Talking point: Texas health workforce

The Statewide Health Coordinating Council is in the process of finalizing its report on healthcare workforce issues in Texas through its 2007-2008 State Health Plan Update. If you're interested, the stats and graphs showing number, distribution, education, and even age (they are so getting older) are included in Chapter 2: Status of the Health Workforce in TX. SHCC's recommendations to the legislature are included in Appendix A: 2005-2010 Texas State Health Plan Recommendations. On page 6 of those recommendations, under "Primary Care Recommendations," we find this little gem:

1. The Legislature should support initiatives that will support public health prevention and education programs in an effort to decrease the incidence and severity of chronic disease in the population by enabling individuals to take personal responsibility for their health.

Yes, I know there are some code words in here, most notably the infamous "personal responsibility," but, used carefully, this can serve as a talking point in support of the legislative appropriation request for increased funding for HIV services and prevention.

The health workforce is going to be an issue of significant concern to the Texas Legislature when it convenes in January. Aligning the request for increased funding for HIV prevention and services with this concern can be useful in creating a more positive reception for the request.

I do not, however, see this as the whole burden of one's argument in support of this funding, but rather as a passing reference that "appeals" to authority of the SHCC. For example, "Senator So-and-So, this request is precisely the sort of initiative that is included by the Statewide Health Coordinating Council in its recommendations for improving primary care in Texas." Then move on to your other points. If there's any question, you have the reference to the original and can quote it.

Condom ad

A friend sent me a video of a condom ad from East Africa. I tracked it down to at least one web site. Go see it. It's fun.

The caption at the end is "Maisha iko sawa na Trust." There may be some double meanings here as well. My first reading was that it meant "Life is the same as Trust," i.e., life = Trust. A second reading made me think that the phrase was somewhat more idiomatic and might mean "Life is good with Trust."

Trust is the condom brand. The phrase seems to have been their ad slogan for some years. The video and discussions of it have been viral, showing up in web discussions in several languages. The consensus seems to go with my second translation, but I kinda like the first, since it focuses so clearly on the prevention concept rather than a more hedonistic ethic. Still, it's a clever ad. Look for the old baba in the car.

Texas HIV/STD Infoline . . . going . . . but not gone

The latest issue of the Texas HIV/STD eUpdate from the DSHS HIV/STD Program carries the story (emphasis added):

InfoLine Callers Now Forwarded to CDC-INFO

The Texas HIV/STD InfoLine you know so well (800-299-2437) is undergoing some changes.

Until recently, callers who wanted to speak to an information specialist would get a DSHS employee. Callers who request to speak with an information specialist are now automatically forwarded to 1-800-CDC-INFO. This new hotline, which replaces the National AIDS Hotline, provides English, Spanish, and TTY service 24 hours a day, seven days a week. Callers can speak to a live information specialist and receive HIV/STD testing and services referrals for Texas or any other state. The Texas HIV/STD InfoLine will continue to be forwarded to CDC-INFO through the end of 2006.

All callers are still greeted with a menu of informational audio tapes in English and
Spanish. Callers wishing to connect with the Texas HIV Medication Program (THMP) or file a complaint are still connected to DSHS employees.

If you have any questions regarding the InfoLine, please contact Jean Gibson at jean.gibson@dshs.state.tx.us or 512-533-3023.

Calling the InfoLine seems only to net that one change: if you want to talk to an information specialist about HIV or STDs, you get a referral to the CDC Infoline. Otherwise, it's all the same, at least until the end of 2006.

This all came about because the person who managed the InfoLine retired, and the Program has made the decision not to rehire. Instead, there are ongoing discussions with the folks at the 211 program and some thinking about rerecording the info messages, etc. Further changes are not likely before 2007, but we have been reassured that there will be an InfoLine for the foreseeable future.

Condoms at DSHS

Well, not exactly at DSHS. On their new website.

