Saturday, February 26, 2005

HIV Infection Rate Among Blacks Doubles

Jeff Donn reports for the Associated Press on research presented in Boston at the 12th Annual Retrovirus Conference that:

The HIV infection rate has doubled among blacks in the United States over a decade while holding steady among whites — stark evidence of a widening racial gap in the epidemic, government scientists said Friday.

The study on which Donn's report is based excluded the homeless, soldiers, and prisoners, making it likely that the infection rate in the African-American community may be higher. Adding insult to injury, the study shows that as much as 44 percent of those who need to be in treatment in this country are not.

FDA Approves First Ever Treatment for Hepatitis C in Patients with HIV

A press release by Roche pharmaceutical company talks about its new FDA approval and what it means for people living with HIV and Hepatitis C:

Roche announced today that the U.S. Food and Drug Administration (FDA) has approved the first and only hepatitis C treatment, Pegasys(R) (peginterferon alfa-2a) in combination with Copegus(R) (ribavirin, USP) for patients coinfected with HIV.

Hepatitis C and HIV are the two most prevalent blood-borne infections in the United States. It is estimated that approximately 30 percent of Americans with HIV are believed to be infected with the even more common blood-borne virus hepatitis C. Chronic hepatitis C affects approximately 2.7 million Americans and HIV, almost one million. Research has shown that hepatitis C is more resistant to treatment in people with HIV.

The approval of Pegasys combination therapy for the treatment of hepatitis C in HIV patients was based on results from the largest study of its kind conducted to date. The results showed that 40 percent of the 860 patients treated had the levels of their virus become and stay undetectable for at least 24 weeks after finishing a course of treatment.
In Texas, this sort of treatment would be available through private insurance and Medicaid (both are listed on the Medicaid formulary as preferred drugs that do not require prior authorization). The Texas HIV Medication Program does not provide treatment for co-infection with either Hepatitis C or tuberculosis.

Monday, February 14, 2005

Happy Valentine's Day

Watch this video. (Watch it all the way to the end. It can get loud, so close the door or adjust your sound.)

It's more fun if I don't give away the surprise, but this link tells you why this video seems appropriate for Valentine's Day.

Friday, February 11, 2005

Senator Lautenberg Introduces Legislation to Provide Comprehensive Sex Education in Schools

In a refreshing change, bills have been introduced in Congress to fund reality-based sexuality education in the schools. Neither text nor numbers are available on Thomas yet, but here is Sentator Lautenberg's press release on his bill.

WASHINGTON, D.C. -- At a press conference today, United States Senator Frank R.
Lautenberg and Rep. Barbara Lee announced the introduction of the "Responsible Education About Life (REAL) Act"; legislation that will bring a comprehensive
approach to teaching young people about the risks of sex, and the steps necessary to prevent unwanted pregnancies and Sexually Transmitted Diseases (STDs).

The measure will create a grant program administered by the Department of Health and Human Services (HHS) that would award $206 million per year to states for comprehensive sexuality education programs that would include medically accurate information about both abstinence and contraception. While $206 million in federal funding currently exists for "abstinence only before marriage education", there is no funding dedicated to comprehensive sex education.

"Abstinence only education only tells young people half the story, and they need the full picture," said Senator Lautenberg. "The abstinence-only programs funded by the federal government are not getting the job done."

Even the Heritage Foundation finds that "Some 75 percent of parents want teens to be taught about both abstinence and contraception." A Hickman-Brown 1999 poll reports that 93 percent of Americans support teaching comprehensive sex education in high schools.

"The REAL Act is a step in a more effective direction. It brings sex education up-to-date in a way that will reflect the serious issues and real life situations millions of children find themselves in every year," said Lautenberg.


I'm guessing that this won't pass, but it could open the dialogue, and dialogue is sorely needed. While abstinence is a good strategy for some people at certain points in their lives, unless one is making a lifelong vow of abstinence, there will come a point when some information about sex is going to be needed. That's the point at which reality-based information about contraception, disease prevention, and sexual health would come in mighty handy.

Thursday, February 10, 2005

Routine HIV testing urged

Linda Johnson writes for the Associated Press that two major studies are advocating routine HIV testing. Such testing would be cost effective since the savings in detection and early intervention would outweigh the cost of testing, except for the celibate and monogamous. The VA participated in one of the studies and appears likely to go ahead with routine testing.

