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"content": "\u003cp>After George Ayala learned last month that San Francisco and Oakland had been chosen to co-host the \u003ca href=\"http://www.aids2020.org/About/Hosting-AIDS-2020\">International AIDS Conference in 2020\u003c/a>, he quickly \u003ca href=\"http://msmgf.org/global-networks-call-upon-ias-to-reevaluate-decision-to-bring-conference-to-us-in-2020/\">published a statement of disapproval. \u003c/a>\u003c/p>\n\u003cp>Ayala, an Oakland-based AIDS advocate, does not want the conference in his own city — or anywhere else in the United States, for that matter.\u003c/p>\n\u003cp>His statement of opposition and a second one drafted by colleagues at other AIDS organizations have been co-signed by hundreds of organizations and individuals in the United States and around the world.\u003c/p>\n\u003cp>Their biggest concern: long-standing U.S. visa policies will prevent many of the people most affected by AIDS and HIV, including \u003ca href=\"https://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006.html#0-0-0-202\">drug users and sex workers\u003c/a> who live in other countries, from attending the conference. They also worry about new restrictions affecting travel from Muslim countries.\u003c/p>\n\u003cfigure id=\"attachment_363357\" class=\"wp-caption alignnone\" style=\"max-width: 400px\">\u003cimg class=\"size-full wp-image-363357\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/04/georgeayala.jpg\" alt=\"\" width=\"400\" height=\"266\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/04/georgeayala.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/georgeayala-160x106.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/georgeayala-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/georgeayala-375x249.jpg 375w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Oakland-based activist George Ayala doesn't want the AIDS conference held in the Bay Area. He is executive director of the Global Forum on MSM & HIV. \u003ccite>(Photo courtesy of Nadia Rafif)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“In this day and age, I have to wonder why we support big international AIDS conferences happening in places that bar anyone,” said Ayala, executive director of the Global Forum on MSM [Men who have Sex with Men] & HIV.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>HIV/AIDS is far more prevalent in many countries, \u003ca href=\"https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html\">especially in Sub-Saharan Africa\u003c/a>, than in the United States. Almost 19 percent of people ages 15 to 49 in South Africa are infected with HIV, as are more than 20 percent in some neighboring countries.\u003c/p>\n\u003cp>In the U.S., prevalence among the same demographic group hovers \u003ca href=\"https://www.reuters.com/article/us-aids-usa/under-1-percent-of-u-s-adults-have-hiv-report-idUSN2962453620080129\">around a half of 1 percent\u003c/a> — although that masks some stark disparities. Last year, the Centers for Disease Control and Prevention projected that \u003ca href=\"https://www.cdc.gov/nchhstp/newsroom/2016/croi-press-release-risk.html\">1 in 2 black men\u003c/a> in the U.S. who have sex with men were at risk of contracting HIV. Globally, \u003ca href=\"http://www.unaids.org/en/resources/fact-sheet\">nearly 37 million\u003c/a> people are living with HIV.\u003c/p>\n\u003cp>Ayala and other critics of the Bay Area location raise broader questions about the cost and frequency of a biennial event they say is enormously expensive and often excludes the very people it purports to represent.\u003c/p>\n\u003cp>The organizers of the conference and others who support the decision to bring it to the Bay Area say they understand these worries.\u003c/p>\n\u003cp>“Travel restrictions to the U.S. remain a significant concern for us,” said Mandy Sugrue, spokeswoman for the International AIDS Society, which organizes the conference.\u003c/p>\n\u003cp>However, Sugrue and other proponents of a San Francisco-Oakland conference venue argue that the politically liberal Bay Area offers a perfect platform for rebuking the Trump administration’s exclusionary immigration policies and its perceived retreat from leadership on AIDS policy.\u003c/p>\n\u003cp>In December, the administration \u003ca href=\"https://www.washingtonpost.com/news/to-your-health/wp/2017/12/29/trump-administration-fires-all-members-of-hivaids-advisory-council/?utm_term=.449b3fa38c17\">fired all remaining members\u003c/a> of the Presidential Advisory Council on HIV/AIDS, six months after a half-dozen others had resigned in protest. Trump officials have also proposed cutting national HIV/AIDS spending by more than $100 million and reducing the U.S. contribution to global funding by more than $1 billion.\u003c/p>\n\u003cp>“If there is any place in the U.S. where people can come and protest and rise up and have their voices heard … Oakland is it,” said Cynthia Carey-Grant, executive director of the Oakland-based group Women Organized to Respond to Life-Threatening Disease. She penned \u003ca href=\"http://www.womenhiv.org/why-oakland-for-iac-2020/\">a statement in support\u003c/a> of the conference location that has been signed by nearly a dozen individuals and groups.\u003c/p>\n\u003cp>Carey-Grant believes the contrast between upscale, predominantly white San Francisco and its decidedly poorer neighbor across the Bay offers a window on the disparities that pervade AIDS treatment and funding around the world – to the detriment of low-income communities of color.\u003c/p>\n\u003cp>Sofia Tobar (Courtesy of Sofia Tobar)\u003c/p>\n\u003cp>Sofia Tobar, a 50-year-old transgender woman from Oakland who was diagnosed with HIV in 1998, said the conference is an opportunity “for Oakland’s diverse humans to embrace people from other countries … and to also highlight what we’re lacking.” She is especially interested in speaking out against federal cuts to AIDS services and violence targeting the transgender community, she said.\u003c/p>\n\u003cp>Others say they are eager to honor San Francisco’s long history of battling AIDS.\u003c/p>\n\u003cp>Joe Hollendoner, CEO of \u003ca href=\"http://www.sfaf.org/\">San Francisco AIDS Foundation\u003c/a>, noted that the conference organizers have secured use of the Moscone Center, the central conference venue, free of charge. They will use the money they save to help more people attend, he said. His foundation, along with the San Francisco Travel Association, led the committee that submitted the successful conference bid.\u003c/p>\n\u003cp>The planners of the International AIDS Conference usually try to alternate venues between affluent and lower-income countries. The conference was last held in the United States in 2012 in Washington, D.C. In 2014, it was in Melbourne, Australia, and in 2016, in Durban, South Africa. This year, the conference will be in Amsterdam.\u003c/p>\n\u003cp>Conference organizers said they reached out to a number of lower-income countries to host the 2020 conference, but \u003ca href=\"http://www.aids2020.org/About/Hosting-AIDS-2020\">none submitted a bid\u003c/a>. As many as 20,000 people, perhaps more, are expected to attend the conference — and many cities cannot accommodate such a large gathering, they said. Sugrue, the International AIDS Society spokeswoman, said they are not considering changing the venue.\u003c/p>\n\u003cp>She said the location of major conference donors was not a factor in the 2020 venue decision.\u003c/p>\n\u003cp>Gilead Sciences Inc., which is based 20 miles from San Francisco and makes the HIV prevention drug Truvada, is one of the \u003ca href=\"http://www.aids2018.org/Sponsors-Exhibitors/Sponsors/Conference-sponsors-supporters\">top sponsors of this year’s conference\u003c/a>, as it was in 2016. Other big industry donors are not located in the Bay Area, including Johnson & Johnson, Merck and ViiV Healthcare, which specializes in HIV drugs. Funding for the 2020 conference has not yet been confirmed, Sugrue said.\u003c/p>\n\u003cp>Naina Khanna, the executive director of the Oakland-based Positive Women’s Network, said the fact that no developing countries submitted a bid isn’t enough to assuage her concern for the people who will likely be excluded. Khanna helped draft \u003ca href=\"https://docs.google.com/forms/d/e/1FAIpQLSfYsezkCUoHWc_8Sdo8WJJGKY518VSU6rnZXLuXpIMtgiJTuw/viewform\">a separate statement\u003c/a> demanding that the conference be relocated outside the U.S. More than 100 organizations and nearly as many individuals have signed the statement.\u003c/p>\n\u003cp>“Where is our commitment to actually holding the conference where the most people are impacted?” asked Ruth Morgan Thomas, global coordinator of the \u003ca href=\"http://www.nswp.org/\">Global Network of Sex Work Projects\u003c/a>, which includes 305 organizations representing sex workers in 85 countries.\u003c/p>\n\u003cp>Prior to the Washington, D.C., conference, the U.S. had lifted a ban on people with HIV entering the country, and many were hopeful that similar prohibitions against sex workers and drug users would also end. But they didn’t, and sex workers scrambled to organize a parallel conference in Kolkata, India, Morgan Thomas said. Drug users convened one in Kiev.\u003c/p>\n\u003cp>Khanna, of the Positive Women’s Network, said that the high cost of accommodations in the Bay Area will also make the conference inaccessible to many people within the United States — especially low-income African-Americans in the South, who are disproportionately burdened with the virus.\u003c/p>\n\u003cp>Marsha Martin, coordinating director of the Global Network of Black People Working in HIV, said she would have been happy had Bangkok or South America or even Atlanta been chosen to host the conference. “But if venues don’t submit bids, there’s nothing to do about it,” she said. So she’s treating the Bay Area conference as an opportunity to grapple with the big disparities in AIDS funding and to reinvigorate efforts in the U.S. to combat the disease.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“If we do bring it [to the Bay Area] and make it the best conference we can make it, then we win,” Martin said. “We show the world we are not giving up.”\u003c/p>\n\n",
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"description": "After George Ayala learned last month that San Francisco and Oakland had been chosen to co-host the International AIDS Conference in 2020, he quickly published a statement of disapproval. Ayala, an Oakland-based AIDS advocate, does not want the conference in his own city — or anywhere else in the United States, for that matter. His",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>After George Ayala learned last month that San Francisco and Oakland had been chosen to co-host the \u003ca href=\"http://www.aids2020.org/About/Hosting-AIDS-2020\">International AIDS Conference in 2020\u003c/a>, he quickly \u003ca href=\"http://msmgf.org/global-networks-call-upon-ias-to-reevaluate-decision-to-bring-conference-to-us-in-2020/\">published a statement of disapproval. \u003c/a>\u003c/p>\n\u003cp>Ayala, an Oakland-based AIDS advocate, does not want the conference in his own city — or anywhere else in the United States, for that matter.\u003c/p>\n\u003cp>His statement of opposition and a second one drafted by colleagues at other AIDS organizations have been co-signed by hundreds of organizations and individuals in the United States and around the world.\u003c/p>\n\u003cp>Their biggest concern: long-standing U.S. visa policies will prevent many of the people most affected by AIDS and HIV, including \u003ca href=\"https://www.uscis.gov/ilink/docView/SLB/HTML/SLB/0-0-0-1/0-0-0-29/0-0-0-2006.html#0-0-0-202\">drug users and sex workers\u003c/a> who live in other countries, from attending the conference. They also worry about new restrictions affecting travel from Muslim countries.\u003c/p>\n\u003cfigure id=\"attachment_363357\" class=\"wp-caption alignnone\" style=\"max-width: 400px\">\u003cimg class=\"size-full wp-image-363357\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/04/georgeayala.jpg\" alt=\"\" width=\"400\" height=\"266\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2018/04/georgeayala.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/georgeayala-160x106.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/georgeayala-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2018/04/georgeayala-375x249.jpg 375w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Oakland-based activist George Ayala doesn't want the AIDS conference held in the Bay Area. He is executive director of the Global Forum on MSM & HIV. \u003ccite>(Photo courtesy of Nadia Rafif)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“In this day and age, I have to wonder why we support big international AIDS conferences happening in places that bar anyone,” said Ayala, executive director of the Global Forum on MSM [Men who have Sex with Men] & HIV.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>HIV/AIDS is far more prevalent in many countries, \u003ca href=\"https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html\">especially in Sub-Saharan Africa\u003c/a>, than in the United States. Almost 19 percent of people ages 15 to 49 in South Africa are infected with HIV, as are more than 20 percent in some neighboring countries.\u003c/p>\n\u003cp>In the U.S., prevalence among the same demographic group hovers \u003ca href=\"https://www.reuters.com/article/us-aids-usa/under-1-percent-of-u-s-adults-have-hiv-report-idUSN2962453620080129\">around a half of 1 percent\u003c/a> — although that masks some stark disparities. Last year, the Centers for Disease Control and Prevention projected that \u003ca href=\"https://www.cdc.gov/nchhstp/newsroom/2016/croi-press-release-risk.html\">1 in 2 black men\u003c/a> in the U.S. who have sex with men were at risk of contracting HIV. Globally, \u003ca href=\"http://www.unaids.org/en/resources/fact-sheet\">nearly 37 million\u003c/a> people are living with HIV.\u003c/p>\n\u003cp>Ayala and other critics of the Bay Area location raise broader questions about the cost and frequency of a biennial event they say is enormously expensive and often excludes the very people it purports to represent.\u003c/p>\n\u003cp>The organizers of the conference and others who support the decision to bring it to the Bay Area say they understand these worries.\u003c/p>\n\u003cp>“Travel restrictions to the U.S. remain a significant concern for us,” said Mandy Sugrue, spokeswoman for the International AIDS Society, which organizes the conference.\u003c/p>\n\u003cp>However, Sugrue and other proponents of a San Francisco-Oakland conference venue argue that the politically liberal Bay Area offers a perfect platform for rebuking the Trump administration’s exclusionary immigration policies and its perceived retreat from leadership on AIDS policy.\u003c/p>\n\u003cp>In December, the administration \u003ca href=\"https://www.washingtonpost.com/news/to-your-health/wp/2017/12/29/trump-administration-fires-all-members-of-hivaids-advisory-council/?utm_term=.449b3fa38c17\">fired all remaining members\u003c/a> of the Presidential Advisory Council on HIV/AIDS, six months after a half-dozen others had resigned in protest. Trump officials have also proposed cutting national HIV/AIDS spending by more than $100 million and reducing the U.S. contribution to global funding by more than $1 billion.\u003c/p>\n\u003cp>“If there is any place in the U.S. where people can come and protest and rise up and have their voices heard … Oakland is it,” said Cynthia Carey-Grant, executive director of the Oakland-based group Women Organized to Respond to Life-Threatening Disease. She penned \u003ca href=\"http://www.womenhiv.org/why-oakland-for-iac-2020/\">a statement in support\u003c/a> of the conference location that has been signed by nearly a dozen individuals and groups.\u003c/p>\n\u003cp>Carey-Grant believes the contrast between upscale, predominantly white San Francisco and its decidedly poorer neighbor across the Bay offers a window on the disparities that pervade AIDS treatment and funding around the world – to the detriment of low-income communities of color.\u003c/p>\n\u003cp>Sofia Tobar (Courtesy of Sofia Tobar)\u003c/p>\n\u003cp>Sofia Tobar, a 50-year-old transgender woman from Oakland who was diagnosed with HIV in 1998, said the conference is an opportunity “for Oakland’s diverse humans to embrace people from other countries … and to also highlight what we’re lacking.” She is especially interested in speaking out against federal cuts to AIDS services and violence targeting the transgender community, she said.\u003c/p>\n\u003cp>Others say they are eager to honor San Francisco’s long history of battling AIDS.\u003c/p>\n\u003cp>Joe Hollendoner, CEO of \u003ca href=\"http://www.sfaf.org/\">San Francisco AIDS Foundation\u003c/a>, noted that the conference organizers have secured use of the Moscone Center, the central conference venue, free of charge. They will use the money they save to help more people attend, he said. His foundation, along with the San Francisco Travel Association, led the committee that submitted the successful conference bid.\u003c/p>\n\u003cp>The planners of the International AIDS Conference usually try to alternate venues between affluent and lower-income countries. The conference was last held in the United States in 2012 in Washington, D.C. In 2014, it was in Melbourne, Australia, and in 2016, in Durban, South Africa. This year, the conference will be in Amsterdam.\u003c/p>\n\u003cp>Conference organizers said they reached out to a number of lower-income countries to host the 2020 conference, but \u003ca href=\"http://www.aids2020.org/About/Hosting-AIDS-2020\">none submitted a bid\u003c/a>. As many as 20,000 people, perhaps more, are expected to attend the conference — and many cities cannot accommodate such a large gathering, they said. Sugrue, the International AIDS Society spokeswoman, said they are not considering changing the venue.\u003c/p>\n\u003cp>She said the location of major conference donors was not a factor in the 2020 venue decision.\u003c/p>\n\u003cp>Gilead Sciences Inc., which is based 20 miles from San Francisco and makes the HIV prevention drug Truvada, is one of the \u003ca href=\"http://www.aids2018.org/Sponsors-Exhibitors/Sponsors/Conference-sponsors-supporters\">top sponsors of this year’s conference\u003c/a>, as it was in 2016. Other big industry donors are not located in the Bay Area, including Johnson & Johnson, Merck and ViiV Healthcare, which specializes in HIV drugs. Funding for the 2020 conference has not yet been confirmed, Sugrue said.\u003c/p>\n\u003cp>Naina Khanna, the executive director of the Oakland-based Positive Women’s Network, said the fact that no developing countries submitted a bid isn’t enough to assuage her concern for the people who will likely be excluded. Khanna helped draft \u003ca href=\"https://docs.google.com/forms/d/e/1FAIpQLSfYsezkCUoHWc_8Sdo8WJJGKY518VSU6rnZXLuXpIMtgiJTuw/viewform\">a separate statement\u003c/a> demanding that the conference be relocated outside the U.S. More than 100 organizations and nearly as many individuals have signed the statement.\u003c/p>\n\u003cp>“Where is our commitment to actually holding the conference where the most people are impacted?” asked Ruth Morgan Thomas, global coordinator of the \u003ca href=\"http://www.nswp.org/\">Global Network of Sex Work Projects\u003c/a>, which includes 305 organizations representing sex workers in 85 countries.\u003c/p>\n\u003cp>Prior to the Washington, D.C., conference, the U.S. had lifted a ban on people with HIV entering the country, and many were hopeful that similar prohibitions against sex workers and drug users would also end. But they didn’t, and sex workers scrambled to organize a parallel conference in Kolkata, India, Morgan Thomas said. Drug users convened one in Kiev.\u003c/p>\n\u003cp>Khanna, of the Positive Women’s Network, said that the high cost of accommodations in the Bay Area will also make the conference inaccessible to many people within the United States — especially low-income African-Americans in the South, who are disproportionately burdened with the virus.\u003c/p>\n\u003cp>Marsha Martin, coordinating director of the Global Network of Black People Working in HIV, said she would have been happy had Bangkok or South America or even Atlanta been chosen to host the conference. “But if venues don’t submit bids, there’s nothing to do about it,” she said. So she’s treating the Bay Area conference as an opportunity to grapple with the big disparities in AIDS funding and to reinvigorate efforts in the U.S. to combat the disease.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "State Fires Contractor After Problems Put California HIV Patients At Risk",
"title": "State Fires Contractor After Problems Put California HIV Patients At Risk",
