About abstinence

I think I need to step back a moment and make sure that I am clear about what I'm thinking about abstinence as a means of preventing the spread of HIV. This will be my personal opinion, not that that doesn't show up here now and then anyway, but it's not endorsed by my Board of Directors (although I think they'd agree with most of it).

Abstinence is a fine thing. Children shouldn't be having sex. Period. They're too young to understand the physical and emotional consequences of early sex, and should be protected from both predators and the peer pressure that leads them to make premature decisions to become sexually active. Doing this is really difficult in a social and cultural context that continually confronts us all with messages that promote sexuality and sex. Parents should be supported in their efforts to protect their children from these influences, and we should all step back now and then to make sure that we are not part of the problem.

Abstinence for adults becomes a somewhat more difficult matter. Clearly, there comes a point where sex is desirable. The social and cultural assumption is that, with marriage comes entitlement to sex (which could lead to a whole other essay on sexual politics). There seems to be universal agreement among religions that procreation is a good thing, which pretty much means that sex to make babies is also a good thing. There is also a generally assumed right to privacy in our society, which says that people should mind their own business, butt out of mine, and let consenting adults do what consenting adults want to do.

How to reconcile these issues is part of the problem of the plain and simple, just-say-no message of abstinence. Of all the things that humans can do, you'd think that sex would be the simplest and easiest. In this age of ever present microbes, it's also one of the most dangerous. So people, at whatever age, do need something a little more sophisticated than "just say no" to get to the point where they can have healthy relationships, make healthy babies, and, more importantly for this discussion, prevent the spread of HIV and other STDs.

Abstinence as a concept is something of a tricky matter. Just like a condom, abstinence has to be used consistently and correctly. There's no "King's X" for prom night. There's no free pass just because you were drunk or high. To be abstinent requires the constant decision that says "no sex under any conditions." Then there's the question of "what is sex"? If Bill Clinton, bless his heart, couldn't figure that out, how do we expect kids to do it? STDs can be transmitted via all sorts of mucosal membranes, breaks in the skin, and other contact points. That leaves out quite a number of activities that young people are pursuing as "alternatives" to sex, but which still place them at risk for transmission of STDs. I'm not convinced "just say no," virginity pledges, and other such strategies quite get at the matter of "consistently and correctly."

Abstinence does, by the way, have a failure rate. Calculating it can be somewhat problematic, but we all know from experience that there are indeed factors that contribute to its failure. I mentioned peer pressure and substance use/abuse. Loooooove (cue violins) is a big one. Marriage and baby-making are, of course, indicators that, except for pledged celibates, abstinence isn't a plan for life anyway.

So--it's not a matter of whether children will be sexually active, it's when. If we can delay sexual activity as long as possible, that's fine. Let's all pitch in and work on that. But someday, the young'uns will reach a point where they will decide (or be forced) to become sexually active. What then? How do we make them ready for the risks?

Here's a hint: honesty, facts, reality.

Wait for the Bling?

I am a closet Atriot, AKA reader of Atrios' sometimes profane, sometimes insightful, always interesting political blog, Eschaton. I usually only have time to skim the posts and click on his links when something really interests me. I'm glad I caught this one.

What were they thinking?

CDC Surveillance Report: Texas (2004)

According to the CDC, at the end of 2004, Texas had reported 22,757 persons living with HIV and 29,891 living with AIDS, for a total of 52,648 people living with HIV/AIDS in the state.

Of those living with HIV, 22,460 were adults and adolescents older than 13 years, and 307 were children 13 years old or younger. Of those living with AIDS, 29,816 were adults and adolescents older than 13 years, and 75 were children 13 or younger.

Texas continues to rank fourth among the states in reported AIDS cases. Its rank for reported HIV cases is less easily determined because of the variation in reporting among the states. However, depending upon the actual number of HIV cases reported in California, Texas still ranks third or fourth among the states in HIV cases reported.

Texas, of course, ranks much lower in its provision of medications to HIV-positive residents.

We can whip AIDS

So says Dr. Robert Gallo. In this season of thanksgiving and brotherly love, coming hard upon World AIDS Day and its emphasis on keeping the promise, this is good to hear. Kudos to Gallo for saying it; kudos to Newsweek for publishing it. But . . .

I read and re-read Gallo's statement--agreeing with just about every word--but still could find no mention of a key component of whipping the crapdoodle out of AIDS right now with what we have at hand. Can you spell P-R-E-V-E-N-T-I-O-N?

Not that there is anything to complain about when Gallo brings up the problem of complacency and the real need to find a vaccine. We are daily confronted with new warnings of impending disasters in the war against microbes, so it important for someone of Gallo's stature to remind us all that complacency is also a risky behavior and that the ROI for an AIDS vaccine will be incredibly huge--for society if not for the manufacturer.

Still, I can't help but cavil that part of the promise that we should be pointing out this week is to provide science-based solutions to HIV. This includes factual, accurate, science-based information to everyone who needs it (meaning everyone) about HIV transmission and prevention. And then, we need the tools for prevention: condoms, clean needles, and honesty.

