Important Happenings in HIV/Health Policy

Important Happenings in
HIV/Health Policy

Week Ending: July 13, 2018
By: Matthew Rose & Sable K. Nelson

Ryan White Funding Clarification
A recent Slate article reported that internal documents from the Office of Refugee Resettlement, an agency within the Administration for Children and Families, which is itself a division of the Department of Health and Human Services (HHS), indicate that HHS plans to pay for child separation by reallocating money from the Ryan White HIV/AIDS ProgramNMAC has been in direct communication with the HIV/AIDS Bureau (HAB) at the Health Resources Services Administration (HRSA). There are four (4) important pieces to mention:

  1. The funds that are allegedly being transferred are from Fiscal Year (FY) 2016 funds that were returned to HHS after not being spent by eligible Ryan White grantees.
  2. HAB staff was unable to state exactly how much FY 2016 funding was being transferred.
  3. However, it was very clear that those funds do not have any impact on the operation or schedule of Ryan White funding for FY 2018 or can the be used by any current parts of the Ryan White Program.
  4. The HHS Secretary has limited authority (generally referred to as “transfer authority”) to shift funding between accounts and programs when specified by law. That authority is limited to discretionary accounts and no appropriation may decrease its budget by more than one percent.

 

Appropriations Update
After a marathon 13-hour markup that touched on a range of contentious issues including the Affordable Care Act, abortion, and the Trump administration’s separation of migrant families at the border, members of the House Appropriations Committee voted along party lines (30-22 vote) to approve a $177.1 billion Labor-HHS-Education spending bill for fiscal year 2019. The panel ultimately adopted 18 amendments, with 14 coming from Democrats and another four offered by Republicans. The vote keeps the legislation on track for full House floor consideration, though several of its most controversial provisions would be unlikely to survive once action shifts to the Senate, where the 60-vote threshold requires support from some Democrats. For more information, READ → https://www.fiercehealthcare.com/hospitals-health-systems/house-lawmakers-take-aim-at-family-separations-during-hhs-appropriations

 

CMS Expected to Propose Cuts to More 340B Providers
The Centers for Medicare and Medicaid Services (CMS) is expected to expand the number of 340B health facilities that will be impacted by payment cuts for all physician-administered drugs. The proposed rule would slash Medicare Part B drug payments to 340B hospital outpatient facilities offsite by nearly 30 percent. The change is expected in the proposed 2019 Physician Fee Schedule Rule, which could be released as early as Thursday of next week. It would impact hospitals that qualify for the 340B program’s steep drug discounts because they serve a disproportionate share of low-income and under-insured patients. The Trump administration has cited the 2018 change in payment to 340B facilities as a move to lower drug costs. It estimated Medicare beneficiaries would save about $320 million on drug co-payments in 2018 because patients’ out-of-pocket costs are tied to what Medicare is billed for the drugs. The administration maintained that the lower reimbursement rate is closer to what hospitals pay for the drugs. Hospitals in the program say 340B was specifically intended to pay more because of the challenges of the populations they serve. For more information, READ → https://www.politico.com/newsletters/politico-pulse/2018/07/12/cms-expected-to-propose-cuts-to-more-340b-providers-276689


What You Can Do
TAKE ACTION: It is very important that our elected officials hear from us to protect federal HIV funding for HIV prevention and care.  Speak truth to power by sharing your personal stories with your elected officials. It is vitally important to meet to your federal elected officials when they are at home. If we don’t support and advocate for HIV funding and programs, who will?  Our movement cannot afford to stand on the sidelines.  Your U.S. Senators and U.S. Representatives need to hear from you. 

Also, MAKE SURE THAT YOU ARE REGISTERED TO VOTE in time for the primary and general elections happening this year!

Minnesota 7/24/2018
Wisconsin 7/25/2018

For more information, VISIT→ https://www.eac.gov/voters/register-and-vote-in-your-state/

Finally, PARTICIPATE IN THE PRIMARY ELECTION(S) in your state!!!

