Friday, December 30, 2005
October 19, Medicare Part D: Texas Stand-Alone PDPs--Not exactly terrific writing, but, because I was so specific in listing individual plans, I seem to be getting a lot of traffic for this post. Would that some of these folks would dink around the site and subscribe. [hint]
October 26, Live Blogging Coburn's Amendment--Not so much real live blogging as learning how to use the technology. Fun, but very time-consuming. I hope to do more of this (and better) next year.
December 7, Beer causes AIDS--It's not that this essay was so great; I just like saying "Beer causes AIDS." It's more fun than "Get high, get stupid, get AIDS." Perhaps we need to work on my sense of humor . . . :)
November 4, Cuts to State HIV Services on the Horizon--Sometimes my day is just one big blur of meetings. What I like about this post is having had the luxury of time to write up the results of one meeting and put it in perspective.
April 12, Disinformation.gov--It's my personal opinion that the current war on condoms is not so much a matter of ignorantly passing along incorrect information as one of deliberately presenting inaccurate and skewed information in order to accomplish a not-so-hidden moral agenda while claiming to be aiming for disease prevention. That's fraud on two levels. Besides, I really like to use the word "disinformation." It sounds just about as evil as the program it describes.
October 31, Katrina Evacuees Get Meds in Texas--Again, not so much the writing as the experience. I was very proud of the speed with which THMP acted in the face of this emergency and similarly proud of the generosity of the pharmaceutical companies that supply meds for the program. They really stepped up when needed.
May 9, Five Questions: The Fifth Question--I just love it when I get to talk all anthropological.
December 19, Oh, those Canadian pharmacies!--This one has everything: research, follow up to past posts, snark, original conclusions, and the all important public service announcement. Did I mention snark?
December 16, Labels and discrimination--I enjoyed writing this essay, both because I like the challenge of pulling assorted threads of thought together and because this issue is something that really matters to me. The only thing that would have made this one better is a whole slew of responses to the question at the end.
November 30, About abstinence--This is an essay that I also enjoyed writing. It sums up my own thoughts rather nicely. While I do mostly strive for a neutral point of view in making the reports for this blog, I also recognize that personal opinion and some snarkiness do creep in. It is a relief sometimes just to "let it all hang out" and not worry about getting the NPOV thing right.
With that, I'm through for the year. See you next year with more news and information for the Texas HIV/AIDS community. In the meantime, stay safe over this holiday weekend as we look forward to new beginnings.
On February 11, I discussed a bill introduced by U. S. Senator Frank Lautenberg that would require reality-based sexuality education in public schools. Here's the bill's status:
13. S.368 : A bill to provide assistance to reduce teen pregnancy, HIV/AIDS, and other sexually transmitted diseases and to support healthy adolescent development. Sponsor: Sen Lautenberg, Frank R. [NJ] (introduced 2/10/2005) Cosponsors (7) Committees: Senate Health, Education, Labor, and Pensions Latest Major Action: 2/10/2005 Referred to Senate committee. Status: Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
On March 30, I talked about a bill introduced by U. S. Senator Gregg (S. 288) that would extend funding for programs related to state high risk insurance pools. At the time, I thought it had been reported out of committee, but I erred. It didn't get reported out of committee until July 29 with this report.
On June 3, I blogged about an issue that concerns me greatly, preying on people with HIV by trying to sell them questionable and fraudulent immune system boosters (Hinky marketing of immune boosters). I reported a web site to the FDA for doing just that and got an email from the fellow who does this sort of thing (well, his minions do), but I haven't seen any reports that say that action has been taken. This week I checked the web site that started the matter (for me) and found that it is still around, still claiming to cure everything. The FDA can move pretty slowly sometimes. I'm just sayin'.
October 18, A Few Bad Apples--The story was about Serono Labs and illegal marketing of Serostim and the settlement of the case. On December 15, the case moved to closure when a judge order Serono to pay a "criminal fine of $136.9 million and a $567 million civil fine." This very day, I checked to see whether Texas would receive any part of that settlement. Yes. $3.6 million.
Two dead bills. One pending investigation. One for the good guys. "E" for effort, I'd say.
Wednesday, December 28, 2005
Here are some of those loose ends and my thoughts on how to tie them up:
May 4, Five Questions--Brad from AIDS Combat Zone asked me five questions. I managed to answer Questions Two and Five. There is an unfinished draft of Question One (What do you see as today's biggest barrier to helping people living with HIV/AIDS in Texas?) in the control panel. I don't know what happened that stopped me from finishing it, but that was at a critical time of the legislative session. I plan to finish the draft and answer the remaining questions to tie up this loose end.
November 11, Medicare Part D Update from THMP (Part I)--Well, Part I implies Part II. There was some follow up provided in this post, but I still should have continued reporting on that meeting. However, the issues of Medicare's prescription drug benefit will not disappear from our radar in the near future, so we will try to incorporate news from THMP on this subject in our other posts.
November 14, FDA Proposed New Rules for Condoms--This was a good report, but it omitted information about how to comment on the rules. I've remedied that while I'm still compiling this post. (You didn't think I wrote it all today, did you?)
December 2, 3 x 5: Failure and politics--I noted that Robert Bazell had issued something of a "challenge" regarding the role that advocacy has played in relation to HIV prevention. I said that we should take the challenge and talk about the issues. I did start an essay on the subject, but then wandered off to other things. I have not forgotten this challenge and will return to it in the coming weeks (rather than days, as noted in the original post).
If you find other loose ends that you think should be tied up, do please note them in the comments.
4. Diamond Miners are Disproportionately Exposed to HIV/AIDS Many diamond mining camps enforce all-male, no-family rules. Men contract HIV/AIDS from camp sex-workers, while women married to miners have no access to employment, no income outside of their husbands and no bargaining power for negotiating safe sex, and thus are at extremely high risk of contracting HIV.
