The Election and the Epidemic

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The Election and the Epidemic
SPECIAL POST-ELECTION DOUBLE FEATURECHAMP
Strategy Lab Community Teleconference

• Aiming Higher for HIV Policies in the Next
  Administration and Congress

Wednesday, November 11, 2008400 530 PM EST
Co-sponsored by WORLD / Positive Womens Network
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Are We There Yet ???

• Mark Jason McLaurin
• Director of Public Policy and Legislative Affairs
• Public Justice Center
• mclaurinm_at_publicjustice.org

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Incredibly Hopeful Signs (With Warnings)

• Incredible motivation of core constituencies.
• Apparent lessening of black/brown tensions.
• The South Rises Again
• Danger of fraying of black/gay coalition.

4
Critical Congressional Gains

• Smaller, more homogenous ideological Freshman
  class.
• Banishing of long standing foes.
• Very Few have any experience in HIV/AIDS

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Administration- A Whole New World !!!

• Too soon to know for absolute certain posture of
  new administration on our issues but hopeful
  signs.
• Focus on efficacy rather than cost.
• Considerable groundwork has been laid !

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Your Mission (Should you choose to accept it,
and you will !!!)

• Arrange for an introductory meeting within the
  next ninety days with EITHER
• New Congressperson in your State (if not in
  district, find someone who is to join you).
• If no new Congressperson in your State, a member
  of the Black or Hispanic Caucus in your State.

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A Step Forward

• Mr. Kali Lindsey
• VP for Federal Government Affairs, NAPWA
  (National Association of People with AIDS)and
  Director for Federal Government Affairs, TAEP
  (Treatment Access Expansion Project)
• Klindsey_at_napwa.org
• [phone]

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Health Care Reform The Obama Method

• Guaranteed to all comers
• Will continue what is already in place
• Win for Americans, especially for people living
  with HIV
• No exclusion for pre-existing conditions,
  poverty, or pre-disability (ETHA)
• Employers must offer health insurance or pay fine
• Fines support National Health Plan (NHP)
• Paradigm shift to preventative health care

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Treatment as Prevention

• Diagnosis
• Knowledge is prevention.
• Healthcare and treatment access
• Available immediately
• Comprehensive and Quality Service
• Treat people with HIV/AIDS with respect and as
  agents
• Access to full and satisfying lives
• Research is showing treatment alone can lower
  incidence and improve health outcomes

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Leadership needed to say goodbye to stigma

• People with HIV are not criminals
• Criminality discourages testing
• Has not shown any benefits
• Imbalanced
• Zero tolerance for inequality
• Story-telling has far more utility than scaring
  people who are at-risk
• Outreach goes both ways

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Get active AIDSWatch 2009

• Silence is complicity Use your voice
• Choosing to be silent is unintended reinforcement
• What needs to be on the agenda?
• Community Unity
• We are all living with HIV/AIDS, what are we
  going to do about it?
• More than a one-night stand
• The more, the better!
• Start identifying resources today

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Visit Often

• National Association of People with AIDS (NAPWA)
• www.napwa.org
• Treatment Access Expansion Project (TAEP)
• www.taepusa.org
• NAPWA/TAEP Policy Reports
• www.poz.com

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Dennis DeLeon

• President
• Latino Commission on AIDS
• New York, NY

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HIV Prevention Policy Women

• Naina Khanna U.S. Positive Womens Network/
  WORLD/ National Women AIDS Collective
• nkhanna_at_womenhiv.org 510.681.1169

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HIV Among Women is driven by Structural
Determinants

• In many cases a womans vulnerability to HIV
  infection is independent of her personal
  behavioral risk factors
• Poverty, access to health care, stable housing,
  and unemployment are all risk factors for HIV
  among women
• According to the HIV Cost and Services
  Utilization Study (HCSUS), women were four times
  more likely than men to lack private health
  insurance at the time of HIV diagnosis.