For more information, VISIT→ http://www.ncsl.org/research/elections-and-campaigns/2018-state-primary-election-dates.aspx

 

Opportunities for Input: Let Your Voice be Heard

Leading up to the US Conference on AIDS (USCA) in September, Act Now: End AIDS will solicit community input to inform the creation of an federal plan to end the epidemic. It’s important that we hear from affected communities from around the country in four primary ways:

  1. An online recommendation form at https://survey.co1.qualtrics.com/jfe/form/SV_eWde8Hsj4p0L4UJ . SUBMISSIONS DUE BY AUGUST 10TH.
  2. Online webinars covering key recommendation topics ( prevention and testing, care and treatment, structural interventions, research, viral hepatitis, sexually transmitted infections, opioids and the overdose epidemic, data and metrics.
  3. Web-based meetings and conference calls led by and soliciting input from specific affected communities
  4. An in person pre-USCA meeting to discuss an early draft of the plan to be held on September 5th in Orlando, FL

We invite you to use any and all of these options to provide recommendations for the plan. The online form may be used for as many recommendations as you want to submit. While individuals are absolutely invited to submit online recommendation forms, we also encourage submissions from groups.


What NMAC is Doing About It

  • NMAC remains vigilant in its advocacy to protect FY19 government funding and the existence of the social safety net.
  • NMAC releaseda Biomedical HIV Prevention “Blueprint” entitled Expanding Access to Biomedical HIV Prevention: Tailoring Approaches for Effectively Serving Communities of Color, a new report that establishes strategies to effectively use techniques such as Pre-Exposure Prophylaxis (PrEP) and Treatment as Prevention (TasP) to end the HIV epidemic in communities of color. The full report can be found by visiting nmac.org/blueprint.
  • NMAC will continue to meet with the administration around priority areas of people of color, pushing for greater access to coverage and making them aware of the challenges affecting people of color
  • NMAC is coordinating three of the ending the epidemic stakeholder calls for older adults, Native Americans, and Asian Pacific islanders.

INPUT REQUESTED: A National Community-Led Plan to End HIV/AIDS as an Epidemic

Since 2014, several U.S. cities, counties, and states have announced Ending the Epidemic (EtE) plans. What makes these initiatives unique– in addition to their ambition– is that they are driven by community leaders, including people living with HIV. In the spirit of the Denver Principles, these plans should be by and for those communities directly impacted by the epidemic.

Recently, the Trump administration has announced that it will be drafting its own national EtE plan by mid 2019. This obviously raises many concerns. First and foremost, can the drafting of such a plan possibly truly be led by the communities disproportionately impacted by the epidemic, when these very communities are facing direct attacks by the current administration?

In order to preserve the community-led spirit of EtE work, Act Now End AIDS (ANEA) – a national coalition of EtE leaders – intends to draft a community-led national plan. We will engage in a broad, multi-tiered process to collect as much information from impacted communities around the country as possible in order to accurately reflect what we need to end the HIV epidemic for all of us.

But for this process to work, WE WILL NEED YOUR HELP!

Below you will find more detailed instructions on how you, your organization, or your coalition can submit recommendations to be part of the national plan. Here are four main ways to provide input:

  1. An online recommendation form https://survey.co1.qualtrics.com/jfe/form/SV_eWde8Hsj4p0L4UJ. SUBMISSIONS DUE BY AUGUST 10TH.
  2. Online webinars covering key recommendation topics (prevention and testing, care and treatment, structural interventions, research, viral hepatitis, sexually transmitted infections, opioids and the overdose epidemic, data and metrics)
  3. Web-based discussions and conference calls led by and soliciting input from specific affected communities
  4. An in person pre-USCA meeting to discuss an early draft of the plan to be held on September 5th in Orlando, FL

***If conference calls or web-based opportunities to provide input do not work for you or if you do not have access to these methods of providing input, please contact Alex Smith, Senior Policy Manager for AIDS United, by email at (asmith@aidsunited.org) by phone at (202) 876-2840 to make arrangements for providing input.

We invite you to use any and all of these options to provide recommendations for the plan. The online form may be used for as many recommendations as you want to submit. While individuals are absolutely invited to submit online recommendation forms, we also encourage submissions from groups.