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"content": "\u003cp>California’s public health department Wednesday fired the contractor responsible for enrolling patients in a state-run AIDS program, saying its poor performance threatened enrollees’ access to life-saving medications.\u003c/p>\n\u003cp>The state announced it had terminated the contract with A.J. Boggs & Company because of several “material breaches,” including the failure to keep an online enrollment portal working properly. The department said in a written statement that the company also neglected to provide notice before hiring a subcontractor to provide services.\u003c/p>\n\u003cp>The state’s contract with Michigan-based A.J. Boggs began last July, when the California public health department decided not to renew the previous contractor, Ramsell Corp. Another company, Magellan Rx Management, of Arizona, got a contract to take over the pharmacy benefit services. It will continue to provide those services.\u003c/p>\n\u003cp>The department said it switched contracts to reduce administrative fees and drug reimbursement rates.\u003c/p>\n\u003cp>A.J. Boggs’ CEO Clarke Anderson declined to comment for this story.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The termination of the company’s enrollment contract followed a report in January by \u003ca href=\"http://aliforniahealthline.org/news/crucial-california-hiv-program-in-disarray-after-contract-switch/\" target=\"_blank\">California Healthline \u003c/a>and \u003ca href=\"http://khn.org/news/crucial-california-hiv-program-in-disarray-after-contract-switch/\" target=\"_blank\">Kaiser Health News\u003c/a> that patients were unable to get necessary drugs and timely care.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.cdph.ca.gov/programs/aids/Pages/tOAADAPindiv.aspx\" target=\"_blank\">AIDS Drug Assistance Program\u003c/a>, overseen by the public health department, helps nearly 30,000 low-income HIV and AIDS patients in California pay for medications, insurance premiums and medical care.\u003c/p>\n\u003cp>Public health department officials said Wednesday they planned to determine eligibility and enroll patients directly rather than contract with a new company to do so. It wasn’t clear how long the state would manage these services in-house, but the department’s statement said it was “exploring all long-term options.”\u003c/p>\n\u003cp>The departure of A.J. Boggs was welcomed by advocates across the state, who for months had been lobbying state officials to fix problems with enrollment and access, said Courtney Mulhern-Pearson, director of state and local affairs for the San Francisco AIDS Foundation.\u003c/p>\n\u003cp>“We are pleased that the state was able to make such a decisive move. This was necessary and what we have been asking them to do for a while,” she said. “We are cautiously optimistic this is going to be a good fix for the program.”\u003c/p>\n\u003cp>Mulhern-Pearson said advocacy groups were notified during a Wednesday morning conference call about the decision to end the contract with A.J. Boggs. She said she believes it will be more efficient for the state to determine eligibility and enroll patients in-house. “I am hoping this will mean less communication breakdown,” she said.\u003c/p>\n\u003cp>AIDS service providers began reporting problems soon after A.J. Boggs took over enrollment. Patients were turned away by pharmacies and had to postpone medical procedures, they said. Some were dropped from the program for no apparent reason, according to the San Francisco AIDS Foundation and APLA Health.\u003c/p>\n\u003cp>In November, the state shut down the online enrollment system because of security breaches. Enrollment workers from HIV and AIDS service organizations had to send in applications by fax.\u003c/p>\n\u003cp>The public health department said Wednesday it hired an independent consulting firm to help create a new system and plans to begin training enrollment workers the week of March 13.\u003c/p>\n\u003cp>State Sen. Scott D. Wiener (D-San Francisco), one of several legislators who wrote a letter late last year to the public health department insisting the problems be fixed, said in an email Wednesday that the contract termination is an “important first step.”\u003c/p>\n\u003cp>“Now, the Department needs to make system changes to ensure that HIV patients get the medication they need to survive and be healthy,” Wiener wrote.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Consistent medical care and access to medication are critical for keeping HIV and AIDS patients healthy and reducing the spread of the disease.\u003c/p>\n\n",
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"nprByline": "\u003ca href=\"http://californiahealthline.org/news/author/anna-gorman/\" target=\"_blank\">\u003cstrong>Anna Gorman\u003c/strong>\u003c/a>\u003c/br>\u003ca href=\"http://californiahealthline.org/\" target=\"_blank\">California Healthline\u003c/a>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California’s public health department Wednesday fired the contractor responsible for enrolling patients in a state-run AIDS program, saying its poor performance threatened enrollees’ access to life-saving medications.\u003c/p>\n\u003cp>The state announced it had terminated the contract with A.J. Boggs & Company because of several “material breaches,” including the failure to keep an online enrollment portal working properly. The department said in a written statement that the company also neglected to provide notice before hiring a subcontractor to provide services.\u003c/p>\n\u003cp>The state’s contract with Michigan-based A.J. Boggs began last July, when the California public health department decided not to renew the previous contractor, Ramsell Corp. Another company, Magellan Rx Management, of Arizona, got a contract to take over the pharmacy benefit services. It will continue to provide those services.\u003c/p>\n\u003cp>The department said it switched contracts to reduce administrative fees and drug reimbursement rates.\u003c/p>\n\u003cp>A.J. Boggs’ CEO Clarke Anderson declined to comment for this story.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The termination of the company’s enrollment contract followed a report in January by \u003ca href=\"http://aliforniahealthline.org/news/crucial-california-hiv-program-in-disarray-after-contract-switch/\" target=\"_blank\">California Healthline \u003c/a>and \u003ca href=\"http://khn.org/news/crucial-california-hiv-program-in-disarray-after-contract-switch/\" target=\"_blank\">Kaiser Health News\u003c/a> that patients were unable to get necessary drugs and timely care.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.cdph.ca.gov/programs/aids/Pages/tOAADAPindiv.aspx\" target=\"_blank\">AIDS Drug Assistance Program\u003c/a>, overseen by the public health department, helps nearly 30,000 low-income HIV and AIDS patients in California pay for medications, insurance premiums and medical care.\u003c/p>\n\u003cp>Public health department officials said Wednesday they planned to determine eligibility and enroll patients directly rather than contract with a new company to do so. It wasn’t clear how long the state would manage these services in-house, but the department’s statement said it was “exploring all long-term options.”\u003c/p>\n\u003cp>The departure of A.J. Boggs was welcomed by advocates across the state, who for months had been lobbying state officials to fix problems with enrollment and access, said Courtney Mulhern-Pearson, director of state and local affairs for the San Francisco AIDS Foundation.\u003c/p>\n\u003cp>“We are pleased that the state was able to make such a decisive move. This was necessary and what we have been asking them to do for a while,” she said. “We are cautiously optimistic this is going to be a good fix for the program.”\u003c/p>\n\u003cp>Mulhern-Pearson said advocacy groups were notified during a Wednesday morning conference call about the decision to end the contract with A.J. Boggs. She said she believes it will be more efficient for the state to determine eligibility and enroll patients in-house. “I am hoping this will mean less communication breakdown,” she said.\u003c/p>\n\u003cp>AIDS service providers began reporting problems soon after A.J. Boggs took over enrollment. Patients were turned away by pharmacies and had to postpone medical procedures, they said. Some were dropped from the program for no apparent reason, according to the San Francisco AIDS Foundation and APLA Health.\u003c/p>\n\u003cp>In November, the state shut down the online enrollment system because of security breaches. Enrollment workers from HIV and AIDS service organizations had to send in applications by fax.\u003c/p>\n\u003cp>The public health department said Wednesday it hired an independent consulting firm to help create a new system and plans to begin training enrollment workers the week of March 13.\u003c/p>\n\u003cp>State Sen. Scott D. Wiener (D-San Francisco), one of several legislators who wrote a letter late last year to the public health department insisting the problems be fixed, said in an email Wednesday that the contract termination is an “important first step.”\u003c/p>\n\u003cp>“Now, the Department needs to make system changes to ensure that HIV patients get the medication they need to survive and be healthy,” Wiener wrote.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Consistent medical care and access to medication are critical for keeping HIV and AIDS patients healthy and reducing the spread of the disease.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>A change in contractors for a state-run AIDS program has resulted in enrollment delays and left some patients unable to get necessary medications and timely medical care, according to legislators and nonprofit organizations across California.\u003c/p>\n\u003cp>\u003ca href=\"https://www.cdph.ca.gov/programs/aids/Pages/tOAADAPindiv.aspx\" target=\"_blank\">The AIDS Drug Assistance Program\u003c/a>, which helps more than 30,000 low-income HIV and AIDS patients pay for medications and insurance premiums, switched pharmacy and enrollment contractors in July. Since then, clients and service providers have reported numerous problems with the program, which is overseen by the \u003ca href=\"http://www.cdph.ca.gov/Pages/DEFAULT.aspx\" target=\"_blank\">California Department of Public Health\u003c/a>.\u003c/p>\n\u003cp>Patients have been turned away by pharmacies, been forced to postpone medical procedures and been dropped from the program altogether for no apparent reason, according to staffers at \u003ca href=\"https://aplahealth.org/\" target=\"_blank\">AIDS Project Los Angeles\u003c/a> and the \u003ca href=\"http://www.sfaf.org/?referrer=http://search.myway.com/search/GGmain.jhtml?p2=&ptb=&n=&ind=&tpr=hpsb&trs=wtt&cn=US&ln=en&si=&brwsid=&searchfor=san%20francisco%20aids%20foundation&st=tab\" target=\"_blank\">San Francisco AIDS Foundation\u003c/a>.\u003c/p>\n\u003cp>In addition, the online system to enroll applicants was shut down in November after security breaches and is still not working. Potential clients and enrollment workers have to send applications by fax and regularly have trouble getting documents through.\u003c/p>\n\u003cp>“It’s a mess,” said Courtney Mulhern-Pearson, director of state and local affairs with the San Francisco AIDS Foundation, a nonprofit service and advocacy organization. “This is the state’s safety net program and the cornerstone to the state’s response to the HIV epidemic. To have it all of a sudden not work and to have that system be thrown in disarray has been so destabilizing, not only for our clients but also for the enrollment workers.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>One Los Angeles client, a 37-year-old Hollywood resident, said his insurance policy was cancelled after the AIDS Drug Assistance Program failed to send the premium to the correct address. As a result, the man, M.G., who only wanted his initials used because not everyone in his life knows he is HIV-positive, got turned away at the pharmacy.\u003c/p>\n\u003cp>“I was on my last pill for HIV medication,” he said. “It was very scary. I thought, ‘What am I going to do now?’”\u003c/p>\n\u003cp>The state’s contract with Oakland, Calif.-based Ramsell Corporation, which had handled both enrollment and pharmacy benefits, ended in July. To replace it, the state contracted with \u003ca href=\"http://www.ajboggs.com/\" target=\"_blank\">A.J. Boggs & Company\u003c/a> to do the enrollment and \u003ca href=\"https://www1.magellanrx.com/magellan-rx/solutions/pharmacy-benefit-management.aspx\" target=\"_blank\">Magellan Rx Management \u003c/a>to provide the pharmacy benefit services. The reason for the change was to reduce administrative fees and drug reimbursement rates, said public health department spokeswoman Ali Bay.\u003c/p>\n\u003cp>Since then, AIDS service organizations have written numerous complaint letters, contacted legislators and sent representatives to Sacramento to meet with public health department officials. State senators Ed Hernandez, Kevin De León and Scott D. Wiener also sent letters to the department insisting that the problems be fixed.\u003c/p>\n\u003cp>Wiener’s letter said he was “astounded that these systems issues have yet to be resolved and continue to arise six months into the transition” to the new vendors. The AIDS Drug Assistance Program, he wrote, is essential to keep HIV patients healthy and reduce their chances of infecting others.\u003c/p>\n\u003cp>“This is matter of life and death for some people,” Wiener said in an interview. “When I learned that the [AIDS Drug Assistance Program] enrollment was essentially in meltdown … I was horrified.”\u003c/p>\n\u003cp>The Department of Public Health’s director, Karen Smith, responded to Wiener in a letter last week saying her agency’s first concern was to ensure clients receive “life-saving medications without any disruption in treatment.” She said the state is “working diligently to address these concerns as quickly as possible.”\u003c/p>\n\u003cp>To help ensure uninterrupted access, the state has allowed its pharmacy benefit provider to authorize an emergency, 30-day supply of medications for enrolled patients who encounter obstacles at the pharmacy. Smith wrote that the state is also trying to resolve the online security issues and to get the enrollment site back up as soon as possible. But she noted that the problems may be “more serious” than the department initially thought.\u003c/p>\n\u003cp>In the meantime, Smith wrote, the department has shortened the application, streamlined the enrollment process and extended the reenrollment and recertification deadlines for clients.\u003c/p>\n\u003cp>Craig Pulsipher, state affairs specialist with AIDS Project Los Angeles, said he appreciated that the state has provided emergency medication access and responded to some of the concerns. But clients, enrollment workers, pharmacists and doctors are still facing hurdles, he said.\u003c/p>\n\u003cp>Pulsipher said he and others had warned the state it wasn’t allowing enough time to prepare for the changeover. The Los Angeles Department of Public Health, for example, had asked the state in June to postpone the transition for six months. About 10,000 L.A. County residents rely on the AIDS Drug Assistance Program.\u003c/p>\n\u003cp>In a letter to the public health department, Mario Perez, director of the L.A. County’s HIV and STD program division, wrote that patients need “unfettered access to antiretroviral therapy,” and any administrative changes to the AIDS Drug Assistance Program that can hamper that access “must be thoughtfully planned and adequately tested.”\u003c/p>\n\u003cp>Pulsipher said he tried to give the state the benefit of the doubt, knowing difficulties arise during every transition. But, he said, “clearly things haven’t been resolved.”\u003c/p>\n\u003cp>“We anticipated some of these issues and those concerns weren’t heeded,” he said. “And now we find ourselves here six months later with a system that is broken.”\u003c/p>\n\u003cp>Meanwhile, patients are struggling to get service they need. M.G, the patient who nearly ran out of drugs, said a surgical procedure to relieve pain in his neck was cancelled. He spent hours calling the AIDS assistance program and his insurance company, he said. He also had to pay about $500 to get his insurance reinstated.\u003c/p>\n\u003cp>A representative from the state AIDS program wrote to Pulsipher in an e-mail that the insurance payment had been sent to the wrong address. “We understand the severity of this issue and we will work … to ensure that this does not happen again,” the email said.\u003c/p>\n\u003cp>Finally, M.G. was able to get his medicine and have the surgery. Now, he plans to call the state and the insurer every month to make sure his drugs and services are covered.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>The program was “supposed to be helping me,” he said. “And because of them, I was denied the medication that is keeping me alive.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A change in contractors for a state-run AIDS program has resulted in enrollment delays and left some patients unable to get necessary medications and timely medical care, according to legislators and nonprofit organizations across California.\u003c/p>\n\u003cp>\u003ca href=\"https://www.cdph.ca.gov/programs/aids/Pages/tOAADAPindiv.aspx\" target=\"_blank\">The AIDS Drug Assistance Program\u003c/a>, which helps more than 30,000 low-income HIV and AIDS patients pay for medications and insurance premiums, switched pharmacy and enrollment contractors in July. Since then, clients and service providers have reported numerous problems with the program, which is overseen by the \u003ca href=\"http://www.cdph.ca.gov/Pages/DEFAULT.aspx\" target=\"_blank\">California Department of Public Health\u003c/a>.\u003c/p>\n\u003cp>Patients have been turned away by pharmacies, been forced to postpone medical procedures and been dropped from the program altogether for no apparent reason, according to staffers at \u003ca href=\"https://aplahealth.org/\" target=\"_blank\">AIDS Project Los Angeles\u003c/a> and the \u003ca href=\"http://www.sfaf.org/?referrer=http://search.myway.com/search/GGmain.jhtml?p2=&ptb=&n=&ind=&tpr=hpsb&trs=wtt&cn=US&ln=en&si=&brwsid=&searchfor=san%20francisco%20aids%20foundation&st=tab\" target=\"_blank\">San Francisco AIDS Foundation\u003c/a>.\u003c/p>\n\u003cp>In addition, the online system to enroll applicants was shut down in November after security breaches and is still not working. Potential clients and enrollment workers have to send applications by fax and regularly have trouble getting documents through.\u003c/p>\n\u003cp>“It’s a mess,” said Courtney Mulhern-Pearson, director of state and local affairs with the San Francisco AIDS Foundation, a nonprofit service and advocacy organization. “This is the state’s safety net program and the cornerstone to the state’s response to the HIV epidemic. To have it all of a sudden not work and to have that system be thrown in disarray has been so destabilizing, not only for our clients but also for the enrollment workers.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>One Los Angeles client, a 37-year-old Hollywood resident, said his insurance policy was cancelled after the AIDS Drug Assistance Program failed to send the premium to the correct address. As a result, the man, M.G., who only wanted his initials used because not everyone in his life knows he is HIV-positive, got turned away at the pharmacy.\u003c/p>\n\u003cp>“I was on my last pill for HIV medication,” he said. “It was very scary. I thought, ‘What am I going to do now?’”\u003c/p>\n\u003cp>The state’s contract with Oakland, Calif.-based Ramsell Corporation, which had handled both enrollment and pharmacy benefits, ended in July. To replace it, the state contracted with \u003ca href=\"http://www.ajboggs.com/\" target=\"_blank\">A.J. Boggs & Company\u003c/a> to do the enrollment and \u003ca href=\"https://www1.magellanrx.com/magellan-rx/solutions/pharmacy-benefit-management.aspx\" target=\"_blank\">Magellan Rx Management \u003c/a>to provide the pharmacy benefit services. The reason for the change was to reduce administrative fees and drug reimbursement rates, said public health department spokeswoman Ali Bay.\u003c/p>\n\u003cp>Since then, AIDS service organizations have written numerous complaint letters, contacted legislators and sent representatives to Sacramento to meet with public health department officials. State senators Ed Hernandez, Kevin De León and Scott D. Wiener also sent letters to the department insisting that the problems be fixed.\u003c/p>\n\u003cp>Wiener’s letter said he was “astounded that these systems issues have yet to be resolved and continue to arise six months into the transition” to the new vendors. The AIDS Drug Assistance Program, he wrote, is essential to keep HIV patients healthy and reduce their chances of infecting others.\u003c/p>\n\u003cp>“This is matter of life and death for some people,” Wiener said in an interview. “When I learned that the [AIDS Drug Assistance Program] enrollment was essentially in meltdown … I was horrified.”\u003c/p>\n\u003cp>The Department of Public Health’s director, Karen Smith, responded to Wiener in a letter last week saying her agency’s first concern was to ensure clients receive “life-saving medications without any disruption in treatment.” She said the state is “working diligently to address these concerns as quickly as possible.”\u003c/p>\n\u003cp>To help ensure uninterrupted access, the state has allowed its pharmacy benefit provider to authorize an emergency, 30-day supply of medications for enrolled patients who encounter obstacles at the pharmacy. Smith wrote that the state is also trying to resolve the online security issues and to get the enrollment site back up as soon as possible. But she noted that the problems may be “more serious” than the department initially thought.\u003c/p>\n\u003cp>In the meantime, Smith wrote, the department has shortened the application, streamlined the enrollment process and extended the reenrollment and recertification deadlines for clients.\u003c/p>\n\u003cp>Craig Pulsipher, state affairs specialist with AIDS Project Los Angeles, said he appreciated that the state has provided emergency medication access and responded to some of the concerns. But clients, enrollment workers, pharmacists and doctors are still facing hurdles, he said.\u003c/p>\n\u003cp>Pulsipher said he and others had warned the state it wasn’t allowing enough time to prepare for the changeover. The Los Angeles Department of Public Health, for example, had asked the state in June to postpone the transition for six months. About 10,000 L.A. County residents rely on the AIDS Drug Assistance Program.\u003c/p>\n\u003cp>In a letter to the public health department, Mario Perez, director of the L.A. County’s HIV and STD program division, wrote that patients need “unfettered access to antiretroviral therapy,” and any administrative changes to the AIDS Drug Assistance Program that can hamper that access “must be thoughtfully planned and adequately tested.”\u003c/p>\n\u003cp>Pulsipher said he tried to give the state the benefit of the doubt, knowing difficulties arise during every transition. But, he said, “clearly things haven’t been resolved.”\u003c/p>\n\u003cp>“We anticipated some of these issues and those concerns weren’t heeded,” he said. “And now we find ourselves here six months later with a system that is broken.”\u003c/p>\n\u003cp>Meanwhile, patients are struggling to get service they need. M.G, the patient who nearly ran out of drugs, said a surgical procedure to relieve pain in his neck was cancelled. He spent hours calling the AIDS assistance program and his insurance company, he said. He also had to pay about $500 to get his insurance reinstated.\u003c/p>\n\u003cp>A representative from the state AIDS program wrote to Pulsipher in an e-mail that the insurance payment had been sent to the wrong address. “We understand the severity of this issue and we will work … to ensure that this does not happen again,” the email said.\u003c/p>\n\u003cp>Finally, M.G. was able to get his medicine and have the surgery. Now, he plans to call the state and the insurer every month to make sure his drugs and services are covered.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "STD Infections Rise to New Highs After States Close Health Clinics",
