From UCSF.edu

http://www.poz.com/articles/Homeless_Men_HIV_1_22313.shtml

By Jeff Sheehy on April 26, 2012

In a groundbreaking study published last year, scientists reported that effective treatment with HIV medications not only restores health and prolongs life in many HIV-infected patients, but also curtails transmission to sexual partners up to ninety-seven percent. However, a new study by UCSF scientists shows that lack of basic living needs severely undercuts these advances in impoverished men.

The new research builds on a 2010 finding by the Centers for Disease Control and Prevention showing that poverty is the single biggest factor linked to HIV infection in heterosexuals living in inner-city neighborhoods. 

In the new study published in the April 25 issue of PLoS ONE, UCSF researchers found that for HIV-infected homeless and unstably housed individuals, a failure to address unmet subsistence needs such as housing, food, clothing and hygiene, undermines these very real individual and public health benefits of HIV medication delivery.

“In this study, we followed a group of homeless and unstably housed HIV-infected people living in San Francisco and found that only about a fifth of those for whom antiretroviral therapy was medically indicated were actually on the medications. More importantly, while viral load was one of the most important predictors of overall health, we found that an inability to meet basic subsistence needs had an even larger influence on health status in this population,” said the study’s principal investigator, Elise Riley, PhD, Associate Professor in the UCSF HIV/AIDS Division at San Francisco General Hospital and Trauma Center.  

“This study shows that a simple focus on providing medications will neither effectively treat nor end HIV in inner cities.  A person’s ability to get needed care and take medications becomes less of a priority when they don’t have food or a place to sleep.  If we could improve opportunities for people to meet their basic subsistence needs, in tandem with providing antiretroviral therapy, we could improve patients’ health and better realize the potential gains to public health,” added Riley.

For six years, the researchers followed a group of 288 HIV-infected men who were recruited from homeless shelters, free meal programs and single room occupancy (SRO) hotels that primarily serve individuals with very low or no income.  Twenty percent had reported being homeless recently.  Over one-third of participants reported current symptoms of chronic illness.

At the study onset, participants had an average of 349 CD4 T-cells (the immune cells targeted and killed by HIV), which is not much higher than the cutoff of 200 often used to diagnose AIDS. While current treatment guidelines in the City and County of San Francisco indicate treatment upon HIV diagnosis, the policy active during the study period specified that individuals with less than 350 CD4 T-cells should start antiretroviral medications.

Results indicating that subsistence needs are the strongest predictor of overall health status among homeless men were consistent with findings from a recent homeless women’s study conducted by the same group and published earlier this year in the American Journal of Epidemiology.

“Previous cost effectiveness studies show that homelessness is more expensive to society than the cost of housing. This is due to situations that are strongly linked to homelessness like emergency room use and incarceration.  Our study suggests that the social barriers inherent in poverty are also likely to continue fueling the American HIV epidemic, which may further add to societal costs,” concluded Riley. 

Study co-investigators include Torsten B. Neilands, Kelly Moore, Jennifer Cohen, David R. Bangsberg and Diane Havlir.  In addition to UCSF, authors of this study are affiliated with the Harvard School of Medicine and the University of California, Berkeley.

The study, funded by the National Institutes of Health, is online in PLoS ONE.

The UCSF HIV/AIDS Division at San Francisco General Hospital and Trauma Center is affiliated with the AIDS Research Institute (ARI) at UCSF.  UCSF ARI houses hundreds of scientists and dozens of programs throughout UCSF and affiliated labs and institutions, making ARI one of the largest AIDS research entities in the world.

UCSF is a leading university dedicated to defining health worldwide through advanced biomedical research, graduate level education in the life sciences and health professions, and excellence in patient care.

Public Health (IDPH) HIV/AIDS funding Reduction

AFC estimated the likely short-term and long-term fiscal and population-health impact of decreased HIV-related services as proposed in the Governor’s FY 13 budget ($4 million funding reduction for HIV services, a 14% cut).

Based on public health evidence of average HIV treatment costs and anticipated HIV infections that result from those with undiagnosed HIV infection, we estimate that this reduction will increase costs to Illinois by $6.9 million in FY 13 because more people will need HIV treatment, and others will be re-incarcerated after re-entry programs are de-funded.

