Tuesday, November 28, 2006

What DSHS says about HIV

On August 31, Commissioner Eduardo Sanchez presented the Texas Department of State Health Services Legislative Appropriations Request to the Legislative Budget Board. He used a PowerPoint presentation that included 44 slides. Slides 27 and 28 are reproduced below.

Regarding Slide 27 (above), his Notes page said:
DSHS also administers programs to prevent the spread of HIV. Treatment has improved dramatically. As it does, the number of Texans with HIV grows. People are living longer with HIV--but we must also remember that they are working, paying taxes, and leading healthier, more productive lives.

Regarding Slide 28 (above), his Notes page said:

Clients of our HIV medications program are living longer as well. Again, the medications allow these Texans to live fuller, more productive lives and to contribute to the economy. Unfortunately, the cost of the medications used in this program has also grown--by 33% per client since 2000.

This is somewhat old news. However, the new news is that the whole question of an Exceptional Item for HIV in the Department's LAR is now somewhat up in the air. Discussion at the November 17 meeting of the HIV Medication Advisory Committee revealed that, while the estimates for potential funding needs for FY 2008-2009 continue to be based on a shifting foundation, the latest shift in the sands of this foundation suggest that the amount of funding needed will be substantially less that earlier proposed. Indeed, the amount may be sufficiently low that no Exceptional Item request will be made for HIV medications at all--with any amount needed being taken from other programs or resources at DSHS.


The questions that next come to mind are: If that happens, what will happen to the funds that were targeted for prevention, services, and surveillance? Will they just disappear also? If they continue to be included in the LAR, do they stand a chance of approval without the added "muscle" of a request for medication funds?

To begin looking for answers to those questions I returned to the Commissioner's presentation to see what he was saying before these questions arose. Oh dear! It looks like HIV prevention, services, and surveillance weren't even part of his spiel. He made nice "Republican" arguments about "productive lives," but he didn't make the connection between the need to increase prevention so that the upward curve of people living with HIV could be straightened out, if not reversed. It looks like we'll have to make the connection for him.

Comprehensive sex ed: Who cares?

As it turns out, most US adults do--and they support the inclusion of comprehensive sex ed in public school curriculum. Isn't it interesting, then, that Rep. Warren Chisum hasn't gotten the message? If he had, he certainly wouldn't have filed HB 311, Relating to parental approval of a student's participation in human sexuality instruction in public schools.

Chisum's bill reverses the current opt-out provision for sexuality education in Texas' public schools to make it opt-in. Whereas parents currently have the option of removing their children from sexuality education if that is their desire, now all parents must specifically sign their children up for this education.

Here are some tidbits from the Annenberg National Health Communication Survey, published in the November issue of the Journal of Pediatrics & Adolescent Medicine (and included in a report on Medscape):
  • The survey was conducted by the Annenberg National Health Communication Survey, a nationally representative measurement of people older than the age of 18 years in the United States. Surveys were conducted by landline telephones between 2005 and 2006.
  • Researchers inquired about respondents feelings about 3 different school-based sex education programs: abstinence only, abstinence plus information regarding contraception and prevention of STIs (comprehensive sex education), and comprehensive sex education plus instruction on the use of condoms. Subjects' responses were placed in reference to their self-described political ideology and rates of attendance of religious services.
  • 1096 respondents provided study data. The mean age of participants was 46.8 years, and 78.7% of subjects were white. Rates of self-identification as conservative, moderate, or liberal were 35.5%, 39.5%, and 25%, respectively. There was a fairly even distribution across different frequencies of attendance at religious services, with 20.4% reporting no attendance and 21.4% reporting attendance once a week.
  • Overall rates of support for comprehensive sex education, comprehensive sex education plus teaching condom use, and abstinence-only education were 82%, 68%, and 36%, respectively. Half of respondents opposed abstinence-only education, making it the most opposed educational option.
  • Only 39% of respondents felt that abstinence was an effective means to prevent unplanned pregnancies. However, 80.4% of subjects felt that comprehensive sex education could reduce unintended pregnancies. Most participants disagreed that teaching teenagers to use condoms would encourage them to have sex. Women tended to have higher rates of opposition to abstinence-only programs compared with men.
  • More liberal political ideology was associated with greater preference for comprehensive sex education. Rates of support for such programs were 70.0%, 86.4%, and 91.6% among participants with conservative, moderate, and liberal political philosophies, respectively.
  • Comprehensive sex education and condom instruction received strong support from respondents who attended religious services a few times a year or less frequently. While abstinence-only programs received more support among subjects who attended church more often, there was equal support for abstinence-only and comprehensive sex education programs among the subgroup of participants who attended services more than once per week.
While I could quibble about how these research results are framed for reporting, the final conclusion is still that US adults support comprehensive sex ed in the schools even when presented with abstinence-only education as an alternative. Even in Texas, there is strong support for comprehensive sex ed in the schools (according to a 2004 Scripps Howard Texas Poll--no link available).

So what's the problem, Warren? Could this be a solution in search of a problem?

Monday, November 20, 2006

Texas AIDS Network 2007 bill track

The Network will be (as much as time and staff resources permit) posting its tracking list for the 80th Texas Legislature on line. The bill track--so far--has three levels of tracking.
  • HIV/STD: Bills on this list specifically address HIV/AIDS or other sexually transmitted diseases. The Network may take a position for or against these bills, may actively support or oppose them through testimony or other means, and may request the Texas HIV/AIDS community to do the same. The Network will also write bill analyses that relate them to the Network's policy principles.
  • Related: Bills on this list have the potential to affect HIV/AIDS prevention, treatment, or care even though they do not specifically reference HIV/AIDS or sexually transmitted disease. The Network may take a position for or against these bills, may support or oppose them in hearings, but may not invest significant resources in doing so. The Network will track the progress of these bills and look for changes that may have an effect, either positive or negative, on prevention, treatment, or care.
  • Of Interest: Bills on this list have the potential to affect the context, such as the social or overall health care environment, in which HIV/AIDS prevention, treatment, or care occur. The Network will review these bills for negative or positive impact and take action as resources are available. In most cases, the Network will simply monitor their progress through the legislative process.

