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.

Katrina Evacuees Get Meds in Texas

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

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

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

Colonel Kaspar

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

New Kaletra Formulation

A notice from the FDA . . .

Today (October 28, 2005) the Food and Drug Administration approved a new formulation of Kaletra. Kaletra (lopinavir/ritonavir) is now available as a film coated tablet (200mg/50mg) that provides advantages over the currently marketed capsule formulation for HIV-1 infected patients. Specifically, the tablet formulation:

• does not require refrigeration,
• can be administered without regard to meals
• does not require dose adjustments for concomitant use with certain NNRTIs and PIs in treatment-naive patients
• has a decreased pill burden compared to the capsule formulation (2 tablets twice daily or 4 tablets once daily in treatment-naive patients only vs 3 capsules twice daily or 6 capsules once daily in treatment-naive patients
  only)

. . .

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

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

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

The Smith Amendment Fails

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

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

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

Live Blogging Coburn's Amendment

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

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

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

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

Hutchison votes no, Cornyn votes aye.

Ayes: 14

Nays: 85

Coburn amendment fails.

Compassion Fatique

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

Coburn's Amendment to Increase ADAP Funding

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

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

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

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

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

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

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

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

I have no background on this.

Burn our feed!

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

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

So subscribe already! :)

Church Council Opposes Proposed $50 Billion Cuts

Via email:

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

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

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

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

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

Methamphetamine: Important Clinical Guidance for Healthcare Providers

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

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

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

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

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

About Medicare Part D Formularies

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

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

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

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

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

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

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

Legal Services for Rita, Katrina Survivors

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

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

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

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

Medicare Part D: Texas Stand-Alone PDPs

October 15 was Medicare's target date for announcing the Prescription Drug Plan for the various states. A PDF file listing the Prescription Drug Plans approved for Texas as of October 10 can be found at: http://www.medicare.gov/medicarereform/mapdpdocs/PDPLandscapetx.pdf.

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

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

Six will have some sort of additional coverage during the "doughnut hole" (coverage gap). Offering generics only will be:

• AETNA Medicare Rx Plus
• AETNA Medicare Rx Premium
• CIGNATURE Rx Complete Plan
• Pacificare Comprehensive Plan
• Medicare Rx Rewards Premier

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

All but Community Care Rx offer mail order delivery.

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

Multi-Drug Resistant HIV

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

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

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

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

A few bad apples

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

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

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

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

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

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

Serono blames the whole thing on a few bad apples.

Congressional Districts and Maps

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

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

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

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

Home Test for HIV

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

That may change.

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

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

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

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

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

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

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

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

DSHS HIV Stakeholder Meetings

The Texas Department of State Health Services (DSHS), HIV and STD Program is planning to hold a series of stakeholder meetings throughout the state this fall and winter. The purpose of these meetings is to:

• Discuss the implications of decreased federal funding
• Discuss HRSA guidance and related challenges
• Solicit stakeholders' thoughts and ideas on how to best address the two issues above.

The meetings will include a brief presentation by DSHS staff and round table discussions addressing the following questions:

• What can be done to simplify local administration and reduce costs?
• What can be done to simplify local planning and reduce costs?
• What changes to services and/or planning boundaries are needed to simplify activities and reduce cost?

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

DSHS STAKEHOLDER MEETING DATES AND LOCATIONS:

AUSTIN
October 24, 2005, 1-4pm
DSHS HIV/STD Program
Austin State Hospital, 4110 Guadalupe
Building 636, Room 1102

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

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

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

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

Disability Funders Network Looks at Disaster Relief

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

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

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

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

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

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

"I gave her AIDS"

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

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

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

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

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

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

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

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

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

Love and Condoms

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

The article reviewed is:

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

Congress May Cut Funding to Vital Services Soon

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

CALL THE CAPITOL TOLL-FREE OCTOBER 17 & 18:
SET CONGRESS'S PRIORITIES STRAIGHT!

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

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

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

CALL YOUR SENATORS AND REP. ON OCTOBER 17 OR 18
TELL THEM THESE CUTS ARE UNTHINKABLE!

For a PDF flier with this information, click here: http://www.chn.org/pdf/congresspriorities.pdf.

For background on cuts, click here:
http://www.chn.org/pdf/congressprioritiesbackground.pdf.

HOW TO CALL:

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

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

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

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

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

If you do not know who your (Texas) representatives are in Congress, a handy tool for locating them can be found at http://www.capitol.state.tx.us/fyi/fyi.htm.

What Marsha Says

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

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

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

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

Abstinence Educator Gets Laid

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

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

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

. . .