Conduct HIV research at home

Rarely does a news story cause me to exclaim out loud, but this one did. It seems that the Scripps Research Institute in San Diego is coordinating an effort to use 100,000 personal computers (like yours and mine) to conduct research on HIV medications when the owner is not using them. According to the Institute's press release, the project is sponsored by IBM, is called "FightAIDS@Home," and anyone can sign on at http://www.worldcommunitygrid.org/ to be part of the World Community Grid.

Texas House Public Health to meet

The House Public Health Committee will hold an organizational meeting on December 14 at 12:00 noon in Room e2.016 of the Capitol Extension. The commitee will hear invited testimony only.

The committee's interim charge (what it will be working on until the next regular legislative session begins in January 2007) includes the effect of Medicare Part D on Medicaid, end-of-life issues, hospital-caused infections, and other matters.

New resources from MTV and the Kaiser Family Foundation

An announcement from MTV and KFF (but I had to fill in the links):

The Kaiser Family Foundation and MTV are partners on think: Sexual Health, a campaign to inform young people about HIV/AIDS, other STDs and related issues. The partnership includes targeted public service announcements (PSAs), long-form documentary and entertainment programming, news segments, and free resources, including the It's Your (Sex) Life guide developed especially for the
campaign, and a comprehensive website.

We would like to let you know about some new resources for your education
and outreach efforts, which are available to you free of cost.

As part of our series of MTV News segments, we have a two-part program that
shadows MTV News Correspondent Gideon Yago visiting a health center to be tested for STDs and HIV. The program addresses some of the barriers that many young people face around testing, including fear, lack of information, cost and confidentiality. It also profiles Gideon going back to pick up his results and talking with his health care provider.

This piece may be useful to you in your outreach efforts with youth, in your waiting rooms or as part of a broader curriculum around these issues. You may use it with the campaign's updated It's Your (Sex) Life guide, which provides information on decision making, communication, HIV and other STDs (including prevention and testing). The show is available for free in VHS format, and free copies of the It's
Your (Sex) Life guide are also available.

For information about the partnership, learn more about the campaign or visit the campaign website.

Blame the victim

Yes, I'm back. Yes, I'm back-posting. Yes, I'm on a tear.

I hate news stories like this. First the writer says that HN51 (the bird flu virus) will infect people with HIV, mutate inside their bloodstreams, and then be even more dangerous to the rest of the world. Then he says that people with HIV might have a better chance to survive bird flu than others because their immune system is already shot. Then he says "maybe not," and large numbers of people with HIV might die from the bird flu.

All of it is, of course, speculation. One Dr. Robert Webster apparently spoke recently at a conference organized by the Council on Foreign Relations in New York and managed to speculate about various scenarios for the transmission of the bird flu, if and when it mutates to become a virus that can be spread from human to human. Our writer picked out the juicy bits and flung them around to excite a few readers.

What I think about, of course, are the days when people were burned out of their houses for being HIV-positive. What will happen when the panic starts about bird flu?

Perhaps I'm over reacting. Perhaps, but I just returned from my own meeting with advocates from several southern states. I cried over some of the stories I heard and was angered by others. This kind of half-told news story won't make the situation any better if we do have a bird flu epicemic.

FDA warns about Amevive (alefacept)

Biogen Idec and FDA notified healthcare professionals of revisions to CONTRAINDICATIONS section of the prescribing information for Amevive, indicated for the treatment of adult patients with moderate to severe chronic plaque psoriasis who are candidates for systemic therapy or phototherapy. Amevive should not be administered to patients infected with HIV. Amevive reduces CD4+ T lymphocyte counts, which might accelerate disease progression or increase complications of disease in these patients. In addition, other sections of the product labeling were revised to reflect additional safety information.

[October 2005 - Letter - Biogen Idec]
[September 2005 - Label - Biogen Idec]

Make your case!

"Partners in Making Your Case" is a handy one-stop-shop for advocacy. If you want a refresher or need to figure out how to get started, try this three-hour online training course. It's free and not too technical.

Written from the standpoint of advocating on developmental disability-related issues (it's from the Minnesota Developmental Disabilities Council), the advocacy skills are the same regardless of the issue(s).

Bid 2 Beat AIDS on eBay

An auction of signed celebrity memorabilia on eBay will benefit LIFEbeat. This is LIFEbeat's World AIDS Day event.

LIFEbeat — the Music Industry Fights AIDS will honor World AIDS Day on Dec. 1 with an Internet auction featuring some 1,000 items from stars in music, film, theater and television.

. . .

The 10-day auction will benefit LIFEbeat, an organization that provides HIV/AIDS information to young people.

But don't forget about keeping the promise.