Testing is now routine for pregnant women in Texas. Women can opt out of the test, but the overwhelming majority consent to be tested. This has reduced the rate of perinatal transmission in Texas dramatically.

Wednesday, February 09, 2005

Texas budget hearings

The House Appropriations Subcommittee on Health and Human Services held its hearing on the Department of State Health Services legislative appropriations request yesterday. (The Senate Finance Committee hearing is today.) For most of the hearing, Commissioner Eduardo Sanchez held the hot seat, while he was grilled by committee members about various aspects of the budget.

The major good news related to HIV appropriations is that the 5 percent reduction originally mandated as an across-the-board cut for all state agencies has been eliminated for HIV. The Legislative Budget Board recommended restoring $4.1 million to HIV, keeping funding at 2005 levels.

However, new actuarial studies of the projected needs of the Texas HIV Medication Program show that the shortfall for FY 2006-2007 is higher than previously projected. The actual need is a little over $15 million (up from $11.7 million). Again, there is good news in that the Department of State Health Services has amended its legislative appropriations request to seek this higher amount of funding. (Historically, getting the Department to do that has been almost impossible.)

During the hearing, the subcommittee members asked several questions about HIV and STDs. All of them showed concern about the direction of the epidemic and the effectiveness of prevention.
  • Rep. Isett (R-Lubbock) expressed concern about the apparent disparity between the low amount of funds being spent on abstinence education and the high amount of funds being spent on the treatment of HIV and STDs. He asked for more information about what other prevention programs were being provided. He also requested more information about funds being spent on HIV in other programs.
  • Rep. Dukes (D-Austin) and others entered into a dialogue about the Texas A & M study of abstinence education in Texas.
  • Rep. Luna (D-Corpus Christi), Vice-Chair of the Appropriations Committee, sat in on most of the hearing. She asked whether there was unmet need for HIV services. Are people who are not getting services from the Department going elsewhere for care, and does this involve cost-shifting to local communities?
  • Rep. Davis (R-Houston), Chair of the Subcommittee, asked about the epidemiological trends for HIV and STDs and reasons for recent increases in new cases.

The Department will be providing additional information to committee members in response to their questions.

Thanks to Rep. Dukes, the hearing also included a lively discussion of Hepatitis C programming in the state. It appears that rumors that most Hep C programming would be abandoned are now not true. (We'll see.)

Texas AIDS Network testified in support of the the exceptional item request for $15 million for HIV medications, thanked the Legislative Budget Board for restoring the 5 percent reduction, and requested that Rider 29 (relating to abstinence education) not be amended.

AARP blogs Social Security

If you are trying to keep up with the debate on Social Security, AARP now has a blog which covers some of the basics and the ongoing dialogue. There is a very real concern that changes in Social Security will negatively affect support for disabled persons.

. . . via TPM.

Tuesday, February 08, 2005

FDA warns about home test kits

The FDA has issued the following warning:

The Food and Drug Administration (FDA) is warning consumers not to use unapproved home-use diagnostic test kits that have been marketed nationwide via the Internet by Globus Media, Montreal, Canada. In fact, no home-use test kits intended for diagnosing HIV*, syphilis and dengue fever are approved for sale in the U.S. The use of these products could result in false results (though there is no confirmed evidence of false positives) that could lead to significant adverse health consequences. The illegal kits are labeled as:

  • Rapid HIV Test Kit
  • Rapid Syphilis Test Kit
  • One Step Cassette Style Cocaine Test
  • One Step Cassette Style Marijuana (THC) Test
  • One Step Cassette Style Amphetamine Test
  • Rapid Dengue Fever Test
  • One Step Midstream Style HCG Urine (Home) Pregnancy Test

FDA has not approved or evaluated the performance of any of Globus Media's products. As a result, consumers cannot know with any degree of certainty that test results are correct. For example, a person testing positive for HIV (human immunodeficiency virus, or the AIDS virus) using one of these tests may not be infected with HIV, or, worse, someone infected with HIV may test negative and not seek medical treatment, or spread the virus to others.