In the meantime, I'm relying on reports from NASTAD regarding all of the appropriations related to HIV/AIDS. This includes their FY2006 Appropriations Chart for Federal HIV/AIDS Programs, FY2006 House Report Language Compilation, and FY2005 Senate Report Language. The bottom line is a slight increase in funding for ADAP ($10 million--when $303 million was needed) and level funding or actual cuts everywhere else (including cuts for prevention). The only place where significant increase occurred was for abstinence education (like that's going to make a difference).
Wherever there is a cut, we can, of course, expect a cut in services. Wherever there is level funding, there will not be enough money to cover rising demand for services or expansion of programs. Indeed, a contraction of programs will be required to stretch the funds available to meet the needs that present themselves. Even where there is an increase in funds, the amount of the increase is small. For states like Texas, the amount of increase is so small that it is little more than a rounding error. It certainly will not help with increased case loads or rising drug prices. Forget about new drugs.
Tuesday, December 27, 2005
The patient assistance programs (PAPs) of various pharmaceutical companies have been used and abused throughout the HIV epidemic. They have been a life preserver for low-income clients who needed help while one or another public assistance program has worked to get its act together enough to add a needed medication or while the individual client was otherwise at risk of sinking in the seas of confusion that surround access to HIV medications. (That was my attempt to avoid mixing metaphors when I really wanted to say "at risk of falling through the cracks." [sigh]) PAPs have also been the standard goto when public assistance programs have fallen short of funds or otherwise been unable to add a medication to their formulary: "It's OK. Clients can get the drug from the company's PAP."
Now it seems the Office of the Inspector General, in an effort to head off potential problems in the future, has issued some guidelines about the use of PAPs by people who are eligible for Medicare Part D. The guidelines talk a lot about what hard work it is to figure out all the ways that PAPs can get into trouble once the Medicare prescription drug benefit becomes a reality, but they persevere in the face of that difficulty to reach the conclusion that giving help to the needy might cost the government more money, so drug companies should stop it already. (Oh, dear, did my sarcasm show there?)
In essence, the OIG is saying that giving assistance to a Medicare Part D-eligible client, either by giving a free medication or providing assistance with co-pays or premiums, would influence the client's choice of medication in favor of the drug company offering the medication. That, in turn, would mess around with Medicare's costs, because the client would not choose a cheaper medication that is just as effective. If any of this were to happen, it would, the OIG opines, look suspiciously like a kickback and make the drug company (but not the Medicare client) subject to prosecution. This doesn't apply, the OIG allows, to otherwise uninsured clients nor to Medicare-eligible clients who have not yet enrolled in a Part D prescription program.
This leads to a couple of questions:
- What happens to Medicare-eligible clients who sign up for a prescription plan that does not include--or drops--a medication that is an integral part of his/her HIV medication regimen?
- What happens to Medicare-eligible clients whose income is greater than 150% of federal poverty guidelines, who do not receive any of the "extra help" that those with lower incomes are provided by Medicare, but who still can't afford the out-of-pocket costs associated with this program?
The answers to those questions don't look good right now. If the pharmaceutical companies have to exclude these clients from their PAPs, there are very few places for them to go. In Texas, that is likely to be the public hospital districts or a program like The Assistance Fund. Since there is only one program like The Assistance Fund in the state, we could see some people start to fall through the cracks (or do I mean "sink in the seas of confusion"?).
While most of the drug companies that provide medications for the Texas HIV Medication Program are taking a wait-and-see attitude toward this special advisory from the OIG, one (GlaxoSmithKline) has become an early adopter. According to a letter issued by Chris Viehbacher, President of US Pharmaceuticals for GSK:
As a result of guidance issued by the Office of Inspector General at the US Department of Health and Human Services, GlaxoSmithKline has decided to make changes to the eligibility criteria for Bridges to Access. After January 1, 2006, patients who have enrolled in Medicare Part D drug plans will no longer be eligible to receive medicines through Bridges to Access. Medicare-eligible patients who have not yet enrolled in Medicare Part D may continue to receive assistance from Bridges to Access through May 15, 2006, the end of the initial enrollment period. After May 15, any patient who is Medicare-eligible will not be eligible to receive products through Bridges to Access. Over the coming months we will investigate other options that may allow us to offer assistance in compliance with Office of Inspector General guidelines.
Oh, dear. Let's hope the other companies drag their feet a bit more on this one. While we don't want anyone to get caught up in the kickback issue, HIV medications do present some special concerns that the OIG's guidance doesn't consider:
- Limited medication choices due to (existing or potential) viral resistance;
- Few cheaper alternatives for current medications (few generics, not widely available);
- Extremely high cost-sharing burden for low-income clients within first four months of fiscal year;
- Lack of federal assistance for clients between 150% and 333% of federal poverty guidelines (333% of FPG is the national average for financial eligibility for AIDS drug assistance programs; 200% is the cut-off for Texas).
Physicians who are licensed in Texas, board certified in infectious disease/internal medicine/family practice, and have at least five years of experience in working with patients with HIV are encouraged to apply.
- (30%) Provides expert consultation on any medical issue involving HIV/AIDS and STDs to the Manager of the Health Promotion Unit. Serves as the consultant to the Quality Management Committee relating to ambulatory/outpatient medical care and the Texas HIV Medication Program (THMP). Provides consultation on the THMP formulary, program rules, utilization issues and projections, eligibility criteria, etc. Assists as needed with desk reviews and on-site reviews of clinical HIV/AIDS and STD programs funded by the department. Provides programmatic and policy consultation on the program's response to HIV/AIDS and STDs within the context of epidemiological data, emerging technologies, and fiscal constraints.