I was looking to see what educational resources related to condoms were still available on the HIV/STD program's new website--and couldn't find it! Naturally, I couldn't stop myself from being just a tad . . . well . . . paranoid about the possibility of the change from one web address to another being used as an opportunity to scrub some things from the website. Condoms have been a central battleground, so to speak, in the culture wars. As I recall, there had been some rather useful information about condoms on the old website. Did it make it to the new one?

Most of it did indeed make it, but finding it takes some effort. The obvious place to look is under Publications and from there under "Publications and Brochures." That will net you references to two brochures: (6-23) "How to Use a Condom" and its Spanish companion (6-23a). The asterisk after each, however, asserts that you must be a "professional" in order to order the brochure. (I'm pretty sure that the humor was unintended.)

I had to have help from a DSHS employee to find the next links. A search of the site assured me that two fact sheets on condoms did in fact exist on the site, but where were they? How would a member of the public find them? With a little help, we managed to locate them in the section: "What are HIV and STDs?" Under the heading: "Information about STD transmssion (sic) and testing." Not under "Information about HIV transmission and testing." And not under anything that would point you to the concept of prevention.

I suspect that there will be some reworking of the new site so that things are easier to find, especially for the general public looking for prevention information. I'm also thinking it may be time to mirror some of these things on Texas AIDS Net . . .

Checking out the new Blogger

Spent some time yesterday dinking around with the new version of Blogger, called, cleverly enough, Blogger Beta. I'm with Peggy Lee on this: is that all there is? I was, as you can guess, underwhelmed.

I'm normally a BIG fan of just about anything Google does (well, except for that China thing), but they've missed the boat on this one. It really is a "beta," and not much of one at that.

Why am I kvetching about this on an AIDS blog? Well, it's a blog--and Blogger is what we have to work with right now. Either I learn a lot more about CSS and HTML than I ever wanted to know so we can have a better interface here, or the Blogger team (which already knows this stuff) makes it work for us.

Here's what's missing:

• Better templates (the instructions are not clear to a novice, the options are too limited, where are the new ones?)
• More features (it's nice that Blogger is finally going to add categories and blog rolls, but where is the connection to Google Earth or Calendar or all those other features?)
• Privacy issues (I'm blogging with my real name because this is an "official" blog; what about folks who want some pseudonymity in their blogging? what about folks who have both official and personal blogs? linking everything to your Gmail account makes it hard to keep those separate)
• Three columns (duh!)
• Statistics (duh!)

There are probably more issues, but these are the ones that popped up on the first pass. I think we'll wait until the "beta" goes away before looking at it again.

/rant

Routine testing on its way?

Todays' CDC Prevention News included a clip from the Fort Wayne (IN) Journal-Gazette regarding the possibility of a recommendation for routine HIV testing in the U.S. The story was a nicely done "local take" on a national issue. I'm guessing that the CDC included this item in its news roundup because overall reporting on the issue is comparatively slim, and this story helps keep the issue floating about in the HIV community.

Even though the article includes a caveat from "CDC spokesperson" Tammy Nunnally that the policy is only under consideration, I fully expect that the next few months will bring it to reality. If so, we'll see something like a quasi-voluntary testing policy (you will be tested unless you refuse) that "offers" the test to every person between the ages of 16 and 60 (or thereabouts) when they enter the health care system. Presumably this would include private as well as public health elements of the system.

The reasons being offered for shifting to routine testing seem to boil down to two things: simplifying testing (by removing mandatory counseling components) and the hope that this policy will duplicate the success of routine testing for pregnant women in reducing new HIV infections. And, of course, the possibility of offering routine testing is assisted by the availability of new tests which provide results in a matter of minutes rather than the wait of two weeks needed in the past.

The results expected include an overall "social desensitization" to HIV testing. Right now, there is sufficient stigma associated with HIV testing, that many who are at risk do not get tested for fear of that stigma. Given that such tests are supposed to be confidential, that whole issue speaks ill of our health care system that it cannot be trusted to keep the mere fact of being tested for HIV confidential. If HIV testing becomes routine, perhaps there will be a concomitant effort to increase the sensitivity of health care providers, especially in the private sector, to handle the results more discreetly.