The tests were sold through websites and distributed throughout the U.S., usually by overnight delivery services. They have been made available for sale on several websites, including www.htkit.com and www.hstkits.com. The kits usually are contained in a paper envelope with instructions inside the packaging. The envelope, instructions and packaging may not accurately identify the manufacturer, packer or distributor. The name of the kit appears on the instructions. Consumers who have these products should not use them. Anyone who has used one of these test kits should be retested using valid test methods. The FDA has issued an import alert which alerts FDA field personnel to the possible importation of these devices, provides guidance as to their detention and refusal of admission into the U.S., and also advises U.S. Customs officials about these products. Other unapproved tests may also be available through the Internet. You can find a list of FDA approved / licensed tests for HIV and Hepatitis on the FDA website at http://www.fda.gov/cber/products/testkits.htm. [emphasis added]

*Please note that one licensed/approved diagnostic home collection kit for HIV, which is mailed to a laboratory for testing and confirmation, is commercially available in the United States.

Monday, February 07, 2005

Congressional Schedule

Congress' schedule for 2005 in now available.

  • The HTML version lists the dates of various recesses and when Congress will reconvene.
  • The PDF version is in calendar format, showing days in session in blue.

You can, for example, use these resources to plan visits to your congressional representatives' district offices.

Bush Budget May Harm PWAs

The response to the President's budget is starting to trickle in. The consensus is likely to be that this budget will cause some real problems for people living with HIV/AIDS. Not only is the proposed increase ($10 million) too small to fit the need (NASTAD recommended an increase of $197 million for AIDS drug assistance programs), cuts in other places will negate any potential benefit.

"This budget does not reflect the concern President Bush showed during his State of the Union for HIV and AIDS care and prevention," said HRC Vice President of Policy David M. Smith. "Unfortunately, the President's actions do not match his words."

. . .

In addition, the Centers for Disease Control saw a $4 million cut to its budget for HIV/AIDS prevention and surveillance. At the same time, unproven non-science-based abstinence-only programs, which do not include education about how HIV/AIDS is transmitted, received $38 million in additional funding. A recent study at Texas A&M University showed that teenagers taking abstinence-only sex education programs endorsed by the President became increasingly sexually active, which is the exact opposite effect that the program is designed to have. "Programs which focus on abstinence as the sole means of preventing HIV/AIDS put our young people at tremendous risk," said Smith. "The President has repeatedly stated his commitment to combating the spread of HIV. We have to question that commitment when his ideology consistently outweighs sound scientific facts."

. . .

Despite the President's recognition that HIV/AIDS is a growing problem in communities of color, the Minority AIDS initiative was flat-funded. Also, $14 million was cut from the Housing for Persons Living With AIDS program, which helps people living with HIV/AIDS afford housing. Having stable living conditions increases the chances of strict adherence to drug regimens, which is necessary for fighting HIV/AIDS and also prevents the development of medication-resistant strains of the virus.

President Bush's budget also includes Medicaid cuts of at least $45 billion over the next 10 years. These cuts would greatly affect a program that is responsible for providing health care to 55 percent of all adults living with AIDS and 90 percent of all children the HRC said.


The good news is that Congress still has something to say about all of this. Letting your congressional representatives know what impact this budget would have on you and your community would be a good place to start. See Texas AIDS Network's "Who Represents Me?" to find out how to contact your representatives.

The President's Budget (part 2)

Well, if I read this correctly(see page 429 [or 3 of 49 in this file]), the President is recommending only a $10 million increase for the Ryan White CARE Act with slightly more than half of that being earmarked for the AIDS drug assistance programs.

This amount will not be adequate to help Texas maintain current services for its clients in the Texas HIV Medication Program. It will effectively constitute another cut for other services provided under the CARE Act.

Ouch!

The President's Budget & HIV/AIDS

According to the federal Office of Management and Budget, President Bush has addressed HIV/AIDS thusly in his proposed budget for federal FY 2006:

Battling HIV/AIDS:
o The Budget devotes almost $18 billion for domestic AIDS prevention, treatment, and research, including almost $2.1 billion for the Ryan White CARE Act program (and its comprehensive approach to address the health needs of persons living with HIV/AIDS.)
o Under the President’s five-year, $15 billion Emergency Plan for AIDS Relief, the Administration has moved quickly and efficiently to mobilize the scientific and programmatic expertise,leadership, and resources of HHS and other Federal government agencies and their partners both here and abroad.

Without specific numbers, this sounds like so much smoke screen. The Ryan White CARE Act numbers don't sound like an increase, but, at this level of rounding, it would be hard to tell.