Web-based discussions and conference calls will be announced over the month of July. We invite you to sign up for the ANEA  listserv at https://groups.google.com/forum/#!forum/act-now-end-aids-distribution/join in order to keep up to date. We will also be providing more information on the in person gathering in Orlando.

We look forward to hearing from communities impacted by HIV from all around the country over the next few months as we engage in this ambitious national planning process. If you have any questions or concerns at all, please asmith@aidsunited.org. Together, we can ensure that community leads the way toward the end of the HIV epidemic.

 

Summary of the Learning Collaborative

Between June 24-27, 2018 NMAC’s Treatment Division hosted a Pre-Exposure Prophylaxis (PrEP) Learning Collaborative. This meeting was part of the culminating activity for our PrEP Education and Awareness Program. At the PrEP Learning Collaborative, nearly 20 leaders from communities of color, primarily representing southern and/or rural jurisdictions across the United States, met in Washington DC to discuss the story behind the racial and ethnic disparities that exist as it relates to PrEP uptake. This conversation took place at the intersection of identities (race, ethnicity, gender, and sexual identity) and socio-structural factors that influence where people play, work, and sleep. Stakeholders from various perspectives of the PrEP cascade (individuals who have been prescribed PrEP, PrEP Navigators, PrEP providers, community based organizations, health departments as well as AIDS Education and Training Centers) shared their perspective and expertise to collaboratively develop a framework to mitigate cost, service and access issues which vary at the local, state and federal level. In order to address these issues, clear and concise policies must be developed and implemented to allow to provide guidance and set long-term standards that will increase use of PrEP (a proven life-saving solution). Specifically, with the rise of HIV diagnoses among gay men of color, it is crucial to educate not only young Black and Latino MSM but also health navigators and service providers. They must learn about policies that facilitate access to PrEP, related services, cost, and access points. As a result of this Learning Collaborative, NMAC shall release a practice-based resource, in the form of a book, guide, or manual for community leaders and clinical providers on how to increase the use of PrEP among people of color at our 2018 Biomedical HIV Prevention Summit in Los Angeles, CA.

NMAC Recognizes National HIV Testing Day

National HIV Testing Day Statement

Today (June 27) marked National HIV Testing Day! I encourage our NMAC Community to use what this day means by holding ourselves and our loved ones accountable. Each of us should be committed to making sure that we know our status (AND that those we care about know their status).

According to the CDC, an estimated 1,122,900 adults and adolescents were living with HIV at the end of 2015 in the United States. Of those, 162,500 (15 percent) were not aware of their status. While this is a relative decrease, population specific disparities exist. For example, being unaware of one’s status is particularly prevalent in youth. According to the CDC, among people aged 13-24 with HIV, an estimated 51 percent didn’t know their status when they tested positive. Since communities of color, especially in the south, are disproportionately impacted by HIV, it is imperative that we harness our collective power to change this narrative.

Right now, we have the behavioral and biomedical tools to prevent HIV. Knowing your status is the first step in ending the epidemic. From there, the goal is two-fold: (1) in the event that an individual tests positive, we must link those individuals to care and set them on the path to treatment adherence and/or viral suppression; and (2) in the event that an individual tests negative, we should educate that person about pre-exposure prophylaxis (PrEP). This week, Representative Barbara Watson Coleman (NJ-12) introduced a resolution written in consultation with NMAC and several national HIV and STD partners which encourages the U.S. House of Representatives to support increasing PrEP awareness and education in an attempt to reduce the number of seroconversions in the United States.

As an organization, NMAC is committed to doing all we can to end the HIV epidemic in the near future. In addition to my professional advocacy, I’m personally committed to #DoingItMyWay. At my well women’s exam earlier this month, I intentionally requested an HIV test. Both after taking the test and receiving the results, I also encouraged my partner, several of my sorority sisters, and cousins to empower themselves by doing the same. Can I count on you to get yourself or someone you care about tested for HIV today? For more information about where to get an HIV test near you, visit: https://locator.aids.gov/.