There is nothing in this proposal, however, that would help with "social desensitization" to an HIV diagnosis. We still remain a society that will judge a person for his/her health status before we are moved to compassion regarding that same health status.

New web site for Texas HIV Bureau

The HIV Bureau (yeah, that's not it's name anymore, w/e) has a new website with a new look. Three years after the Department of State Health Services arose from the ashes (thanks, Arlene) of the old Texas Department of Health, the HIV Bureau is now being added to the Department's website as a full-fledged section rather than as a link to a legacy site. (That probably doesn't matter to the rest of the world, but I always found it curious that it HIV managed to hang out in limbo so long.)

The new web address: http://www.dshs.state.tx.us/hivstd/default.shtm.

The "home page" shows the new look--which is just like the (bland) DSHS look--with links to other sections of the department's web site. The left side of the page holds the HIV Bureau's links, and I have to say that they are now much easier for me to read and to distinguish one from another. I am more familiar with some sections of the old site than with others.

In those cases where I have some familiarity, it looks like nothing has been lost in the transition. I'd be curious to know what you find in looking at the site.

America is Africa?

So says Patrick Moore in his op ed for Long Island Newsday, and I couldn't agree more. He makes his comparison thusly:

But, in large parts of this country, America is Africa. With skyrocketing infection rates, poverty, lack of health insurance and a paucity of doctors, people with AIDS in the American rural South face prospects almost as grim as people living with AIDS in Africa.

The Kaiser Daily HIV/AIDS Report gives this summary of his op ed (emphasis added):

Over the last few years, the U.S. increasingly has "turned its attention" to the HIV/AIDS "crisis" in Africa even though in "large parts of this country, America is Africa," Patrick Moore, author of "Tweaked: A Crystal Meth Memoir," writes in a Long Island Newsday opinion piece. "With skyrocketing infection rates, poverty, lack of health insurance and a paucity of doctors, people with AIDS in the American rural South face prospects almost as grim as people living with AIDS in Africa," Moore writes. According to Moore, the "deeper story" of how HIV/AIDS in parts of the U.S. compares to the situation in developing countries "involves not just racism but our national character as a whole." The U.S. tends to "bounce along from one crisis to another, without addressing underlying, persistent problems," such as injection drug use, poverty and the "failure of the American health care system," Moore writes. According to Moore, the "solution" to fighting domestic HIV/AIDS is "not to reapportion a shrinking pool of existing funds but to increase the funding to appropriate levels for the entire country." Moore writes, "None of this is to argue that we should decrease funding to AIDS programs in Africa," concluding, "In fact, we can have greater compassion for Africa if we understand that this disease remains a crisis at home as well. When that awareness is achieved, we can be proud to say America is Africa" (Moore, Long Island Newsday, 9/6).

I could have highlighted several other phrases, but I focused on the funding issue because that one seems to be the easiest and simplest to deal with. Issues of national character (bouncing along the surface of crises without dealing with underlying causes) and chronic infrastructural probems (failure of the health care system) are neither attractive to policy makers nor amenable to solution in the near term. Full funding for the Ryan White CARE Act is. Doing so should take nothing, of course, from concern and support for dealing with HIV in Africa. That's a serious issue and really is in our national interest to address--completely apart from the humanitarian issues there. We should not, however, allow the media or policymakers to distract us--or themselves--from the serious issue of HIV at home by focusing more attention on Africa than on America when there are waiting lists for medications in this country, when people on those waiting lists die for lack of medication, when AIDS drug assistance programs cannot provide all of the medications that are needed to meet the standard of care for this nation in this nation.

Where the epidemic is now

CDC Prevention News cites the following research study:

"Epidemiology of HIV and AIDS Among Adolescents and Young Adults in the United States" Journal of Adolescent Health Vol. 39; No. 2: P. 156-163 (08..06):: María C. Rangel, MD, PhD; Loretta Gavin, MPH, PhD: Christie Reed, MD, MPH, FAAP; Mary G. Fowler, MD; Lisa M. Lee, PhD

The study's conclusion:

National case surveillance data for people ages 13-24 revealed that the burden of HIV/AIDS falls most heavily on the Southern region of the country and disproportionately on black and Hispanic youth, the study found. "The observed increases in the number of HIV cases among men who have sex with men are congruent with recent reports that suggest a resurgence of HIV among these young men," the authors noted. "Our findings highlight the need for intensified HIV prevention efforts within minority communities and among men who have sex with men as well as strengthened efforts to encourage at-risk youth to get tested for
HIV," the researchers concluded.