- (10%) Reviews Texas HIV Medication Program (THMP) client applications to ensure they meet current medical eligibility criteria.
- (10%) Provides medical consultation to physicians throughout the state concerning issues related to the treatment of HIV/AIDS and STDs.
- (10%) Provides technical assistance in professional staff development and training related to HIV/AIDS and STD medical issues. Prepares and delivers presentations on issues related to HIV/AIDS and STDs at public and professional meetings.
- (15%) Maintains the most up to date knowledge on medical issues related to HIV/AIDS and STDs.
- (3%) Collaborates with other physicians and experts throughout the state and the nation on medical issues related to HIV/AIDS.
- (10%) Collaborates with the department, community and Medication Advisory Committee (MAC) regarding strategic planning for the THMP.
- (10%) Prepares or provides expert medical review for all proposed policies and procedures related to HIV/AIDS and STD medical issues.
- (2%) May plan, assign, or supervise the work of others. Physician on duty.
Additional information is available at https://accesshr.hhsc.state.tx.us/. Enter "physician" as your search term and "Austin" as the location. This is posting No. 16897. Interested applicants can also contact Janna Zumbrun (512-458-7111 X2406), Felipe Rocha (512-533-3107), or Dwayne Haught (512-533-3002).
Thursday, December 22, 2005
[Docket No. 2004N-0556]
DATES: Submit written or electronic comments on the proposed rule by February 13, 2006.
ADDRESSES: You may submit comments, identified by Docket No. 2004N-0556 and/RIN number 0910-AF21, by any of the following methods:
Submit electronic comments in the following ways:
Federal eRulemaking Portal: http://www.regulations.gov. Follow the instructions for submitting comments.
Agency Web site: http://www.fda.gov/dockets/ecomments. Follow the instructions for submitting comments on the agency Web site.
Submit written submissions in the following ways:
Mail/Hand delivery/Courier [For paper, disk, or CD-ROM submissions]: Division of Dockets Management (HFA-305), Food and Drug Administration, 5630 Fishers Lane, rm. 1061, Rockville, MD 20852.
To ensure more timely processing of comments, FDA is no longer accepting comments submitted to the agency by e-mail. FDA encourages you to continue to submit electronic comments by using the Federal eRulemaking Portal or the agency Web site, as described in the Electronic Submissions portion of this paragraph.
Instructions: All submissions received must include the agency name and Docket No. and Regulatory Information Number (RIN) (if a RIN number has been assigned) for this rulemaking. All comments received may be posted without change to http://www.fda.gov/ohrms/dockets/default.htm, including any personal information provided.
Docket: For access to the docket to read background documents or comments received, go to http://www.fda.gov/ohrms/dockets/default.htm and insert the docket number, found in brackets in the heading of this document, into the "Search'' box and follow the prompts and/or go to the Division of Dockets Management, 5630 Fishers Lane, rm. 1061, Rockville, MD 20852.
FOR FURTHER INFORMATION CONTACT: Colin M. Pollard, Center for Devices and Radiological Health (HFZ-470), Food and Drug Administration, 9200 Corporate Blvd., Rockville, MD 20850, 301-594-1180.
Things to remember:
- Comment by February 13.
- Include the Docket Number and the RIN.
- Use the comment methods allowed; do not send email.
- Be careful about the personal information that you include (your comment will be on the public record).
Things to do:
The FDA has done a nice job of laying out the history of the issue, in case you've missed anything. They are proposing to make factual statements in the new labeling for condoms and to steer clear of the "culture war." They are likely to receive a ton of comments that argue that condoms don't prevent HIV, that the package label should include an abstinence message, etc. They will need to hear from folks who support reality-based public health information.
Wednesday, December 21, 2005
- At year end 2004 there were 3,218 black male sentenced prison inmates per 100,000 black males in the United States, compared to 1,220 Hispanic male inmates per 100,000 Hispanic males and 463 white male inmates per 100,000 white males. (http://www.ojp.gov/bjs/prisons.htm)
- In 2004, rates of AIDS cases were 56.4 per 100,000 in the black population, 18.6 per 100,000 in the Hispanic population, . . . 6.0 per 100,000 in the white population, . . .(Table 5a). (http://www.cdc.gov/hiv/stats/2004SurveillanceReport.pdf )
What I'm saying is that, yes, statistics have to be examined a bit to make sure they are not the subject of Twain's rant.
On the other hand, I'm also saying that disproportionate is disproportionate any way you cut it (but especially when you're dealing with an epidemic caused by a virus that really is no respecter of persons). How then does the virus manage such disproportionate effect? Just askin', y'know.
Tuesday, December 20, 2005
If the second test's result is negative, the patient would still need to undergo the more sophisticated Western Blot lab tests. Results for this can take a week, but in the meantime, the patient could be sent home with the assurance that the initial oral test's positive result was likely wrong.
The CDC is expected to issue an advisory and perhaps new guidelines for use of the test soon. This test is also being considered for over-the-counter sale by the FDA.
I'm wondering if the over-the-counter version will include two testing units, one for a swab and one for a finger-stick. Just in case. At any rate, this brings the concerns we expressed earlier about the over-the-counter proposal into somewhat clearer focus.