Abstinence Fun Fact!

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

. . .

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

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

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

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

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

. . .

The Case for Marriage

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

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

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

. . .

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

. . .

Abstinence Fun Fact!

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

. . .

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

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

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

. . .

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

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

Updated Guidelines for Post Exposure Prophylaxis

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

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

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

KFF Webcast on Medicare Part D

LIVE Webcast - Ask the Experts: Medicare Part D

On Thursday, October 6, a panel of experts will answer questions about the Medicare Part D implementation during a live webcast of "Ask the Experts," a kaisernetwork.org program. Send questions in advance of the live program to ask@kaisernetwork.org .
http://cme.kff.org/Key=9269.F9l.C.D.n7Nhz

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

WHO: The panel of experts:

• Leslie Norwalk, Esq., deputy administrator, Centers for Medicare and Medicaid Services
• Tricia Neuman, Sc.D., vice president, Kaiser Family Foundation and director, Medicare Policy Project
• Aileen Harper, executive director, Center for Health Care Rights

WHEN: Thursday, October 6 at 2:00 p.m. ET

WHERE: Watch the live webcast on kaisernetwork.org. http://cme.kff.org/Key=9269.F9l.C.D.n7Nhz

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

Please note: The toll-free phone number will function only during the live program and is for submitting questions only. The program is accessible via webcast on the Internet and not via teleconference. If you have never viewed a webcast before, please test your media player in advance of the live webcast at http://cme.kff.org/Key=9269.F9l.D.D.CC7Ryt.

Webcast on HIV Screening

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

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

This program will be available for viewing at http://www.phppo.cdc.gov/phtn

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

Presenters:

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

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

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

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

Webcast website: http://www.cdcnpin-broadcast.org/

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

Change to comments

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

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

Ryan White funding for urban areas shouldn't be cut

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

A bigger pie. We can live with that!

HOPWA deadline extended

From the National AIDS Housing Coalition:

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

For a PDF; for text.

Electric, phone deposit waivers extended

Hurricane Katrina, Rita Victims Eligible

Contact:Terry Hadley
512-936-7135
Pager: 512-322-1457

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

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

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

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

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

Last Updated: 10/03/05

Twenty years ago today . . .

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

Request from the Clinton Foundation

The Clinton Foundation HIV/AIDS Initiative is seeking experienced HIV nurses and nurse practitioners to work as clinical preceptors in Lesotho for 6-12 week assignments. The program will begin in November and continue for approximately 1 year.

For more information, contact Anne Sliney, ACRN, at aslineyATclintonfoundation.org or call 401 487-2700.

Americorps Funding Opportunity

Under funding authority CFDA# 94.006
Corporation for National and Community Service

OneStar National Service Commission is accepting applications from eligible organizations for 2006 - 2009 AmeriCorps*State competition. OneStar anticipates awarding over $6.6 million in grants to place AmeriCorps members in service in Texas communities.

Step 1: Go to http://www.onestarfoundation.org/ to download the Organizational Readiness Assessment, the Program Planning Toolkit, and the Application Instructions.

Step 2: Submit a Notice of Intent to Apply by Oct. 21, 2005. (optional but strongly encouraged)

Step 3: Submit your completed Application. OneStar must receive your application by mail or drop off in our office by Nov. 18, 2005 at 6 p.m. CST. No e-mail submissions.

Conference Call Help Sessions: Send an e-mail to rfpquestions@OneStarFoundation.org to sign up. Dates are 10/14, 10/27 & 11/2. Times to be announced.

Questions? rfpquestions@onestarfoundation.org 512-473-2140 x 228 (voice mail)

New Tip Sheet on Medicare and AIDS

If you (or your clients) are covered by Medicare, the new Part D coverage to provide prescription drugs is now a matter of some importance. The U.S. Department of Health and Human Services has issued a new "tip sheet" in Question and Answer format to address some of the questions that a person living with HIV might have. For example:

Question: Since the new Medicare prescription drug coverage is voluntary,
can I not join a Medicare drug plan and remain on ADAP ?

Food Stamps for Rita

Special Food Stamp Assistance Now Available for Families Affected by Rita

The Texas Health and Human Services Commission received rapid approval from the U.S. Department of Agriculture (USDA) to allow the state to provide disaster food stamp assistance to individuals and families displaced by Hurricane Rita.

The USDA-approved waiver [PDF] applies to food stamp applicants in nine Texas counties and one Louisiana parish declared a disaster area as a result of Hurricane Rita. The program allows HHSC to act quickly to provide families with assistance by waiving certain eligibility requirements. Eligible families can receive assistance for up to 90 days.