Wednesday, February 02, 2005

House Appropriations on Dual Eligibles

Clicking on the title for this post will bring up the broadcast for the House Appropriations Committee meeting held this morning. (RealAudio is required to view the broadcast.) The second item on the agenda was a presentation regarding the state's "give back" requirement under Medicare Part D. The discussion occurs about 17:55 (minutes:seconds) into the broadcast and ends at about 58:00.

Melitta Bustamante, an analyst for the Legislative Budget Board, laid out the basics on the state's role in financing prescription drug coverage for Medicaid/Medicare dual eligibles beginning January 1, 2006.

At that time, dual eligibles will no longer be able to receive medications through Medicaid. Instead, they will receive them through Medicare. The medications themselves will come from private providers (HMOs, insurance companies) that choose to participate in providing this pharmacy benefit. Persons who are dual eligible will be able to choose (in most cases) among two or more programs. A premium and co-pays will be charged. Each provider will determine its own formulary.

The state will be required to "give back" to the federal government's Medicare program 90 percent of the amount that it would otherwise have spent on providing medications for this group of people. (The estimate is that there are 316,000 dual eligibles in Texas.) The amount of the "give back" will decline over a period of years until it reaches 75 percent, so that the state will eventually "save" 25 percent of the cost of providing medications to this population.

Questions from Representatives Vilma Luna, Dawnna Dukes, and Graig Eiland zeroed in on several elements still at issue on this program. Dukes spent a fair amount of time questioning what would happen when a needed drug is not on the formulary of the provider selected by a client. She also pointed out the heavy burden of co-pays on the low income population. Representative Luna discussed the problem of clients being targeted by aggressive marketing campaigns with the result that naive clients may end up signed up for (and financially obligated to) more than one program. Representative Eiland asked some pointed numbers questions about losses to Medicaid from drug rebates (suggesting that the cost savings of Medicare Part D are less than 10 percent).

If you're at all wonky, this is a good session to listen to. I just hope that your feed is better than mine. The whole committee looked like smurfs.

Leavitt Sees $60 Billion in Medicaid Savings

(registration required to read entire article)

Ceci Connolly, writes in the Washington Post, that the new Health and Human Services Secretary Mike Leavitt

said yesterday that $60 billion can be saved over the next decade in the Medicaid health program for the poor by closing loopholes, prohibiting "accounting gimmicks" by states and eliminating wasteful spending on items such as overpriced prescription drugs.
Leavitt assured his audience that there would be no cap on mandatory benefits under Medicaid, but that left in limbo the question of what the administration might do about such optional services as prescription drugs.


Diane Rowland, executive vice president of the nonpartisan Henry J. Kaiser Family Foundation, said that because children are the largest group of mandatory beneficiaries, Leavitt's comments seemed to indicate "the potential goal here is to reduce spending on the aged and people with disabilities, who tend to be classified as optional and are the most expensive."
Unfortunately, details of that $60 billion in savings are elusive.

He promised aides would provide details on the $60 billion in savings. But a staff e-mail later said only: "The estimated savings numbers used in the speech are formal HHS estimates and can be attributed as such."


The Texas Health and Human Services Commission publishes an annual report on Medicaid in Texas, the most recent called Medicaid in Perspective 2004. In Chapter 5 (p. 16), a pie chart shows the federal budget expenditures for FY 2003. Medicaid and CHIP combined comprise 8 percent of spending. (Interestingly, interest on the national debt comes in at 7 percent, which is almost as much as Medicaid.) According to the Texas Fact Book 60.5 per cent of the federal funds that Texas received in FY 2004-2005 were for health and human services ($23,729.4 million).

Tuesday, February 01, 2005

Senate Health and Human Services Committee

The committee held its organizational meeting today and adopted rules. The committee's regular meeting time during the session will be Tuesday mornings at 9:00 a.m. in the Senate Chamber. The committee will meet more often if the workload necessitates it.

Governor's Budget Recommendations

The governor has made his recommendations for the appropriations for the coming biennium. While his budget document does not show allocations as specifically as the Legislative Budget Board recommendations do, the budget does show that the Governor is recommending more than $100 million less for the Department of State Health Services than the Department is requesting.

The Governor's priorities for increased funding include:
  • Reform child and adultprotective services
  • Create emerging technology fund
  • Add offices of inspectors general
  • Increase skills development fund
  • Expand mentoring initiatives
  • Improve student financial aid
  • Etc.