Category Archives: Health

ADAP Watch 1/13/2012

by D Gregory Smith
ADAPs With Waiting Lists
(4,717 individuals in 12 states*, as of January 12, 2012)
State Number of Individuals on ADAP Waiting List Percent of the Total ADAP Waiting List Increase/Decrease From Previous Reporting Period Date Waiting List Began
Alabama 47 1% -44 October 2011
Florida 1,301 28% 135 June 2010
Georgia 1,275 27% -12 July 2010
Idaho 6 0.1% -3 February 2011
Louisiana** 628 13% 27 June 2010
Montana 11 0.2% -2 January 2008
Nebraska 17 0.4% 2 October 2011
North Carolina 126 3% 1 January 2010
Ohio 0 0% 0 July 2010
South Carolina 164 3% 0 March 2010
Utah 32 1% 0 May 2011
Virginia 1,110 24% 7 November 2010
* As a result of FY2011 ADAP emergency funding, Alabama, Florida, Georgia, Idaho, Louisiana, Montana, North Carolina, Ohio, South Carolina, Utah, and Virginia were able to reduce the overall number of individuals on their waiting lists.

** Louisiana has a capped enrollment on their program. This number represents their current unmet need.

 

ADAPs With Other Cost-Containment Strategies: Financial Eligibility
(445 Individuals in 6 States, as of November 9, 2011)
State Lowered Financial Eligibility Disenrolled Clients
Arkansas 500% to 200% FPL 99 clients (September 2009)
Illinois 500% to 300% FPL Grandfathered in current clients from 301-500% FPL
North Dakota 400% to 300% FPL Grandfathered in current clients from 301-400% FPL
Ohio 500% to 300% FPL 257 clients (July 2010)
South Carolina 550% to 300% FPL Grandfathered in current clients from 301-550% FPL
Utah 400% to 250% FPL 89 clients (September 2009)

ADAPs with Other Cost-containment Strategies (instituted since April 1, 2009, as of November 9, 2011)

Alabama: reduced formulary Arizona: reduced formulary Arkansas: reduced formulary Colorado: reduced formulary Florida: reduced formulary, transitioned 5,403 clients to Welvista from February 15 to March 31, 2011 Georgia: reduced formulary, implemented medical criteria, participating in the Alternative Method Demonstration Project Illinois: reduced formulary, instituted monthly expenditure cap ($2,000 per client per month), disenrolled clients not accessing ADAP for 90-days Kentucky: reduced formulary Louisiana: discontinued reimbursement of laboratory assays North Carolina: reduced formulary North Dakota: capped enrollment, instituted annual expenditure cap Ohio: reduced formulary Puerto Rico: reduced formulary Utah: reduced formulary Virginia: reduced formulary, restricted eligibility criteria, transitioned 204 clients onto waiting list Washington: instituted client cost sharing, reduced formulary, only paying insurance premiums for clients currently on antiretrovirals Wyoming: capped enrollment, reduced formulary, instituted client cost sharing

ADAPs Considering New/Additional Cost-containment Measures (before March 31, 2012***)

Alaska: reduce formulary Florida: lower financial eligibility Kentucky: reduce formulary Montana: reduce formulary Oregon: reduce formulary Puerto Rico: reduce formulary Tennessee: establish waiting list Wyoming: establish waiting list, lower financial eligibility, institute client cost sharing

Access to Medications (as of November 9, 2011)

Case management services are being provided to ADAP waiting list clients through ADAP (2 ADAP), Part B (9 ADAPs), contracted agencies (5 ADAPs), and other agencies, including other Parts of Ryan White (4 ADAPs).

For clients on ADAP waiting lists who are currently on or in need of medications, 11 ADAP waiting list states can confirm that ADAP waiting list clients are receiving medications through either pharmaceutical company patient assistance programs (PAPs), Welvista, or other mechanisms available within the state.

***March 31, 2012 is the end of ADAP FY2011. ADAP fiscal years begin April 1 and ends March 31. To receive The ADAP Watch, please e-mail Britten Pund at bpund@NASTAD.org.

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“The Race To End AIDS”

by D Gregory Smith

On Today’s Morning Edition from NPR, a story about HIV Treatment As Prevention:

AIDS Awareness

2011 has been a momentous year in the 30-year-old AIDS pandemic.

The big breakthrough was the discovery that antiviral drugs can prevent someone who’s infected with HIV from passing the virus to others. It’s nearly 100 percent effective. That led President Obama to declare earlier this month that the U.S. will expand HIV treatment in hard-hit countries by 50 percent.