On the road again

I'll be traveling this week, so posting is likely to be light to non-existant. (Yes, I need a laptop.) In the meantime, remember that there are stakeholder meetings all over the place and the the Texas HIV Medication Program Medication Advisory Committee will be meeting on Friday. We've asked the MAC Chair to raise some issues about the budget during the meeting, so the discussion could be lively. The MAC meeting will be Friday, November 18, from noon until 3 pm, at the Texas Department of State Health Services, 4110 Guadalupe, building 636, room 1102. Call 1-800-255-1090 for information.

Flu Fraud

The Houston Chronicle reports on a case of fraudulent flu vaccine (i.e., water) being administered to Exxon Mobil employees and residents of three nursing homes in Houston. Not only were these folks placed at further risk for the flu,

Many of those who received the shots are being tested for blood-borne pathogens such as HIV and hepatitis C in case dirty needles were reused.

Ouch!

FDA Proposes New Rules for Condoms

The US Food and Drug Administration is proposing new rules for condom labeling. Of course, they can't just say that, so the document published in the Federal Register will make you pull your hair out while you wait for them to get to the point. And the point is that some congresscritters got all upset about condoms in 2000 (I'm thinking this was Dr. Tom Coburn, then Representative from Oklahoma, now Senator Coburn), and stuck a requirement in HR 4577, the Consolidated Appropriations Act for Fy 2000, now PL 106-554 (PDF, pp. 74-75) for a whole new look at condom labeling.

Here's what PL 106-554 says about condoms:

(c) HPV EDUCATION AND PREVENTION.—
(1) IN GENERAL.—The Secretary shall prepare and distribute educational materials for health care providers and the public that include information on HPV. Such materials shall address—
(A) modes of transmission;
(B) consequences of infection, including the link between HPV and cervical cancer;
(C) the available scientific evidence on the effectiveness or lack of effectiveness of condoms in preventing infection with HPV; and
(D) the importance of regular Pap smears, and other diagnostics for early intervention and prevention of cervical cancer purposes in preventing cervical cancer.
(2) MEDICALLY ACCURATE INFORMATION.—Educational material under paragraph (1), and all other relevant educational and prevention materials prepared and printed from this date forward for the public and health care providers by the Secretary (including materials prepared through the Food and Drug Administration, the Centers for Disease Control and Prevention, and the Health Resources and Services Administration), or by contractors, grantees, or subgrantees thereof, that are specifically designed to address STDs including HPV shall contain medically accurate information regarding the effectiveness or lack of effectiveness of condoms in preventing the STD the materials are designed to address. Such requirement only applies to materials mass produced for the public and health care providers, and not to routine communications.
(b) LABELING OF CONDOMS.—The Secretary of Health and Human Services shall reexamine existing condom labels that are authorized pursuant to the Federal Food, Drug, and Cosmetic Act determine whether the labels are medically accurate regarding overall effectiveness or lack of effectiveness of condoms in preventing sexually transmitted diseases, including HPV. [emphasis added]

The FDA is now doing its part to comply with this requirement by drafting new labeling requirements for condoms. As bad as the legalese is in the Federal Register announcement of the new rules, the document includes an extensive analysis of the current state of research on condom effectiveness and is worth a read by any who are concerned about the ongoing War on Condoms. As near as I can tell, however, the FDA is basically saying, "Duh! A barrier protects what it covers. What it doesn't cover, not so much."

Here is a summary of what the FDA is recommending regarding new labeling for condoms:

The labeling recommendations in the draft guidance are intended to provide information to users of latex condoms with and without spermicidal lubricant. The draft special controls guidance recommends labeling to inform users about the extent of protection provided by condoms against unintended pregnancy and against various types of STDs, as well as information about possible risks associated with exposure to N-9 contained in the spermicidal lubricant of some condoms. The labeling recommendations provide important information for condom users to assist them in determining whether latex condoms are appropriate for their needs and, if so, to determine whether a condom with or without N-9 lubricant is most suitable. Many of the labeling recommendations are similar to statements in existing condom labeling, but are being updated to reflect current information. The labeling recommendations related to N-9 are more comprehensive than existing labeling.

An interesting aside comes when the FDA notes what it will not recommend for the new labels:

The guidance for condom labeling does not recommend including information about other ways to prevent the transmission of STDs or to reduce the adverse clinical outcomes associated with these infections. There is important additional public health information about strategies to prevent transmission of HPV and to reduce serious clinical outcomes. These strategies include abstinence for men and women and regular cervical screening for women. However, the agency believes its primary role in this area is its jurisdiction over labeling for latex condoms and that its main goal must be to ensure that such labeling supports the safe and effective use of latex condoms by users who have chosen latex condoms for protection. At this time, the agency has concluded that it would not be useful to include in condom labeling additional educational information about social behaviors or public health programs that can reduce the risk and consequences of STD transmission. Additional information in condom labeling may confuse condom purchasers or cause them to overlook important messages. However, providing this information through other mechanisms not under FDA's jurisdiction may be beneficial.