In addition, the state will face an additional $40 million in lifetime health care costs for people newly infected with HIV because of the proposed funding cuts.

108 additional people will be newly infected with HIV

• 54 are likely to be African American, 17 Latino, and 37 white, based on the racial/ethnic distribution of HIV new cases in Illinois
• 38 infants will be born with preventable HIV-infection because 150 HIV-positive pregnant women won’t get intensive case management
• 38 additional people will be newly infected because 6,467 fewer HIV tests and other services will be offered
• 32 people will be newly infected because 1,262 drug users won’t get counseling & supplies

563 people with HIV will lose life-supporting services 563 low-income people with HIV will lose access to food, dental, primary physician care, medical case management, transportation, mental health and substance abuse treatment, likely worsening health outcomes and increasing health care costs.

114 people with HIV will lose housing 114 highly vulnerable people with HIV will lose access to housing, resulting in homelessness and less adherence to medications.

They will face worse health outcomes and higher health care costs.

• 255 people with HIV will be re-incarcerated at a cost of $5.6 million
• 255 people with HIV who left prison or jail will be re-incarcerated at a cost of $5.6 million per year (23% recidivism rate for participants vs. 51% general IDOC recidivism rate) because of funding cuts to a reentry program for people with HIV
• 150 people with HIV released from prison or jail will not receive case management, housing, primary medical care, and mental health services, making them less likely to access HIV treatment

Estimates are based on data obtained from IDPH, service utilization and funding data, and state and national data and research.

Contact: Ramon Gardenhire, AIDS Foundation of Chicago, 301-379-3024, rgardenhire@aidschicago.org. 4/2/12

Public Health (IDPH) HIV/AIDS funding Reduction

AFC estimated the likely short-term and long-term fiscal and population-health impact of decreased HIV-related services as proposed in the Governor’s FY 13 budget ($4 million funding reduction for HIV services, a 14% cut).

Based on public health evidence of average HIV treatment costs and anticipated HIV infections that result from those with undiagnosed HIV infection, we estimate that this reduction will increase costs to Illinois by $6.9 million in FY 13 because more people will need HIV treatment, and others will be re-incarcerated after re-entry programs are de-funded.

In addition, the state will face an additional $40 million in lifetime health care costs for people newly infected with HIV because of the proposed funding cuts.

108 additional people will be newly infected with HIV

• 54 are likely to be African American, 17 Latino, and 37 white, based on the racial/ethnic distribution of HIV new cases in Illinois
• 38 infants will be born with preventable HIV-infection because 150 HIV-positive pregnant women won’t get intensive case management
• 38 additional people will be newly infected because 6,467 fewer HIV tests and other services will be offered
• 32 people will be newly infected because 1,262 drug users won’t get counseling & supplies

563 people with HIV will lose life-supporting services 563 low-income people with HIV will lose access to food, dental, primary physician care, medical case management, transportation, mental health and substance abuse treatment, likely worsening health outcomes and increasing health care costs.

114 people with HIV will lose housing 114 highly vulnerable people with HIV will lose access to housing, resulting in homelessness and less adherence to medications.

They will face worse health outcomes and higher health care costs.

• 255 people with HIV will be re-incarcerated at a cost of $5.6 million
• 255 people with HIV who left prison or jail will be re-incarcerated at a cost of $5.6 million per year (23% recidivism rate for participants vs. 51% general IDOC recidivism rate) because of funding cuts to a reentry program for people with HIV
• 150 people with HIV released from prison or jail will not receive case management, housing, primary medical care, and mental health services, making them less likely to access HIV treatment

Estimates are based on data obtained from IDPH, service utilization and funding data, and state and national data and research.

Contact: Ramon Gardenhire, AIDS Foundation of Chicago, 301-379-3024, rgardenhire@aidschicago.org. 4/2/12

From the Miami Herald:

Magic Johnson Enterprises is investing in a Miami-based insurer, Simply Healthcare Plans, to create a major Medicaid program for HIV-AIDS patients that takes advantage of a bill signed last week by Gov. Rick Scott.