[Yes, this article was published on December 10. I discovered that, if I tried to backdate my posts, Feedburner wouldn't send them out as part of the blog feed. Instead they would simply fall back into the obscure past set by the date of the post. I'm still catching up on news that happened while I was on the road that is still important enough to highlight in the blog. Sorry 'bout that.]
a nation-wide community mobilization initiative that leads to capacity building to increase awareness, participation, and support for HIV prevention among African Americans. The goal of NBHAAD is to motivate Black Americans at risk for HIV to get educated and tested, and to get HIV/AIDS stakeholders involved in prevention education programs, HIV testing, press conferences, community forums and other activities to raise awareness, participation and support for HIV prevention among Black Americans. Since 2001, federal, state, and local governmental agencies, community-based organizations, AIDS service organizations, public and private partners in prevention, treatment and care, as well as partners in the business, entertainment, and faith communities have all joined together in support of National Black HIV/AIDS Awareness Day. Please help us to prevent HIV in Black communities, one voice, one experience, one conversation at a time! Please register, and order supplies for your event(s) at www.blackaidsday.org.
So mark you calendar and make plans for how you can use this opportunity to increase awareness in your community.
Monday, December 19, 2005
Given that THMP was already pursuing this strategy to some degree with through the advice being given by its medical director (now, unfortunately, in the Army and not where we need him in Texas), it's hard to see how much further this measure can be pushed before the next level of cost containment (eliminating spend down) is instituted.
[I decided that I didn't want the "picture," but can't get rid of it now that it's here. That's my punishment for playing with the tools.]
The document is a useful "cheat sheet" for all of us as January 1 comes closer.
However, only 15 percent of the “Canadian” drugs in the parcels examined actually originated in Canada. The remaining 85 percent were manufactured in 27 different countries. In addition to having been falsely promoted as being of Canadian origin, many of these drugs were not adequately labeled in English to help assure safe and effective use.
Thirty two of the pharmaceuticals sampled, representing three distinct drug products, have been determined to be counterfeit.
Reading these messages reminded me of the bill that Representative Hochberg introduced regarding Canadian pharmacies in this past legislative session. As you may recall, the substance of the bill was added as an amendment to the reauthorization of the Texas Board of Pharmacy, and the substance was basically that that Board would help certify real "brick and mortar" Canadian pharmacies as being real "brick and mortar" pharmacies that can safely ship safe medications to Texans.
All of this made me curious about how things were coming along on this matter, so I popped over to the Board of Pharmacy web site and found a link to information about this very subject right on the front page. It would seem that the FDA is also unhappy with Texas for "promoting" the reimportation of medications through this safety measure and says that the Texas law is in conflict with federal law. The Board has already written its rules but is holding them in abeyance while it waits for an Attorney General's opinion about whether any part of the Texas law is still salvageable (or whether Austin trumps Washington).
The ins and out of this whole reimportation thing can get a little complicated, but the safety issues are very clear, as the two press releases from the FDA show.
- Sometimes people lie on the Internet. If you choose to order any medications through an online pharmacy, no matter whether it is Canadian or otherwise, it would be wise to take some steps to determine whether the pharmacy is legitimate.
- Sometimes drugs that are ordered from Canada are actually shipped from a third country. Look at the package before you take the medication to make sure that it comes from a safe source. If the package is labelled in Cyrillic, there's a pretty good clue that you're not getting what you ordered.
- Sometimes counterfeit "drugs" are substituted for the medications that you order. Again, look at the package, look at the actual medication.
Sunday, December 18, 2005
that legal repressiveness may have little deterrent on drug injection and may have a high cost in terms of HIV and perhaps other diseases among injectors and their partners - and that alternative methods of maintaining social order should be investigated, the authors concluded.
That would be because their research showed no correlation between injecting drug use and "legal repressiveness" but did show a positive correlation between law enforcement activities and the incidence of HIV in the IDU population.
It's food for thought anyway.
"Relationships of Deterrence and Law Enforcement to Drug-Related Harms Among Drug Injectors in US Metropolitan Areas" AIDS Vol. 20; No. 1: P. 93-99, (01.02.2006) Samuel R. Friedman; Hannah L.F. Cooper; Barbara Tempalski; Maria Keem; Risa Friedman; Peter L. Flom; Don C. Des Jarlais
Once you type in a group of drugs, the Medicare web site will search through all of the plans in your area to see who provides them and what it will cost you in a month or over a year. You can then click on each plan to get the details of what those costs are.
I thought it was interesting that, when I typed in all of the protease inhibitors on the THMP formulary, there was significant difference in cost between the plans. There is supposed to be a limit to the out-of-pocket costs that someone pays once catatrophic coverage has been reached. Some of the totals were well beyond what I thought it would be, so I started clicking to find out more.
As it turns out, while most of the plans seem to include all of the protease inhibitors on the THMP list, some of them don't. Just for an example, Wellcare Signature would provide all of these drugs (not that anyone would be taking all of them at the same time) for an estimated annual cost of $7,401. Drilling down a bit, it turns out that a hefty chunk of that cost comes from a single drug, which is not on their formulary.
When a drug that you might need is not on a plan's formulary, you will have to pay the full cost of the drug, rather than the 25 percent co-pay that you might pay for other drugs. What's more, the amount that you pay for this drug will not count toward your out-of-pocket costs in determining when catastrophic coverage will begin. Once catastrophic coverage begins, you are still stuck paying the full price for this drug.
Regardless of the plan and regardless of the drug, the point is that you should check each plan carefully for its coverage of the medications that you are taking. You should also be alert to any changes in the plan's formulary and be prepared to challenge the plan regarding the medical necessity of your medical regimen. Easier said than done, I know, but still worth saying.
Wednesday, December 14, 2005
In the HIV/AIDS community, we insisted on person-first language a long time ago. Rather than being labeled as “AIDS victims,” the preferred designation was “people with AIDS.” Later, the even more positive “people living with AIDS” (or HIV) was introduced. And yet, we continue to see stigma attached to AIDS that is not attached to lung cancer or cervical cancer or hepatitis C or any of the other diseases and conditions that, in many instances, can be attributed to unsafe behaviors. More than stigma, we also see harmful and discriminatory acts committed against persons living with HIV/AIDS and against their families/associates and against people who are assumed to be at risk for HIV/AIDS.