Medicare Part D Update from THMP (Part I)

I attended the update on Medicare Part D provided by the Texas HIV Medication Program Director, Dwayne Haught, RN, here in Austin yesterday. (He’s been giving a series of these updates, and I recently listed the dates of those I know about here in Texas AIDS Blog.) I requested that the presentation that he is using be placed on the HIV/STD Program’s website, and he directed his staff to try to get that done next week. In the meantime, there are a couple of highlights from his presentation that are important to THMP clients.

First, there are about 1800 THMP clients who will receive assistance in accessing the prescription benefit for Medicare, and these clients will be transitioned out of THMP as soon as possible. These clients are those who are Dual Eligibles (people who are currently receiving both Medicaid and Medicare services), Partial Dual Eligibles (people who receive Medicare services but whose Medicare premiums are paid by Medicaid), and Low Income Subsidy/Extra Help clients (those whose income is below 135% of Federal Poverty Guidelines [FPG] and who receive Extra Help from Medicare in paying their premiums). These groups of THMP clients will end up with no premiums, no deductibles, small (or no) co-pays, and access to a much wider range of medications than is currently available through THMP. They will, it appears, be much better off in terms of their prescription coverage, so there will be no advantage to the client in remaining in THMP.

The deadline for these transitions is rapidly approaching. Dual Eligibles will stop receiving their medications through Medicaid on December 31, 2005, and begin receiving them through Medicare on January 1, 2006. The transition for the others should happen by May 15, 2006. THMP is working to identify these clients and to assist them in making the transition as rapidly as possible.

Second, clients who do not qualify for assistance under these categories should still apply for Extra Help. The reason for this is that applying and being rejected creates documentation that no assistance is available and allows for Ryan White funds to be used for assistance. Since Ryan White funds are “last resort” funds, the client will have to show that other sources of help have been “exhausted.”

There is, however, a bit of a catch involved with the application for Extra Help. There are only two ways to apply. One way is to apply on line by filling out a web-based form and submitting the information electronically. The other is to request a printed form, fill it out, and then mail it back. Printing out the web-based form, filling it out, and mailing it in is not acceptable. (Go figure.) THMP is handing out application forms at its update meetings.

More to come.

What "Science Says" to Teens

The National Campaign to End Teen Pregnancy now has two new "Science Says" research briefs on HIV testing and HIV counseling now available for sexually experienced teens.

Among the primary findings:

• Only about one in three sexually experienced teens (aged 15-19) have ever been tested for HIV.
• Sexually experienced teen girls are more likely than sexually experienced teen boys to be tested.
• And only about one-third of sexually experienced teens who are tested for HIV talk to a doctor or other health professional about AIDS after the test.

These briefs can be viewed or downloaded from the Campaign's website.

Stop AIDS: Keep the Promise

The 18th annual observance of World AIDS Day will take place on Thursday, December 1, 2005. The United Nations Program on AIDS (UNAIDS) has chosen "Stop AIDS: Keep the Promise" as this year's World AIDS Day theme. "Keep the Promise" is an appeal to governments and policy makers to ensure they meet the targets they have agreed to in the fight against HIV/AIDS. More information about World AIDS Day, including downloadable campaign materials, can be accessed at www.worldaidscampaign.info.

THMP Presentations Examine Medicare Part D

The Texas HIV Medication Program (THMP) is holding several information sessions around the state in November and December to discuss upcoming Medicare Part D-related changes to the program. These sessions will include a general overview of Medicare Part D (also known as "Medicare Rx" in Texas), "Extra Help" resources for low-income persons, and implications for THMP clients. Upcoming session dates and locations are listed below.

Wednesday, November 9, 9am
Dallas Area Ryan White Planning Council and Consortium, Dallas
Dallas County Health and Human Services
2377 N. Stemmons Fwy., Ste. 200
214-819-1840

Thursday, November 10, 1pm
Department of State Health Services Auditorium (K-100), Austin
1100 W. 49th St.
1-800-255-1090

Thursday, November 10, 6pm
AIDS Services of Austin, Austin
7215 Cameron Rd.
512-458-2437 (dinner served - please call to reserve a spot)

Tuesday, November 15, 11:30-2pm
North Central Texas HIV Planning Council, Fort Worth
Tarrant County Health Department
1100 S. Main, Ste. 2500
817-763-8622

Thursday, December 8, 11:30am
David Powell Clinic, Austin
4614 N. IH-35
512-972-4900

Friday, December 9, 10:30am
FFACTS Clinic, San Antonio
527 N. Leona
210-358-3674

For more information, please contact THMP at 1-800-255-1090.

Of First Ladies, Lice, and Working Together

I couldn't resist this story about the First Ladies of Africa forming an organization to fight HIV/AIDS on the continent. When a story begins with the mention of lice and that mention happens to be in the form of a proverb, my old interests just can't help but be called into action:

AS the adage, "One finger cannot pick up lice" goes, First Lady Penehupifo Pohamba and her Zambian counterpart Maureen Mwanawasa have called for collective planning and joint action to tackle the deadly HIV/AIDS.