As recently as last year, many of those experts were saying that just giving more people with HIV more drugs would never work. “For every one person that was put on antiretroviral therapy or treatment, we would have two to three new infections identified,” Dr. Eric Goosby, U.S. Global AIDS coordinator, says.

It looked like a losing game, but not anymore.

The new research shows that antiviral drugs not only save the lives of infected people, they also stop people from spreading the virus and causing new infections, if the drugs can be given early enough after someone gets infected. The new strategy is called “treatment as prevention.”

“So we suddenly are looking at a moment where we can treat our way out of the epidemic,” Goosby says. “That’s the turning point that we’re looking at.” Still, it’ll take decades to end AIDS, according to experts. But many say the world has to be much more aggressive about treating HIV.

But just the fact that this is being reported on and is being taken seriously is a big deal.

You can read and/or listen to the whole story here

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‘Montanans With HIV’ makes the paper

by D Gregory Smith
Map of USA with Montana highlighted
Image via Wikipedia

The Great Falls Tribune yesterday did a featured story on HIV in Montana with several sidebars on testing and the classification of the disease from AIDS to HIV stages 1-3. Along with Trisha Gardner of the Cascade County Health Department, Dean Wells of the Yellowstone AIDS Project and an anonymous man living with HIV in Great Falls, I was interviewed for the piece, which, among other things, focused on the stigma of persons living with HIV in the state.

Excerpt:

On average, about 20 Montanans are diagnosed with the disease every year, said Trisha Gardner, community health education specialist and HIV case manager at the Cascade City-County Health Department.

“The number of newly diagnosed cases has held pretty steady every year,” Gardner said.

Overall, the number of people in Montana living with HIV is increasing because they are living longer, she said.

While that number is on the rise, most in Montana never publicly disclose they have HIV, Gardner said.

“They don’t have to,” she said. “For the most part it’s kept a pretty private issue.”

Many who live with the disease in Montana fear losing their jobs, friends or family, and even becoming a social outcast.

“My view is that the stigma definitely reduced over the years, but it’s still there,” said Dean Wells, executive director of the Yellowstone AIDS Project in Billings. “Many of our clients live in fear of someone finding out about it.”

John, a pseudonym because he fears losing his livelihood, was diagnosed with HIV eight and a half years ago.

Trying to be honest and open after his diagnosis, John told his employer.

“It wasn’t a week later, they asked me to find another job,” he said.

Fear and stigma is still with us but there’s a lot of hope in current HIV treatment and prevention.
The key is to get tested. HIV unsuppressed in the body does damage- sometimes very significant damage- which  cannot be reversed by treatment.

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HIV 2fer: Early Treatment Works and Truvada Prevents

by D Gregory Smith

HIV DataToday’s HIV News shelf is crowded. Two stories on the HIV front involve good news about early HIV treatment and Pre-Exposure Prophylaxis(PrEP) to reduce infection rates among high-risk persons.

A study (popularly known as the Setpoint Study) finds that people newly-infected with HIV-1 who immediately start anti-retroviral therapy are more likely to have beneficial medical outcomes than those who wait until CD4 counts fall below medically acceptable levels (currently 350-500 depending who you talk to).

“This is very welcome news,” said Frank J. Oldham, NAPWA President and CEO. “The study supplies scientific confirmation of something we at NAPWA have always believed: the closer we can come to bringing all people living with HIV into treatment, and the earlier they start treatment, the better. We already knew this is true for populations as a whole: more and earlier treatment means fewer new infections. Now we know that – on the whole – it’s also better for individuals already infected.”

The news on the HIV front just keeps getting better. The setpoint study follows on the heels of a groundbreaking study which provides proof of HIV treatment as prevention: HIV-infected persons on medication with undetectable viral levels are 96% less likely to pass on the virus.

It also accompanies Gilead’s application to offer Truvada as the first drug marketed to prevent HIV:

Gilead Sciences Inc. announced that it has submitted a supplemental New Drug Application (sNDA) to the U.S. Food and Drug Administration (FDA)for the approval of once-daily Truvada (emtricitabine/tenofovir disoproxil fumarate) for pre-exposure prophylaxis (PrEP) to reduce the risk of HIV-1 infection among uninfected adults. Truvada was approved by the FDA in 2004 for the treatment of HIV-1 infection and is currently the most-prescribed antiretroviral treatment in the United States.

If the sNDA is approved, Truvada would be the first agent indicated for uninfected individuals to reduce the risk of acquiring HIV through sex, a prevention approach called PrEP. The sNDA is based on the results of two large placebo-controlled trials of Truvada as PrEP, sponsored by the U.S. National Institutes of Health (NIH) and the University of Washington. Several other clinical studies support the use of Truvada for HIV risk reduction.