"title": "STD Infections Rise to New Highs After States Close Health Clinics",
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"content": "\u003cp>The number of people infected with three major sexually transmitted diseases is at an all-time high, according to a CDC report released Wednesday. And the increase in reported cases of chlamydia, gonorrhea and syphilis is hitting teenagers and young adults hardest.\u003c/p>\n\u003cp>Over half of gonorrhea and chlamydia cases are in people under the age of 25, says Dr. \u003ca href=\"http://www.cdc.gov/about/leadership/new-leaders/nchhstp.html\">Jonathan Mermin\u003c/a>, director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention for the CDC.\u003c/p>\n\u003cp>These STDs can have serious long term health consequences, including chronic pain and fertility problems. Pregnant women can pass syphilis on to their children, leading to \u003ca href=\"http://www.npr.org/sections/health-shots/2015/11/12/455768422/more-babies-are-dying-because-of-congenital-syphilis\">stillbirth or birth defects\u003c/a>.\u003c/p>\n\u003cp>State and local budget cuts to STD care and prevention programs are major drivers in the surge in STDs, Mermin says.\u003c/p>\n\u003cp>\"Our ability to prevent STDs is only as strong as the public health infrastructure to support it,\" he says. \"More than half of state and local STD programs have experienced budget cuts. In 2012, 20 health departments reported having to close their STD clinics.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Syphilis infections have been increasing at a particularly troubling rate, \u003ca href=\"http://www.cdc.gov/nchhstp/newsroom/2016/2015-std-surveillance-report.html\">according to the report\u003c/a>. In 2015, 23,872 cases were reported, a 19 percent increase since 2014. \u003ca href=\"http://www.cdc.gov/std/syphilis/stdfact-syphilis.htm\">Syphilis\u003c/a> cases have been going up over the past decade, while the spike in cases of chlamydia and gonorrhea is more recent.\u003c/p>\n\u003cp>There were 395,216 cases of \u003ca href=\"http://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea.htm\">gonorrhea\u003c/a> and 1.5 million cases of \u003ca href=\"http://www.cdc.gov/std/chlamydia/stdfact-chlamydia.htm\">chlamydia \u003c/a>reported in the same year, showing a rise of 6 and 13 percent over the past year. All three infections can be treated with antibiotics, though gonorrhea is becoming \u003ca href=\"http://www.npr.org/sections/thetwo-way/2016/08/30/491969011/u-n-health-officials-warn-gonorrhea-is-becoming-untreatable\">increasingly resistant to antibiotics\u003c/a>.\u003c/p>\n\u003cp>\"This basically tells us we have to do a better job of reach out to some of these communities that are disproportionately affected by these infections,\" says \u003ca href=\"https://internalmedicine.osu.edu/infectiousdisease/directory/faculty/josebazan/\">Dr. Jose Bazan\u003c/a>, a medical director for an STD clinic at Columbus Public Health and an assistant professor of internal medicine at Ohio State University who was not involved with the report.\u003c/p>\n\u003cp>Men who have sex with men face a greater risk of being infected with syphilis. Over 80 percent of male syphilis cases were reported among gay and bisexual males, and over 90 percent of all syphilis cases were in men. People in racial and sexual minority groups can have more than the usual trouble finding care for preventing and treating STDs.\u003c/p>\n\u003cp>According to a congressional briefing last April by Dr. Gail Bolan, the director for the CDC Division of STD Prevention, over 40 percent of health departments reduced clinic hours, screening, or tracing people who may have been infected.\u003c/p>\n\u003cp>\"If that infrastructure gets STDeroded, people are more likely to have their STDs for a longer period of time, and that can lead to increased transmission,\" Mermin says.\u003c/p>\n\u003cp>The federal government also helps fund state and local STD programs through the CDC, but federal funds have not helped make up for some of the budget cuts on the local level, according to \u003ca href=\"http://www.ncsddc.org/who-we-are/board\">David Harvey\u003c/a>, the executive director for the National Coalition of STD Directors.\u003c/p>\n\u003cp>\"We believe there's a direct relationship between budget cuts and increases in STDs in the United States. There has been no federal increases for STD programs in this country since 2003,\" he says.\u003c/p>\n\u003cp>If the trend is to be reversed, Mermin says there needs to be a real investment in STD prevention so that clinics can monitor these diseases and quickly diagnose and treat people who are infected.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"We've seen success in the past where investments have paid off,\" he says. \"We know what we need to do. We just need to do it more effectively than we've been able to do with this eroding infrastructure.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=STD+Infections+Rise+To+New+Highs+After+States+Close+Health+Clinics&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The number of people infected with three major sexually transmitted diseases is at an all-time high, according to a CDC report released Wednesday. And the increase in reported cases of chlamydia, gonorrhea and syphilis is hitting teenagers and young adults hardest.\u003c/p>\n\u003cp>Over half of gonorrhea and chlamydia cases are in people under the age of 25, says Dr. \u003ca href=\"http://www.cdc.gov/about/leadership/new-leaders/nchhstp.html\">Jonathan Mermin\u003c/a>, director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention for the CDC.\u003c/p>\n\u003cp>These STDs can have serious long term health consequences, including chronic pain and fertility problems. Pregnant women can pass syphilis on to their children, leading to \u003ca href=\"http://www.npr.org/sections/health-shots/2015/11/12/455768422/more-babies-are-dying-because-of-congenital-syphilis\">stillbirth or birth defects\u003c/a>.\u003c/p>\n\u003cp>State and local budget cuts to STD care and prevention programs are major drivers in the surge in STDs, Mermin says.\u003c/p>\n\u003cp>\"Our ability to prevent STDs is only as strong as the public health infrastructure to support it,\" he says. \"More than half of state and local STD programs have experienced budget cuts. In 2012, 20 health departments reported having to close their STD clinics.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Syphilis infections have been increasing at a particularly troubling rate, \u003ca href=\"http://www.cdc.gov/nchhstp/newsroom/2016/2015-std-surveillance-report.html\">according to the report\u003c/a>. In 2015, 23,872 cases were reported, a 19 percent increase since 2014. \u003ca href=\"http://www.cdc.gov/std/syphilis/stdfact-syphilis.htm\">Syphilis\u003c/a> cases have been going up over the past decade, while the spike in cases of chlamydia and gonorrhea is more recent.\u003c/p>\n\u003cp>There were 395,216 cases of \u003ca href=\"http://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea.htm\">gonorrhea\u003c/a> and 1.5 million cases of \u003ca href=\"http://www.cdc.gov/std/chlamydia/stdfact-chlamydia.htm\">chlamydia \u003c/a>reported in the same year, showing a rise of 6 and 13 percent over the past year. All three infections can be treated with antibiotics, though gonorrhea is becoming \u003ca href=\"http://www.npr.org/sections/thetwo-way/2016/08/30/491969011/u-n-health-officials-warn-gonorrhea-is-becoming-untreatable\">increasingly resistant to antibiotics\u003c/a>.\u003c/p>\n\u003cp>\"This basically tells us we have to do a better job of reach out to some of these communities that are disproportionately affected by these infections,\" says \u003ca href=\"https://internalmedicine.osu.edu/infectiousdisease/directory/faculty/josebazan/\">Dr. Jose Bazan\u003c/a>, a medical director for an STD clinic at Columbus Public Health and an assistant professor of internal medicine at Ohio State University who was not involved with the report.\u003c/p>\n\u003cp>Men who have sex with men face a greater risk of being infected with syphilis. Over 80 percent of male syphilis cases were reported among gay and bisexual males, and over 90 percent of all syphilis cases were in men. People in racial and sexual minority groups can have more than the usual trouble finding care for preventing and treating STDs.\u003c/p>\n\u003cp>According to a congressional briefing last April by Dr. Gail Bolan, the director for the CDC Division of STD Prevention, over 40 percent of health departments reduced clinic hours, screening, or tracing people who may have been infected.\u003c/p>\n\u003cp>\"If that infrastructure gets STDeroded, people are more likely to have their STDs for a longer period of time, and that can lead to increased transmission,\" Mermin says.\u003c/p>\n\u003cp>The federal government also helps fund state and local STD programs through the CDC, but federal funds have not helped make up for some of the budget cuts on the local level, according to \u003ca href=\"http://www.ncsddc.org/who-we-are/board\">David Harvey\u003c/a>, the executive director for the National Coalition of STD Directors.\u003c/p>\n\u003cp>\"We believe there's a direct relationship between budget cuts and increases in STDs in the United States. There has been no federal increases for STD programs in this country since 2003,\" he says.\u003c/p>\n\u003cp>If the trend is to be reversed, Mermin says there needs to be a real investment in STD prevention so that clinics can monitor these diseases and quickly diagnose and treat people who are infected.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"We've seen success in the past where investments have paid off,\" he says. \"We know what we need to do. We just need to do it more effectively than we've been able to do with this eroding infrastructure.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=STD+Infections+Rise+To+New+Highs+After+States+Close+Health+Clinics&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Surpasses National HIV Target -- 6 Years Early",
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"content": "\u003cp>State health officials say California has passed a major goal in fighting HIV/AIDS: more than 90 percent of people living with the virus have been diagnosed, a necessary first step in treatment.\u003c/p>\n\u003cp>The state accomplished this goal six years ahead of the target 2020 set in the \u003ca href=\"https://www.aids.gov/federal-resources/national-hiv-aids-strategy/overview/https://www.aids.gov/federal-resources/national-hiv-aids-strategy/overview/\" target=\"_blank\">National HIV/AIDS Strategy\u003c/a>, established by the White House.\u003c/p>\n\u003cp>\u003ca href=\"http://www.cdph.ca.gov/programs/aids/Documents/California%20Continuum%20of%20HIV%20Care%20-%202014.pdf\" target=\"_blank\">Data\u003c/a> released Monday from 2014 shows 91 percent of Californians with HIV had been diagnosed.\u003c/p>\n\u003cp>In a statement, state public health officer Dr. Karen Smith said she was \"proud of the work we’ve done across the Golden State to meet and surpass this key indicator, which will help us improve viral suppression rates and reduce new HIV infections.”\u003c/p>\n\u003cp>Only after people have been diagnosed can they be treated and dramatically reduce the virus in their blood, usually to undetectable levels. Successful treatment can reduce the risk of transmitting the virus to sex partners by 96 percent, according to the California Department of Public Health.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Chris Richey, a spokesman for the San Francisco AIDS Foundation, called the milestone \"a huge deal\" and said that diagnosis was a sign of being engaged in care.\u003c/p>\n\u003cp>\"If you're not engaged in care in general,\" Richey said, \"then you're not able to know or be in control of your sexual health or your overall health.\"\u003c/p>\n\u003cp>The Centers for Disease Control and Prevention recommend that everyone between the ages of 13 and 64 get tested for HIV at least once, as part of routine health care. Some people should be tested more frequently, CDC says. State health officials recommend annual testing for sexually active gay and bisexual men, transgender individuals and anyone who injects drugs.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>About 140,000 people in California are living with HIV.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>State health officials say California has passed a major goal in fighting HIV/AIDS: more than 90 percent of people living with the virus have been diagnosed, a necessary first step in treatment.\u003c/p>\n\u003cp>The state accomplished this goal six years ahead of the target 2020 set in the \u003ca href=\"https://www.aids.gov/federal-resources/national-hiv-aids-strategy/overview/https://www.aids.gov/federal-resources/national-hiv-aids-strategy/overview/\" target=\"_blank\">National HIV/AIDS Strategy\u003c/a>, established by the White House.\u003c/p>\n\u003cp>\u003ca href=\"http://www.cdph.ca.gov/programs/aids/Documents/California%20Continuum%20of%20HIV%20Care%20-%202014.pdf\" target=\"_blank\">Data\u003c/a> released Monday from 2014 shows 91 percent of Californians with HIV had been diagnosed.\u003c/p>\n\u003cp>In a statement, state public health officer Dr. Karen Smith said she was \"proud of the work we’ve done across the Golden State to meet and surpass this key indicator, which will help us improve viral suppression rates and reduce new HIV infections.”\u003c/p>\n\u003cp>Only after people have been diagnosed can they be treated and dramatically reduce the virus in their blood, usually to undetectable levels. Successful treatment can reduce the risk of transmitting the virus to sex partners by 96 percent, according to the California Department of Public Health.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Chris Richey, a spokesman for the San Francisco AIDS Foundation, called the milestone \"a huge deal\" and said that diagnosis was a sign of being engaged in care.\u003c/p>\n\u003cp>\"If you're not engaged in care in general,\" Richey said, \"then you're not able to know or be in control of your sexual health or your overall health.\"\u003c/p>\n\u003cp>The Centers for Disease Control and Prevention recommend that everyone between the ages of 13 and 64 get tested for HIV at least once, as part of routine health care. Some people should be tested more frequently, CDC says. State health officials recommend annual testing for sexually active gay and bisexual men, transgender individuals and anyone who injects drugs.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>About 140,000 people in California are living with HIV.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "How Theater Helps This HIV-Positive Grandmother Transform Lives",
"title": "How Theater Helps This HIV-Positive Grandmother Transform Lives",
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"content": "\u003cp>For decades, Cassandra Steptoe felt like she couldn’t talk about her HIV diagnosis with anyone.\u003c/p>\n\u003cp>\"I couldn't forgive myself for getting HIV,\" says Steptoe, who spent much of her early adult life in and out of jail for shoplifting and burglaries linked to her IV drug use. \"But someone told me a long time ago, if you are looking for a reason to feel shame, you can always find it. I learned to look for something else: forgiveness.\"\u003c/p>\n\u003cp>For Steptoe, now 59 and a grandmother, it wasn't until her 40s -- after decades of struggling with addiction -- that she finally completed a rehab program and committed to ongoing HIV treatment.\u003c/p>\n\u003cp>Today she talks openly about that experience onstage, as part of a theater project aimed at inspiring others. The quote about learning to forgive herself is part of an autobiographical monologue Steptoe wrote and performs in a San Francisco theater production of \u003ca href=\"https://www.facebook.com/MedeaProject/\" target=\"_blank\">The Medea Project: Theater for Incarcerated Women/HIV Circle\u003c/a>.\u003c/p>\n\u003cp>It was Steptoe's physician, \u003ca href=\"http://whp.ucsf.edu/about/team-members/edward-machtinger-m-d\">Dr. Edward Machtinger\u003c/a>, who first told her about the project. Established by playwright and director \u003ca href=\"http://www.culturalodyssey.org/v2/aboutus/rhodessa_bio.html\" target=\"_blank\">Rhodessa Jones\u003c/a> in 2008 as an extension of an improvisational production that draws on and explores the \u003ca href=\"http://www.npr.org/templates/story/story.php?storyId=15146105\" target=\"_blank\">experiences of jailed women\u003c/a>, the \"HIV Circle\" focuses on the experiences of women living with the AIDS virus.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The therapeutic aspect of the performance workshop is called \u003ca href=\"http://rtc.umn.edu/docs/pep_facguide.pdf\" target=\"_blank\">peer empowerment\u003c/a>, explains Machtinger, an internist and director of the Women's HIV Program at the University of California, San Francisco. The strength and healing Steptoe and others have gained from processing and sharing their stories this way is profound, he says — and can serve as a model for helping other patients deal with psychological trauma.\u003c/p>\n\u003cfigure id=\"attachment_164615\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-164615\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/03/RS18863_IMG_9455-qut.jpg\" alt=\"Cassandra Steptoe at the apartment she shares with her 8-year-old granddaughter in San Francisco. She credits The Medea Project with helping her improve her overall well-being.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Cassandra Steptoe at the apartment she shares with her 8-year-old granddaughter in San Francisco. She credits The Medea Project with helping her improve her overall well-being. \u003ccite>(Farida Jhabvala Romero / KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Medications 'Not Enough'\u003c/strong>\u003c/p>\n\u003cp>With the theater group, Steptoe began writing about her experiences and sharing them with a small group of women, some of whom had gone through similar struggles of addiction and histories of incarceration. The process of uncovering her past and making sense of her experiences in a cathartic, supportive environment helped Steptoe end her feelings of isolation.\u003c/p>\n\u003cp>\"Having these women that really love you and support you ... it feels good to have some real friends, 'cause I never had that before,\" Steptoe says. \"We're all sharing something together 'cause we all get something out of everybody's story.\"\u003c/p>\n\u003cp>The potential of peer empowerment is not just anecdotal. Machtinger has \u003ca href=\"http://www.sciencedirect.com/science/article/pii/S1055329014000971\" target=\"_blank\">studied\u003c/a> the Medea Project's life-saving impact on his patients.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/256844757\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>Machtinger says the patients in the Medea Project followed by his research team went through an extraordinary transformation. Many who had barely disclosed their HIV status to anyone when they began, became activists and leaders in their communities, helping to destigmatize HIV while pursuing personal goals and leading productive lives.\u003c/p>\n\u003cp>\"For them to develop what they described as \"sisterhood\" was the most important and most profound type of healing that I ever witnessed,\" Machtinger says.