As I knew the proverb, in Swahili, it was "Kidole kimoja hakivunji chawa." I would translate that as "One finger doesn't break (kill) a louse." The imagery comes from the act of popping a louse between the nails of two fingers, usually the thumbs. It is commonly used to advocate for working together to solve a problem or make progress. As the news article shows, the same proverb occurs in other African languages and cultures with slight variation in text.

Aside from pulling at those old interests--well, not so old. I still have boxes of research material on the subject. Someday, when this is all over, I'll be able to go back to my love of Swahili proverbs and their fascinating imagery. In the meantime, I have an excuse to talk about proverb message in a new context.

The message of the proverb is that people should work together. I touched on that a bit yesterday in what can only be called a rant about coverage of the Campaign to End AIDS in a San Francisco newspaper. Perhaps I can be a bit more positive today, by making the point that, just as in Africa, we still need to work together in Texas (not to mention the entire country) to make positive things happen for our fight against HIV. None of us can do it alone. And even the good that each of us can do as individuals could still be magnified into something greater if we worked at it with others.

The next legislative session is a little more than a year away, the processes that will lead to making a new budget for the next biennium are already underway. There are, in addition, several interim activities going on that will have a direct effect on the care that Texans with HIV receive. Here are a few suggestions for how we can start working together now:

• Subscribe to this blog so that you can stay informed about the Network's activities. We will be monitoring state agencies and legislative activities both between and during legislative sessions and report on what we see here. The more you know, the better prepared you will be to act when the time comes. You can now subscribe through Feedburner (see the button on the right) if you use a news reader or via email (see the box on the right) if you prefer to receive updates by email.
• Comment on this blog. Your comments can provide us with information about what is going on in your area. You can comment anonymously, pseudonymously, or with your own name--whatever you prefer. We'd like to know how prevention, services, and treatment activities are going in your area. We'd like to know if there are problems, if there are victories, if there are good things happening. The more we share about local events and issues, the more we will know about how things are going in the state.
• Send us email. If you don't want to publish your information on a public blog, then email us at tan AT texasaids DOT net. We'll answer (eventually) and be grateful (immediately). If tell us to, we'll add you to our mailing list for action alerts and other urgent communications.

These may be small things, but they are certainly important parts of working together to make Texas a better place.

Missing the Campaign to End AIDS

The Campaign to End AIDS has led a series of caravans across the country and is now in Washington, DC. I've seen little news coverage of the Campaign, but here's one story I could do without.

Here's all I have:

Local AIDS groups bypass D.C. march / Leaders say money is better spent on projects at home

San Francisco Chronicle Sun, 06 Nov 2005 3:43 AM PST

As a ragtag band of activists from around the nation marched Saturday through a predominantly black Washington, D.C., neighborhood in an effort to reinvigorate a flagging AIDS movement, notably absent from the crowd of demonstrators were representatives from...

The link doesn't work in my source news feed, so I can't read the original story. Still, two things popped out at me from this news feed without even getting to see the rest of the story.

One, look at the adjectives: "ragtag," "flagging." Both are diminishing terms. The "band of activists" is not only small ("band"), they are "ragtag," meaning without organization, without uniform appearance, perhaps even shabby in their appearance. And the "AIDS movement" is declining, weakening, even drooping. Whatever the rest of the story might have said, it's clear that already the people who marched and the cause for which they were marching have been dismissed by the reporter (and presumably his/her editor and publisher).

If I could have reponded with a letter to the editor, I'd have made a couple of points in reply. I would have said: "If the marchers were indeed 'ragtag,' then they did an excellent job of presenting an accurate and vivid display of the face of AIDS. They showed by their diversity and their poverty of appearance where we are with HIV today in America. We are facing an epidemic that affects people from many different communities, not merely men, not merely homosexuals, not merely white folk. We are facing, moreover, an epidemic that devastates rich and poor alike, sapping their ability to make a living and draining away any wealth that they may have had in order to pay for treatment. Behold the image of AIDS in America!" I would also have said: "Movement, schmovement! What is flagging in this country is the will to fight HIV with all the weapons we have at our disposal. We have a government that declares war on condoms, that refuses to accept the science that supports the success of needle exchange, that pumps money into medications but not into services or prevention, that diverts attention from the needs of Americans with stories of devastation elsewhere, that will spend billions overseas and make cuts at home. We have no panacea available to us, to be sure, but it certainly seems as if this administration has surrendered to HIV at home while making a big show of fighting it elsewhere."

The second thing? Look at the headline itself. Local organizations, presumably in San Francisco (and I have no idea which ones), decided not to participate in the Campaign to End AIDS. No problem here. We all have work to do. We can't all be two places at once, although, goodness knows, I've tried. But then the headline continues with a dis: "money is better spent on projects at home." I'm spluttering here. Lest I say something tacky, let me approach the issue obliquely.