So what's my point? Words are merely channels for the thought (just like 95.5 FM is the channel for my favorite oldies music). We will always try to define our world by categorizing people. Some are tall, some short. Some are skinny, some not so much. We value some categories and disdain others. At some point, yes, the labels can become weapons, wielded to hurt and oppress the people that they label, reinforcing hurtful and discriminatory behavior, turning the people that are labeled into objects and not persons. But it starts, I think, with the thought that the category that we are creating (and for which we must create a label) is “less than,” “worse than,” “inferior to,” “not as good as,” or the ever useful “bad.” Once we place such evaluations on the category, then there are all sorts of bad behaviors that can accompany them, and it doesn’t really matter how nice and polite we are when actually assigning labels to the category.
Just think about the word “chairman.” Women argued that the word almost established in people’s minds that only a man could lead a committee. To eliminate sex discrimination, they argued, the word should be “chairperson.” So here we are, thirty some years later. Attend any committee hearing that you choose, and you’ll hear one of two things: “Mr. Chairman” or “Madame Chairperson.” We changed the language, but we couldn’t change the categories. The good news is that we really have made some progress in changing the behaviors. While sex discrimination continues in the U.S., we’ve ended a fair chunk of it. I attribute that less to manipulating the language than to changing the law, modeling the correct behavior, lots and lots of education, and some direct challenges to bad behaviors.
If people don’t want to be labeled a particular way, especially if they consider the label to be hurtful, yes, get rid of the label. The “R word” is a negative label, and it is often used in a hurtful way. We should ban it from our everyday language. I hope that the disability community also uses the process of banning the label to educate people about the bad behaviors that the label allows. I expect that they will also work on the laws that allow such bad behaviors. There might even be some progress through a few in-your-face challenges to attitudes and behaviors. It is, after all, harder to discriminate against someone who is perceived as being powerful than it is to discriminate against someone who is perceived as being weaker.
I’m thinking that we need to do something of the same for “people living with HIV/AIDS.” Not, I’d say, to change the label, but to change the values placed on the category that the label identifies. A good place to start would be to talk about those bad behaviors.
What’s happening in your community?
Tuesday, December 13, 2005
I've been re-working our web site this month to make it look a little spiffier and to update assorted pages and sections. It will take a while to work my way through the entire site, and it is apparently going to take a while to figure out how to get that pretty new button on to the front page. Right now you have to go to the What's New page to find it and then scroll down to December 8. Sigh.
If that isn't hard enough, I can hardly wait until I try to put the button on this blog. Ai yi yi! Even so, follow the link, scroll down, click the button, and try it out. ;)
Friday, December 09, 2005
In the meantime, here's something to keep us all warm: The plans we will be discussing are for a major campaign to increase funding for HIV in Texas. It promises to fun. I'm sure you'll be hearing more about this in the days ahead.
SAC and NAHC also included the following "directly from HUD":
U.S. Department of Housing and Urban Development The Katrina Disaster Housing
Assistance Program – Special Needs (KDHAP-SN)
December 7, 2005 – The Katrina Disaster Housing Assistance Program – Special Needs (KDHAP-SN) rental subsidy program has been announced to provide assistance to persons who were living in the Hurricane Katrina Presidential Disaster Declaration areas in Louisiana, Mississippi or Alabama and were sleeping on the
streets or other places not meant for human habitation or residing in emergency shelters, transitional housing or in housing assisted by one of three HUD programs (SHP-PH, S+C, HOPWA) between August 21-28, 2005. There are three attached documents to this email that provide details.
Please note: an urgent response is required to select the Katrina Administering Agency (KAA) for the KDHAP-SN populations. Please discuss within your Continuum of Care and/or HOPWA provider community to determine the appropriate KAA. At this time, any compensation to the KAA has not been addressed and the operating instructions for the KDHAP-SN should be released shortly. The operating requirements for the initial KDHAP program (not special needs targeted) may be found [on HUD's web site at http://tinyurl.com/cc984.] [modified for format]
This may be helpful in your selection of a KAA for your area.
Please also consider areas that are not covered by other existing Continua of Care that you would be willing to cover as the KAA to ensure the broadest reach possible of providers for this needed program.
What do Continua of Cares need to do?
- Through outreach and intake processes, identify KDHAP-SN eligible households currently in the Continuum of Care.
- Assist households to register with FEMA no later than December 31, 2005. (Register at www.fema.gov or 1-800-621-3362)
- Nominate a KDHAP-SN Administering Agency (KAA) for the CoC.
- Submit completed KAA nomination and KAA SF 424 via fax by 5:00 PM EST on December 8, 2005
- Review attached materials [the materials listed can be downloaded from NAHC's Katrina page: http://www.nationalaidshousing.org/Katrina%20Response.htm#KDHAP-SN]:
KDHAP-SN Fact Sheet
KAA Eligibility Criteria
List of KDHAP Participating PHAs
KAA Nomination Fax
SF 424 (Application for federal assistance)
List of CoC #s and names (link may not yet be functional)
Phone or email questions to: 1-866-373-9509 or [modified for format] email@example.com (include contact name, phone, city and state)
If you have any questions, the KDHAP email is firstname.lastname@example.org .
Thursday, December 08, 2005
Take a moment to call your congresscritter and both senators to let them know that you don't want Medicaid cuts for Christmas/Hannukah/Kwanzaa/ever. Go to Who Represents Me? to find out who represents you, and call 'em!