\u003c/p>\n\u003cp>He began seeking alternative methods to help his patients after increasingly noticing that a large proportion were successfully receiving antiretroviral treatment, but still dying from reasons that had \"nothing to do with HIV,\" such as murder, suicide or drug overdose.\u003c/p>\n\u003cp>\"They could have their HIV under control, (but) their lives were not getting better,\" Machtinger says. \"That was because their core issue -- a life of trauma and the impacts of depression, isolation and shame -- wasn’t being effectively addressed. And to us, that's not acceptable.\"\u003c/p>\n\u003cp>Machtinger's experience is reverberating beyond the Medea Project. He says witnessing and studying the impact of peer empowerment has helped inform a broader role. He is part of an advisory group helping to develop new guidelines for trauma-informed primary care for the federal Substance Abuse and Mental Health Services Administration.\u003c/p>\n\u003cp>The new guidelines will likely include a substantial focus on interventions with peer empowerment as one ingredient to help people with severe trauma heal, says Machtinger.\u003c/p>\n\u003cp>\"The core elements of the Medea Project are really lessons for other interventions to help people overcome trauma and other stigmatizing situations and conditions,\" says Machtinger, adding that childhood and adult trauma have been linked to a variety of illnesses, such as hepatitis C, heart disease and diabetes.\u003c/p>\n\u003cp>He expects the new guidelines for primary care clinics and other health providers to be finalized and published later this year.\u003c/p>\n\u003cp>\u003cstrong>Trauma at the Root of HIV Diagnosis\u003c/strong>\u003c/p>\n\u003cp>Steptoe now realizes she was infected with HIV through unprotected sex and sharing needles. She used to be addicted to heroin and cocaine. During a decades-long period of her life, she was in and out of the criminal justice system. She worked as a prostitute and survived abusive relationships -- getting beat up so badly one time that she spent three months recovering at a hospital, she said.\u003c/p>\n\u003cp>Steptoe says experiencing sexual abuse repeatedly as a child and teen led her on the path that eventually resulted in HIV infection.\u003c/p>\n\u003cp>\"Sexual abuse came from family,\" she says. \"And I guess I was kind of covering all that up by choosing the drugs. It kind of took me out there into the street, looking for love in the wrong places because I didn't have it at home. I started shooting drugs and that led into prostitution and to prison.\"\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/03/20/trauma-fuels-hiv-epidemic-among-women/http://ww2.kqed.org/stateofhealth/2012/03/20/trauma-fuels-hiv-epidemic-among-women/\">Recent studies\u003c/a> show that HIV-positive women suffer disproportionately from high rates of trauma and post-traumatic stress disorder. The high rates of trauma also lead to increased risk of further spreading HIV, according to researchers.\u003c/p>\n\u003cp>\u003cstrong>Transforming Her Life\u003c/strong>\u003c/p>\n\u003cp>Now Steptoe is busy and full of energy. She takes antiretroviral medication religiously every morning, eats a healthy diet and works out by taking Zumba fitness classes at her gym.\u003c/p>\n\u003cp>Steptoe, a mother of three and grandmother of nine has also taken full custody of her 8-year-old granddaughter, who frequently accompanies her to rehearsals.\u003c/p>\n\u003cp>\"She teaches me how to love, and she gives me patience,\" says Steptoe, who also cares for other kids in her Mission apartment building.\u003c/p>\n\u003cp>Rhodessa Jones, the Medea Project's dynamic and energetic director, says Steptoe has flourished since she joined the organization, becoming a leader and inspiration to other women.\u003c/p>\n\u003cp>\"She’s so powerful, positive and forceful. She gets it,\" says Jones, who founded Medea more than 23 years ago. \"Theater has really been expressive therapy for her. It gives her a space to speak her truth.\"\u003c/p>\n\u003cfigure id=\"attachment_164614\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-164614\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/03/RS18862_IMG_9445-qut.jpg\" alt='Performers at The Medea Project rehearse in San Francisco. Founder and director Rhodessa Jones, uses Greek, Roman and African mythology to introduce \"the universality of all of our stories.\"' width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Performers at The Medea Project rehearse in San Francisco. Founder and director Rhodessa Jones, uses Greek, Roman and African mythology to introduce \"the universality of all of our stories.\" \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Medea Project uses Greek, Roman and African mythology to introduce \"the universality of all of our stories,\" says Jones, who asked Steptoe to imagine going back in time to age 14 and write the lessons she would give herself. The result was Steptoe's piece \"Younger Self.\"\u003c/p>\n\u003cp>Steptoe wrote the piece, performed in January in San Francisco, about the moment in 1987 when she first found out she was HIV-positive. She was serving time in jail and received a health checkup.\u003c/p>\n\u003cp>\"My world crashed. I didn't have no education of what I had, I didn't have no support,\" says Steptoe, adding that she considered her condition \"a death sentence\" at the time. \"I had to relive that again by writing this because I needed to heal.\"\u003c/p>\n\u003cp>\u003cstrong>'HIV is a Health Condition, Not a Crime'\u003c/strong>\u003c/p>\n\u003cp>After receiving the diagnosis, she remembers crying at night with a pillow over her head so others wouldn't hear.\u003c/p>\n\u003cp>Steptoe then kept her HIV status a secret for many years.\u003c/p>\n\u003cp>But, years later, the key for her to find and use her voice was becoming a part of The Medea Project, she says. The main motivation for telling her story? She wants to give hope to others, and help them feel they are not alone.\u003c/p>\n\u003cp>\"Now I can tell the world that HIV is just a health condition, not a crime,\" says Steptoe, who doesn't hesitate to share her story as a lead actress for Medea in front of audiences of hundreds of people.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"I don't have shame around it no more,” Steptoe says. “I let my grandkids know that even if you go the wrong way, you can still turn your life around.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>For decades, Cassandra Steptoe felt like she couldn’t talk about her HIV diagnosis with anyone.\u003c/p>\n\u003cp>\"I couldn't forgive myself for getting HIV,\" says Steptoe, who spent much of her early adult life in and out of jail for shoplifting and burglaries linked to her IV drug use. \"But someone told me a long time ago, if you are looking for a reason to feel shame, you can always find it. I learned to look for something else: forgiveness.\"\u003c/p>\n\u003cp>For Steptoe, now 59 and a grandmother, it wasn't until her 40s -- after decades of struggling with addiction -- that she finally completed a rehab program and committed to ongoing HIV treatment.\u003c/p>\n\u003cp>Today she talks openly about that experience onstage, as part of a theater project aimed at inspiring others. The quote about learning to forgive herself is part of an autobiographical monologue Steptoe wrote and performs in a San Francisco theater production of \u003ca href=\"https://www.facebook.com/MedeaProject/\" target=\"_blank\">The Medea Project: Theater for Incarcerated Women/HIV Circle\u003c/a>.\u003c/p>\n\u003cp>It was Steptoe's physician, \u003ca href=\"http://whp.ucsf.edu/about/team-members/edward-machtinger-m-d\">Dr. Edward Machtinger\u003c/a>, who first told her about the project. Established by playwright and director \u003ca href=\"http://www.culturalodyssey.org/v2/aboutus/rhodessa_bio.html\" target=\"_blank\">Rhodessa Jones\u003c/a> in 2008 as an extension of an improvisational production that draws on and explores the \u003ca href=\"http://www.npr.org/templates/story/story.php?storyId=15146105\" target=\"_blank\">experiences of jailed women\u003c/a>, the \"HIV Circle\" focuses on the experiences of women living with the AIDS virus.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The therapeutic aspect of the performance workshop is called \u003ca href=\"http://rtc.umn.edu/docs/pep_facguide.pdf\" target=\"_blank\">peer empowerment\u003c/a>, explains Machtinger, an internist and director of the Women's HIV Program at the University of California, San Francisco. The strength and healing Steptoe and others have gained from processing and sharing their stories this way is profound, he says — and can serve as a model for helping other patients deal with psychological trauma.\u003c/p>\n\u003cfigure id=\"attachment_164615\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-164615\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/03/RS18863_IMG_9455-qut.jpg\" alt=\"Cassandra Steptoe at the apartment she shares with her 8-year-old granddaughter in San Francisco. She credits The Medea Project with helping her improve her overall well-being.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Cassandra Steptoe at the apartment she shares with her 8-year-old granddaughter in San Francisco. She credits The Medea Project with helping her improve her overall well-being. \u003ccite>(Farida Jhabvala Romero / KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Medications 'Not Enough'\u003c/strong>\u003c/p>\n\u003cp>With the theater group, Steptoe began writing about her experiences and sharing them with a small group of women, some of whom had gone through similar struggles of addiction and histories of incarceration. The process of uncovering her past and making sense of her experiences in a cathartic, supportive environment helped Steptoe end her feelings of isolation.\u003c/p>\n\u003cp>\"Having these women that really love you and support you ... it feels good to have some real friends, 'cause I never had that before,\" Steptoe says. \"We're all sharing something together 'cause we all get something out of everybody's story.\"\u003c/p>\n\u003cp>The potential of peer empowerment is not just anecdotal. Machtinger has \u003ca href=\"http://www.sciencedirect.com/science/article/pii/S1055329014000971\" target=\"_blank\">studied\u003c/a> the Medea Project's life-saving impact on his patients.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/256844757&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/256844757'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Machtinger says the patients in the Medea Project followed by his research team went through an extraordinary transformation. Many who had barely disclosed their HIV status to anyone when they began, became activists and leaders in their communities, helping to destigmatize HIV while pursuing personal goals and leading productive lives.\u003c/p>\n\u003cp>\"For them to develop what they described as \"sisterhood\" was the most important and most profound type of healing that I ever witnessed,\" Machtinger says.\u003c/p>\n\u003cp>He began seeking alternative methods to help his patients after increasingly noticing that a large proportion were successfully receiving antiretroviral treatment, but still dying from reasons that had \"nothing to do with HIV,\" such as murder, suicide or drug overdose.\u003c/p>\n\u003cp>\"They could have their HIV under control, (but) their lives were not getting better,\" Machtinger says. \"That was because their core issue -- a life of trauma and the impacts of depression, isolation and shame -- wasn’t being effectively addressed. And to us, that's not acceptable.\"\u003c/p>\n\u003cp>Machtinger's experience is reverberating beyond the Medea Project. He says witnessing and studying the impact of peer empowerment has helped inform a broader role. He is part of an advisory group helping to develop new guidelines for trauma-informed primary care for the federal Substance Abuse and Mental Health Services Administration.\u003c/p>\n\u003cp>The new guidelines will likely include a substantial focus on interventions with peer empowerment as one ingredient to help people with severe trauma heal, says Machtinger.\u003c/p>\n\u003cp>\"The core elements of the Medea Project are really lessons for other interventions to help people overcome trauma and other stigmatizing situations and conditions,\" says Machtinger, adding that childhood and adult trauma have been linked to a variety of illnesses, such as hepatitis C, heart disease and diabetes.\u003c/p>\n\u003cp>He expects the new guidelines for primary care clinics and other health providers to be finalized and published later this year.\u003c/p>\n\u003cp>\u003cstrong>Trauma at the Root of HIV Diagnosis\u003c/strong>\u003c/p>\n\u003cp>Steptoe now realizes she was infected with HIV through unprotected sex and sharing needles. She used to be addicted to heroin and cocaine. During a decades-long period of her life, she was in and out of the criminal justice system. She worked as a prostitute and survived abusive relationships -- getting beat up so badly one time that she spent three months recovering at a hospital, she said.\u003c/p>\n\u003cp>Steptoe says experiencing sexual abuse repeatedly as a child and teen led her on the path that eventually resulted in HIV infection.\u003c/p>\n\u003cp>\"Sexual abuse came from family,\" she says. \"And I guess I was kind of covering all that up by choosing the drugs. It kind of took me out there into the street, looking for love in the wrong places because I didn't have it at home. I started shooting drugs and that led into prostitution and to prison.\"\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/03/20/trauma-fuels-hiv-epidemic-among-women/http://ww2.kqed.org/stateofhealth/2012/03/20/trauma-fuels-hiv-epidemic-among-women/\">Recent studies\u003c/a> show that HIV-positive women suffer disproportionately from high rates of trauma and post-traumatic stress disorder. The high rates of trauma also lead to increased risk of further spreading HIV, according to researchers.\u003c/p>\n\u003cp>\u003cstrong>Transforming Her Life\u003c/strong>\u003c/p>\n\u003cp>Now Steptoe is busy and full of energy. She takes antiretroviral medication religiously every morning, eats a healthy diet and works out by taking Zumba fitness classes at her gym.\u003c/p>\n\u003cp>Steptoe, a mother of three and grandmother of nine has also taken full custody of her 8-year-old granddaughter, who frequently accompanies her to rehearsals.\u003c/p>\n\u003cp>\"She teaches me how to love, and she gives me patience,\" says Steptoe, who also cares for other kids in her Mission apartment building.\u003c/p>\n\u003cp>Rhodessa Jones, the Medea Project's dynamic and energetic director, says Steptoe has flourished since she joined the organization, becoming a leader and inspiration to other women.\u003c/p>\n\u003cp>\"She’s so powerful, positive and forceful. She gets it,\" says Jones, who founded Medea more than 23 years ago. \"Theater has really been expressive therapy for her. It gives her a space to speak her truth.\"\u003c/p>\n\u003cfigure id=\"attachment_164614\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-164614\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/03/RS18862_IMG_9445-qut.jpg\" alt='Performers at The Medea Project rehearse in San Francisco. Founder and director Rhodessa Jones, uses Greek, Roman and African mythology to introduce \"the universality of all of our stories.\"' width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Performers at The Medea Project rehearse in San Francisco. Founder and director Rhodessa Jones, uses Greek, Roman and African mythology to introduce \"the universality of all of our stories.\" \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Medea Project uses Greek, Roman and African mythology to introduce \"the universality of all of our stories,\" says Jones, who asked Steptoe to imagine going back in time to age 14 and write the lessons she would give herself. The result was Steptoe's piece \"Younger Self.\"\u003c/p>\n\u003cp>Steptoe wrote the piece, performed in January in San Francisco, about the moment in 1987 when she first found out she was HIV-positive. She was serving time in jail and received a health checkup.\u003c/p>\n\u003cp>\"My world crashed. I didn't have no education of what I had, I didn't have no support,\" says Steptoe, adding that she considered her condition \"a death sentence\" at the time. \"I had to relive that again by writing this because I needed to heal.\"\u003c/p>\n\u003cp>\u003cstrong>'HIV is a Health Condition, Not a Crime'\u003c/strong>\u003c/p>\n\u003cp>After receiving the diagnosis, she remembers crying at night with a pillow over her head so others wouldn't hear.\u003c/p>\n\u003cp>Steptoe then kept her HIV status a secret for many years.\u003c/p>\n\u003cp>But, years later, the key for her to find and use her voice was becoming a part of The Medea Project, she says. The main motivation for telling her story? She wants to give hope to others, and help them feel they are not alone.\u003c/p>\n\u003cp>\"Now I can tell the world that HIV is just a health condition, not a crime,\" says Steptoe, who doesn't hesitate to share her story as a lead actress for Medea in front of audiences of hundreds of people.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"I don't have shame around it no more,” Steptoe says. “I let my grandkids know that even if you go the wrong way, you can still turn your life around.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Half of Gay Black Men Will Get HIV, CDC Analysis Shows",
"title": "Half of Gay Black Men Will Get HIV, CDC Analysis Shows",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>NEW YORK (AP) — About half of gay and bisexual black men will be diagnosed with the AIDS virus in their lifetime, according to the \u003ca href=\"http://www.cdc.gov/nchhstp/newsroom/docs/factsheets/lifetime-risk-hiv-dx-us.pdf\" target=\"_blank\">first-ever comprehensive national estimates\u003c/a> from the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>Overall, for the average American, the odds of an HIV infection is 1 in 99 and has been declining.\u003c/p>\n\u003cp>But the risk varies widely for different groups. For example, the projection is 1 in 2 for gay black men but fewer than 1 in 2,500 for heterosexual white men.\u003c/p>\n\u003cp>\"The differences are stark,\" said Dr. Jonathan Mermin of the CDC's National Center for HIV/AIDS. The CDC released the estimates at a Boston medical conference on Tuesday.\u003c/p>\n\u003cp>HIV, or human immunodeficiency virus, is spread mainly through sex and sharing needles for injecting drugs. In the U.S., infections have long been most common in men who have sex with men. Since AIDS was first identified more than 30 years ago, medicines have changed it from a death sentence to a chronic threat.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The report provides an unusually vivid picture of what's been happening with HIV infections. The estimates were calculated from HIV diagnosis and death figures from 2009 through 2013.\u003c/p>\n\u003cp>New HIV infections have been falling in the United States, to about 40,000 annually. A disproportionately large share — about 10,000 cases — has been in gay and bisexual black men. That number has been holding steady while infections in other groups have fallen.\u003c/p>\n\u003cp>The lifetime risk of HIV has also has been declining. Several years ago, the CDC put that estimate at less than 1 in 78 for all Americans. It fell about 20 percent, to 1 in 99, and dropped for both men and women. That suggests prevention efforts are paying off, Mermin said.\u003c/p>\n\u003cp>The earlier estimate was based on 33 states; the \u003ca href=\"http://www.cdc.gov/nchhstp/newsroom/docs/factsheets/lifetime-risk-hiv-dx-us.pdf\" target=\"_blank\">new report\u003c/a> covers all 50 states and the District of Columbia. That allowed the agency — for the first time — to calculate lifetime risk for specific groups, like gay black men, and for states.\u003c/p>\n\u003cp>Again, the overall risk that the average American will be diagnosed with HIV during his or her lifetime is 1 in 99.\u003c/p>\n\u003cp>Findings include:\u003c/p>\n\u003cul>\n\u003cli>Based on geography, the chances of being diagnosed with HIV is highest in Washington, D.C., and Southern states like Georgia, Florida, Louisiana and Maryland.\u003c/li>\n\u003cli>The risk is lowest in North Dakota. One in 670 residents of that state will be diagnosed with HIV, compared to about 1 in 50 in Maryland and Georgia.\u003c/li>\n\u003cli>In California, the overall risk is 1 in 102\u003c/li>\n\u003cli>Gay and bisexual men have the highest risk, but there are racial differences within that group. For gay white men it's about 1 in 11 — a significantly smaller proportion than the estimate for blacks and Hispanics.\u003c/li>\n\u003cli>Among heterosexuals, blacks are far more likely to be infected than other racial groups. For example, 1 in 49 black women compared to 1 in 1,083 white women.\u003c/li>\n\u003c/ul>\n\u003cp>“You see this community that is at far higher risk for HIV infection, but there almost seems to be a concerted effort not to talk about it,” Greg Millett, vice president and director of Public Policy at AmfAR, the Foundation for AIDS Research, told \u003ca href=\"http://www.bloomberg.com/news/articles/2016-02-23/gay-black-men-are-still-bearing-the-brunt-of-the-hiv-crisis\" target=\"_blank\">Bloomberg News\u003c/a>. He was not involved in the research, but did work at CDC until 2014.