Residents of Chambers, Galveston, Hardin, Jasper, Jefferson, Liberty, Newtown, Orange and Tyler counties, as well as Beauregard parish, can apply for disaster food stamps through any Texas Health and Human Services Commission field office. To find the nearest office, evacuees should call 2-1-1 or 1-888-312-4567.

Non-HIV Specialists Caring for Hurricane Displaced PWAs Get Guidelines

Recommendations for Non-HIV-Specialized Providers Caring for Displaced HIV-Infected Residents from the Hurricane Disasters: Essential Information for Managing HIV-Infected Patients Receiving Antiretroviral Therapy

Some HIV-infected patients may have interrupted their antiretroviral therapy and other medications due to the recent hurricane disasters. The following information provides some guidance to general practitioners attending to the medical needs of displaced HIV-infected adult or pediatric patients who have not yet secured HIV care in the local area. Management of antiretroviral therapy is complex and is best done with the assistance of specialized clinicians. Medical consultation may also be available at specific local or regional HIV clinics or via the 24-hour NIH Medical Consultation Services at 866/887-2842 or the National HIV Telephone Consultation Service at 800/933-3413.

http://aidsinfo.nih.gov/guidelines/disaster/2EssentialsforManagingHIV1ap.pdf

Emtriva: New Formulation and Labeling Change

On September 28, 2005, The Food and Drug Administration approved EMTRIVA (emtricitabine) Oral Solution 10 mg/mL. The approval of this Oral Solution formulation allows for dosing recommendations in pediatric patients. EMTRIVA is now indicated in combination with other antiretroviral agents, for the treatment of HIV-1 infection in patients over three months of age.

Additional changes to the package insert were made.

Listserv for CBO's Helping Katrina Survivors

The CDC National Prevention Information Network has established a listserv for providers working with Hurricane Katrina evacuees. These providers are encouraged to post any needs they may have on the listserv. Those needs will be reviewed by other organizations across the country, who may reply and offer their support.

New KFF Fact Sheets

The Kaiser Family Foundation has updated the following fact sheets.

• The HIV/AIDS Epidemic in the United States - features the most recent estimates for HIV prevalence in the United States, key trends, and data on the U.S. Government's response to the epidemic. http://www.kff.org/hivaids/3029-05.cfm
• Medicaid and HIV/AIDS - examines Medicaid eligibility, benefits, spending, caseload, and the profile of beneficiaries with HIV/AIDS, and projects the future outlook of the program. http://www.kff.org/hivaids/7172-02.cfm
• Medicare and HIV/AIDS - examines coverage provided under Medicare for people with HIV/AIDS and looks at the impact of the new Medicare prescription drug benefit and other aspects of the program's future. http://www.kff.org/hivaids/7171-02.cfm

HUD, FEMA Announce Housing Assistance

HUD and the Department of Homeland Security announced earlier today their new "Comprehensive Transitional Housing Assistance Program for Katrina Evacuees." Click here to read the press release detailing the new assistance offered by FEMA and HUD.

STD Communications Database

After looking at the Focus Groups on STD Communications, I checked out the STD Communications Database. This is a CDC website that contains a searchable database of articles and monographs that can assist health professionals in talking to clients and communities about STDs more effectively. The user can search the database in terms based on behaviors, barriers, knowledge and awareness, interventions, communication channels, diseases, and audience.

A search using "Texas" and "condom distribution" brought back 34 articles. The results included abstracts, summary results, and information about the quality of the article.

The site also includes useful information about design principles, so that the user can design more effective educational materials.

Focus Groups on STD Communications

Just wandering around on the Internet can be an enlightening activity. That's how I stumbled across this report on some focus groups held in 2004 to find out more about what the general public knew and thought about STDs. Some of the focus groups were held in McAllen, Texas.

The Executive Summary is a very interesting read. Just cherry-picking some of the comments:

For most participants, STDs were not a major health concern. They said this was because other health conditions were more of a concern for them and because they just do not think of STDs except for AIDS.

. . .

The American Red Cross, CDC, and Planned Parenthood were frequently mentioned as specific organizations that would be trusted. Other trusted organizations include community-based organizations, doctors’ offices, health departments/clinics, and insurance companies. Participants further stated that they would not trust information developed by pharmaceutical companies.