The epidemic is now hitting young people, especially young men who have sex with men, especially black and hispanic youth. Trends show a decline in reported HIV cases among women. In some ways, there might be a tendency to say "we're back where we started." I, however, am thinking that the whole thing is rather like whack-a-mole. You hit it here, and it pops up there. Without a comprehensive approach to prevention, one that goes beyond "just say no," any strong emphasis on one demographic group may lead another group to think that it is not at risk.

Maybe we shouldn't talk about where the epidemic is now, but emphasize that the epidemic shifts. It gains a foothold in one social network and spreads there; awareness and prevention may reduce or eliminate (we can wish) the infection rate in that community, but the virus can easily spread to another where individuals have been less vigilent. Just a thought.

RWCA: Reauthorization vs. funding

CDC's Prevention News includes the following story from the Washington Blade:

UNITED STATES: "Congress Poised to Renew Ryan White Act" Washington Blade (09.01.06):: Joshua Lynsen

A revised formula for the Ryan White CARE Act is expected to be unveiled in the House in the next week, one year after the act that provides more than $2 billion in federal funding for people living with HIV/AIDS expired. Renewal of Ryan White has been hampered by political infighting and bureaucratic procedures. Revisions to the act will likely see money distributed based on a state's total number of HIV cases, not just AIDS cases. Activists fear such a change, combined with the act's flat funding, could take money away from states and cities that have had longtime epidemics. "A certain amount of redistribution has to be done," said Edward Hopkins, director of federal affairs for the San Francisco AIDS Foundation. "But it can't be done in a way that dismantles the systems of care that already exist." Some legislators were aiming to pass the act by the end of the month, said Hopkins. Critics worry the revised formula will benefit rural regions at the expense of metropolitan areas. The new plan is widely expected to be a reworked version of a Senate plan offered earlier this year by Tom Coburn (R-Okla.). Hillary Clinton (D-N.Y.) in May cast the lone dissenting vote to approve that version in the Senate Committee on Health, Education, Labor and Pensions, arguing her state could lose $20 million under the proposed revisions. Dr. Patricia Hawkins, associate director for policy and external affairs at the Whitman-Walker Clinic in Washington, D.C., said the House plan includes a "hold harmless provision" to limit jurisdictions from losing more than 10 percent of their previous allocation. "That might protect us to some degree," she said. "But the next year, you lose more money, and the next year you lose more money, and so on," she suggested. Activists agree that what is needed is increased funding for the act. While current Ryan White allocations may appear impressive, said AIDS Action Council Executive Director Rebecca Haag, they remain insufficient. "The reality is that we need additional funding to meet that unmet need."

And so it goes. Every time the Ryan White CARE Act comes up for reauthorization, there is a battle over the funding formula. In one of the most unseemly legislative battles one can imagine, people who care for people are forced to fight each other so that they can continue to take care of the people that they care for. Notice that I didn't say "take better care" of those people, just "continue to take care" of them.

The issue is not really whether the Title I cities are getting too much money or the Title II areas getting too little. It's whether Congress ever really wanted to care for those same people and provide the funding necessary to do so. Twenty-five years ago, people really did die on the streets of America--from AIDS. For all of the commitment that Congress has shown these past five years to preventing that from recurring, we may see it again.

A little metablogging

I'm looking back over the month of August (yes, I didn't post much; no, I'm probably not going to back post; yes, it was an awful month) and checking up on user stats.