\u003c/p>\n\u003cp>In a \u003ca href=\"http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60899-X/abstract\" target=\"_blank\">2012 analysis,\u003c/a> Millett found the disparity was not linked to gay black men engaging in riskier sex. As Bloomberg reports:\u003c/p>\n\u003cblockquote>\u003cp>Rather, he cites such structural barriers as access to health insurance that have made it harder for blacks to get HIV testing and treatment that can control the virus and reduce the risk of infecting a partner.\u003c/p>\u003c/blockquote>\n\u003cp>Marguerita Lightfoot, director of the UC San Francisco Center for AIDS Prevention called the numbers \"shocking.\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"UwZFLWI6km758gDhJI39O7UhloU3at8y\"]She agreed that HIV testing is a first step toward reducing the risk of infected men spreading the virus to others. With treatments available today, the virus can be reduced to undetectable levels in the bloodstream, making it virtually impossible to infect others.\u003c/p>\n\u003cp>For those who are negative, a key strategy that has become available just in the last two years is \"PrEP\" -- pre-exposure prophylaxis -- a pill that can dramatically reduce the risk of acquiring the virus. \"The big thing we can be doing is making sure young, black men in particular get access to PrEP,\" Lightfoot said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The report is a \"wake up call,\" Lightfoot said. \"We know clearly who we need to be targeting. We just need to get to work.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>NEW YORK (AP) — About half of gay and bisexual black men will be diagnosed with the AIDS virus in their lifetime, according to the \u003ca href=\"http://www.cdc.gov/nchhstp/newsroom/docs/factsheets/lifetime-risk-hiv-dx-us.pdf\" target=\"_blank\">first-ever comprehensive national estimates\u003c/a> from the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>Overall, for the average American, the odds of an HIV infection is 1 in 99 and has been declining.\u003c/p>\n\u003cp>But the risk varies widely for different groups. For example, the projection is 1 in 2 for gay black men but fewer than 1 in 2,500 for heterosexual white men.\u003c/p>\n\u003cp>\"The differences are stark,\" said Dr. Jonathan Mermin of the CDC's National Center for HIV/AIDS. The CDC released the estimates at a Boston medical conference on Tuesday.\u003c/p>\n\u003cp>HIV, or human immunodeficiency virus, is spread mainly through sex and sharing needles for injecting drugs. In the U.S., infections have long been most common in men who have sex with men. Since AIDS was first identified more than 30 years ago, medicines have changed it from a death sentence to a chronic threat.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The report provides an unusually vivid picture of what's been happening with HIV infections. The estimates were calculated from HIV diagnosis and death figures from 2009 through 2013.\u003c/p>\n\u003cp>New HIV infections have been falling in the United States, to about 40,000 annually. A disproportionately large share — about 10,000 cases — has been in gay and bisexual black men. That number has been holding steady while infections in other groups have fallen.\u003c/p>\n\u003cp>The lifetime risk of HIV has also has been declining. Several years ago, the CDC put that estimate at less than 1 in 78 for all Americans. It fell about 20 percent, to 1 in 99, and dropped for both men and women. That suggests prevention efforts are paying off, Mermin said.\u003c/p>\n\u003cp>The earlier estimate was based on 33 states; the \u003ca href=\"http://www.cdc.gov/nchhstp/newsroom/docs/factsheets/lifetime-risk-hiv-dx-us.pdf\" target=\"_blank\">new report\u003c/a> covers all 50 states and the District of Columbia. That allowed the agency — for the first time — to calculate lifetime risk for specific groups, like gay black men, and for states.\u003c/p>\n\u003cp>Again, the overall risk that the average American will be diagnosed with HIV during his or her lifetime is 1 in 99.\u003c/p>\n\u003cp>Findings include:\u003c/p>\n\u003cul>\n\u003cli>Based on geography, the chances of being diagnosed with HIV is highest in Washington, D.C., and Southern states like Georgia, Florida, Louisiana and Maryland.\u003c/li>\n\u003cli>The risk is lowest in North Dakota. One in 670 residents of that state will be diagnosed with HIV, compared to about 1 in 50 in Maryland and Georgia.\u003c/li>\n\u003cli>In California, the overall risk is 1 in 102\u003c/li>\n\u003cli>Gay and bisexual men have the highest risk, but there are racial differences within that group. For gay white men it's about 1 in 11 — a significantly smaller proportion than the estimate for blacks and Hispanics.\u003c/li>\n\u003cli>Among heterosexuals, blacks are far more likely to be infected than other racial groups. For example, 1 in 49 black women compared to 1 in 1,083 white women.\u003c/li>\n\u003c/ul>\n\u003cp>“You see this community that is at far higher risk for HIV infection, but there almost seems to be a concerted effort not to talk about it,” Greg Millett, vice president and director of Public Policy at AmfAR, the Foundation for AIDS Research, told \u003ca href=\"http://www.bloomberg.com/news/articles/2016-02-23/gay-black-men-are-still-bearing-the-brunt-of-the-hiv-crisis\" target=\"_blank\">Bloomberg News\u003c/a>. He was not involved in the research, but did work at CDC until 2014.\u003c/p>\n\u003cp>In a \u003ca href=\"http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60899-X/abstract\" target=\"_blank\">2012 analysis,\u003c/a> Millett found the disparity was not linked to gay black men engaging in riskier sex. As Bloomberg reports:\u003c/p>\n\u003cblockquote>\u003cp>Rather, he cites such structural barriers as access to health insurance that have made it harder for blacks to get HIV testing and treatment that can control the virus and reduce the risk of infecting a partner.\u003c/p>\u003c/blockquote>\n\u003cp>Marguerita Lightfoot, director of the UC San Francisco Center for AIDS Prevention called the numbers \"shocking.\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>She agreed that HIV testing is a first step toward reducing the risk of infected men spreading the virus to others. With treatments available today, the virus can be reduced to undetectable levels in the bloodstream, making it virtually impossible to infect others.\u003c/p>\n\u003cp>For those who are negative, a key strategy that has become available just in the last two years is \"PrEP\" -- pre-exposure prophylaxis -- a pill that can dramatically reduce the risk of acquiring the virus. \"The big thing we can be doing is making sure young, black men in particular get access to PrEP,\" Lightfoot said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The report is a \"wake up call,\" Lightfoot said. \"We know clearly who we need to be targeting. We just need to get to work.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Congress Lifts Ban, Needle Exchanges Now Eligible for Federal Funds",
"title": "Congress Lifts Ban, Needle Exchanges Now Eligible for Federal Funds",
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"content": "\u003cp>LOS ANGELES — At precisely 8:30 a.m. on a Tuesday morning, the doors to the needle exchange on Skid Row open and the daily procession of injection drug users begins.\u003c/p>\n\u003cp>Michael Poor, 47, is one of the first customers. He has used his last clean syringe. Poor, who is homeless and addicted to methamphetamines, says coming to the downtown exchange puts his mind at ease: clean needles lower his risk for HIV.\u003c/p>\n\u003cp>“It is a very needed service, not just in downtown but anywhere drugs are an issue,” says Poor, a lanky, friendly man who is missing all of his teeth. “Thanks to needle exchange … I have stayed pretty healthy, which is a hard thing to do when you are injecting drugs.”\u003c/p>\n\u003cp>Needle exchanges like the one Poor visits could receive a financial boost this year \u003ca href=\"http://www.npr.org/2016/01/08/462412631/congress-ends-ban-on-federal-funding-for-needle-exchange-programs\" target=\"_blank\">following a decision by Congress \u003c/a>in January to lift a ban on federal funding. As abuse of prescription drugs and opiates continues to spread across the nation, more states are considering exchanges as a way to save lives.\u003c/p>\n\u003cp>Indiana, for instance, opened its first exchange after an HIV outbreak last year.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The change in federal policy, part of a spending bill approved earlier this month, allows funding only in areas where drug-related cases of hepatitis and HIV are rising or are likely to. State and city health departments will make that determination along with the federal Centers for Disease Control and Prevention, according to the legislation.\u003c/p>\n\u003cp>The money can be used to pay for staff and programs, but not for syringes.\u003c/p>\n\u003cp>“It is really an important and historic moment for us at syringe exchanges,” said Mark Casanova, executive director of Homeless Health Care Los Angeles, which runs the syringe exchange on Skid Row, known as the Center for Harm Reduction. “But it doesn’t go far enough.”\u003c/p>\n\u003cp>Casanova said about a third of his $350,000 budget for the exchange program is spent on the 1.2 million syringes he hands out each year, and he will have to continue relying heavily on private donations to pay for them.\u003c/p>\n\u003cp>Despite the restrictions, lifting the ban underscores a growing recognition that needle exchange programs can help reduce the the spread of infectious diseases, said Daniel Raymond, policy director for Harm Reduction Coalition.\u003c/p>\n\u003cp>“This is a huge victory,” said Raymond, whose national organization advocates and provides training for exchange programs. “It is in some way the last chapter of an era where syringe exchange was considered too volatile and too partisan [for policy makers] to come to a consensus.”\u003c/p>\n\u003cfigure id=\"attachment_149292\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"wp-image-149292 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/needle-exchange-1-400x267.jpg\" alt=\"The Center for Harm Reduction in Skid Row has a syringe exchange program, which provides treatment, prevention and disease management for injection drug users. \" width=\"400\" height=\"267\">\u003cfigcaption class=\"wp-caption-text\">The Center for Harm Reduction on LA's Skid Row has a syringe exchange program, which provides treatment, prevention and disease management for injection drug users. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Critics of needle programs counter that opening the door to federal funding could leave less money for treatment of people who want to get sober. The new law does not allot additional funds for the exchanges, but rather allows them to compete for existing drug program money.\u003c/p>\n\u003cp>“The dollars are precious these days,” said Calvina Fay, executive director of Drug Free America Foundation, a drug policy and prevention organization. “When we have people wanting to get clean and standing in line waiting for a treatment bed … the money could certainly be better spent.”\u003c/p>\n\u003cp>Needle exchanges began at the height of the AIDS epidemic and today number roughly 200 around the United States, including about 40 in California.\u003c/p>\n\u003cp>Using clean syringes continues to be the safest way to prevent transmission among injection drug users, according to a 2012 CDC report, which said the percentage of injection drug users infected with HIV dropped by half from the mid-1990s to 2009.\u003c/p>\n\u003cp>“Syringe programs have really been concentrated in large cities and have done an excellent job of preventing HIV infection where they have been implemented, but we now really need to move to address the new injectors that we see in small towns and in rural areas, particularly in Appalachia,” said Don Des Jarlais of the Icahn School of Medicine at Mount Sinai, who has spent 25 years studying the exchanges.\u003c/p>\n\u003cfigure id=\"attachment_149293\" class=\"wp-caption aligncenter\" style=\"max-width: 1919px\">\u003cimg class=\"size-full wp-image-149293\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/needle-exchange-6-e1455750248794.jpg\" alt=\"James Nolen, 65, gets his kit with needles, cotton balls and alcohol swabs at the Harm Reduction Center in Los Angeles.\" width=\"1919\" height=\"1281\">\u003cfigcaption class=\"wp-caption-text\">James Nolen, 65, gets his kit with needles, cotton balls and alcohol swabs at the Harm Reduction Center in Los Angeles. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Des Jarlais said federal funding should enable existing centers to expand and new ones to open.. “With the exception of a few states, there really has not been adequate funding of needle exchange programs in the US,” he said.\u003c/p>\n\u003cp>Libby Harrison, who manages the Cincinnati Exchange Project in Ohio, said it was “about damn time” for the change in federal policy.\u003c/p>\n\u003cp>“We’ve had the science on syringe exchange for almost 30 years. People and their politics getting in the way of science drives me crazy,” said Harrison, whose exchange has two staff members and is open three days a week in a region that has been hit hard by drug abuse.\u003c/p>\n\u003cp>Inside the lobby of the Harm Reduction Center in Los Angeles, customers wait in a line marked with red tape on the floor. A poster on the wall reads in big letters, “Needle exchange saves lives.”\u003c/p>\n\u003cp>At the front of the room, plastic bins are filled with syringes, sterile water ampoules, rubber bands, antibacterial ointment and alcohol swabs. An oversized, locked red bin sits nearby, and clients deposit dirty needles into it.\u003c/p>\n\u003cfigure id=\"attachment_149291\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"wp-image-149291 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/needle-exchange-9-400x599.jpg\" alt=\"Michael Poor, 47, visits the needle exchange at the Center for Harm Reduction, which is part of Homeless Healthcare Los Angeles, on a daily basis. He lives in a tent on Skid Row and is addicted to methamphetamine.\" width=\"400\" height=\"599\">\u003cfigcaption class=\"wp-caption-text\">Michael Poor, 47, visits the needle exchange at the Center for Harm Reduction, which is part of Homeless Healthcare Los Angeles, on a daily basis. He lives in a tent on Skid Row and is addicted to methamphetamine. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>They don’t need appointments, insurance or even identification. They simply answer a few questions, including whether they are homeless. When 26-year-old Eli Guerra walks up to the front counter, he tells the clerk he is out of needles. The clerk asks him what he uses now.\u003c/p>\n\u003cp>“Whatever I get my hands on,” he replies.\u003c/p>\n\u003cp>Guerra, who uses heroin, has been coming to the needle exchange for about a year but says he hopes this will be one of his last visits.\u003c/p>\n\u003cp>“This ain’t me, really,” he says. “I am really trying to stop.”\u003c/p>\n\u003cp>Chloe Blalock, program coordinator of the center, said she hopes federal funding will enable her to hire more people and expand services such as therapy, medical care, overdose prevention training and medication-assisted treatment. For now, she can afford to stay open only seven hours on weekdays and six on weekends.\u003c/p>\n\u003cp>“We should be open 24 hours,” she said. “From a public health standpoint, you want to make sure people have what they need — or more than what they need — no matter what.”\u003c/p>\n\u003cp>On a recent Tuesday, Dr. Rolando Tringale was at the center, teaching medical students about the health effects of drug use.\u003c/p>\n\u003cp>Tringale, who treats abscesses and wounds, explained why staffers hand out alcohol swabs. “This is an important part of harm reduction education, preventing skin-based infections,” he said.\u003c/p>\n\u003cp>Diamond Mendoza, a self-described homeless man who is addicted to heroin, said that since coming to the exchange he has learned a lot about injecting drugs more safely. He wipes his skin with alcohol before puncturing it. He goes to see the doctor whenever he gets a wound or an abscess. And he always uses clean needles, he said.\u003c/p>\n\u003cfigure id=\"attachment_149290\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-149290\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/needle-exchange-5-400x607.jpg\" alt=\"Heroin addict Diamond Mendoza, 49, dropped off a pile of syringes. “I usually bring about 40 needles at a time. I exchange my dirties for my cleans. And it’s really good here,” he said. \" width=\"400\" height=\"607\">\u003cfigcaption class=\"wp-caption-text\">Heroin addict Diamond Mendoza, 49, dropped off a pile of syringes. “I usually bring about 40 needles at a time. I exchange my dirties for my cleans. And it’s really good here,” he said. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“I don’t have HIV because I am really careful,” said Mendoza, who exchanged 40 needles on a recent morning.\u003c/p>\n\u003cp>Michael Poor said he has been using drugs since getting hooked on Vicodin, when he was a registered nurse. At first, Poor said, he couldn’t get clean syringes and often reused and shared them.\u003c/p>\n\u003cp>“You had to use one that had been used 15 or 20 times,” he said.\u003c/p>\n\u003cp>He said he believes that’s how he became infected with hepatitis C.\u003c/p>\n\u003cp>Poor said he has been coming to the center for about five years and stocks up so he can give clean needles to others. Staff members know him by name.\u003c/p>\n\u003cp>During his recent visit, he dumped about 35 used syringes into the red bin.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Minutes later, he was back out on the street, holding a small brown lunch bag filled with supplies.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>LOS ANGELES — At precisely 8:30 a.m. on a Tuesday morning, the doors to the needle exchange on Skid Row open and the daily procession of injection drug users begins.\u003c/p>\n\u003cp>Michael Poor, 47, is one of the first customers. He has used his last clean syringe. Poor, who is homeless and addicted to methamphetamines, says coming to the downtown exchange puts his mind at ease: clean needles lower his risk for HIV.\u003c/p>\n\u003cp>“It is a very needed service, not just in downtown but anywhere drugs are an issue,” says Poor, a lanky, friendly man who is missing all of his teeth. “Thanks to needle exchange … I have stayed pretty healthy, which is a hard thing to do when you are injecting drugs.”\u003c/p>\n\u003cp>Needle exchanges like the one Poor visits could receive a financial boost this year \u003ca href=\"http://www.npr.org/2016/01/08/462412631/congress-ends-ban-on-federal-funding-for-needle-exchange-programs\" target=\"_blank\">following a decision by Congress \u003c/a>in January to lift a ban on federal funding. As abuse of prescription drugs and opiates continues to spread across the nation, more states are considering exchanges as a way to save lives.\u003c/p>\n\u003cp>Indiana, for instance, opened its first exchange after an HIV outbreak last year.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The change in federal policy, part of a spending bill approved earlier this month, allows funding only in areas where drug-related cases of hepatitis and HIV are rising or are likely to. State and city health departments will make that determination along with the federal Centers for Disease Control and Prevention, according to the legislation.\u003c/p>\n\u003cp>The money can be used to pay for staff and programs, but not for syringes.\u003c/p>\n\u003cp>“It is really an important and historic moment for us at syringe exchanges,” said Mark Casanova, executive director of Homeless Health Care Los Angeles, which runs the syringe exchange on Skid Row, known as the Center for Harm Reduction. “But it doesn’t go far enough.”\u003c/p>\n\u003cp>Casanova said about a third of his $350,000 budget for the exchange program is spent on the 1.2 million syringes he hands out each year, and he will have to continue relying heavily on private donations to pay for them.\u003c/p>\n\u003cp>Despite the restrictions, lifting the ban underscores a growing recognition that needle exchange programs can help reduce the the spread of infectious diseases, said Daniel Raymond, policy director for Harm Reduction Coalition.\u003c/p>\n\u003cp>“This is a huge victory,” said Raymond, whose national organization advocates and provides training for exchange programs. “It is in some way the last chapter of an era where syringe exchange was considered too volatile and too partisan [for policy makers] to come to a consensus.”\u003c/p>\n\u003cfigure id=\"attachment_149292\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"wp-image-149292 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/needle-exchange-1-400x267.jpg\" alt=\"The Center for Harm Reduction in Skid Row has a syringe exchange program, which provides treatment, prevention and disease management for injection drug users. \" width=\"400\" height=\"267\">\u003cfigcaption class=\"wp-caption-text\">The Center for Harm Reduction on LA's Skid Row has a syringe exchange program, which provides treatment, prevention and disease management for injection drug users. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Critics of needle programs counter that opening the door to federal funding could leave less money for treatment of people who want to get sober. The new law does not allot additional funds for the exchanges, but rather allows them to compete for existing drug program money.