“The data from these large-scale clinical trials suggest that Truvada may have a role to play in meeting the urgent public health need to reduce new HIV infections,” said John C. Martin, PhD, Chairman and Chief Executive Officer of Gilead Sciences. “Gilead is proud to have played a part in helping to define the use of Truvada as a potential new prevention tool and we commend the many institutions, investigators and study volunteers for their commitment to advancing this important area of research.”

Truvada is not currently labeled to reduce the risk of infection, it is labeled only for HIV treatment.

This could be an important step in slowing HIV. Around 50,000 people are still being infected with HIV every year in the U.S. according to the CDC. More than half of new infections (61%) occur among men who have sex with men, and nearly a quarter (23%) occur among women.

If Truvada can be given to high-risk persons (which includes negative partners in a sero-discordant relationship) and insurance companies will pay for it, it may, along with the groundswell of early treatment science, start a trend of slowing the progression of HIV in this country.

But only if we can get more high-risk people in for testing and treatment….

When was your last HIV test?

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Wanted: Members For Montana’s HIV Community Planning Group

by D Gregory Smith

Are you interested in community service? Do you want to help shape Montana’s HIV policies, treatment strategies and prevention interventions?

English: The Red ribbon is a symbol for solida...

I have a challenge for you.

Montana’s Community Planning Group for the Prevention of HIV (CPG) needs active community voices from around the state to provide valuable input and experience regarding HIV/AIDS in Montana. I have been active in this group for the last four years, and I would encourage anyone interested to apply- especially if you are involved with HIV education, prevention, treatment and/or are a person living with HIV. From the DPHHS Website:

The Community Planning Group (CPG) is an advisory group instrumental in the planning and implementation of HIV prevention interventions in Montana. CPG helps ensure that target populations are represented in the planning of state prevention efforts. The CPG consists of 36 members and is coordinated by the Montana Department of Public Health and Human Services HIV/STD Section.

Membership in the CPG requires a firm commitment.  The following is a basic outline of what this commitment entails:

  • Attend and actively participate in all CPG meetings to the fullest extent of your ability.  This usually includes 4 meetings each year. Meetings typically include a full day on a Friday and a half day on a Saturday.  Travel expenses are paid.
  • Speak for your Community Representation to the benefit of the community group.  Each member is assigned to represent a specific community group and needs to be able and willing to do so.
  • Actively participate in a workgroup.  Workgroups conduct business and meet during and possibly outside of the full CPG meetings as needed.  This work is usually conducted through e-mail or phone conferences, but may occasionally include a meeting that requires travel.

Our challenge has always been getting broad community representation from all communities affected by HIV in Montana. I’m asking you to consider this opportunity- and/or passing it on to someone you think would make a good representative.

Please click on the application link below for more information. We’d love to have you!

CPG Application 2011              Application Deadline is January 16

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ADAP Waiting List for 12/15/11

by D Gregory Smith

The waiting list continues- up 59 persons in 2 weeks:

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8 Tips To Lower Holiday Stress

by D Gregory Smith

I wrote this a few years ago- but I think it’s still good information- so I revised a few things and thought I’d offer it again (Also published on The Bilerico Project)

Feeling stressed and/or depressed lately? You’re not alone. The Holiday Season is reported to be “problematic” for about forty-five percent of the general population, and there may be added concerns for LGBTIQ persons.

A Christmas tree inside a home.

There is often so much pressure to be joyous and to share “the most wonderful time of the year”. It can be especially hard for those of us who feel wounded by the various Ghosts of Christmas/Hanukkah/Kwanzaa Past. Family and work dynamics can be hard at the best of times, during the holiday season it can reach a torturous crescendo:

“I can’t stand so-and-so, and they’re going to be at Grandma’s for dinner.”

“I do not want to go to Midnight Mass with the family, but I’m more upset by the thought of dealing with the fallout of not going.”

“I just know that Bible-thumper at work thinks I’m going to hell. The office party is always a nightmare.”

“I’m going to have to fend off all the questions of why I’m not married.”

“If they knew the truth, I’d be fired (disowned, disgraced, etc.).”

“I don’t have enough money for gifts. Shopping is so much pressure. I feel inadequate compared to….”

“I’m bringing my partner, and this is the first time. I’m worried that they’ll say or do hurtful things.”

Yep. All familiar. But there are some things to keep in mind when dealing with the stresses of the Holiday Season….