• It was nice to see Texas folks drop by the site. They came from Austin, McKinney, DeSoto, Dallas, Plano, San Antonio, Duncanville, Houston, and Tyler last month.
• It's interesting to see how the ClustrMap is developing. I haven't gotten around to finding another mapping service; this one may or may not redeem itself. The date on the current map doesn't coordinate with the numbers. I'm pretty sure that that lone dot off on the right side of Africa is supposed to be in Tanzania, not Uganda (hi, Jen). But it's always nice to see lots of dots from lots of places, and another tracking service (Tracksy) is telling me that people really are coming from from various parts of the world for one reason or another. Brazil may show up on the map eventually (at least, Tracksy suggests that it will), giving us (at last) "full coverage" of the continents.
• We noticed that a couple of people tried to sign up as email subscribers in the past few weeks and then didn't show up on the subscriber list. I contacted FeedBlitz about this, wondering if there was some glitch with the feed (or their software). The problem seems to be that signing up is a two-step process. You enter your email address to subscribe and then you confirm your subscription when a confirmation email is sent to that address. If this is not the problem, please let me know.
• ZoomClouds, who provides our current tag cloud is now definitely a keeper. I am tinkering with the format a bit, trying to change the background and setting things up so that the search results that come from clicking on a link pop up in a new window (so you don't lose your place on the blog), but we can only wait and see how well my tinkering works. The good news (for me, at least) is that ZoomClouds has added statistics to its service. I'm sure that I will eventually learn a great deal from these stats about the things that readers are looking for and how to provide more of it. One thing that I have learned already is that you are using the tag cloud to get around the site. In June, for example, you used the tag cloud 273 times to find information on the site. Cool beans. One thing that I can already see from the links that you have clicked is that there are some really weird tags showing up. What I long for is the day that Blogger actually allows for creating tags on each post. Won't that be fun?

And that's it for this month's meta. Unless I think of something else or decide to do more tinkering.

Gay community tired of AIDS?

And so are we all. Sick of it. Bored with it. Depressed by it. Don't want to talk about it, think about it, see it.

And yet it doesn't seem to go away. Jose Antonio Vargas writes for the Washington Post about DC Young Gay Positives, a social and support organization for HIV-positive young gay men in Washington, DC. The story profiles Josh, a recently diagnosed young man who is having trouble adjusting to his HIV status, and Henderson, an older gay man, still comparatively recently diagnosed, who is active in the organization and trying to help others. While the thrust of the story is the apparent social divide between gay men who are positive and those who are not and the apparent AIDS fatigue that explains the divide, the description of the lives of these two men and the social context in which they live is enlightening.

While the focus of the story is on the DC gay community, it may as well be on US society at large: the denial of HIV as a health risk, the social divide between those who are positive and those who are not, the stigma at work and elsewhere, the increasing risk for young people while effective prevention messages are contradicted by media and social institutions.

Appalling journalism: when hacks write tabloid crap

It is possible that some of the coverage of the International AIDS Conference will take a neutral point of view. It is even possible that some of it, although probably a smaller percentage, will describe the research being presented at the conference in clear and scientifically accurate terms. It is, however, absolutely certain that much of the coverage of the conference will present garbled information, sensationalized to sell the story and, far too often, emphasize the storyline that AIDS is controversial and the people who have it are immoral.

Case in point: Time's "Giving AIDS Drugs to Prevent Infection," by Christine Gorman. She begins her article in a manner sure to get attention:

You think giving condoms to high school kids is controversial? How about giving anti-AIDS drugs to folks who aren’t HIV-positive so that they can continue working as prostitutes or engaging in sex without having to worry about their partner's HIV status?

Note the parallelism of the word "giving." In the one case, the reference is to handing out an item for free. In the second case, the reference may be the same, but it may also be to the act of prescribing something that an individual would then purchase. There is no indication in the article that there may be any distinction between the two acts of "giving." There is also no indication of who might be doing the giving or how the gift is paid for. Yet the comment section following the article shows just exactly the reaction this introduction was intended to elicit: "I'm tired of spending my tax dollars . . ."