Bills may be moved from one list to another depending upon Network resources and the degree to which they may be expected to have an effect on HIV/AIDS prevention, treatment, and care.

80th Texas Legislature, Pre-filed bills

The 8th Texas Legislature won't begin until January 9, but legislators are already pre-filing bills. Doing so gives their legislation an official number and a stronger possibility (they hope) of getting their bill passed during the actual session. Once committees are formed in the new session, bills with be formally "read" in the House and Senate and referred to committee where they will be recommended for passage--or die.

You can find a list of the prefiled bills at the Capitol website. Click the link for reports. Make sure that the box for Legislature says "80R - 2007." There are a number of ways to search for bills, including author, subject, and filing date. If you choose filing date, start with November 13 to see bills pre-filed from the beginning--and select every week day thereafter to see all of the bills.

If you want to follow any bills during the session, you can create a "My TLO" account and set up your own tracking lists. I am setting up online tracking lists for Texas AIDS Network using Google Docs & Spreadsheets. You can, if you want to, follow what I'm following by checking the Texas AIDS Network 2007 Bill Track.

Friday, November 10, 2006

Progressing on legislative contact list

At some point, I suppose that my struggles with the legislative contact lists could get boring if all you're interested in is getting your hands on the lists and then using them. It's that latter part that is, of course, my goal in all of this activity. Once the contact lists are completed, you will be able to use them to find contact information for your elected representatives and then start sending letters and faxes, making calls and visits--to tell them about the need for increased funding for HIV and to support good policy for HIV prevention.

Until then, however, I'm busily working away on those lists. A couple of points related to the lists arise.

  • For Texas House and Senate members, I will eventually list the room number for their offices at the capitol. This room number is not needed for sending mail to them but rather will matter only if you plan to come to Austin for a legislative visit. I have started adding this room number for re-elected incumbents (new legislators won't have an office until later on), but it should not be "trusted" come January and the new legislative session. After every general election, Texas legislators play a sort of "fruit basket turn over" game with offices at the capitol. As "good" offices are vacated by retiring (or defeated) members, others scramble to take over their office space. This means that a lot of legislators will be moving around in the next few weeks--and, of course, that room number will change. Phone numbers will mostly stay the same, but some fax numbers will also change. I will make these "corrections" as the information becomes available.
  • Email addresses should be pretty standard for most state legislators. The pattern is (firstname).(lastname)@house(or senate).state.tx.us. The problem is with that first name, since many legislators have nicknames. Sometimes they use the nickname for their email, sometimes not. Robby Cook, for example, uses his nickname for most purposes, but his email is robert.cook. As my good friend, Gollum, would say: "Tricksy!" If you want to send email to your representative before the list is completed, there are two possibilities. One, take a chance on your legislator following the pattern for creating an email address without any variation. Two, go to the legislator's official web site to send a message via the online email form. To do the latter, start at www.house.state.tx.us or www.senate.state.tx.us to find those official web pages.

Find the lists at Texas Congressional Delegation: 2007-2008 and Texas State Government: 2007-2008. Fee; free to volunteer to help complete these lists. :)

Thursday, November 09, 2006

Legislative contact lists grow

Continuing with the activity of compiling contact information for the 80th Texas Legislature and Texas' delegation to the 110th Congress, I created a second spreadsheet. This one is called "Texas State Government: 2007-2008." The spreadsheet includes separate sheets for the Texas House, Senate, and State Board of Education. There is also a sheet for State Leadership, a catchall for the Governor and anyone else I think you might need to contact at some point.

Once again, volunteers are invited to collaborate on completing these data sheets. While data entry can sometimes be mindnumbing, there is some excitement in chasing down the information. Fax numbers in particular are somewhat elusive as are personal or campaign web sites. Just send an email to cparker AT texasaids DOT net, and I'll sign you up as a collaborator (and be eternally grateful for the help).

Wednesday, November 08, 2006

2006 election results

Results are in (mostly) for the 2006 mid-term election. Unlike some other states, Texas did not vote for much of a change. Most incumbents won re-election; the Republican Party retains control of most branches of state government and continues to dominate the Texas congressional delegation.

Detailed election results for state- and federal-level races are available from the Secretary of State.

In preparation for new congressional and legislative sessions, I have begun compiling contact information for our various representatives. I will be using Google Docs & Spreadsheets for this effort. The spreadsheets can be imported and exported in various formats so that you can download them to your own computer and sort them as you prefer. Good news, from my perspective, is that Google has set this service up so that authors can collaborate with others on both documents and spreadsheets. That means that you can volunteer to help in this effort!

The first spreadsheet that I have set up is "Texas Congressional Delegation: 2007-2008." When completed, this spreadsheet will include contact information for Texas members of the U. S. House of Representatives and Senate. If you want to help complete this set of data, drop me an email at cparker AT texasaids DOT net. I'll add you as a collaborator, and you can get right to work.

Other spreadsheets will be prepared for the Texas House, Senate, and State Board of Education. Again, if you want to help with this effort, send me an email and I will add you as a collaborator. (More collaborators, faster work.)

One other result of the election is that the 80th Texas Legislature, while it begins its regular session in January, will begin pre-filing legislation tomorrow. The capitol website will allow you to see these bills as they are filed and to set up your own tracking list for them. Expect this session to be an active one for HIV-related legislation.