The companies announced the partnership Tuesday to mark the official launch of Clear Health Alliance, a subsidiary of Simply that is a Medicaid plan for those with HIV and AIDS. The alliance will start in Miami-Dade and expand throughout Florida.

“This is two minority powerhouses coming together — an African-American and an Hispanic,” said Miguel “Mike” Fernandez, chairman of Simply.

Earvin “Magic” Johnson, a former basketball star who is HIV-positive, has long been active in promoting care for HIV-AIDs patients. In a prepared statement, Johnson said he was looking forward to working with Simply to develop “healthcare programs focused on the needs of individuals in underserved communities.”

Fernandez praised Johnson as “incredible businessman” for his astute investments, including Starbucks. Last month, Johnson led a group that bought the Los Angeles Dodgers for $2 billion.

The “facilitator” for their alliance was a mutual friend, Miami Heat President Pat Riley, Fernandez said. Riley and Fernandez are neighbors in Gables Estates. Riley coached Johnson at the Los Angeles Lakers in the 1980s.

Fernandez, best known for selling CarePlus to Humana for $450 million in 2004, said he and Johnson envisioned “a high-touch, high-care program” that would include transportation services and nutrition advice to provide “a more holistic approach than we have ever done.”

They plan to extend the concept nationwide, partly through clinics, a form of healthcare delivery that has prospered in Miami-Dade in companies led by Fernandez and Leon Medical Centers.

“Leon is the best medical care operation there is in a community of Cuban-Americans,” Fernandez said, “but that model has yet to be proven outside of Miami-Dade County. We intend to take this concept into the national scene, to include medical centers to treat HIV patients, targeting the inner city of low-income Hispanics and African-Americans.”

HIV-AIDS patients often need extensive — and expensive — medical treatment, but they have historically “not participated in managed care,” Fernandez said.

For several years, the Republican-led Legislature has advocated putting patients into managed care programs on the theory that private companies can control healthcare costs better than government agencies can. Scott is also a strong supporter of the concept.

Last year, Fernandez said, the Legislature passed a law allowing the creation of special Medicaid plans for HIV patients in South Florida. This year, as part of a bill to control Medicaid costs, HIV Medicaid patients statewide will be required to join special health maintenance organizations. Medicaid is a form of state-federal health insurance for the poor.

That paved the way for the Johnson-Fernandez partnership. “This could not have been done without the governor’s office and the Agency for Health Care Administration,” Fernandez said. “They saw the value and supported our ideas.”

Fernandez has been a strong supporter of Scott and Florida Republicans. In the fall of 2010, Fernandez and six companies controlled by him donated a total of $700,000 to Scott’s political action committee, Let’s Get to Work. Fernandez also personally contributed $510,000 to the Republican Party of Florida in the past two years, as well as $25,000 to the Florida Democratic Party.

Miami Herald Staff Writer Scott Hiaasen contributed to this article.

Read more here: http://www.miamiherald.com/2012/04/03/2729569/magic-johnson-invests-in-miami.html#storylink=cpy

Re-Posted from www.blackaidsproject.org

In July 2012, the International AIDS Conference returns to the U.S. for the first time in 22 years thanks to the administration’s lifting of the travel ban on persons living with HIV. With over 25,000 researchers, advocates, government officials, journalists, non-governmental organization service providers, clinicians, health department staff, people living with HIV and other committed persons waiting anxiously to hear what President Obama (or the administration’s representative) says at the meeting, we must urgently consider what preparations the U.S. needs to make for this global stage.

Here, I focus on issues related to HIV in the U.S. because the conference traditionally spotlights the epidemic in the host country. We have serious policy and programmatic work to do to get our house in order before the world comes to our door.

The president is clearly interested in HIV/AIDS. On July 13, 2010, he released the National HIV/AIDS Strategy (NHAS), and challenged the country, saying, “So the question is not whether we know what to do, but whether we will do it.” This landmark comprehensive HIV plan includes five-year goals regarding HIV prevention, care, housing, program coordination and health disparities (highlighting especially the disproportionate burden of HIV among gay men of all races and ethnicities, and in African American and Latino/Latina communities). But in the past 20 months roadblocks have emerged, and we have real hurdles to overcome quickly to stay on track for NHAS progress; it will be critical for the administration to address these challenges before the conference. I describe below some challenges I believe are critical, and hope that HuffPost readers will add their own.