Gorman's story, despite its benign title, is all about controversy. This includes the fact that some branches of the research trial testing PrEP have been shut down, that there are moral concerns about the prevention strategy being studied, that there may be medical issues related to long term exposure to the drugs used in PrEP. There is little about the prevention context of this research; nothing that would help a reader understand its importance to women or discordant couples. Her emphasis leads the reader directly to mental images of orgy and irresponsible welfare leeches.

I don't often react this strongly to a news story. It could be blood sugar issue. And I'm no great personal fan of PrEP. However, I think it's time to give this sort of journalism a label ("tabloid crap") and this sort of journalist a title ("hack"). Time Magazine has done a better job of covering AIDS issues in the past; someone should have a little chat with the editor who allowed this garbage to get through. As for Ms. Gorman, she should just cross her legs. Then she'll never have to worry about PrEP. I don't know what it would take to get her to stop writing, but maybe she'll take an interest in fashion or celebrity home decor. That might be more suited to her style.

Human rights and HIV prevention/care

I've been reading with interest the news coverage (and sometimes lack of it) of Human Rights Watch's statement about the effects of human rights abuses in Zimbabwe on HIV prevention and care. Appropriately enough, the coverage focuses, as it was intended to, on the specific issues of discrimination against and persecution of persons with HIV and AIDS in that African nation, noting that these abuses hinder the fight against HIV, even spreading it further.

I'm not seeing much coverage of the report in the U.S., however. This doesn't particularly surprise me. And, if there were such coverage, it would also not surprise me if the reporters failed to make a connection between Zimbabwe and the U.S. or, for that matter, Texas.

I'll just help them out a little. While we don't seem to be bulldozing houses where people with HIV/AIDS live in Texas nor do we show overt patterns of exclusion from health care (on the basis of health status), we still have our little human rights quirks.

Nearly every one of the providers with whom we spoke reported serious violations of medical privacy. In New Mexico, a patient first learned that he was HIV-positive from a receptionist in front of a waiting room full of people. Police in St. Louis found a young man's HIV medication when they searched his car and disclosed his HIV status to his father, saying he had a right to know. The New York City Department of Health disclosed a person's HIV status to his employer. A teacher in Florida informed an entire class that a particular student was HIV positive. A receptionist at a nursing home in Texas told a woman that the man holding her baby might give it AIDS. These incidents are likely the tip of the iceberg, for even people who reported egregious breaches of confidentiality were typically too afraid to confront the problem if it meant disclosing their HIV status to more people. Nevertheless, such breaches of confidentiality can and do unravel HIV-positive people's lives. After their HIV status was disclosed, several people were literally driven out of Paris, Texas with hate mail and vandalism of their homes.

Actually, that passage is from an ACLU study, completed in 2003. Notice how often "Texas" occurs as a keyword in that passage. Somehow I doubt things have changed all that much in the past 36 months.

And what this means is: fear of loss of confidentiality, reluctance to get tested, continued spread of HIV, continuing disparaties in accessing health services even when services are available.

Confusion about the doughnut hole

The New York Times looks at consumers' pain with the doughnut hole, the gap in coverage for the Medicare prescription drug plan. It turns out that consumers are not the only ones confused about this gap. Count me as confused, and, I'd say, count a fair number of the people who are trying to help consumers enroll as misinformed.

Other beneficiaries have underestimated the size of the coverage gap. They incorrectly believed that it would run from $2,250 to $3,600, the figures emphasized in brochures published by the government and insurance companies.

In fact, the coverage gap is twice as large as those numbers would suggest. The $2,250 is a measure of total drug spending. The $3,600 is a measure of out-of-pocket costs; it corresponds to about $5,100 in total drug spending. Under the standard benefit, a consumer is personally responsible for $2,850 of drug spending in the coverage gap — the amount from $2,250 to $5,100.

If I understand this, the initial coverage is calculated on the cost of the medications that a consumer receives. What the consumer pays does not matter. While the initial amount of $2,250 was set there because that was the average cost paid by Medicare consumers for medications prior to the introduction of this benefit, the program is not counting consumer cost but cost to the program for medications. That means, of course, that those with only average or below average medication needs might save some money on the program--if premiums and co-pays do not exceed what they paid for medications in the past. With a 25 percent co-pay, this first segment of coverage involves consumers paying $562.50 for $2,250 in medications, plus the monthly cost of premiums.