This week marks the tenth anniversary of the approval of the first protease inhibitor. In December of 1995, a then new class of drug for the treatment of HIV/AIDS in combination with other antiretroviral drugs represented an historic landmark in the treatment of HIV/AIDS. Protease inhibitors helped establish a new treatment standard of triple combination therapy, significantly improving the lives and health of people living with HIV in the United States and around the world.
Of course, the FDA would know when the real anniversary would be. In my mind, I tend to think of the advent of protease inhibitors in terms of when they became more widely available, when we struggled to find the funding to get them added to AIDS Drug Assistance Programs, when we began to see the incredible reversals in people's health once they began taking the "cocktail."
We can celebrate that later anniversary time next year, but now is a good time--in between our seasons of thanks giving and good will to all--to think about our friends whose lives were, quite literally, saved by these medications. Many of them are still with us, still working beside us, and many of them would not have been had it not been for these medications. This is a happy anniversary indeed!
And yet, it remains to be said that some states still cannot provide these medications to all who need them. It remains to be said that these drugs worked so well for those who did receive them that we face even greater pressures on our public safety net as we try to find ways to maintain standards of care. It remains to be said that the public has become complacent because of these drugs, thinking, all too erroneously, that they are a cure, that by making HIV/AIDS "chronic" and "manageable" it is no longer life threatening.
It's still a happy anniversary, but we do have some work to do, don't we?
HIV clinical care providers are increasingly confronted by comorbid psychiatric illness among their patients. Prevalence rates of psychiatric disorders among HIV-infected patients approach 50%. These conditions commonly manifest around the time of diagnosis, but many patients develop symptoms later in their course of illness. Axis I disorders, including anxiety and depression, are particularly likely to occur at times of stress-including an illness episode, a psychosocial stressor such as divorce or loss of a loved one, and when facing a new disability. Anxiety and depression are among the most commonly diagnosed psychiatric conditions affecting HIV-infected patients.[3,4] These can complicate the treatment of HIV, presenting numerous diagnostic and interventional challenges for the clinician.
The authors provide information about diagnosing and treating depression and anxiety. If left untreated, these disorders can affect the ability of an HIV patient to adhere to therapy and therefore affect the course of the patient's HIV disease. If there is a history of substance abuse, failure to treat these psychiatric illnesses may lead to a relapse into substance using behaviors. Even for non-HIV patients, they note, diagnosis and treatment of these illnesses is important because, left untreated, they may lead the patient into engaging in riskier behaviors which may lead to the "acquisition and spread of HIV."
The article is reprinted on Medscape (sub. req.).
Wednesday, December 07, 2005
One of those "old" items (2004) makes the startling assertion that:
Behavior associated with drug abuse is now the single largest factor in the spread of HIV infection in the United States. [emphasis added]
Although we've never made the claim in quite those extreme terms, we've often pointed out to Texas legislators that substance use/abuse is a major factor in the increase of HIV infections among women due either to their own or their partner's use/abuse. When we talk about needle exchange, we point out that the harm reduction comes not only to the user but to sexual partners and family members. As drug use/abuse and HIV go hand in hand, harm reduction strategies pay off for the whole community.
The NIDA fact sheet makes the link be tween use/abuse and HIV quite clear:
Using or sharing unsterile needles, cotton swabs, rinse water, and cookers, such as when injecting heroin, cocaine, or other drugs, leaves a drug abuser vulnerable to contracting or transmitting HIV. Another way people may be at risk for contracting HIV is simply by using drugs of abuse, regardless of whether a needle and syringe are involved. Research sponsored by NIDA and the National Institute on Alcohol Abuse and Alcoholism has shown that drug and alcohol use can interfere with judgment about sexual (and other) behavior and thereby affect the likelihood of engaging in unplanned and unprotected sex. This increases the risk for contracting HIV from infected sex partners. [emphasis added]
This reminds me of the exchange that I had with a young man several years ago, who said: "You're not telling me that beer causes AIDS , are you?" "No," I replied, "but too much beer can make you careless enough to have unprotected sex and place yourself at risk for AIDS." Or words to that effect.
NIDA's campaign doesn't say that "Beer causes AIDS," but it gets to the same point with "Send the Msg."
Tuesday, December 06, 2005
That shows progress [clapping hands], but it also shows that in the 14 months we've been publishing the blog, there have been some gaps. In October, we started making the effort to get at least one post up for each day. In November, we succeeded, with 30 posts for "30 days hath November." This month we're working on our variety. While the topics covered will remain within the framework of "news and information for the Texas HIV/AIDS community," the kinds of articles will, we hope, have a better mix of original news, media analysis, and other types of stories. With the holidays--and yet another road trip coming up this week--getting in 31 posts with the balanced mix that we are striving for will be quite a challenge. We'll see how we've done in the new year.
On another but similar note, our webmaster woes may have improved. (We're only cautiously optimistic because of that blinking orange light on the modem.) Our web host--Web Site Source--fixed our FrontPage extensions first thing Monday morning. They've always been good about answering my newbie questions and quick to take care of problems, but this was extra fine. So the next problem came when the modem started blinking at me. When the orange light turned to red and stayed there for several hours, I got fed up and called the ISP. A line check showed that there was a problem "downstream." They came out this morning and found corrosion in the phone connection box. Once that was replaced, everything was green.
Until now. And that blinking orange light has turned to red. This is not good (so they don't get a link).
Still, never say die. We made substantial progress on the web site yesterday, getting a couple of information pages updated and making a good start on revising and updating a major section "all about" Texas AIDS Network. Check out our new front page. It has buttons!