Once upon a time in a legislative session that has long faded from memory, there was a heated battle among pro-choice organizations regarding something or other. The Choice Girls were being so active in dissing one another and generally not getting along that they drew legislative attention to their disagreement, while their issue took a back seat. The situation was so dire that then-Representative Glen Maxey (a hero for HIV legislation in Texas if there ever was one) called me to his office along with representatives from a couple of other organizations that, now and then, also worked on HIV issues. His message was simple: "Do not, under any circumstances, disagree with each other in public." We were all (a) truly convinced of Rep. Maxey's wisdom in just about all things and (b) not stupid. As much as there may have been some elements of sibling rivalry among the groups, we weren't going to parade that before conservative Texas legislators who needed very little excuse to sink our issues.

I'm going to take a leap of faith here and blame the Chronicle (without the least bit of evidence one way or the other) for going a little too far with its headline. Instead, I'm going to think (and say) that what must have happened is that the Chronicle simply misunderstood a local San Francisco organization when its representative surely said something like: "The Campaign to End AIDS is an important effort by many who have been affected by HIV to remind Congress that the epidemic still needs serious policy and funding support in this country. While we ourselves are unable to participate in the Campaign because of funding, we strongly support their efforts and wish them success, because their success will help us do more and better work for the San Francisco community."

Feed Changes

I've done a little tinkering with the blog feed. The feed itself will now be in short form, which I understand is somewhat tidier for those who subscribe to it. If this turns out not to be a good thing, please do let me know in the comments.

I've also added an email subscription thingie for our readers who don't use newsreaders and prefer email.

March on the White House Monday

Part of the Campaign to End AIDS activities in Washington on Monday. (Sorry I can't make it any bigger.)

Moral Disaster of Monumental Proportion Reconciliation Act

That's the name that Senator Lautenberg would give to the Omnibus Budget Reconciliation Act of 2005. Why? Because that's the act that cuts Medicaid and other safety net programs to pay for reconstructions costs associated with Katrina and Rita.

The Senate has passed the bill. The House has yet to act. You know what to do.

Cuts to State HIV Services on the Horizon

The HIV/STD Program conducted the first of five Stakeholder Meetings in Austin on October 24. The PowerPoint presentation given at the meeting is available on the program's website. The website also provides an online form for those who are unable to attend the meetings in person and still wish to comment.

Texas AIDS Network participated in the Austin meeting. The central issue was, of course, lack of funding. The discussion focused, not on whether to cut the program, but how it would be cut.

Funding pressures come primarily from the steady decline in Ryan White CARE Act funding for the Title II Base allocation and from the lack of increase in state funding. A cap on administrative costs and the state's decision to take a bigger cut for indirect costs completes the grim picture.

One other possible source of pressure on funding for services is the reauthorization of the Ryan White CARE Act. Some scenarios being discussed will allow Texas to maintain stability. At least one will force a $2.5 million cut in the Title II Base.

Even without the "worst case scenario," the program must make cuts in the next fiscal year. Stakeholders were asked to suggest ways to cut the program without cutting direct client services. There were the four key questions:

• What could be done to simplify local administration and reduce costs?
• What could be done to simplify local planning and reduce costs?
• What changes to services and/or planning boundaries are needed to simplify activities and reduce costs?
• Should we be considering other changes to administrative structure overall?

While the discussion groups provided many useful suggestions, the Network's concern was (and is) that the Department of State Health Services (and its past iteration as the Texas Department of Health) has made no requests for services funding (or prevention for that matter) for several years. Indeed, even when information about those funding needs was requested, the program has stonewalled the Network, despite the fact that "How much do you need for services?" is a pretty simple question.

While several productive suggestions came out of the Austin discussions and more will surely arise in the other meetings, the Network is concerned that too many more cuts will simply destroy the infrastructure that supports HIV treatment as well as prevention.

So what to do? First, we strongly encourage all stakeholders to participate in the meetings and/or provide their comments through the online form. Second, we are urging the Department to be more open about the budget process and more forthcoming about actual needs for funding.

Failing that, we go to the third option and the reminder that this blog is a source of news and information. To paraphrase that old joke, "Yesterday I couldn't spell 'journalist,' and today I are one." All sources are confidential. Operators are standing by. And the big question is:

What level of state GR is needed to maintain HIV services at their current level?

House Foreign Aid Bill Boosts AIDS Funding

Before you get your hopes up, note that "foreign" in the title.

A compromise between House and Senate measures, the bill commits millions of dollars more to fight the spread of AIDS and other diseases in Africa and poor countries elsewhere. The AIDS effort is slated to get $2.8 billion — $629 million above last year's total and $268 million more than what the president
sought for this year.

This is H.R. 3057, "An act making appropriations for the Department of State, foreign operations, and related programs for the fiscal year ending September 30, 2006, and for other purposes." There is no appropriation for domestic needs for HIV/AIDS.

That being said, here are relevant snippets from the Congressional Research Services bill summary:

Title III: Bilateral Economic Assistance - Makes FY 2006 appropriations for: (1) expenses of the President in carrying out certain programs under the Foreign Assistance Act of 1961; (2) the United States Agency for International Development (USAID) for child survival and disease programs, including HIV/AIDS and other infectious diseases, and family planning/reproductive health programs; . . .