Yours in the Struggle,


Sable K. Nelson
Policy Analyst
NMAC

Statement from HIV, STD & Hepatitis Policy Partnership on Meeting with CDC Director Robert Redfield


 

Statement from HIV, STD & Hepatitis Policy Partnership on Meeting with CDC Director Robert Redfield

 

Washington, D.C. – Last week, the executive directors of the National HIV, STD & Hepatitis Policy Partnership met with Robert Redfield, M.D., the new director of the Centers for Disease Control & Prevention (CDC). During our very encouraging meeting, the partnership advanced a series of requests and had a productive discussion about ending the HIV epidemic and the intersecting epidemics of STDs, viral hepatitis and opioid misuse. Dr. Redfield committed to an ongoing collaboration and a process that would seek broad community input around any newly developed strategies to end these epidemics. We look forward to working with Dr. Redfield and his team as well as other relevant federal agencies and the community in realizing these goals.

The executive directors of the National H,I,V, S,T,D & Hepatitis Policy Partnership with Robert Redfield, M.D., the new director of the Centers for Disease Control & Prevention (CDC)
(L to R: Mitch Wolfe, Acting Director, CDC Washington Office; Paul Kawata, Executive Director, NMAC; Murray Penner, Executive Director, NASTAD; David Harvey, Executive Director, NCSD; Dr. Robert Redfield, Director, CDC; Jesse Milan, Jr., President & CEO, AIDS United; Michael Ruppal, Executive Director, The AIDS Institute; Jonathan Mermin, Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP))

 

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Transgender Community & HIV

Important Happenings in HIV/Health Policy

Important Happenings in HIV/Health Policy

Week Ending: June 15, 2018
By: Matthew Rose & Sable K. Nelson

House Marking Up Federal Fiscal Year 2019 Appropriations Bill

On Friday, June 15, 2018 the Labor, Health and Human Services (Labor-HHS) Subcommittee of the U.S. House Appropriation Committee marked up its Federal Fiscal Year 2019 (FY19) Appropriations bills. Passing along party lines, the House’s Labor HHS spending bill would increase HHS’s budget by $1 billion for FY19. “Markup” is the process by which a Congress debates, amends, and rewrites proposed legislation. An appropriations bill is a piece of legislation that sets money aside for specific government spending. This is the third step in the Federal Budget Process:

Here are the funding levels proposed by the House Labor-HHS Subcommittee for key HIV/AIDS programs:

The Senate version of the Labor-HHS spending bill set top-line spending $2 billion higher than the House version. It is unknown at this time how those funds will be allocated for each of the Senate Labor-HHS spending bill will be marked up in the upcoming days/weeks.

 

NEXT STEPS: In the coming weeks, tentatively scheduled for June 26, the full House Appropriations Committee is expected to mark up the Labor-HHS bill. It is likely that several Representatives will propose amendments targeting federal funding for programs impacting minority health, rural health, Title X family planning, operation of supervised consumption facilities, and programs affiliated with the Affordable Care Act that the current spending bill proposes reducing or eliminating.

 

CDC Releases its 2017 YRBS Data

The Centers for Disease Control and Prevention (CDC) released its latest data from its Youth Risk Behavior Surveillance System (YRBSS). The YRSSS monitors six categories of health-related behaviors that contribute to the leading causes of death and disability among youth and adults, including:

  • Behaviors that contribute to unintentional injuries and violence
  • Sexual behaviors related to unintended pregnancy and sexually transmitted diseases, including HIV infection
  • Alcohol and other drug use
  • Tobacco use
  • Unhealthy dietary behaviors
  • Inadequate physical activity

Below is a table that summarizes the “Progress At-A-Glance for Sexual Behavior Variables:”

For more information, READ → https://www.cdc.gov/healthyyouth/data/yrbs/index.htm; https://www.cdc.gov/healthyyouth/data/yrbs/pdf/trendsreport.pdf

 

What You Can Do

TAKE ACTION: It is very important that our elected officials hear from us to protect federal HIV funding for HIV prevention and care.  Speak truth to power by sharing your personal stories with your elected officials. It is vitally important to meet your federal elected officials when they are at home. If we don’t support and advocate for HIV funding and programs, who will?  Our movement cannot afford to stand on the sidelines.  Your U.S. Senators and U.S. Representatives need to hear from you.