Participants had mixed reactions to the notion of a specific spokesperson for an STD campaign. Some participants believed that individuals who have, or are affected by, a particular STD would be most appropriate. They also believed that other reputable celebrities with knowledge of health issues, such as the U.S. Surgeon General, would be appropriate representatives to speak about STDs. Other participants stated that the most believable spokesperson would be an "average person" who has been affected by an STD. These participants believed that this person would be able to provide a credible testimonial about his/her experience with STDs. African American participants believed that the most effective spokesperson to deliver STD messages to their community would be an African American person.

. . .

Across all segments participants stated that the main point of materials should be factual information about the diseases, their symptoms, and means to prevent them. Participants expressed that prevention information should focus on abstinence, safer sex, and condom usage. In addition, participants noted the importance of including resource information about whom to contact with questions or when experiencing symptoms.

. . .

Across the groups, participants recognized the need to be "realistic" about people engaging in sexual activity. This recognition led participants to suggest that a combination of abstinence and condom usage messages would be appropriate. Most people agreed that messages should focus on abstinence as an effective method to prevent STDs, but that providing information on using condoms correctly to reduce the likelihood of contracting STDs was imperative.

As I said, interesting.

DSHS HIV/STD Offices Move to Central Location

The HIV/STD Offices of the Texas State Department of Health Services recently relocated to a more central location in Austin. The "new" offices are located in the old complex of the Austin State School, near the main DSHS campus.

New Phone Numbers

Main Phone Number:512.533.3000

Texas HIV Medication Program:1.800.255.1090(same number as before)

New Fax Numbers

Medication Orders:512.371.4671

All other faxes for THMP:512.371.4677

The division's mailing address remains the same (1100 W. 49th St, Austin, 78756), but the new physical address is: 4110 Guadalupe, Building 636, Austin, Texas 78751.

Simplified ADAP Access for Hurricane Displaced PWAs

For displaced persons living with HIV/AIDS Due to the recent tragedy, the Texas HIV Medication Program (THMP) has developed a one-page "Emergency Relief ADAP Application" that may be completed by displaced residents of Louisiana, Mississippi and Alabama that have sought refuge in Texas and would normally receive their medications through their state AIDS Drug Assistance Program. The form should be completed and faxed along with a copy of the applicant's photo ID, ADAP ID card/letter (if available). A copy of the THMP Medical Certification should also be submitted if the client is receiving healthcare now at a Texas location. The fax number is (512) 371-4670.

A copy of the Emergency Relief ADAP Application can be found in PDF format by clicking here.

A copy of the information release regarding this effort can be found in PDF format by clicking here.

The standard THMP Medical Certification form can be found in PDF format by clicking here.

The Texas State Board of Pharmacy (TSBP) also has extended emergency refill supply time to aid emergency relief. For more information, click here, or visit the TSBP website.

Texas HIV Testing Follow-Up Day

Today is National HIV Testing Day. Since many people who get tested for HIV do not return for their test results, the HIV/STD Division of the Texas State Department of Health Services is sponsoring a Follow-Up Day to encourage people to get those test results. Follow-Up Day is scheduled for July 11. The Division has more information available on its website/

In 2001, there were 106,143 HIV tests reported to the Texas Department of Health. Approximately 33 percent of those persons who received HIV tests did not return for their results. Approximately 67 percent of the persons who tested negative returned to the clinic for their results. Among positive results, the return rate was 83 percent, meaning that 17 percent did NOT return for their test results. Therefore, there were 235 people who tested positive for HIV and did not receive their test results.

The goal of this event is to get HIV test results to EVERY person who is tested for HIV in the State of Texas in order to prevent the further spread of HIV.

China More Pragmatic than Texas?

ABCNews is carrying an AP story about recent recommendations by the Chinese Health Ministry about ways to combat the spread of HIV in that nation. The recommendations? Needle exchange for drug users, condoms for sex workers and people diagnosed with STDs.

In Texas, we couldn't go that far. SB 127, Senator Jon Lindsay's bill to allow needle exchange programs where local health authorities wanted them, passed on second reading by a 17-9 vote (5 absent) but then couldn't get called back for a third reading. You can see the vote and discussion here. HB 2057, Garnet Coleman's bill to allow condom distribution in prisons and jails, received a committee hearing on April 21, but did not get a favorable vote. Both bills died at the end of the session.

China took a long time to acknowledge that there was any HIV epidemic in that nation. It was slow to reveal the problems with blood infusions. It has penalized health officials for speaking out about the risks for infection. This makes it all the more significant that China is now apparently ready to get serious about fighting HIV. The epidemic has been in the public eye a lot longer in Texas. Too bad our leaders can't seem to learn as fast as those in China.