\u003c/p>\n\u003cp>“The dollars are precious these days,” said Calvina Fay, executive director of Drug Free America Foundation, a drug policy and prevention organization. “When we have people wanting to get clean and standing in line waiting for a treatment bed … the money could certainly be better spent.”\u003c/p>\n\u003cp>Needle exchanges began at the height of the AIDS epidemic and today number roughly 200 around the United States, including about 40 in California.\u003c/p>\n\u003cp>Using clean syringes continues to be the safest way to prevent transmission among injection drug users, according to a 2012 CDC report, which said the percentage of injection drug users infected with HIV dropped by half from the mid-1990s to 2009.\u003c/p>\n\u003cp>“Syringe programs have really been concentrated in large cities and have done an excellent job of preventing HIV infection where they have been implemented, but we now really need to move to address the new injectors that we see in small towns and in rural areas, particularly in Appalachia,” said Don Des Jarlais of the Icahn School of Medicine at Mount Sinai, who has spent 25 years studying the exchanges.\u003c/p>\n\u003cfigure id=\"attachment_149293\" class=\"wp-caption aligncenter\" style=\"max-width: 1919px\">\u003cimg class=\"size-full wp-image-149293\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/needle-exchange-6-e1455750248794.jpg\" alt=\"James Nolen, 65, gets his kit with needles, cotton balls and alcohol swabs at the Harm Reduction Center in Los Angeles.\" width=\"1919\" height=\"1281\">\u003cfigcaption class=\"wp-caption-text\">James Nolen, 65, gets his kit with needles, cotton balls and alcohol swabs at the Harm Reduction Center in Los Angeles. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Des Jarlais said federal funding should enable existing centers to expand and new ones to open.. “With the exception of a few states, there really has not been adequate funding of needle exchange programs in the US,” he said.\u003c/p>\n\u003cp>Libby Harrison, who manages the Cincinnati Exchange Project in Ohio, said it was “about damn time” for the change in federal policy.\u003c/p>\n\u003cp>“We’ve had the science on syringe exchange for almost 30 years. People and their politics getting in the way of science drives me crazy,” said Harrison, whose exchange has two staff members and is open three days a week in a region that has been hit hard by drug abuse.\u003c/p>\n\u003cp>Inside the lobby of the Harm Reduction Center in Los Angeles, customers wait in a line marked with red tape on the floor. A poster on the wall reads in big letters, “Needle exchange saves lives.”\u003c/p>\n\u003cp>At the front of the room, plastic bins are filled with syringes, sterile water ampoules, rubber bands, antibacterial ointment and alcohol swabs. An oversized, locked red bin sits nearby, and clients deposit dirty needles into it.\u003c/p>\n\u003cfigure id=\"attachment_149291\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"wp-image-149291 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/needle-exchange-9-400x599.jpg\" alt=\"Michael Poor, 47, visits the needle exchange at the Center for Harm Reduction, which is part of Homeless Healthcare Los Angeles, on a daily basis. He lives in a tent on Skid Row and is addicted to methamphetamine.\" width=\"400\" height=\"599\">\u003cfigcaption class=\"wp-caption-text\">Michael Poor, 47, visits the needle exchange at the Center for Harm Reduction, which is part of Homeless Healthcare Los Angeles, on a daily basis. He lives in a tent on Skid Row and is addicted to methamphetamine. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>They don’t need appointments, insurance or even identification. They simply answer a few questions, including whether they are homeless. When 26-year-old Eli Guerra walks up to the front counter, he tells the clerk he is out of needles. The clerk asks him what he uses now.\u003c/p>\n\u003cp>“Whatever I get my hands on,” he replies.\u003c/p>\n\u003cp>Guerra, who uses heroin, has been coming to the needle exchange for about a year but says he hopes this will be one of his last visits.\u003c/p>\n\u003cp>“This ain’t me, really,” he says. “I am really trying to stop.”\u003c/p>\n\u003cp>Chloe Blalock, program coordinator of the center, said she hopes federal funding will enable her to hire more people and expand services such as therapy, medical care, overdose prevention training and medication-assisted treatment. For now, she can afford to stay open only seven hours on weekdays and six on weekends.\u003c/p>\n\u003cp>“We should be open 24 hours,” she said. “From a public health standpoint, you want to make sure people have what they need — or more than what they need — no matter what.”\u003c/p>\n\u003cp>On a recent Tuesday, Dr. Rolando Tringale was at the center, teaching medical students about the health effects of drug use.\u003c/p>\n\u003cp>Tringale, who treats abscesses and wounds, explained why staffers hand out alcohol swabs. “This is an important part of harm reduction education, preventing skin-based infections,” he said.\u003c/p>\n\u003cp>Diamond Mendoza, a self-described homeless man who is addicted to heroin, said that since coming to the exchange he has learned a lot about injecting drugs more safely. He wipes his skin with alcohol before puncturing it. He goes to see the doctor whenever he gets a wound or an abscess. And he always uses clean needles, he said.\u003c/p>\n\u003cfigure id=\"attachment_149290\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-149290\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/needle-exchange-5-400x607.jpg\" alt=\"Heroin addict Diamond Mendoza, 49, dropped off a pile of syringes. “I usually bring about 40 needles at a time. I exchange my dirties for my cleans. And it’s really good here,” he said. \" width=\"400\" height=\"607\">\u003cfigcaption class=\"wp-caption-text\">Heroin addict Diamond Mendoza, 49, dropped off a pile of syringes. “I usually bring about 40 needles at a time. I exchange my dirties for my cleans. And it’s really good here,” he said. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“I don’t have HIV because I am really careful,” said Mendoza, who exchanged 40 needles on a recent morning.\u003c/p>\n\u003cp>Michael Poor said he has been using drugs since getting hooked on Vicodin, when he was a registered nurse. At first, Poor said, he couldn’t get clean syringes and often reused and shared them.\u003c/p>\n\u003cp>“You had to use one that had been used 15 or 20 times,” he said.\u003c/p>\n\u003cp>He said he believes that’s how he became infected with hepatitis C.\u003c/p>\n\u003cp>Poor said he has been coming to the center for about five years and stocks up so he can give clean needles to others. Staff members know him by name.\u003c/p>\n\u003cp>During his recent visit, he dumped about 35 used syringes into the red bin.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Minutes later, he was back out on the street, holding a small brown lunch bag filled with supplies.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>A major insurer said recently it would \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/12/01/major-insurer-says-it-will-offer-individual-life-insurance-to-people-with-hiv/\" target=\"_blank\">offer life insurance\u003c/a> to HIV-positive people because of their rising life expectancies, prompting cheers from AIDS activists. But on the very same day, the nation’s top disease control official described an America \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMms1513641\" target=\"_blank\">falling far short in its fight against AIDS.\u003c/a>\u003c/p>\n\u003caside class=\"pullquote alignright\">“It’s very hard to talk about HIV prevention with someone who is homeless or someone who isn’t sure where they’re going to find their next meal.”\u003ccite> Anthony Hayes, GMHC\u003c/cite>\u003c/aside>\n\u003cp>It might seem a jarring disconnect — but it reflects very different realities dividing the estimated 1.2 million Americans living with the human immunodeficiency virus that causes AIDS.\u003c/p>\n\u003cp>While life expectancies are approaching the national norm among white, affluent gay men, about 66 percent of the 1.2 million people living with HIV/AIDS in the United States \u003ca href=\"http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6347a5.htm?s_cid=mm6347a5_w\" target=\"_blank\">are not in treatment\u003c/a>, imperiling their health and putting them at risk for infecting others.\u003c/p>\n\u003cp>\u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMms1513641\" target=\"_blank\">Nearly half\u003c/a> of the approximately 45,000 Americans infected with HIV each year are African-Americans, mostly they are gay or bisexual men. Both African-Americans and Latinos are \u003ca href=\"http://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillancereport_vol20_no2.pdf\" target=\"_blank\">less likely to remain in treatment\u003c/a> than whites. Compared to white men, African American men were more than seven times and Latino men were almost twice as likely to die from HIV-related complications.\u003c/p>\n\u003cp>HIV/AIDS activists and physicians say that despite the significant medical advances in treating the disease, many patients are being left behind because of their life circumstances. Groups that once held angry demonstrations against government agencies and pharmaceutical companies to speed access to affordable, life-saving HIV medications now emphasize the socioeconomic barriers that keep some people living with HIV from consistently obtaining and using those drugs to remain healthy.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“There is an extreme disparity when it comes to treating HIV and AIDS,” said Anthony Hayes, managing director of public affairs and policy for GMHC, formerly Gay Men’s Health Crisis.\u003c/p>\n\u003cp>“It’s critical, when we talk about ending the epidemic, to not just talk about the science. These are people who are incredibly vulnerable as it relates to all aspects of society. In contrast, more affluent HIV positive people — specifically gay white men — are able to access care, they have jobs, they have homes, they have access to life’s basic necessities that many do not.\u003c/p>\n\u003cp>“It’s very hard to talk about HIV prevention with someone who is homeless or someone who isn’t sure where they’re going to find their next meal.”\u003c/p>\n\u003cp>It’s not a simple matter of financing care for those who can’t afford it. Treatment and social services are currently available for low-income and uninsured or underinsured patients under the \u003ca href=\"http://www.hhs.gov/about/news/2015/08/18/ryan-white-care-act-celebrates-25th-anniversary.html\">Ryan White Act\u003c/a>. Once long waiting lists for free HIV medications \u003ca href=\"https://www.nastad.org/sites/default/files/ADAP-Watch-July-2014.pdf\">have virtually been eliminated\u003c/a>. But basic survival – money to live, a place to sleep — often takes precedence over seeking help and closely managing a disease that can be symptom-free in its early stages, doctors say.\u003c/p>\n\u003cp>Loren Jones, 63, of Berkeley, was homeless when she was first diagnosed with HIV about 30 years ago. And for many years she wasn’t symptomatic, so her diagnosis was rarely at the top of her list of worries, Jones said. “It actually sinks to the bottom. HIV becomes another thing on your, like, to-do list.”\u003c/p>\n\u003cfigure id=\"attachment_131140\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-131140\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/loren-jones-4-400x267.jpg\" alt=\"Loren Jones takes antiretroviral drugs to suppress her HIV viral load. “You have to be a hustler for your own health,” she said.\" width=\"400\" height=\"267\">\u003cfigcaption class=\"wp-caption-text\">Loren Jones takes antiretroviral drugs to suppress her HIV viral load. “You have to be a hustler for your own health,” she said. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Jones eventually was able to find a government-subsidized studio apartment in Berkeley and qualify for Social Security disability benefits. She recently had a bout with eczema, a serious skin rash that can be a marker for the progression of HIV-related disease. Her blood pressure spiked, leading to discovery of kidney disease, a common complication of HIV.\u003c/p>\n\u003cp>Newer approaches to controlling HIV/AIDS focus on a \u003ca href=\"http://www.cdc.gov/hiv/pdf/dhap_continuum.pdf\">“continuum of care,”\u003c/a> from the very beginning. Federal health official are trying to track improvements or setbacks at every stage: testing, linking the newly diagnosed to care within three months, getting HIV-positive people to remain in treatment, prescribing them antiretroviral drugs, and suppressing HIV viral load – the amount of HIV in the blood – to a very low level.\u003c/p>\n\u003cp>People fall out of care at every stage, with \u003ca href=\"http://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillancereport_vol20_no2.pdf\" target=\"_blank\">minorities generally faring worse\u003c/a> than whites. The the goal is to keep them in treatment, not only for their sake but because research has shown that people with low or undetectable viral loads are far less likely to transmit the disease to others.\u003c/p>\n\u003cp>Dr. Edward Machtinger, director of the Women’s HIV Program at the UC, San Francisco, said his clinic has been able to achieve viral suppression in up to 80 percent of its patients. But the focus on biomedical treatment of their HIV obscures the deep challenges many of his patients face: poverty, domestic abuse, addiction, mental illness, he noted.\u003c/p>\n\u003cp>“Complex trauma is what led many of my patients to get HIV in first place and gets them to remain depressed, stay addicted and have trouble adhering to their meds,” Machtinger said. “Medicine and HIV primary care has not considered these health issues to be in their domain and their responsibility. I’ve heard many clinicians brag about having patients on crack be undetectable in their viral load, as if HIV was going to kill them in the first place. It’s not. Crack is going to kill them.”\u003c/p>\n\u003cp>Addressing HIV patients’ social and economic challenges — often referred to as “social determinants of health” — is complicated and not reimbursable, Machtinger said. “What we really need to do is find a way for patients to be safer, more empowered and healthy.”\u003c/p>\n\u003cp>Dr. William Cunningham, a UCLA medicine and public health professor, is researching ways to help marginalized HIV-positive people stay in treatment and avoid infecting others. He’s co-directing a $4.6 million, five-year \u003ca href=\"http://newsroom.ucla.edu/releases/ucla-researchers-get-4-6-million-176799\" target=\"_blank\">study\u003c/a> that pairs recently released Los Angeles County jail inmates who are HIV-positive with peer navigators who help them find medical care and new prescriptions of antiretroviral medications they received while incarcerated.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“They’re trying to survive outside — to get housing, to get a job. We just don’t have a system that’s designed for people who have those kinds of issues. It’s designed for well-educated, well-informed consumers in a market type system,” Cunningham said. “It’s the context of people’s lives that is just so difficult that HIV is not their biggest problem. We haven’t come up with any kind of magic bullet, but at the very least, we need to focus on these social barriers to a greater extent.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A major insurer said recently it would \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/12/01/major-insurer-says-it-will-offer-individual-life-insurance-to-people-with-hiv/\" target=\"_blank\">offer life insurance\u003c/a> to HIV-positive people because of their rising life expectancies, prompting cheers from AIDS activists. But on the very same day, the nation’s top disease control official described an America \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMms1513641\" target=\"_blank\">falling far short in its fight against AIDS.\u003c/a>\u003c/p>\n\u003caside class=\"pullquote alignright\">“It’s very hard to talk about HIV prevention with someone who is homeless or someone who isn’t sure where they’re going to find their next meal.”\u003ccite> Anthony Hayes, GMHC\u003c/cite>\u003c/aside>\n\u003cp>It might seem a jarring disconnect — but it reflects very different realities dividing the estimated 1.2 million Americans living with the human immunodeficiency virus that causes AIDS.\u003c/p>\n\u003cp>While life expectancies are approaching the national norm among white, affluent gay men, about 66 percent of the 1.2 million people living with HIV/AIDS in the United States \u003ca href=\"http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6347a5.htm?s_cid=mm6347a5_w\" target=\"_blank\">are not in treatment\u003c/a>, imperiling their health and putting them at risk for infecting others.\u003c/p>\n\u003cp>\u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMms1513641\" target=\"_blank\">Nearly half\u003c/a> of the approximately 45,000 Americans infected with HIV each year are African-Americans, mostly they are gay or bisexual men. Both African-Americans and Latinos are \u003ca href=\"http://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillancereport_vol20_no2.pdf\" target=\"_blank\">less likely to remain in treatment\u003c/a> than whites. Compared to white men, African American men were more than seven times and Latino men were almost twice as likely to die from HIV-related complications.\u003c/p>\n\u003cp>HIV/AIDS activists and physicians say that despite the significant medical advances in treating the disease, many patients are being left behind because of their life circumstances. Groups that once held angry demonstrations against government agencies and pharmaceutical companies to speed access to affordable, life-saving HIV medications now emphasize the socioeconomic barriers that keep some people living with HIV from consistently obtaining and using those drugs to remain healthy.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“There is an extreme disparity when it comes to treating HIV and AIDS,” said Anthony Hayes, managing director of public affairs and policy for GMHC, formerly Gay Men’s Health Crisis.\u003c/p>\n\u003cp>“It’s critical, when we talk about ending the epidemic, to not just talk about the science. These are people who are incredibly vulnerable as it relates to all aspects of society. In contrast, more affluent HIV positive people — specifically gay white men — are able to access care, they have jobs, they have homes, they have access to life’s basic necessities that many do not.\u003c/p>\n\u003cp>“It’s very hard to talk about HIV prevention with someone who is homeless or someone who isn’t sure where they’re going to find their next meal.”\u003c/p>\n\u003cp>It’s not a simple matter of financing care for those who can’t afford it. Treatment and social services are currently available for low-income and uninsured or underinsured patients under the \u003ca href=\"http://www.hhs.gov/about/news/2015/08/18/ryan-white-care-act-celebrates-25th-anniversary.html\">Ryan White Act\u003c/a>. Once long waiting lists for free HIV medications \u003ca href=\"https://www.nastad.org/sites/default/files/ADAP-Watch-July-2014.pdf\">have virtually been eliminated\u003c/a>. But basic survival – money to live, a place to sleep — often takes precedence over seeking help and closely managing a disease that can be symptom-free in its early stages, doctors say.\u003c/p>\n\u003cp>Loren Jones, 63, of Berkeley, was homeless when she was first diagnosed with HIV about 30 years ago. And for many years she wasn’t symptomatic, so her diagnosis was rarely at the top of her list of worries, Jones said. “It actually sinks to the bottom. HIV becomes another thing on your, like, to-do list.”\u003c/p>\n\u003cfigure id=\"attachment_131140\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-131140\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/loren-jones-4-400x267.jpg\" alt=\"Loren Jones takes antiretroviral drugs to suppress her HIV viral load. “You have to be a hustler for your own health,” she said.\" width=\"400\" height=\"267\">\u003cfigcaption class=\"wp-caption-text\">Loren Jones takes antiretroviral drugs to suppress her HIV viral load. “You have to be a hustler for your own health,” she said. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Jones eventually was able to find a government-subsidized studio apartment in Berkeley and qualify for Social Security disability benefits. She recently had a bout with eczema, a serious skin rash that can be a marker for the progression of HIV-related disease. Her blood pressure spiked, leading to discovery of kidney disease, a common complication of HIV.\u003c/p>\n\u003cp>Newer approaches to controlling HIV/AIDS focus on a \u003ca href=\"http://www.cdc.gov/hiv/pdf/dhap_continuum.pdf\">“continuum of care,”\u003c/a> from the very beginning. Federal health official are trying to track improvements or setbacks at every stage: testing, linking the newly diagnosed to care within three months, getting HIV-positive people to remain in treatment, prescribing them antiretroviral drugs, and suppressing HIV viral load – the amount of HIV in the blood – to a very low level.\u003c/p>\n\u003cp>People fall out of care at every stage, with \u003ca href=\"http://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillancereport_vol20_no2.pdf\" target=\"_blank\">minorities generally faring worse\u003c/a> than whites. The the goal is to keep them in treatment, not only for their sake but because research has shown that people with low or undetectable viral loads are far less likely to transmit the disease to others.\u003c/p>\n\u003cp>Dr. Edward Machtinger, director of the Women’s HIV Program at the UC, San Francisco, said his clinic has been able to achieve viral suppression in up to 80 percent of its patients. But the focus on biomedical treatment of their HIV obscures the deep challenges many of his patients face: poverty, domestic abuse, addiction, mental illness, he noted.\u003c/p>\n\u003cp>“Complex trauma is what led many of my patients to get HIV in first place and gets them to remain depressed, stay addicted and have trouble adhering to their meds,” Machtinger said. “Medicine and HIV primary care has not considered these health issues to be in their domain and their responsibility. I’ve heard many clinicians brag about having patients on crack be undetectable in their viral load, as if HIV was going to kill them in the first place. It’s not. Crack is going to kill them.”\u003c/p>\n\u003cp>Addressing HIV patients’ social and economic challenges — often referred to as “social determinants of health” — is complicated and not reimbursable, Machtinger said. “What we really need to do is find a way for patients to be safer, more empowered and healthy.”\u003c/p>\n\u003cp>Dr. William Cunningham, a UCLA medicine and public health professor, is researching ways to help marginalized HIV-positive people stay in treatment and avoid infecting others. He’s co-directing a $4.6 million, five-year \u003ca href=\"http://newsroom.ucla.edu/releases/ucla-researchers-get-4-6-million-176799\" target=\"_blank\">study\u003c/a> that pairs recently released Los Angeles County jail inmates who are HIV-positive with peer navigators who help them find medical care and new prescriptions of antiretroviral medications they received while incarcerated.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“They’re trying to survive outside — to get housing, to get a job. We just don’t have a system that’s designed for people who have those kinds of issues. It’s designed for well-educated, well-informed consumers in a market type system,” Cunningham said. “It’s the context of people’s lives that is just so difficult that HIV is not their biggest problem. We haven’t come up with any kind of magic bullet, but at the very least, we need to focus on these social barriers to a greater extent.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Future of Program for Low-Income HIV/AIDS Patients Unclear After Obamacare",