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Surveillance Current Prevention Tools are
Failing Women

• Current CDC Surveillance system does not capture
  risk of women -- instead captures risk factor of
  male partner
• Therefore women are falling into No Identified
  Risk Category-- drives funding resource
  allocations including disincentive for testing
  low-risk populations --gt results in women being
  tested later and progressing to AIDS faster.
• There are currently no female-controlled
  prevention options - with gender inequality makes
  women vulnerable

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Executive Branch Favorable Overall

• Obama Platform for Women lists Health Care as 1
  and HIV/AIDS as priority 2
• Obama is cosponsor of Microbicides Development
  Act (MDA)
• Biden was original drafter of VAWA
• Equal Pay for Equal Work
• Lifting of Global Gag Rule
• Dr. Susan F. Wood on the transition team

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Still plenty to do

• Build support for Microbicides Development Act
• Push for a real living wage
• Increased resources funding for vaccine
  research
• Push for better surveillance expanded
  risk-targeting model that accounts for
  socio-economic determinants of vulnerability

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WOMENS HEALTH COMMUNITY HEALTH

• U.S. Positive Womens Network www.womenhiv.org/po
  sitivewomen
• National Women AIDS Collectivewww.ms.foundatio
  n.org
• HIV Vaccines and Microbicides Resource Tracking
  Working Grouphttp//www.hivresourcetracking.org/
  

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LGBT Health Mixed Election Results and the Way
Ahead

• Rebecca E. Fox
• National Coalition for LGBT Health
• Rebecca_at_lgbthealth.net

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Election Results and the Health of the LGBT
Community

• Federal Level
• President-Elect Obama
• Support of LGBT Rights (mostly)
• Focus on health disparities
• State Level
• Removal of Rights
• Marriage
• Adoption

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Moving Forward

• Need to create LGBT health infrastructure
• Data Collection
• Recognition
• Funding
• Programs

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Action Item

• Push for LGBT Data Collection
• Federal
• State
• Local
• Programmatic

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The Ask

• Tested questions for LGBT identity? 
• Do you consider yourself to be one or more of the
  following
• r     Straight
• r     Gay or lesbian
• r     Bisexual
• r     Transgender
• Add option for respondent to name another
  category if feasible for the survey

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HIV/AIDS Housing

• Christine Campbell
• Vice President, National Advocacy and Organizing,
  
• Housing Works, Inc.
• campbell_at_housingworks.org

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Housing Needs to be Part of the National AIDS
Strategy

• Half the people living with HIV/AIDS will need
  some form of housing assistance during the course
  of their illness
• The need for safe, affordable decent housing
  comes is 1st, 2nd, or 3rd in just about all
  community needs assessments
• Its more than just HOPWA Housing Opportunities
  for Persons living with AIDS

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Increasing HOPWA without increasing the rest of
the affordable housing portfolio does no good

• Need to pay attention to the National Housing
  Trust Fund, McKinney Vento, Housing Choice
  (Section 8) and HUD 811 for people with
  disabilities
• As with other areas of the HIV/AIDS community,
  need to work collectively with other area such as
  homeless, substance abuse, mental health, and
  other disabilities

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Research has shown that

• Safe, affordable decent housing improves health
  outcomes for PLWHAs
• Homelessness is a major risk factor for HIV and
  HIV is a major risk factor for homelessness
• persons who are stably housed are more likely to
  know their status and change in housing status is
  strongly associated with risk behavior change

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How to turn information into action!

• World AIDS Day in Washington DC
• Washington DC, in addition to its out of control
  incident rate, has at least 220 people on the
  HIV/AIDS Housing Waiting List
• Rally on North Capitol Street, 12 Noon, Demanding
  that DC place the people on the waiting list in
  safe affordable, decent housing by June 2009.

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Resources

• www.nationalaidshousing.org for further
  information on research, further information on
  HOPWA and other housing options
• www.nlichc.org for congressional district
  profiles and Out of reach report that gives you
  the living wage in your jurisdiction.
• www.c2ea.org for more on how you can take action
• www.housingworks.org

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Next steps for The National AIDS Strategy

• Chris Collins
• Coalition for a National AIDS Strategy
• www.nationalaidsstrategy.org
• info_at_nationalaidsstrategy.org

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Need a plan, not a patchwork

• Many HIV/AIDS programs have proven highly
  effective
• Hundreds of thousands infections averted
  thousands of lives saved and improved
• Many committed and talented people involved
• Significant, though insufficient, resources
• Yet in many ways the US response to HIV is a
  patchwork of uncoordinated programs
• Federal response does not have the strategic and
  coordinated approach needed to accomplish key
  goals, for example reducing incidence, increasing
  access to care, and reducing racial disparities