1. Acknowledging That Care Needs Are Larger Than Commonly Perceived.

It is widely recognized that there are roughly 4,000 persons living with HIV in the U.S. who are on treatment waiting lists for the federal AIDS Drug Assistance Program (ADAP is the payer of last resort). However, CDC has recently estimated that of the approximately 1.2 million people living with HIV in the U.S. just 80 percent are diagnosed, only 62 percent are linked to care, just 41 percent are retained in care and a mere 28 percent have suppressed viral load; this “cascade” indicates that the unmet care, treatment and support needs in the U.S. are dramatically larger than ADAP waiting lists. The federal government has taken very important steps to bolster ADAP, but to truly address unmet needs will require an effort of a new scale even prior to the full implementation of the Affordable Care Act. When we talk about unmet care and treatment needs, we must begin to refer to the entire treatment needs cascade, and we must address the infrastructure cracks evident in the already strained systems of prevention and care service delivery.

2. “The Beginning of the End of AIDS.”

During the President’s Dec. 1, 2011 World AIDS Day talk, he referred to “the beginning of the end of AIDS” and “getting to zero” because a remarkable new study has found that HIV treatment in heterosexual couples in which one person is living with HIV and the other partner is HIV negative can reduce the relative risk of HIV transmission by up to 96 percent. We do know what to do to “end AIDS.” But at the population level, this goal cannot be realized if we do not address the cascade of unmet care, treatment and support needs noted above. We should use this wonderfully inspiring phraseology in July… if we mean to make the investments to achieve it.

3. Price Tag.

Some HIV advocates, researchers and members of Congress have asked that the federal government produce an official estimate of the cost of implementing the NHAS. I agree. In a 2010 academic paper, I estimated that the total five-year cost of the NHAS would be just over $15 billion in new funding from either the public sector, private sector or both (roughly two billion in prevention programs, one billion in housing and the remainder for care and treatment). Making this investment was estimated to save just under $18 billion in future treatment costs, and therefore would more than pay for itself. But the longer we wait to make the investment, the worse the public health and economic returns before 2015. A Congressional Budget Office “official” estimate of the NHAS could still be produced before July, current investments gauged against it, and a plan developed and announced for phased-in “full funding” of the NHAS.

4. HIV Is Transmitted By Human Behavior — You Might Have To Say “Sex.”

During the President’s World AIDS Day talk, and during Secretary Clinton’s Nov. 8, 2011 speech on “Creating an AIDS-Free Generation,” references to the behavioral aspects of HIV were notably scarce. Neither said “sex” or referred to injection drug use behaviors; Secretary Clinton mentioned condoms once. Clear statements about the importance of age-appropriate comprehensive sexual education and sterile syringe exchange programs that provide a pathway to substance use treatment will be especially important at the July conference.

5. Initial Amendments to the NHAS.

When it was released, the administration positioned the NHAS as a living document that might change over time. Since 2010, it has been repeatedly noted by advocates that structural factors which disproportionately impact women and homeless populations are insufficiently addressed by the NHAS. Also, HIV-related discrimination is noted, but solutions need additional development. A small set of truly critical NHAS amendments could be issued in July to further strengthen our response to the domestic epidemic.

6. Measuring Progress.

The NHAS was unveiled with five-year goals, but several of the key goals (such as reducing HIV incidence in the U.S. by 25 percent) do not yet have a 2010 baseline measure. The Department of Health and Human Services has done an excellent job of identifying a draft set of indicators by which to track NHAS progress; but we urgently need the baseline data on those metrics to help inform midcourse corrections.

The next four months are a critical time for the Administration, the International AIDS Conference, and the National HIV/AIDS Strategy. We might ask a familiar question: We know what to do, but will we do it?