"title": "Future of Program for Low-Income HIV/AIDS Patients Unclear After Obamacare",
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"content": "\u003cfigure id=\"attachment_16313\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/11/Sharon-Wilson.jpg\">\u003cimg class=\"size-large wp-image-16313\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/11/Sharon-Wilson-640x425.jpg\" alt=\"Sharon Wilson, 53, picks up her weekly allotment of produce from the AIDS Project of the East Bay. Wilson, who has HIV, says without help, she couldn't afford to buy fresh vegetables. (Angela Hart/KQED) \" width=\"640\" height=\"425\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Sharon Wilson, 53, picks up her weekly allotment of produce from the AIDS Project of the East Bay. Wilson, who has HIV, says without help, she couldn't afford to buy fresh vegetables. (Angela Hart/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Angela Hart\u003c/strong>\u003c/p>\n\u003cp>Several times each week, Sharon Wilson, a 53-year-old HIV-positive retired caregiver, takes an hour-long bus ride from her Berkeley home to her clinic in downtown Oakland. Wilson doesn’t mind making the trip, because she says the care she has received there since her diagnosis has saved her life.\u003c/p>\n\u003cp>Wilson says multiple chronic diseases, including HIV, have made it impossible for her to work. Ensuing financial struggles make managing her disease increasingly difficult.\u003c/p>\n\u003cp>\"I can't afford healthy food and all the medications I need to take,\" Wilson said as she described her strict antiretroviral drug regimen. \"It's not easy to learn a new way of living. I take a handful of pills when I wake up in the morning, a handful of pills with lunch, and another handful before I go to bed.\"\u003c/p>\n\u003cp>For people like Wilson, the AIDS Project of the East Bay — one of Alameda County's six HIV specialty clinics — is a place of refuge. There, Wilson has received primary care for her HIV and specialty care since 2006. She's been referred to Oakland's Highland Hospital multiple times to treat other chronic conditions, including congestive heart failure and arthritis.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But Wilson said equally important to her medical care is the bevy of other resources the clinic provides: food, housing assistance, free transportation, nutrition classes, and substance abuse counseling.\u003c/p>\n\u003cp>\"This place is the reason I'm not homeless — it's my lifeline,\" she said on a recent day as she picked up her weekly allotment of vegetables.\u003c/p>\n\u003cp>It's because of a federal program commonly referred to as \u003ca href=\"http://hab.hrsa.gov/abouthab/aboutprogram.html\">Ryan White\u003c/a> that clinics like AIDS Project of the East Bay can afford to provide that range of other services, in addition to primary and specialty care. Ryan White funds are divvied out to clinics that offer these services for low-income, HIV-positive patients and people with AIDS to provide a broad spectrum of care — from being able to purchase a bus ticket, to scheduling a medical appointment, to buying groceries with food vouchers.\u003c/p>\n\u003cp>For Wilson and hundreds of others in Alameda County who are poor and chronically ill, the program is critical. Ryan White, passed by Congress in 1990 to provide life-saving health care for the poor and uninsured, is credited with building some of the first effective coordinated care for people with the disease.\u003c/p>\n\u003cp>But the future of Ryan White is uncertain.\u003c/p>\n\u003cp>The program expired at the end of September, although Congress approved its continuance without an official reauthorization.\u003c/p>\n\u003cp>As of Jan. 1, as part of the Affordable Care Act, California is expanding Medi-Cal, the state's version of Medicaid, and will allow childless adults making less than $15,856 a year to sign up.\u003c/p>\n\u003cp>That means that the vast majority of low-income Californians who currently use Ryan White funds for their medical care will move into Medi-Cal on Jan. 1.\u003c/p>\n\u003cp>The transition of poor, sick people living with HIV or AIDS moving from one public program to another has ignited concerns among patient advocates and nonprofits that provide care for a population whose health relies on stable medical homes and expensive antiretroviral medications.\u003c/p>\n\u003cp>Patient advocates say Ryan White remains important because it can pay for the other necessities that HIV/AIDS patients find crucial.\u003c/p>\n\u003cp>\"Health reform has been challenging for us in a number of ways,\" said Alvan Quamina, the executive director for the AIDS Project of the East Bay, which provides services for about 700 people in Alameda County annually. \"Though long-term benefits are obvious, health reform means funding streams for HIV services are in jeopardy.\"\u003c/p>\n\u003cp>Alameda County HIV specialists argue that Ryan White is critical for clinics to provide the services that make daily life possible: transportation, counseling, housing assistance, and emergency food..\u003c/p>\n\u003cp>\"Ryan White will continue to be important to provide the ancillary support services,\" Quamina said. \"While primary care transitioning to Medi-Cal, Ryan White can pay for things like BART fare or a free bus pass, food vouchers, and peer counseling,\" he said.\u003c/p>\n\u003cp>\u003cstrong>PUBLIC HEALTH BENEFIT\u003c/strong>\u003c/p>\n\u003cp>Keith Waltrip, the acting director for the Alameda County Office of AIDS Administration, agreed that Ryan White is critical to ensure a continuum of care for patients with sensitive health needs.\u003c/p>\n\u003cp>\"Support services help get these low-income people into care,\" Waltrip said. \"So making sure they have transportation, and healthy food, and psycho-social services is important. Those services aren't going to be paid for under Medi-Cal, so that's where Ryan White comes in.\"\u003c/p>\n\u003cp>Waltrip said those services benefit not only the health of an individual, but also the health of a community.\u003c/p>\n\u003cp>\"There is a public health benefit of keeping patients in care,\" Waltrip said. \"Continuous treatment reduces their viral load, and decreases their chances of passing along HIV to another individual, thus reducing the number of infections in a community.\"\u003c/p>\n\u003cp>Kathleen Clanon is an HIV specialist and the interim chief medical officer for the Health Program of Alameda County. She is overseeing the transition of Ryan White patients to Medi-Cal.\u003c/p>\n\u003cp>Clanon said Alameda County is ahead of the curve in aggressively preparing for the transition of Ryan White patients to Medi-Cal, or Covered California — whichever program patients are eligible for, depending on income.\u003c/p>\n\u003cp>Each of the county's six HIV specialty clinics will welcome new Medi-Cal patients after ACA implementation — something the county has been negotiating since January. That will mean better access to health care for the low income and a reduction in the likelihood for patients having to switch providers, Clanon said.\u003c/p>\n\u003cp>Though the long-term future of Ryan White is uncertain, Clanon said she expects it to remain in place at least through 2014, in some capacity.\u003c/p>\n\u003cp>Other county health officials agreed, and said that meanwhile, HIV workers are advocating for the program's continuance at the local, state and federal levels.\u003c/p>\n\u003cp>\"It's unclear where we're headed, and it really doesn't look good,\" Quamina said. \"What we're hearing is we should start planning, but my response is we're going to prepare, but we need to fight.\"\u003c/p>\n\u003cp>For patients like Wilson, the shaky future of the program that she relies on is worrisome.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"I just hope we can get people educated about what's happening, so we can keep getting the assistance we depend on,\" she said.\u003c/p>\n\n",
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"excerpt": "Several times each week, Sharon Wilson, a 53-year-old HIV-positive retired caregiver, takes an hour-long bus ride from her Berkeley home to her clinic in downtown Oakland. Wilson doesn’t mind making the trip, because she says the care she has received there since her diagnosis has saved her life.\r\n\r\nWilson says multiple chronic diseases, including HIV, have made it impossible for her to work. Ensuing financial struggles make managing her disease increasingly difficult.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_16313\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/11/Sharon-Wilson.jpg\">\u003cimg class=\"size-large wp-image-16313\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/11/Sharon-Wilson-640x425.jpg\" alt=\"Sharon Wilson, 53, picks up her weekly allotment of produce from the AIDS Project of the East Bay. Wilson, who has HIV, says without help, she couldn't afford to buy fresh vegetables. (Angela Hart/KQED) \" width=\"640\" height=\"425\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Sharon Wilson, 53, picks up her weekly allotment of produce from the AIDS Project of the East Bay. Wilson, who has HIV, says without help, she couldn't afford to buy fresh vegetables. (Angela Hart/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Angela Hart\u003c/strong>\u003c/p>\n\u003cp>Several times each week, Sharon Wilson, a 53-year-old HIV-positive retired caregiver, takes an hour-long bus ride from her Berkeley home to her clinic in downtown Oakland. Wilson doesn’t mind making the trip, because she says the care she has received there since her diagnosis has saved her life.\u003c/p>\n\u003cp>Wilson says multiple chronic diseases, including HIV, have made it impossible for her to work. Ensuing financial struggles make managing her disease increasingly difficult.\u003c/p>\n\u003cp>\"I can't afford healthy food and all the medications I need to take,\" Wilson said as she described her strict antiretroviral drug regimen. \"It's not easy to learn a new way of living. I take a handful of pills when I wake up in the morning, a handful of pills with lunch, and another handful before I go to bed.\"\u003c/p>\n\u003cp>For people like Wilson, the AIDS Project of the East Bay — one of Alameda County's six HIV specialty clinics — is a place of refuge. There, Wilson has received primary care for her HIV and specialty care since 2006. She's been referred to Oakland's Highland Hospital multiple times to treat other chronic conditions, including congestive heart failure and arthritis.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But Wilson said equally important to her medical care is the bevy of other resources the clinic provides: food, housing assistance, free transportation, nutrition classes, and substance abuse counseling.\u003c/p>\n\u003cp>\"This place is the reason I'm not homeless — it's my lifeline,\" she said on a recent day as she picked up her weekly allotment of vegetables.\u003c/p>\n\u003cp>It's because of a federal program commonly referred to as \u003ca href=\"http://hab.hrsa.gov/abouthab/aboutprogram.html\">Ryan White\u003c/a> that clinics like AIDS Project of the East Bay can afford to provide that range of other services, in addition to primary and specialty care. Ryan White funds are divvied out to clinics that offer these services for low-income, HIV-positive patients and people with AIDS to provide a broad spectrum of care — from being able to purchase a bus ticket, to scheduling a medical appointment, to buying groceries with food vouchers.\u003c/p>\n\u003cp>For Wilson and hundreds of others in Alameda County who are poor and chronically ill, the program is critical. Ryan White, passed by Congress in 1990 to provide life-saving health care for the poor and uninsured, is credited with building some of the first effective coordinated care for people with the disease.\u003c/p>\n\u003cp>But the future of Ryan White is uncertain.\u003c/p>\n\u003cp>The program expired at the end of September, although Congress approved its continuance without an official reauthorization.\u003c/p>\n\u003cp>As of Jan. 1, as part of the Affordable Care Act, California is expanding Medi-Cal, the state's version of Medicaid, and will allow childless adults making less than $15,856 a year to sign up.\u003c/p>\n\u003cp>That means that the vast majority of low-income Californians who currently use Ryan White funds for their medical care will move into Medi-Cal on Jan. 1.\u003c/p>\n\u003cp>The transition of poor, sick people living with HIV or AIDS moving from one public program to another has ignited concerns among patient advocates and nonprofits that provide care for a population whose health relies on stable medical homes and expensive antiretroviral medications.\u003c/p>\n\u003cp>Patient advocates say Ryan White remains important because it can pay for the other necessities that HIV/AIDS patients find crucial.\u003c/p>\n\u003cp>\"Health reform has been challenging for us in a number of ways,\" said Alvan Quamina, the executive director for the AIDS Project of the East Bay, which provides services for about 700 people in Alameda County annually. \"Though long-term benefits are obvious, health reform means funding streams for HIV services are in jeopardy.\"\u003c/p>\n\u003cp>Alameda County HIV specialists argue that Ryan White is critical for clinics to provide the services that make daily life possible: transportation, counseling, housing assistance, and emergency food..\u003c/p>\n\u003cp>\"Ryan White will continue to be important to provide the ancillary support services,\" Quamina said. \"While primary care transitioning to Medi-Cal, Ryan White can pay for things like BART fare or a free bus pass, food vouchers, and peer counseling,\" he said.\u003c/p>\n\u003cp>\u003cstrong>PUBLIC HEALTH BENEFIT\u003c/strong>\u003c/p>\n\u003cp>Keith Waltrip, the acting director for the Alameda County Office of AIDS Administration, agreed that Ryan White is critical to ensure a continuum of care for patients with sensitive health needs.\u003c/p>\n\u003cp>\"Support services help get these low-income people into care,\" Waltrip said. \"So making sure they have transportation, and healthy food, and psycho-social services is important. Those services aren't going to be paid for under Medi-Cal, so that's where Ryan White comes in.\"\u003c/p>\n\u003cp>Waltrip said those services benefit not only the health of an individual, but also the health of a community.\u003c/p>\n\u003cp>\"There is a public health benefit of keeping patients in care,\" Waltrip said. \"Continuous treatment reduces their viral load, and decreases their chances of passing along HIV to another individual, thus reducing the number of infections in a community.\"\u003c/p>\n\u003cp>Kathleen Clanon is an HIV specialist and the interim chief medical officer for the Health Program of Alameda County. She is overseeing the transition of Ryan White patients to Medi-Cal.\u003c/p>\n\u003cp>Clanon said Alameda County is ahead of the curve in aggressively preparing for the transition of Ryan White patients to Medi-Cal, or Covered California — whichever program patients are eligible for, depending on income.\u003c/p>\n\u003cp>Each of the county's six HIV specialty clinics will welcome new Medi-Cal patients after ACA implementation — something the county has been negotiating since January. That will mean better access to health care for the low income and a reduction in the likelihood for patients having to switch providers, Clanon said.\u003c/p>\n\u003cp>Though the long-term future of Ryan White is uncertain, Clanon said she expects it to remain in place at least through 2014, in some capacity.\u003c/p>\n\u003cp>Other county health officials agreed, and said that meanwhile, HIV workers are advocating for the program's continuance at the local, state and federal levels.\u003c/p>\n\u003cp>\"It's unclear where we're headed, and it really doesn't look good,\" Quamina said. \"What we're hearing is we should start planning, but my response is we're going to prepare, but we need to fight.\"\u003c/p>\n\u003cp>For patients like Wilson, the shaky future of the program that she relies on is worrisome.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"I just hope we can get people educated about what's happening, so we can keep getting the assistance we depend on,\" she said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Doctors Fear HIV Patients Will Fall Through Cracks As Obamacare Rolls Out",
"title": "Doctors Fear HIV Patients Will Fall Through Cracks As Obamacare Rolls Out",