 

Also, MAKE SURE THAT YOU ARE REGISTERED TO VOTE in time for the primary and general elections happening this year!

For more information, VISIT→ https://www.eac.gov/voters/register-and-vote-in-your-state/

 

Finally, PARTICIPATE IN THE PRIMARY ELECTION(S) in your state:

For more information, VISIT→ http://www.ncsl.org/research/elections-and-campaigns/2018-state-primary-election-dates.aspx


What NMAC is Doing About It

  • NMAC remains vigilant in its advocacy to protect FY19 government funding and the existence of the social safety net.
  • NMAC will meet with hill staff to support amendments that are favorable for our programs.
  • NMAC is also working with lawmakers to address PrEP access and HIV in the military in a new partnership.

Why You Need to Attend USCA!

This year’s United States Conference on AIDS is very important because the federal government will discuss its plan to end the HIV epidemic in America during a USCA plenary, then hold a town hall to collect feedback from attendees. Everyone needs to come prepared to share their thoughts on what it will take to make this happen.

Biomedical HIV prevention has given us real pathways to end the epidemic. U=U, PrEP, PEP, and TasP have made it possible to consider the end. However, it can’t happen without a plan.

While NMAC is encouraged by this development, we are also very concerned about working with this administration. Can we put aside our differences and work together? NMAC hopes the value of planning to end an epidemic that disproportionately impacts communities of color greatly outweighs the difficult politics. This will be a true test of our leadership and there are no guarantees.

There are many communities and organizations who want and need to be part of the process. NMAC supports and encourages multiple efforts. We are particularly excited about our work with the Coalition to End AIDS. Working collaboratively on a document from AIDS United, we will bring a consensus statement to USCA.

Let’s encourage the feds to create a real plan, not some bullshit paper that sits on a shelf. What have we learned over the last 37 years? HIV sits at the intersection of oppression, discrimination, and stigma. When the world turned its back on us, we did not wait to be saved; we saved ourselves and the people we loved. For many years we suffered unimaginable pain as we buried more people than we remember. Now we have the opportunity to build the plan to end the epidemic. What should the plan say about us? While the federal government will have its own process, NMAC calls on them to make community a full and equal partner. The new strategy needs input from the many sectors and communities highly impacted by HIV.

What innovations can we bring along with our efforts to end the HIV epidemic? For example, every time there is an HIV test, let’s also test for STDsand Hepatitis. These sexually transmitted infectious diseases are drivers for each other. Working to reduce any of these infections supports our overall efforts to end the HIV epidemic.

This process has the potential to implode. Community needs to monitor and work directly with multiple federal agencies. The specific agency plans are probably more important than the overall federal plan. HRSA, CDC, HUD, SAMHSA, NIH, NIAID, OAR, and other federal departments need to be accountable to community. We must be at the table as these plans are built, implemented, and reviewed.

The 2018 USCA is all about putting together the federal plan to end the HIV epidemic in America. If you want to be part of this process, then you need to attend the meeting. Just because we ask to be part of the process does not mean we support the final plan. Our support is not guaranteed. It depends on the plan’s level of community engagement, real biomedical HIV prevention initiatives that speak to the realities of the communities highly impacted by HIV, and funding to make it happen. If it’s a good plan, then the 2019 United States Conference on AIDS and the 2019 Biomedical HIV Prevention Summit will focus on its implementation. This is a multi-year effort that needs your engagement from the beginning. See you in Orlando!

CDC SURVEY SHOWS MIXED RESULTS FOR YOUTH ON HIV, OTHER STDS

For Immediate Release
Contact: Chip Lewis, 202.853.1846, clewis@nmac.org

 

CDC SURVEY SHOWS MIXED RESULTS
FOR YOUTH
ON HIV, OTHER STDS

 

June 15, 2018 – The Centers for Disease Control and Prevention (CDC)’s Morbidity and Mortality Weekly Report Surveillance Summary on the 2017 National Youth Risk Behavior Survey (YRBS) shows mixed results for youth, especially for youth of color when it comes to HIV and other STDs.