She was part of RAIN, the Regional AIDS Interfaith Network, and constantly inspired me by providing a living example of what her work was about. She was also a complete contrast to the hateful things being preached in other parts of the faith community, reminding me daily that tolerance cuts both ways (so I needed to work on mine). She moved out of state; we lost contact.
Out of curiosity, I have tried to track down the remnants of the old RAIN and TRAIN (Texas Regional AIDS Interfaith Network). TRAIN was a project of the Texas Conference of Churches and appears to have ended. What is nice about all of this is that it has opened the door for a new dialogue with TCC about what Texas churches can do about AIDS in Texas (lots!) Wish me luck!
Monday, December 05, 2005
No one is suggesting we ignore the threat of a bird-flu pandemic. But the world's eight wealthiest countries pledged to cut AIDS, TB and malaria deaths in half by 2015, and work toward universal AIDS treatment by 2010. The progress made thus far won't get us to this goal. [emphasis added]
Making deeper inroads in treatment is just as critical as reducing the rate of infections. We all know that drugs cannot cure AIDS. But they can make it possible for parents to be healthy enough to work and support families. With about 15 million children under 17 having lost one or both parents to the disease, keeping parents around long enough to raise their children is an investment worth making.
Maybe a "glass half full" analogy will work for some, but I'm in the mood to promote my version of the headline. Have I mentioned that Texas has a waiting list for one of the medications on its ADAP formulary? Have I mentioned that the Texas HIV Medication Program is looking at a funding shortfall before the end of the biennium? Have I mentioned that HIV services in Texas face cuts in the next year?
Now the last of these tasks, working on the web site, is just a wee bit challenging on the best of days. For many months, I've had some problems with making things work. As usual, I figured, since I know comparatively little about computers, that the fault was mine. It didn't help that a recent service pack for my software seemed to have turn it into an entirely new program with an interface for aliens.
This past week, I decided that it was time to get serious and get the blasted thing updated. So I waded in and did my usual trial, error, look for answers to whatever corner I had backed myself into. Happily, Microsoft has rectified the error of its ways (sorta) and created some online training courses that even I can pass. Sadly, there are a lot of them to catch us poor ignorant geek wannabes up with the changes that they have made in FrontPage. Still, I started tackling them one by one.
I have quite a few training courses to go, but I am making progress. In fact, I made enough progress to try to tackle one or two of the simpler pages on the site. How hard could it be to spiff up the page with contact information or the list of my Board of Directors? Plenty hard, as it turns out. No matter what I did, the server kept returning "responses that FrontPage could not parse."
Late last night it finally dawned on me that maybe, just maybe, I wasn't the problem. So I contacted our web host for help. Yup. Our FrontPage extensions were corrupt, and it's taking a while to fix them.
In the meantime, the website is now not only out of date but a mess, since some of my changes posted and some didn't. We had over 5,000 page views last month. [sigh] Woe is me!
Friday, December 02, 2005
What is interesting (to me) in his report is the fact that he also points to failures to deal with the epidemic in the US and his finger-pointing in the matter of prevention:
Some well known prevention strategies could lower that number—public education, condom use, clean needles and syringes and more widespread testing for infection with the AIDS virus. An old fashioned public health method where people who are infected are identified and their sexual partners are contacted anonymously could also lower the infection rate. But as New York City Health Commissioner Thomas Frieden and his colleagues write in the current New England Journal of Medicine “religious and political groups oppose the use of effective prevention measures” while “some advocacy groups oppose” contact tracing and widespread testing.
Bazell mentions several issues that we have talked about on this blog: education, condoms, clean needles and syringes. I expect we'll keep talking about these things as long as there are barriers to their effective use in HIV prevention.
We have also talked a bit about HIV testing issues, but we've said almost nothing about partner notification issues. Since the Network occasionally functions as an advocacy group (we also do education and research), it almost feels like Bazell has issued a challenge to us to rethink these issues and look more closely at how we talk about them.
So let's do some of that thinking and looking and talking in the next few days. It's worth it, I'd say, because there's one thing that Bazell said that really has to change:
World AIDS Day seems destined to be a time when we call attention to our failures in the face of the greatest public health crisis ever.
Thursday, December 01, 2005
The 8th Annual Interfaith Service of Remembrance & Hope will take place Thursday, December 1 at 7pm at the Tarrytown United Methodist Church, 2601 Exposition. All are invited to this service. For more information, please contact Roger Temme, Interfaith Care Alliance, at 512-459-5883 or email@example.com.
The South Texas Interfaith Council will sponsor its annual World AIDS Day Interfaith Service on Thursday, December 1 at 7pm. The service will take place at St. Luke's United Methodist Church, 3151 Reid Dr., in Corpus Christi. A reception will follow the service. Each year the service is hosted by a different faith community, emphasizing the fact that all denominations and religions have been affected by this pandemic. The service provides a unique opportunity for the public to offer support for those who are living with HIV as well as family, friends, care givers and health care professionals who assist them. For more information, please contact Sandi Santana or Ann Rogers at STICInfaithall@aol.com.
AIDS Arms, The Resource Center, Legacy Counseling, AIDS Interfaith Network, and Dallas Legal Hospice in partnership with United Way of Metropolitan Dallas will host a leadership luncheon entitled "Crisis on Crisis: The Impact of HIV/AIDS" on Thursday, December 1 at 11:30am. Community leaders throughout the Dallas/Fort Worth Metroplex will hear critical updates on the AIDS epidemic and its impact on the quality of life and economic status of North Texas. For more information, contact AIDS Arms at 214-521-5191.
AIDS Arms will recognize World AIDS Day on Thursday, December 1 at 6:30pm at Urban Market, located at 1500 Jackson Street in Dallas. Information about the local and global HIV/AIDS epidemics will be provided, along with food, drink, and entertainment. For more information, contact AIDS Arms at 214-521-5191.
