coalition:

Due to the effects of Hurricane Katrina, HUD has extended the due date for the second round of the HOPWA Competitive Grants competition from October 6, 2005 to Thursday, October 13, 2005. Click on the below links to view the notice in the federal register.

For a PDF; for text.

Electric, phone deposit waivers extended

Hurricane Katrina, Rita Victims Eligible

Contact:Terry Hadley
Pager: 512-322-1457

Wednesday, October 3, 2005 -- The Public Utility Commission (PUC) on Monday approved an emergency rule to provide deposit waivers for both Hurricane Katrina and Rita victims when applying for new basic local telephone and electric service in Texas.

The waivers are good for 60 days and are designed to make it easier for hurricane victims to establish a new residence. Some Texas providers already have voluntarily waived deposit requirements and eliminated installation fees. Last month the PUC ordered electric and telephone deposit waivers for Hurricane Katrina victims.

The order is effective until Dec. 2. The Commission will review the issue over the next few months to determine if an extension is warranted.

Hurricane victims may also be eligible for other utility programs to make it easier to establish a new residence. These include Link-up and Lifeline program benefits for low-income telephone customers, average bill payment plans, utility-sponsored payment assistance funds, and shopping for the best value in phone and electric service.

The PUC does not have the authority to waive deposit requirements for customers of municipal electric utilities and electric cooperatives, but the Commission encourages these entities to authorize such waivers.

Last Updated: 10/03/05

Sunday, October 02, 2005

Twenty years ago today . . .

Rock Hudson died and changed the nation's perception of AIDS.