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"content": "\u003cp>\u003cstrong>Public health implications as people who stop taking HIV medications can quickly become infectious\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_12372\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/04/26/doctors-fear-hiv-patients-will-fall-through-cracks-as-obamacare-rolls-out/hiv_kathleenclanon_minakim/\" rel=\"attachment wp-att-12372\">\u003cimg class=\"size-medium wp-image-12372\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/04/HIV_KathleenClanon_MinaKim-300x200.jpg\" alt=\"Dr. Kathleen Clanon talks to patient Andrew Solis about keeping his HIV under control. Clanon worries her patients will have disruptions in their care if they don't navigate the changes coming under federal health reform. (Mina Kim/KQED)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Kathleen Clanon talks to patient Andrew Solis about keeping his HIV under control. Clanon worries her patients will have disruptions in their care if they don't navigate the changes coming under federal health reform. (Mina Kim/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>A major goal of the federal health care law is that millions of people who currently do not have health insurance will have improved access to care. But the massive overhaul is also expected to be widely disruptive, and doctors worry that many people with chronic illness could suffer during the changeover, as KQED's Mina Kim details today on \u003ca href=\"http://www.californiareport.org/archive/R201304260850/b\" target=\"_blank\">The California Report\u003c/a>.\u003c/p>\n\u003cp>Kim tells the story of 33-year-old Andrew Solis who stopped taking HIV medications more than a year ago after becoming addicted to methamphetamine while in a \"rocky relationship.\" He resumed treatment at the Oakland Highland Hospital HIV clinic last October after ending the relationship.\u003c/p>\n\u003cp>Solis has been able to get back in to treatment fairly easily, Kiim reports. But changes coming under the Affordable Care Act could complicate care for clinic patients, says Kathleen Clanon, chief medical officer at Highland Hospital.\u003c!--more-->\u003c/p>\n\u003cp>From Kim's report:\u003c/p>\n\u003cblockquote>\u003cp>\"They are all poor basically. It's been 15 years or so since HIV was really a disease in the U.S. of middle-class men. It's been a disease of poverty in the U.S., really, for about 15 years now.\"\u003c/p>\n\u003cp>Right now, low-income patients without insurance get their health care paid for by the federal Ryan White program which only covers HIV related care. In order for them to get the full benefits of the Affordable Care Act, they'll need to move to a more traditional insurance-based care. For starters, they'll have to first choose an insurance carrier and a primary care doctor and Clanon says, that won't always be easy.\u003c/p>\n\u003cp>\"Most of the information that goes to people about their choices and how they're becoming insured is going to come by snail mail, and people who are low-income frequently don't have stable addresses, and the majority of my patients don't have regular access to the internet.\"\u003c/p>\n\u003cp>If her patients don't fill out the paperwork, they will be automatically assigned to a primary doctor -- one that Clanon says is unlikely to have a specialty in HIV care. Or worse, she fears her patients won't tell their new doctor that they're infected, because of stigma surrounding people with the virus.\u003c/p>\n\u003cp>\"I have a patient that I saw about a month ago, he needed to move in with his mom. However she was so afraid of him that she was making him eat in his room off paper plates that she would then throw away. So stigma will make it difficult for people to fix any weirdness that happens in terms of where they get assigned.\"\u003c/p>\n\u003cp>And people with HIV, Clanon says, don't have time to be away from treatment.\u003c/p>\n\u003cp>\"Within a week, ten days, two weeks, if you stop taking your HIV medication, the virus comes back. And treatment interruptions are dangerous for people with HIV, they're dangerous for their health, and they're dangerous for our whole community because during that time that person is infectious to others.\"\u003c/p>\u003c/blockquote>\n\u003cp>Still, the Affordable Care Act earmarks money to deal with all that paperwork. Covered California, the state's new health insurance marketplace will soon announce grants totaling $49 million for education and outreach. Much of the money is expected to be awarded to community groups which have extensive networks in ethnic and low-income populations -- the very people who might have the most trouble navigating the new system.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The primary goal of that outreach is simply to get people enrolled in a health insurance plan. But Dana Howard, a spokesman with Covered California says these \"assisters\" will also be charged with helping people directly. \"Assisters are there to say, 'Let's figure out who you're seeing. Let's find a plan that has your network in there and find the one that has the best price,'\" Howard described.\u003c/p>\n\u003cp>Anthony Wright of Health Access, a statewide consumer advocacy group, was a bit more circumspect, saying, \"that is the hope\" when asked if assisters would help make sure people made it into a plan that includes their current doctor.\u003c/p>\n\u003cp>In the meantime, Dr. Clanon is moving ahead on her own, Kim reports. Two staff members at Highland's HIV clinic are becoming experts in the Affordable Care Act. They're also working with insurance plans to make sure that one of their HIV/AIDS doctors can be listed as a primary care provider.\u003c/p>\n\u003cp>Again, from Kim's report:\u003c/p>\n\u003cblockquote>\u003cp>Clanon says her clinic is ahead of the game, but she worries about clinics in rural areas or clinics with fewer resources. To help them along, Clanon's been traveling up and down the state talking with other HIV providers about ways to prepare for health reform.\u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post has been updated to include a quote and information from Dana Howard of Covered California. It also corrects the amount of money to be granted for education and outreach.\u003c/em>\u003c/p>\n\n",
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"excerpt": "A major goal of the federal health care law is that millions of people who currently do not have health insurance will have improved access to care. But the massive overhaul is also expected to be widely disruptive, and doctors worry that many people with chronic illness could suffer during the changeover, as KQED's Mina Kim details today on The California Report.\r\n\r\nKim tells the story of 33-year-old Andrew Solis who stopped taking HIV medications more than a year ago after becoming addicted to methamphetamine while in a \"rocky relationship.\" He resumed treatment at the Oakland Highland Hospital HIV clinic last October after ending the relationship.",
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"title": "Doctors Fear HIV Patients Will Fall Through Cracks As Obamacare Rolls Out | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Public health implications as people who stop taking HIV medications can quickly become infectious\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_12372\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/04/26/doctors-fear-hiv-patients-will-fall-through-cracks-as-obamacare-rolls-out/hiv_kathleenclanon_minakim/\" rel=\"attachment wp-att-12372\">\u003cimg class=\"size-medium wp-image-12372\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/04/HIV_KathleenClanon_MinaKim-300x200.jpg\" alt=\"Dr. Kathleen Clanon talks to patient Andrew Solis about keeping his HIV under control. Clanon worries her patients will have disruptions in their care if they don't navigate the changes coming under federal health reform. (Mina Kim/KQED)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Kathleen Clanon talks to patient Andrew Solis about keeping his HIV under control. Clanon worries her patients will have disruptions in their care if they don't navigate the changes coming under federal health reform. (Mina Kim/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>A major goal of the federal health care law is that millions of people who currently do not have health insurance will have improved access to care. But the massive overhaul is also expected to be widely disruptive, and doctors worry that many people with chronic illness could suffer during the changeover, as KQED's Mina Kim details today on \u003ca href=\"http://www.californiareport.org/archive/R201304260850/b\" target=\"_blank\">The California Report\u003c/a>.\u003c/p>\n\u003cp>Kim tells the story of 33-year-old Andrew Solis who stopped taking HIV medications more than a year ago after becoming addicted to methamphetamine while in a \"rocky relationship.\" He resumed treatment at the Oakland Highland Hospital HIV clinic last October after ending the relationship.\u003c/p>\n\u003cp>Solis has been able to get back in to treatment fairly easily, Kiim reports. But changes coming under the Affordable Care Act could complicate care for clinic patients, says Kathleen Clanon, chief medical officer at Highland Hospital.\u003c!--more-->\u003c/p>\n\u003cp>From Kim's report:\u003c/p>\n\u003cblockquote>\u003cp>\"They are all poor basically. It's been 15 years or so since HIV was really a disease in the U.S. of middle-class men. It's been a disease of poverty in the U.S., really, for about 15 years now.\"\u003c/p>\n\u003cp>Right now, low-income patients without insurance get their health care paid for by the federal Ryan White program which only covers HIV related care. In order for them to get the full benefits of the Affordable Care Act, they'll need to move to a more traditional insurance-based care. For starters, they'll have to first choose an insurance carrier and a primary care doctor and Clanon says, that won't always be easy.\u003c/p>\n\u003cp>\"Most of the information that goes to people about their choices and how they're becoming insured is going to come by snail mail, and people who are low-income frequently don't have stable addresses, and the majority of my patients don't have regular access to the internet.\"\u003c/p>\n\u003cp>If her patients don't fill out the paperwork, they will be automatically assigned to a primary doctor -- one that Clanon says is unlikely to have a specialty in HIV care. Or worse, she fears her patients won't tell their new doctor that they're infected, because of stigma surrounding people with the virus.\u003c/p>\n\u003cp>\"I have a patient that I saw about a month ago, he needed to move in with his mom. However she was so afraid of him that she was making him eat in his room off paper plates that she would then throw away. So stigma will make it difficult for people to fix any weirdness that happens in terms of where they get assigned.\"\u003c/p>\n\u003cp>And people with HIV, Clanon says, don't have time to be away from treatment.\u003c/p>\n\u003cp>\"Within a week, ten days, two weeks, if you stop taking your HIV medication, the virus comes back. And treatment interruptions are dangerous for people with HIV, they're dangerous for their health, and they're dangerous for our whole community because during that time that person is infectious to others.\"\u003c/p>\u003c/blockquote>\n\u003cp>Still, the Affordable Care Act earmarks money to deal with all that paperwork. Covered California, the state's new health insurance marketplace will soon announce grants totaling $49 million for education and outreach. Much of the money is expected to be awarded to community groups which have extensive networks in ethnic and low-income populations -- the very people who might have the most trouble navigating the new system.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The primary goal of that outreach is simply to get people enrolled in a health insurance plan. But Dana Howard, a spokesman with Covered California says these \"assisters\" will also be charged with helping people directly. \"Assisters are there to say, 'Let's figure out who you're seeing. Let's find a plan that has your network in there and find the one that has the best price,'\" Howard described.\u003c/p>\n\u003cp>Anthony Wright of Health Access, a statewide consumer advocacy group, was a bit more circumspect, saying, \"that is the hope\" when asked if assisters would help make sure people made it into a plan that includes their current doctor.\u003c/p>\n\u003cp>In the meantime, Dr. Clanon is moving ahead on her own, Kim reports. Two staff members at Highland's HIV clinic are becoming experts in the Affordable Care Act. They're also working with insurance plans to make sure that one of their HIV/AIDS doctors can be listed as a primary care provider.\u003c/p>\n\u003cp>Again, from Kim's report:\u003c/p>\n\u003cblockquote>\u003cp>Clanon says her clinic is ahead of the game, but she worries about clinics in rural areas or clinics with fewer resources. To help them along, Clanon's been traveling up and down the state talking with other HIV providers about ways to prepare for health reform.\u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post has been updated to include a quote and information from Dana Howard of Covered California. It also corrects the amount of money to be granted for education and outreach.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Researchers Report First Cure of HIV in a Child; Reaction in California",
"title": "Researchers Report First Cure of HIV in a Child; Reaction in California",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_11052\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/04/researchers-report-first-cure-of-hiv-in-a-child-reaction-in-california/boxes-of-antiretroviral-medicines-sit-on/\" rel=\"attachment wp-att-11052\">\u003cimg class=\"size-medium wp-image-11052\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/AIDS052611-300x218.jpg\" alt=\"Antiretroviral medicines are used to treat HIV/AIDS. (SONNYTUMBELAKA/AFP/Getty Images)\" width=\"300\" height=\"218\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Antiretroviral medicines are used to treat HIV/AIDS. (Sonny Tumbelaka/AFP/Getty Images) \u003ccite>(SONNY TUMBELAKA/AFP/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>A baby born with HIV, the virus that causes AIDS, \u003ca href=\"http://www.npr.org/blogs/health/2013/10/23/240272831/a-toddler-remains-hiv-free-raising-hope-for-babies-worldwide\" target=\"_blank\">appears to have been cured\u003c/a>, scientists announced at a meeting on Sunday in Atlanta. They described the case of a child -- as yet unnamed -- from Mississippi who is now 2 1/2. The child has been off medication for about a year and appears to be free of infection.\u003c/p>\n\u003cp>From AP:\u003c/p>\n\u003cblockquote>\u003cp>There's no guarantee the child will remain healthy, although sophisticated testing uncovered just traces of the virus' genetic material still lingering. If so, it would mark only the world's second reported cure.\u003c/p>\n\u003cp>Specialists say Sunday's announcement, at a major AIDS meeting in Atlanta, offers promising clues for efforts to eliminate HIV infection in children, especially in AIDS-plagued African countries where too many babies are born with the virus.\u003c!--more-->\u003c/p>\n\u003cp>\"You could call this about as close to a cure, if not a cure, that we've seen,\" Dr. Anthony Fauci of the National Institutes of Health, who is familiar with the findings, told The Associated Press.\u003c/p>\u003c/blockquote>\n\u003cp>Here in California, researchers have been electrified by the news. California reported the largest number of HIV diagnoses in the country in 2011, according to the Centers for Disease Control. More than 60 percent of Californians with HIV live in Los Angeles or San Francisco.\u003c/p>\n\u003cp>Dr. Deborah Cohan, an obstetrician at UC San Francisco, who specializes in the care of pregnant women with HIV was at the conference in Atlanta and described to Mina Kim how the discovery might impact her work.\u003c/p>\n\u003cp>\"There are many things we have already been doing in San Francisco,\" Cohan said. \"The most important piece is that we've been successful at essentially eliminating HIV transmission to babies. In this case, the baby was infected wiht HIV at birth, and we have been exceptionally successful at preventing that from happening to begin with. The last case of HIV transmission we had in a baby in San Fancisco was in 2004.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Mother-to-baby transmissions in the U.S. are fairly uncommon -- about 130 a year. Where this discovery may have significant implications, Cohan says, is in sub-Saharan Africa, where new infections in babies are much more common.\u003c/p>\n\u003cp>\"One of the things this points to is the importance of early diagnosis of HIV in babies,\" Cohan said. \"Currently national guidelines considers it optional to do a birth test on an HIV-exposed baby. The national recommendations are that it should be done in the first two weeks of life. In this case, they did a birth testing, and that really had an impact on how they ended up managing the baby because the baby was diagnosed so early.\"\u003c/p>\n\u003cp>Cohan said this child's case could have an impact on national guidelines and national recommendations. Currently, if a child is HIV positive at birth, the recommendation is a lifetime of antiretroviral medications, which is expensive and come with side effects.\u003c/p>\n\u003cp>\"While in general we think these medications are safe, taken over a long period of time and for very early exposure with an HIV-infected baby, certainly there are cumulative toxicities that can occur, so if that can be avoided, certainly that would be an optimal strategy.\"\u003c/p>\n\u003cp>The only other case of an HIV/AIDS cure is that of Timothy Brown, the so-called Berlin Patient. As a treatment for cancer, he received a bone marrow transplant in Germany from a donor who was genetically resistant to HIV.\u003c/p>\n\u003cp>\u003cstrong>Learn more:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kqed.org/a/forum/R201303050900\" target=\"_blank\">Child Cured of HIV\u003c/a> (Forum)\u003c/p>\n\n",
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"excerpt": "A baby born with HIV, the virus that causes AIDS, appears to have been cured, scientists announced at a meeting on Sunday in Atlanta. They described the case of a child -- as yet unnamed -- from Mississippi who is now 2 1/2. The child has been off medication for about a year and appears to be free of infection. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_11052\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/04/researchers-report-first-cure-of-hiv-in-a-child-reaction-in-california/boxes-of-antiretroviral-medicines-sit-on/\" rel=\"attachment wp-att-11052\">\u003cimg class=\"size-medium wp-image-11052\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/AIDS052611-300x218.jpg\" alt=\"Antiretroviral medicines are used to treat HIV/AIDS. (SONNYTUMBELAKA/AFP/Getty Images)\" width=\"300\" height=\"218\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Antiretroviral medicines are used to treat HIV/AIDS. (Sonny Tumbelaka/AFP/Getty Images) \u003ccite>(SONNY TUMBELAKA/AFP/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>A baby born with HIV, the virus that causes AIDS, \u003ca href=\"http://www.npr.org/blogs/health/2013/10/23/240272831/a-toddler-remains-hiv-free-raising-hope-for-babies-worldwide\" target=\"_blank\">appears to have been cured\u003c/a>, scientists announced at a meeting on Sunday in Atlanta. They described the case of a child -- as yet unnamed -- from Mississippi who is now 2 1/2. The child has been off medication for about a year and appears to be free of infection.\u003c/p>\n\u003cp>From AP:\u003c/p>\n\u003cblockquote>\u003cp>There's no guarantee the child will remain healthy, although sophisticated testing uncovered just traces of the virus' genetic material still lingering. If so, it would mark only the world's second reported cure.\u003c/p>\n\u003cp>Specialists say Sunday's announcement, at a major AIDS meeting in Atlanta, offers promising clues for efforts to eliminate HIV infection in children, especially in AIDS-plagued African countries where too many babies are born with the virus.\u003c!--more-->\u003c/p>\n\u003cp>\"You could call this about as close to a cure, if not a cure, that we've seen,\" Dr. Anthony Fauci of the National Institutes of Health, who is familiar with the findings, told The Associated Press.\u003c/p>\u003c/blockquote>\n\u003cp>Here in California, researchers have been electrified by the news. California reported the largest number of HIV diagnoses in the country in 2011, according to the Centers for Disease Control. More than 60 percent of Californians with HIV live in Los Angeles or San Francisco.\u003c/p>\n\u003cp>Dr. Deborah Cohan, an obstetrician at UC San Francisco, who specializes in the care of pregnant women with HIV was at the conference in Atlanta and described to Mina Kim how the discovery might impact her work.\u003c/p>\n\u003cp>\"There are many things we have already been doing in San Francisco,\" Cohan said. \"The most important piece is that we've been successful at essentially eliminating HIV transmission to babies. In this case, the baby was infected wiht HIV at birth, and we have been exceptionally successful at preventing that from happening to begin with. The last case of HIV transmission we had in a baby in San Fancisco was in 2004.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Mother-to-baby transmissions in the U.S. are fairly uncommon -- about 130 a year. Where this discovery may have significant implications, Cohan says, is in sub-Saharan Africa, where new infections in babies are much more common.\u003c/p>\n\u003cp>\"One of the things this points to is the importance of early diagnosis of HIV in babies,\" Cohan said. \"Currently national guidelines considers it optional to do a birth test on an HIV-exposed baby. The national recommendations are that it should be done in the first two weeks of life. In this case, they did a birth testing, and that really had an impact on how they ended up managing the baby because the baby was diagnosed so early.\"\u003c/p>\n\u003cp>Cohan said this child's case could have an impact on national guidelines and national recommendations. Currently, if a child is HIV positive at birth, the recommendation is a lifetime of antiretroviral medications, which is expensive and come with side effects.\u003c/p>\n\u003cp>\"While in general we think these medications are safe, taken over a long period of time and for very early exposure with an HIV-infected baby, certainly there are cumulative toxicities that can occur, so if that can be avoided, certainly that would be an optimal strategy.\"\u003c/p>\n\u003cp>The only other case of an HIV/AIDS cure is that of Timothy Brown, the so-called Berlin Patient. As a treatment for cancer, he received a bone marrow transplant in Germany from a donor who was genetically resistant to HIV.\u003c/p>\n\u003cp>\u003cstrong>Learn more:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kqed.org/a/forum/R201303050900\" target=\"_blank\">Child Cured of HIV\u003c/a> (Forum)\u003c/p>\n\n\u003c/div>\u003c/p>",
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"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"soldout": {
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"info": "Tech Nation is a weekly public radio program, hosted by Dr. Moira Gunn. Founded in 1993, it has grown from a simple interview show to a multi-faceted production, featuring conversations with noted technology and science leaders, and a weekly science and technology-related commentary.",
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"info": "The TED Radio Hour is a journey through fascinating ideas, astonishing inventions, fresh approaches to old problems, and new ways to think and create.",
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"tagline": "Local news to keep you rooted",
"info": "Host Devin Katayama walks you through the biggest story of the day with reporters and newsmakers.",
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