Skillful Living Center will present the Fall Teen Summit 2005 for approximately 800 high school teens. The event will be held Thursday, December 1 from 9:30am to 2:30 pm at Oak Cliff Bible Fellowship, 1808 W. Camp Wisdom Rd., in Dallas. The theme is "Empowering the Hip Hop Generation with Healthy Sexuality and Relationship Skills." The audience is comprised of the students that have attended the Sexual Abstinence & Relationship Education Program. There will be video clips, special presentations from students, media presentations, food, fun, prizes, speakers, and entertainment. Please contact Mary Tavares at 214-330-8468 for more information.
The Tarrant County Public Health Department's Adult Health Services unit will display a panel of the Quilt in the lobby of the health department at 1101 S. Main in Fort Worth. Literature and red ribbons will be available for the public. Free testing for HIV and syphilis will be offered December 1-2 at the Adult Health Services clinic. For more information, please contact Elaine Allen at 817-321-4862 or EHAllen@tarrantcounty.com.
The University of Texas Medical Branch's AIDS Clinical Trials Unit will host an open house to unveil its Wall of Remembrance on Thursday, December 1 from 12-2pm at 707 Tremont in Galveston. Lunch will be served. Please call 409-763-2437 for more information.
The Harris County Hospital District's Thomas Street Health Center and Houston Health and Human Services will be hosting a Celebration of Remembrance. This World AIDS Day event will consist of an hour of remembrance with commemorative speeches from PWAs, health care professionals, and city/county officials. The ceremony will conclude with the traditional Remembrance Tree, where community members are asked to place ornaments on a 12-foot Christmas tree. The ornaments are in honor of those who have passed away this year due to AIDS. Following the Celebration of Remembrance, Thomas Street Health Center will host an open house and information fair. This will be a collaborative effort with agencies from the City of Houston. Many HIV/AIDS agencies will display information about their agency and their services. The community will be able to talk and network with these agencies for further assistance and understanding. The event will be held from 11am to 2pm at 2015 Thomas Street in Houston. For further information, please contact Jeff Benavides at 713-873-4026.
The Montrose Counseling Center (MCC) in Houston is commemorating World AIDS Day 2005 with the following events:
Red Ribbon Chain of Remembrance:
The Red Ribbon Chain of Remembrance is a colorful art project to honor those affected/infected with HIV/AIDS. Each link of the chain will be decorated in memory of a loved one or friend with a display of words encouragement, artwork, or a commemoration of a special moment or memory in time. Strips of red and white paper will be available for anyone who is inspired to add a link to the chain, which will be on display in the lobby of MCC during the week of World AIDS Day. The community at large is encouraged to participate in this simple, yet powerful, project.
On Thursday, December 1, MCC will hold a candlelight observance at 6 p.m. in the MCC parking lot at 701 Richmond Av. (two blocks east of Montrose Blvd). Candles will be provided. The observance will be marked with words of encouragement and hope, about what we are dealing with in terms of the epidemic, and honoring those lives that have been touched by HIV/AIDS. A moment of silence will be held in remembrance of those who have passed. This observance is free and open to the public.
Free Anonymous HIV Testing:
MCC will provide free and anonymous Ora-quick HIV testing, as well as HIV/AIDS education and awareness on Wednesday, November 30, and Thursday, December 1. A booth will be set up at Kroger, 3300 Montrose Blvd. on those days from noon to 5pm. Testing will be on a first come, first served basis.
For more information about these events, please contact Sally A. Huffer at 713-529-0037, ext. 324.
Planned Parenthood Association of Lubbock, Inc. and Metropolitan Community Church (MCC) will host a World AIDS Day Memorial Service from 7 to 9pm at the MCC, located at 4501 University Av. After the service, attendees will be invited into Palmer Hall to view six AIDS quilt panels on display. For more information, contact Tony R. Thornton at Tony.Thornton@ppfa.org, or MCC at 806-792-5562.
The Community Coalition for AIDS Education will host the 13th Annual World AIDS Day Seminar on Thursday, December 1 from 8:30-11:30am at the Pitser Garrison Civic Center, 601 N. Second St., Lufkin. This event is for all high school students in local and surrounding counties. In addition, the Coalition, in collaboration with Planned Parenthood Lufkin Health Center, will offer free and confidential HIV testing at two locations:
Planned Parenthood Lufkin Health Center 1404 Frank St., Lufkin, 936-634-8446 8:30am-4pm
The Pitser Garrison Civic Center 601 N. Second St., Lufkin 1-4:30pm
Test Results will be available in approximately 20 minutes. For more information, contact Bonnie Lee at 936-634-8446, ext. 223.
In the Permian Basin, DSHS Public Health Region 9/10, the Permian Basin Counseling Center and the Ector County Health Department are coordinating the following World AIDS Day activities with several community agencies:
o A memorial at the University of the Permian Basin at 12pm, releasing of hundreds of balloons in the sky at the end of the memorial;
o An HIV forum from 1-2pm for university students and the public who wish to learn or have questions about HIV;
o HIV/AIDS awareness ribbons will be passed out throughout the community;
o Community churches are being asked to ring their church bells at 12 noon in remembrance of those millions that have passed away; and
o Public service announcements and media coverage.
Contact Anita Montanez, DSHS Region 9/10, at 432-571-4143 for more information about these events.
Special Health Resources for Texas (SHRT) in Texarkana will host a World AIDS Day remembrance ceremony on Thursday, December 1 at 803 Spruce St. During November, SHRT placed poster boards on the walls of its clinic for anyone to write or draw on. These posters will be on display at the ceremony. For more information, please contact Joey Pack or Annette Martin at 903-792-5924.