First, remember, you’re not alone.

“Forced fun” with co-workers, family and extended circles of families and friends happens to everybody. Many people, straight, gay and otherwise feel that they aren’t part of the celebration because they don’t feel particularly festive or “in the Christmas spirit”. The pressure to have fun, be nice and ignore grudges and difficulties can result in the completely opposite effect.

Not out to family, co-workers or friends? This can dramatically increase holiday stress. Maintaining a front and keeping secrets is hard- especially at a time of year that focuses on kindness and generosity. Constantly protecting yourself can be exhausting. Constantly worrying about safety, acceptance, integrity and livelihood is excruciating- especially at a holiday party.

It can be even worse if you’ve been rejected by your family or friends because of your sexuality or gender identity.

For many of us, our day-to-day lives are lived with people who care for and support us emotionally. We’ve created our own families. We’ve created routines that encourage and nurture us. We’ve developed our own beliefs

The holidays can totally upset that.

Even the mentally healthiest among us can be challenged by relatives and parents, regardless of acceptance or support. Ram Dass once said, “If you think you’re enlightened, go spend a week with your parents.”

And even if we are out, during the holidays we’re often surrounded by people who may be biologically related or who share the same work, but who do not support us, or who are even openly hostile. Whether this is true or simply a suspicion or feeling, it still causes anxiety, which in turn causes increased stress levels- often leading to some very depressing thoughts. A very slippery slope mentally….

What to do? If your particular situation seems to be causing problematic stress or depression, please seek out professional help. But for those relatively-minor-once-a-year issues, below are a few suggestions I have found helpful.  Please feel free to add your own:

  • Be aware of your anxiety. Notice when your tension levels are rising, and let yourself feel them. Feelings never hurt anybody- the actions resulting from those feelings are the real kicker, and quite often those actions happen because feelings are so bottled up that the pressure forces an explosion. Often, simply noticing and naming the anxiety can calm it.
  • Breathe. Under stress, the breath is often shallow, keeping oxygen levels at a minimum which just adds more stress. As simple as it sounds, three deep, conscious breaths can bring instant relief, slowing the heart rate, reducing hypertension- and anxiety levels.
  • “Is that true?” That question has been my lifesaver in many situations. My brain can run amok with fantasies of what people will say or do in response to me- things that I can’t possibly know for certain. Anxiety levels rise in the face of uncertainty. This simple question slows my thoughts and brings me back to the facts.
  • Be here now. Most stress involves either the past or the future- both are perspective distortion agents. Staying in the here and now reduces stress.
  • Resist the urge to self-medicate. Most people eat and drink more and exercise less than they normally would at this time of year.  If you’re prone to depression already, (and even if you’re not) a hangover and love handles won’t help. Plus, alcohol, a depressant, may seem to help for a while, but usually worsens depression and stress symptoms later on. It also reduces inhibitions, making hurt feelings, disagreements and fights much more likely.
  • Give yourself an out. If you have to spend an extended amount of time with family, work some down time into the schedule. Removing yourself from the situation can be vital, and it can be done gracefully. “I just need some alone time” is something that almost anyone will respect. There are lots of reasons to be alone- get creative. A short walk, a hot shower, a nap, an AA meeting, or even extended time behind the locked door of a bathroom can do amazing things to renew self-confidence, perspective and energy.
  • Remember, this is temporary. Most of us can survive anything for a few days. If you’re in a situation that you feel you may not be able to handle well, by all means, get out! But if staying will do less damage to yourself and others than leaving, remembering the finite nature of the visit may help.
  • Take care of yourself. You know what you need to do to be healthy. Eat well, exercise, hydrate, rest, play and give yourself permission to be human.

No matter what the situation, my greatest stressor is this:

Worrying about something I have little or no control over.

Recognizing that is key.

People are going to think what they think, and my thoughts or actions will probably not change that- especially in the short amount of time I have to spend with them during the holiday season. Whether they approve of me or not is none of my business. My business is to be happy, honest, kind, and healthy.

And I can do it. I do it by knowing myself and taking care of myself- even under the pressure of Midnight Mass.

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Rehberg Supports Raising Medicare Premiums

by D Gregory Smith

Millionaire Congressman Dennis Rehberg is throwing his support behind a controversial proposal that will raise Medicare premiums for one out of four seniors.

Denny Rehberg - Caricature

Image by DonkeyHotey via Flickr

After voting twice this year to force major cuts to Medicare, Rehberg falsely claimed he was the “only member of Montana’s delegation who has consistently voted to protect Medicare and Social Security.” [Lee Newspapers, 12/4/2011]

Now he’s poised to hurt Medicare again by supporting the controversial House payroll tax holiday.