“While there were encouraging signs across all races and ethnicities in terms of decreased sexual activity, it is alarming that condom use dropped so significantly” said Linda H. Scruggs, Director of NMAC’s Leadership Pipeline and Youth Initiative. “This report indicates that youth, particularly youth of color, are engaging in riskier behavior and are at greater chance of contracting HIV or other STDs. It also shows that, with a decreased use of condoms, we will need to look at biomedical prevention methods, like Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP).”

“While there is no data in this update about LGBTQ youth, we know that data is coming soon and we look forward to seeing it,” said Scruggs.

“Through NMAC’s Youth Initiative and our Building Young Leaders of Color (BYLOC), we know that youth are eager to take a leadership role in the fight against HIV in their communities and with their peers,” said Scruggs. “The data from this update and coming updates gives them the information they need to effectively communicate with their peers and develop HIV fighting strategies for their communities.”

NMAC leads with race to urgently fight for health equity and racial justice to end the HIV epidemic in America. Since 1987, NMAC has advanced our mission through a variety of programs and services, including: a public policy education program, national and regional training conferences, a treatment and research program, numerous electronic and print materials, and a website: www.nmac.org. NMAC also serves as an association of AIDS service organizations, providing valuable information to community-based organizations, hospitals, clinics, and other groups assisting individuals and families affected by the HIV epidemic.

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HIV Funding at Risk! Call Your Reps Now!!

The Latest HIV & Health News From DC
On Friday, June 15, the Labor, Health and Human Services Subcommittee of the U.S. House Appropriations Committee will begin to mark up the Federal Fiscal Year 2019 Appropriations bills. Markup is the process by which a Congress debates, amends, and rewrites proposed legislation. That means we need you contact your Representatives and Senators and tell them to keep federal HIV funding! Read the latest update from our Policy Team.

 

Loss of Protection for Pre-Existing Conditions Will Hurt HIV Fight
The Trump Administration announcement that they will no longer defend the Affordable Care Act’s protections for people with preexisting conditions endangers health care coverage for people with pre-existing conditions like HIV, cancer, asthma, or diabetes, all of which have a disproportionate impact on communities of color. Read NMAC’s full statement.

 

NMAC Opposes Proposed Gag Rule on Medical Providers
NMAC opposes the Trump Administration’s proposed “gag rule” to remove Title X family planning funds from providers that offer abortion services or referrals. Such providers are a vital, life-saving point of entry to care for people living with HIV and to prevention services for those at higher risk for HIV, particularly people of color and those in lower-income communities. Read NMAC’s full statement.

 

Progress in National HIV/AIDS Strategy, But Much Work Still Ahead
The 2017 Progress Report on the National HIV/AIDS Strategy (link) released by the Department of Health and Human Services shows that progress is being made in some areas, but much work still needs to be done in other areas to not only reach the strategy’s goals for 2020 but to prevent any loss of progress made. Read NMAC’s full statement.

 

USCA Scholarship Deadline is June 29
Time is running out to apply for a USCA scholarship! The deadline to apply for an Option A or B Scholarship is 5:00 PM EST, Friday, June 29.

Scholarship A recipients will receive a non-transferrable complimentary conference registration. Those who qualify for Option B will receive a $100 travel subsidy, a non-transferrable complementary conference registration, and two nights lodging at the host hotel.

 

HIV & Transgender Community Spotlight Webinar is June 20
Join NMAC for our next Community Spotlight webinar on June 20, when we will look at HIV among Transgender Americans. Our presenters will be Luis Gutierrez-Mock, TRIUMPH Project Director at the Center of Excellence for Transgender Health and Aryah Lester, Conference Coordinator at NMAC. Register now.

 

Become an NMAC Member!
NMAC relies on the support of both individuals and organizations to advance its critical work to end the HIV epidemic in the U.S. Your generous support allows us to ensure that the voices of minorities vulnerable to and living with HIV are heard in Washington, DC. It also helps us provide our critical training, education activities, and programming. Become an NMAC member today!