(15) the global HIV/AIDS initiative; . . .

(Sec. 6060) Obligates specified FY2006 international organization and program funds for the United Nations Population Fund (UNFPA) (except for any country program in the PRC). Conditions such funds' availability on specified requirements, including that it does not fund abortions. Requires that funds be used to: (1) provide childbirth and obstetric care equipment, medicine, and supplies; (2) prevent and treat obstetric fistula; (3) provide contraceptives for the prevention of pregnancy and sexually transmitted infections, including HIV/AIDS; (4) reestablish maternal health services in
natural disaster-affected areas; (5) eliminate female genital mutilation; or (6) promote the access of unaccompanied women and other vulnerable people to health, food, and sanitation services.

. . .

(Sec. 6062) Directs the Secretary of the Treasury to instruct
U.S. executive directors at specified international financial institutions to oppose any loan, grant, strategy, or policy that would require user fees or service charges on poor people for primary education or primary health care, including prevention and treatment efforts for HIV/AIDS, malaria, tuberculosis,
and infant, child, and maternal well-being, in connection with the institution's lending programs.

. . .

(Sec. 6116) Directs the Coordinator of United States Government Activities to Combat HIV/AIDS Globally to report on anti-retroviral drug procurement.

. . .

(Sec. 6118) Transfers specified funds under this Act for: (1) a
U.S. contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria; and (2) the African Union Mission in Sudan.

The bill has passed both houses of Congress and now goes to the President for his signature.

Of India, Little Elm, and Needlestick Prevention

This just in from India:

Retractable Technologies, Inc. (AMEX:RVP) has announced that it has been awarded its second major U.S. government contract to provide VanishPoint(R) safety syringes under the Bush Administration's Global HIV/AIDS initiative (President's Emergency Plan for AIDS Relief).

Under the contract, awarded in connection with Phase II of the syringe program, Retractable will supply at least 11.7 million of its patented automated retraction syringes to Haiti and seven African nations: Botswana, Cote d'Ivoire, Ethiopia, Kenya, Nigeria, Tanzania, and Uganda.

As the article notes, dirty needles used in healthcare settings is suspected of being a significant factor for transmission of HIV in Africa. That retractable needles are now being requested for the second phase of the program is hopeful news that safer practices in healthcare settings can help reduce the spread of HIV there.

But there's a bit more to the story. Retractable Technologies is a Texas-based company (Little Elm, Texas, to be exact). Their web site has some interesting information about the use of retractable needles in the prevention of needlestick injuries for healthcare workers and is worth a look.

One bit of misinformation shows up in their discussion of legislation regarding needlestick prevention. (Click the link for View legislation map.) The first thing you see is that not nearly enough states have passed any legislation regarding needlestick prevention. The second thing you might do (I did) is click the image of Texas. At that point you would see that the legislation that "passed" was HB 2085 and SB 905 in the 76th Legislative Session (1999).

Now SB 905 was a fine piece of legislation. So was it companion, HB 1646. Texas AIDS Network supported them both. But neither of them actually passed. Both made it pretty far along in the legislative process. SB 905 even got as far as the House Calendar. But, neither one of them passed.

Still, we do have needlestick protection in Texas law. How so? Thanks to the efforts of Representative Harriet Ehrhardt and Senator David Bernson and their staffs the text of SB 905 was added as an amendment to HB 2085, the reauthorization of the Texas Department of Health.

As misinformation goes, this is not big deal. However it does give me a chance to take this molehill and point you to the mountain that is Chapter 81 of the Health and Safety Code. Starting with Section 81.301 you'll find out how healthcare workers in public institutions are protected from needlestick injuries--and the risk of disease transmission--by the requirement that engineered safety devices (including retractable needles) be available.

The next question is: what about healthcare workers employed in non-public settings?

Action Alert: Stop Dangerous Medicaid Cuts

HIV Medicaid & Medicare Workgroup Action Alert

Call your U.S. House of Representative member today to stop dangerous Medicaid cuts

Ask them to vote NO on the budget reconciliation package.

Next week, The U.S. House of Representatives will be voting on the federal budget reconciliation package. This package contains severe cuts to the Medicaid program, changes that will force poor and disabled Americans living with AIDS to lose their medications and healthcare. Under this proposal, state Medicaid programs will be allowed to charge premiums, deductibles, and co-pays, reduce coverage of drugs and doctor visits, deny treatment and care, and force people off the program if they are unable to pay. These cuts will affect vulnerable PWAs living on fixed disability incomes the most, including those needing multiple prescriptions or dealing with long-term illnesses.

Medicaid is a popular healthcare program covering over 230,000 low income and disabled PWAs. These cuts are controversial and can be stopped, your House member needs to hear from you that these cuts are deadly to People living with AIDS.

