Tag Archives: HIV

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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Janus, Chaz, Hillary, The Military, Barack, Science And HIV

by D Gregory Smith
Français : Demi-statère de Rome, tête de Janus...

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(Also Published on LGBTQNation)
Janus was the Roman God of Thresholds, of transition, of beginnings and ending. He is often depicted with two faces, one for looking forward and one for looking back. January, the beginning month of the new year is named for Janus, and so, it’s natural that humans take this time to look back- and look forward- at the approach of the New Year.

As I take a look back, I’m very grateful for some amazing things that have happened this year in the U.S.- things that I never thought would happen in my lifetime- including:

All good stuff.

But what I am finding amazing is the conspicuous absence or light mentions in the LGBT media about the dramatic advances in HIV treatment and prevention in the “best of” roundups this year. A year when there have arguably been more advances in treatment, prevention and scientific breakthroughs than in any other year in the 30 since AIDS was discovered. A year when top government officials committed time, money and policy to ending this disease. A year when Science magazine called the HPTN 052 Study the scientific breakthrough of the year.

It’s puzzling.

Are we getting complacent about HIV? Are we in denial about the very real danger it still poses to our community? Do people understand that having HIV is difficult- creating financial, medical, emotional and social problems that can be devastating for people, families and communities?

It seems so.

I am, like I said, grateful for all the things listed above. I am grateful for Chaz and trans representation. I am grateful for relationship rcognition. I am grateful for advances in employment nondiscrimination. I am grateful that my government is taking LGBT rights seriously. I am especially grateful that the elected administration of this land is treating HIV like it should be treated- as a disease, a viral infection- and not as some Divine Punishment inflicted on the sexually and socially repugnant dregs of society. That is a big deal.

In fact it’s huge.

So why did we miss it?

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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
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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 Watch 12/19/11

by D Gregory Smith

From NAPWA:

President Obama called for the end of AIDS on World AIDS Day. But achieving that in America requires more public sector funding than Congress has provided to date, and the political climate for more funding is brutal.

 

We could make a classic business Republican argument for more funds: the increases would be trivial in the context of a $3.5 trillion federal budget, and the rate of return on investment would be as high as it gets – reduced public sector health care costs in future years, and improved private sector productivity. It cost next to nothing (in context) this year, and it pays back big for years to come. 

 

With recent additional federal money, ADAP waiting list numbers have come down some over the past month, but more than 4,000 Americans are still on wait lists. Ninety percent of them are in four Southern states, Florida, Georgia, Louisiana, and Virginia. All four are having financial difficulties in this economy, but the millions of dollars they would have to spend to eliminate their waiting lists are insignificant in multibillion dollar budgets, and spending the millions or not will not make their difficult positions materially any worse or any better.

 

Here are the latest numbers from our friends at NASTAD:

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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...

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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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Mayo Clinic Makes Kidney and Pancreas Transplant Available to HIV-Infected Patients

by D Gregory Smith

Science Daily reports that:

Mayo Clinic in Florida is now offering kidney and pancreas transplants to HIV positive patients with advanced kidney disease and diabetes. Evidence is now solid that HIV-positive patients have the same favorable outcome in terms of patient and allograft survival as non-HIV positive organ transplant recipients, says Mary Prendergast, M.D., a kidney specialist whose focus is the care of patients who receive kidney and pancreas transplants.

Full story here.

World AIDS Day 2011

by D Gregory Smith

This time of the year is probably the best time (at least in our hemisphere) for World AIDS Day. Our twenty four hour days are filled with more darkness than light in December than any other month of the year. In some places it can be very dark and dreary, indeed. It’s an appropriate time of the year to remember the darkness of HIV.

The darkness can be frightening.

We have sometimes been very afraid here in our communities, in our states, in our country and in our world, because at times, it has been very, very dark. I especially remember the darkness and terror of 30 years ago when AIDS made itself known.

I also remember the panic that ensued- people bullied, driven from their families, homes, schools and places of employment out of fear and ignorance. Gay men were shamed and vilified openly by politicians and communities and churches.

I remember the shame that halted progress for research, treatment and prevention. I especially remember people- my friends- who wasted away in front of my eyes. Some died painfully and alone- their families too ashamed to ask for help or proper care.

We have lost good men, women and children to HIV/AIDS. Families have been broken, beautiful lives have been twisted by suffering.

It has been very dark, indeed.

But in this darkness, in this December, there always flickers the promise of light.

This disease can now be treated- treatment is now quite possibly the key to prevention. Shame has decreased. It is not gone, but it has decreased.

In this promise of light, I remember with gratitude the people whose bravery has driven away darkness. Whose voices refused to give in to hopelessness or complacency or fear. They got us here.

HIV is still here; it is still among us, it is still causing fear and shame. But the voices of reason and compassion have grown stronger.

You have heard those voices. You also are those voices. And when we use our voices to proclaim the truth- that disease is not a reason for judgment and shame- the light grows stronger.

When we refuse to give in to fear, we change for the better- and so does the world.

As a gay kid growing up in Montana, I remember walking in the cold dark of a wintery Big Sky, feeling alone, misunderstood and very small. But I also remember being under that same dark sky with friends and family, working happily to build a bonfire beside the skating pond. The dark of the night is no match for the voices of friends- especially when they’re united in a common purpose.

As a gay man living with HIV in a rural state, I know that my voice alone isn’t going to make much of a difference when it comes to education, treatment and prevention. It’s only together that we can truly make a significant difference for the lives of all HIV+ persons in our country and in our world. Because there is still work to be done. That’s why I”ll be going to a vigil tonight, holding a candle  in the dark with other people who know what it’s like to feel small and alone

The darkness never really goes away- but it’s also never a match for the voices and presence of friends. Especially when there’s a fire to build.