According to the Associated Press, Rehberg’s plan will be paid for by raising Medicare premiums on seniors, a proposal that would “expand over time to include the highest-earning one-fourth of seniors.”

Both Senators Jon Tester and Max Baucus have voted for alternative plans to extend the payroll tax holiday for middle class families, through higher taxes on only millionaires.

According to the Associated Press:

“Raising taxes on millionaires may be a non-starter for Republicans, but they seem to have no problem hiking Medicare premiums for retirees making a lot less.” [Associated Press, 12/13/2011]

“This couldn’t be a more clear example of Dennis Rehberg sticking up for his fellow multimillionaires while sticking it to middle-class Montana seniors,” said Ted Dick, Executive Director of the Montana Democratic Party.  “Dennis Rehberg has forgotten who he’s working for, and it’s clear whose side he’s on: the special interests who have bankrolled his 35-year career in politics.”

Rehberg recently touted the controversial House payroll tax plan after he inserted a rider in the legislation, despite his promise last year to abandon the practice of inserting irrelevant riders to bills.

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New York Times: Expanding HIV Treatment Necessary And Overdue

by D Gregory Smith

This hasn’t taken that long.

I’m blaming Hillary Clinton and Barack Obama.

The news that HIV treatment is prevention has taken a remarkably short time to hit the mainstream media, and it’s due to Secretary Clinton’s address to the NIH last month, and the President of The United States.

The NYT:

President Barack Obama announces a new compreh...

Image via Wikipedia

Important new findings show that very early treatment of people infected with H.I.V. enhances their health and greatly lessens the likelihood that they will spread the virus that causes AIDS. We welcome the Obama administration’s announcement of a farsighted effort to treat millions more infected people abroad, especially in sub-Saharan Africa.

The administration expects that the expanded treatments can be paid for with existing resources, by pushing for greater efficiencies and more financing from recipient nations. But if that effort stalls, the administration should re-evaluate quickly whether to ask Congress for money.

… Mr. Obama also announced that he would commit an additional $50 million in this country in fiscal year 2012 to help pay for treatments at AIDS clinics and in-state programs that provide AIDS drugs to people who can’t afford them. The money may be drawn from $1 billion available through the health care reform law.

Working to get these changes made legislatively have proven impossible in a Republican-owned House and a Republican-bullied Senate- especially when it involves the health of gay and bisexual men- so policy and administrative action were required. And by beginning to make testing and immediate treatment for HIV routine, medical practices are established that will be hard to take back.

An estimated 1.2 million Americans were infected with the virus at latest count, of whom 240,000 people are unaware. The Centers for Disease Control and Prevention started a campaign last week to increase testing with special emphasis on warning black gay and bisexual men, whose infection rates have been soaring, to get tested and treated.

Meanwhile, the New York City Health Department became the second (after San Francisco’s) to recommend doctors offer drug therapy immediately to every person diagnosed as infected, instead of waiting for the virus to damage their immune systems. The city has made enormous strides in testing, treating and cutting the number of new infections. Some 110,000 infected residents are under treatment; aggressive testing might find another 2,500 immediately and perhaps 500 a year thereafter.

The investments here and abroad should pay off in the long run by reducing the number of people infected and easing the severity of illnesses.

Thanks to you both.

 

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Study: Rural Persons Less Likely To Be Tested For HIV

by D Gregory Smith

A new study reports that rural areas score lower on self-reported testing of high-risk populations than urban areas:

In this nationally-representative, population-based study of HIV testing frequencies in the United States, we found that the frequency of self-reported HIV testing decreased substantially as the residential environment became progressively more rural. After adjusting for differences in demographics and self-reported HIV risk factors, the odds of HIV testing in the past year were 35% lower among persons living in the most remote rural areas compared to persons in the most urban areas. Rural persons with a prior HIV test were more likely than urban to report testing in a hospital, but less likely in the outpatient setting.

A prior study in the early years of the HIV epidemic in the US also found that rural persons were less likely than urban to report HIV testing.[6] Our results demonstrate that this gap in testing persists in the modern era of effective HIV therapy, when early diagnosis and linkage to care are even more essential. Moreover, recent efforts to increase testing have not impacted the rural-urban gap in testing. Although rural persons with HIV experience barriers to care, prior studies have described effective models for delivering high-quality HIV care in rural settings.[12–18] This accentuates the importance of early testing and diagnosis among rural persons with HIV.

Still work to do…