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Example reduce incidence

• CDC HIV prevention fails in government rating
  system
• Domestic HIV prevention efforts at the CDC are
  not performing and results are not
  demonstrated.
• CDCs Strategic Plan
• Less ambitious than previous plan does not set
  priorities and lay out strategies its 42
  objectives do not promote an outcomes focus
• Limited transparency of CDC funding
• Reliance on particular behavioral interventions,
  many developed long ago
• Prevention not well coordinated across agencies
• Need to connect testing to care to housing, etc

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Example increase care access utilization

• Institute of Medicine (2004) describes a
  fragmented system of care
• Fragmentation of insurance coverage and differing
  eligibility requirements and services across
  states, do not allow for comprehensive and
  sustained access to quality HIV care
• Limited coordination on the ground of HRSA,
  Medicare, Medicaid, Veterans Administration,
  CDC, HUD
• AIDS (not HIV) diagnosis required for Medicaid
• Limited consistent, quality data on care
  utilization and barriers to access and
  utilization
• Expanded insurance coverage will help greatly,
  but will not address many issues in care
  utilization

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Need coordinated effort, not a quick fix

• Many improvements should not wait for a NAS (e.g.
  funding increases and evidence-based policy)
• Long term need a reformed effort to tackle AIDS
  in America a more coordinated, accountable, and
  outcomes-oriented approach
• Bring the best prevention interventions to scale
• Assess and address barriers to care utilization
• Develop a true cross-agency plan on disparities
• Make spending transparent to enable
  accountability
• Set ambitious, achievable goals and make
  strategic choices to accomplish them

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Need for Presidential leadership ownership

• Obama has pledged that, in the first year of
  his presidency, he will develop and begin to
  implement a comprehensive national HIV/AIDS
  strategy that includes all federal agencies. The
  strategy will be designed to reduce HIV
  infections, increase access to care, and reduce
  HIV-related health disparities. His strategy
  will include measurable goals, timelines, and
  accountability mechanisms.
• Obama AIDS platform

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What needs to be different about this AIDS plan?

• A strategic orientation, not a laundry list
• A limited number of clear objectives
• Accountability measures including target setting
  and annual reporting
• Assignment of responsibility for follow through
• Priority setting and strategies to realize goals
• Better information on incidence and care access
• Comprehensiveness across agencies
• Additional resources
• Buy-in from a range of stakeholders

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The first 100 days

• Appointment of a National AIDS Strategy Panel
• Creation of a White House-level office to lead
  the effort
• Needed now and in 2009
• Broaden support
• www.nationalaidsstrategy.org
• Continued engagement
• Grassroots, Allied Stakeholders, Communications,
  Political Working Groups (Get involved)
• Community dialogue

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The First 100 Days and Beyond Syringe Exchange,
Sexuality Education and the First Mobilization

• Vanessa Brocato, Executive Director
• vanessa_at_champnetwork.org
• Wednesday, November 12th
• Strategy Lab/Community Teleconference

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Syringe Exchange Lift the Ban

• Support lifting the federal ban contained in
  appropriation bills on all syringe exchange
  programs to allow for the broader implementation
  and scale up of evidence-based, proven effective,
  HIV prevention programs for injecting drug users.
• Federal Ban Listserve William D. McColl, AIDS
  ACTION, wmccoll_at_aidsaction.org, 202 530 8030
  x3096

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Sexuality Education Tell the Truth

• Support evidenced-based sexuality education by
  discontinuing funding for abstinence-only until
  marriage programs and redirecting such funding to
  support comprehensive evidence-based prevention
  programs.
• National Coalition to Support Sexuality
  Education NCSSE c/o SIECUS Colin Schwartz,
  ncsse_at_siecusdc.org, [phone]

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Rally and March to White HouseStart McPherson
Square (15th Eye NW) Thursday, November 20th
100 pm

• www.100daystofightaids.org
• Philadelphia, PA buses ACT UP Philadelphia,
  actupphilly_at_gmail.com, 215.386.1981
• New York, NY buses NYC AIDS Housing Network,
  jeremy_at_nycahn.org, 718-802-9540

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Discussion