For those with "above average" medication needs, say someone with HIV, the program counts the cost of medications up to $2,250--not counting premiums and co-pays--and then counts out-of-pocket expenses--premiums, co-pays, medication costs--in the gap before beginning catastrophic coverage. The co-pay is 100 percent of $2850 in medications, plus the cost of monthly premiums.

The total that the consumer would pay in drug costs prior to catatrophic coverage is apparently $3,412.50. Is the remainder the estimated cost of premiums? What a cockamammy program!

Web site collects HIV/AIDS prevention videos

Eric Krock, Executive Director of AIDSvideos.org, has sent us a notice that this organization has been

busy creating a free basic HIV/AIDS video curriculum in English. On the web site, you can already see:
- Introduction to HIV and AIDS: What You Need to Know (17 min.)
- Top Ten Myths About HIV/AIDS (9 min.)
- Crystal Methamphetamine and HIV: The Connection (7 min.)

Krock says that the curriculum will be rounded out with a video on prevention for positives and one on sterilizing drug works in the near future. The next phase of the organization's work includes getting this basic "doctor-approved" curriculum translated and filmed in "every language in the world."

In the meantime, the site provides links to videos already available in other languages and English from several other organizations, including PBS, faith-based organizations, and others.

The videos are free for viewing online or for downloading. The site takes a neutral point of view, but acknowledges that some of the video sources to which it links may not. This looks like a good resource for prevention workers and for individuals seeking prevention information.

Community forum in Brazos Valley

Another dink-around, and I found an interesting new resource from the Brazos Valley area. It's called "Consumer Connection," and it is an online discussion board for "those who are infected or affected by HIV/AIDS." The forum is managed by Christopher Hamilton, MPH, a planner with the Brazos Valley Council of Governments. BVCOG is the administrative agency for Ryan White planning and services in the central Texas area.

Topic areas include planning, events, stigma, medications, local meetings, and so on. While some of the discussion has a local flair, there is focus on state and national concerns. It's worth a visit.

XVI International AIDS Conference online

The International AIDS Conference will be held in Toronto (Canada, not Texas*) next month. The Kasiser Family Foundation will be the official web casters. Some parts of the conference will be available on the web in real time for free. Others will be available later, along with transscripts. Texas AIDS Network will (attempt to) carry headlines provided by KFF on our website for easy updates.

*Yep, there really is a Toronto, Texas. It's out there off Hwy 67 between Alpine and Marfa, which is why neither of us have ever heard of it before. Now I'm curious to know more about it, but that's for another day.

"Sweeping" changes to Medicare

I am puzzled by this and trying to track down more information. Apparently the feds are changing their payment system for Medicare, getting ready to adopt a new software system (from [what a shock] a no-bid contract with 3M). There's a lot of squealing going on. I was around during the transition to DRG's (diagnosis related groups) and their threat to the Free World, and this is all sounding somewhat similar.

From the squealing, it's clear that some things will be reimbursed at lower rates, e.g., hip transplants. There's not information that I can see about where increased reimbursement is going to happen--and that is the part of the story that is missing so far. The feds are apparently going to shift things around, pay more for some things, less for others, not save any money, just make things a little more in line with current thinking about health care priorities.

Now I don't know what those priorities are and where the money is going. I'd save the squealing until we see the whole picture here.

Local funding cuts in Denton County

It's almost a sign of the times, some would say. The temperatures are soaring. Hurricane season is upon up. And Texas is cutting funds to social services. Why should we be surprised?

This time the cuts are in Denton County, according to Ava Thomas Benson, reporting for the Denton Record-Chronicle and republished in the Dallas Morning News. Among the agencies facing cuts is AIDS Services of North Texas. The rationale for the cuts is that the county is only going to fund those agencies that provide the services that the county would have to provide anyway--that is, they don't want to raise taxes to pay for health and social services. It's a Texas thing.