David Holtgrave, PhD, is professor and chair, department of health, behavior and society, Johns Hopkins Bloomberg School of Public Health

Disclaimer: This post is my personal opinion, and does not reflect the views of my employer or the views of any advisory council on which I serve.

From The Black Youth Project

According to a recent report, the rate of HIV infections among Black women is five times higher than originally thought.

The CDC estimates that 1 in 32 Black women are HIV positive.

However, a recent study conducted by the HIV Prevention Trials Network reveals that the situation is much worse. Women constitute one quarter of new HIV infections in the US; 66 percent of these women are Black women, even though they only represent 14 percent of the US female population.

The rate of HIV infection among Black women is comparable to those in sub-Saharan Africa.

Read more here:

http://www.blackyouthproject.com/2012/03/hiv-among-black-women-higher-than-initally-thought-comparable-to-sub-saharan-africa/

From The AIDS Foundation of Chicago:

Monday, March 05, 2012

Chicago’s 2012 Teen Girls & Women’s Health Awareness Day
Breaking the Cycle
FAM Entertainment Theater Company, National Women and Girls HIV/AIDS Awareness Day

Contact: Kenya Robertson, 312-572-9373, Kenya@fament.org This e-mail address is being protected from spambots. You need JavaScript enabled to view it
chicagos2012hivaidsday@gmail.com This e-mail address is being protected from spambots. You need JavaScript enabled to view it

The AIDS Foundation of Chicago (AFC) and the FAM Entertainment Theater Company are proud to present a day of fun and learning on National Women and Girls HIV/AIDS Awareness Day.

On Saturday, March 10, from 8:30 a.m. to 3 p.m., at the Ford City Shopping Mall, there will be workshops, performances and health screenings to encourage an open and honest conversation about female sexual and reproductive health.

National Women and Girls HIV/AIDS Awareness Day is a nationwide observance to raise awareness of the increasing impact of HIV/AIDS on women and girls and encourage them to get tested. It is also aimed at empowering communities and organizations to take action in the fight against HIV/AIDS.

In 2009, women represented 23 percent of new HIV infections in the United States, according to the most recent data from the U.S. Centers for Disease Control and Prevention. African-American women are 15 times more likely to be infected with HIV than white women.

The event at the Ford City Shopping Mall will host local organizations providing performances, free health screenings, health and preventive health care information, and giveaways for over 1,200 women and teen girls in the community.

The program will feature speakers from the Chicago WVON radio show, including Kendall Moore, director of the South Side Help Center; Janks Morton, film director of the groundbreaking documentary “Dear Daddy,” New Foundations, Imani Niah; HawkFilmz; and educators/trainers from the Chicago Metropolitan Battered Women’s Network. 

On this important day, AFC and the FAM Entertainment Theater Company are partnering with Ford City Shopping Mall, The South Shore Hospital Wellness Center, Chicago’s Women’s AIDS Project, Chicago’s Women’s Health Center, P.A.V.E., and The Women’s Health Foundation.

Other sponsors and participants include the Chicago Department of Public Health, South Suburban Family Shelter and over 20 participating high schools and grammar schools, including the Illinois Math and Science Academy of Aurora, Ill., and many other motivational speakers.

WHEN:      Saturday, March 10, 2012, 8:30 a.m. - 3:00 p.m.

WHERE:     Ford City Shopping Mall, 7601 S. Cicero, Chicago, IL  60652.

FREE PARKING.

For more information about Chicago’s 2012 HIV/AIDS awareness day of workshops: visit and like:  http://www.facebook.com/Chicagos2012hivaidsday

The Care Center of Jackson Park Hospital is proud to be the recipient of the Gilead Grant. This grant will enable the Center to make additions to our care for the community.

Some of the benefits are:

• 24 hour FREE HIV testing in the Emergency Room of Jackson Park Hospital.
• Two new staff members - Emergency Room Testing Coordinator (Cherron Franklin) and HIV Patient Navigator (Valarie Stowe).
• We now have a Facebook page and a Twitter! Maybe sure to follow us for updates and news about the clinic.

We are pleased to have won the grant - we are dedicated to our mission and will continue to improve the health of our community. The power to prevent starts with you!

-The Care Center Staff