Sample script:

"My name is ______ and I'm a constituent of Congressman/Congresswoman _________. I'm calling to ask him/her not to use the lives of Americans living with AIDS to balance the budget. Making poor and disabled people pay more for Medicaid and limiting their access to lifesaving drugs and medical care is cruel. Please vote NO on the budget reconciliation package."

To find out your House Member's contact info, go to http://www.congressmerge.com/onlinedb/index.htm and type in your address.

Or you can call the Capitol Switchboard toll-free at 1-877-762-8762 and ask to speak to your House Member.

Improving Western Healthcare with Lessons Learned in the Third World

Dr. Marie Charles has announced the beginning of a series of articles on Medscape (sub. req.) that talks about the experiences of healthcare professionals who have participated in a mentoring project in third world countries. The focus of their mentoring was to help share western medical knowledge and practices regarding HIV/AIDS. In return, they learned a few things themselves.

While we suspected that our endeavors would benefit the patients in developing countries and create access to care for them, the results of our programs caught us by surprise as well. Our partners in developing countries have been very happy with our clinical mentors, and although their impact in the field has been fantastic, what we didn't anticipate is the extent to which our clinical mentors also learned from their colleagues in developing countries. Even in our resource-rich Western environments, not all patients are reached; some are left behind. Often these patients belong to minority groups, are immigrants, are poor, and have limited interaction with the healthcare system we run. As Westerners, our medical education didn't teach us how to engage the medically disenfranchised people in our own countries so that they too may have access to the care they need. While overseas, many of our clinical mentors have learned new program methods and have identified clinical care issues that could greatly help all of us reach those patients that we fail to reach now. We also have learned some novel ways to help these patients gain access to proper treatment, and we have enhanced the way in which clinical care in some resource-poor settings in the West is provided.

There are many medically disenfranchised persons in Texas. We look forward to the rest of the series--and "some novel ways to help these patients gain access to proper treatment."

HIV/AIDS Infusion Fraud in South Florida

Once again, the flow of information through the Texas AIDS Health Fraud Information Network has managed to surprise me. TAHFIN, as the task force calls itself, is primarily focused on fraudulent treatments for HIV. We are not equipped to look at fraud within the healthcare system. We just want to make sure that consumers have a fair shot at making informed decisions about their own health care and access to a few helpful facts.

Still, we are aware that there are other versions of fraud out there. This week a really sad case came through the electronic grapevine from the listserve for the National Association of Drug Diversion Investigators. In a message that originated from Special Agent Rick Zenuch (Florida Department of Law Enforcement, Office of Statewide Intelligence) comes the story of a Medicare boondoggle that is bad enough in itself but which also involved paying clients with HIV to submit to treatments that included diluted or counterfeit medications.

Here’s what Special Agent Zenuch had to say:

I wanted to share with you a problem we are working on in the Miami area that while it is more appropriately classified as healthcare fraud, may come to the attention of diversion investigators. The bulk of the problem is predominantly in Miami-Dade county but the practice is not necessarily limited to this area. Here is an excerpt from a brief I recently wrote:

"The fraud involves medical clinics billing the Medicare/Medicaid system for drug infusion treatments that are administered to HIV/AIDS patients. One of the treatments for HIV/AIDS patients involves the intravenous administration of different drugs designed to fight the disease and boost the immune system. Some of these drugs are extremely expensive and can range between an estimated $2000-$8000 a treatment. These treatments are usually billed to Medicare because once a person is diagnosed with HID/AIDS (sic), they become classified as disabled by the Social Security Administration and become eligible for Medicare benefits. Many of these patients are also indigent, qualifying them for Medicaid benefits as well.

Data from Jan-May of 2005 shows that Florida's average submitted charge for these IV type treatments, per beneficiary, is four times higher than California and ten times higher than New York. Florida, with fewer AIDS cases than California and New York, (94,725 to 133,292 and 162,466 respectively) has submitted total charges for these billing codes to the Medicare/Medicaid system in excess of 1.5 billion dollars, three times California and 5 times the New York charges.

What has emerged in Miami, where the largest percentage of this billable procedure takes place in Florida, is a systematic fraud by health care clinics and practitioners whereby patients are recruited for treatments and either infused with placebos, adulterated (diluted) drugs or simply not treated at all, while the practitioner/clinic bills the system for full payment. The patient receives a "fee" for participating in the scheme, usually from $100-$400.
(Emphasis added.)

Special Agent Zenuch goes on to explain how the Medicare billing system allows for such fraud and ongoing efforts to correct the problem. He also talks about law enforcement activities from state and federal agencies to further address the problem.

Good News for Prevention

As several news articles are pointing out, Merck and Bristol Myers Squib have joined forces to develop a microbicide that women can use (with or without their partner's knowledge or cooperation) to prevent the transmission of HIV.

• Drug firms to make anti-AIDS gels for women
• Companies to develop Aids defence for women
• AIDS Gel on a Faster Track

This news comes from an article to be published in this week's Nature. A significant part of the story's news value come from the facts that it's a major step to have such major investors in the development of a microbicide and that Merck and BMS are licensing the product for use in third world countries for free.