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LGBT provisions cut from health care reform bill

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The health care package President Obama signed into law Tuesday drew mixed reactions from LGBT rights advocates who praised the legislation for bringing sweeping reform, but expressed disappointment at the exclusion of some LGBT and HIV/AIDS provisions.

After he signed the $940 billion package in the East Room of the White House, Obama touted that the bill would set up insurance exchanges to extend coverage to 32 million uninsured Americans.

ā€œBut now what weā€™re going to do is create exchanges all across the country where uninsured people ā€” small businesses ā€” theyā€™re going to be able to purchase affordable, quality insurance,ā€ he said. ā€œThey will be part of a big pool, just like federal employees are part of a big pool.ā€

Rea Carey, executive director of the National Gay & Lesbian Task Force, praised the legislation. In a statement, she called it ā€œa historic step toward ensuring access to health care for roughly 32 million people.ā€

ā€œMillions of people across the country are suffering from a lack of adequate, affordable health care and experience unfair, inhumane treatment at the hands of the health insurance industry,ā€ she said. ā€œLesbian, gay, bisexual and transgender people and our families are among those affected by this broken and imbalanced health care system, which this law aims to fix.ā€

But the legislation that made its way to the presidentā€™s desk lacked any of the LGBT-specific or HIV/AIDS language passed last year in the House version of the bill.

Gone from the final package was a provision eliminating the tax paid on domestic partner health benefits received under an employer plan, as well as language authorizing states to cover low-income people with HIV before they develop AIDS. Also missing is language providing for non-discrimination in health care and a provision authorizing the federal government to collect health care data on the LGBT population.

In a statement, Terry Hamilton, board chair of the Log Cabin Republicans, lambasted Obama and Congress for excluding those provisions from the final health care bill.

ā€œIt is disheartening to see the Democratic congressional majority continue to sideline LGBT agenda items ā€” especially critical health care issues ā€” in the name of political expediency,ā€ Hamilton said. ā€œHow much longer do they expect gays and lesbians to support them as they continue to take a pass on every opportunity to support our community?ā€

Acknowledging the lack of those provisions, Carey said the Task Force would continue to fight for additional health care reform that specifically targets LGBT people and disadvantaged groups.

ā€œEvery April 15, same-sex couples and our families write an extra check to the [Internal Revenue Service] to pay for domestic partner and spousal benefits ā€” the very same benefits opposite-sex married couples get tax free,ā€ she said. ā€œThe federal government must add sexual orientation and gender identity-specific questions to all national health surveys in order to get a more accurate picture of the communityā€™s needs.ā€

A House Democratic leadership aide, who spoke on the condition of anonymity, said the early treatment for HIV and data collection provisions werenā€™t included in the final bill because they had no budgetary implications and thus were ineligible under parliamentary rules.

Congress is passing health care reform through the reconciliation process so that only 51 votes are required in the Senate for passage for the final bill as opposed to the 60 that would be needed to overcome any filibuster. Under this process, any changes the House wanted to make to the previously approved Senate bill had to be part of a sidecar reconciliation package. But under reconciliation, only matters related to the budget are eligible for a vote.

As for the domestic partner tax elimination provision, which may have budgetary implications because it deals with taxation, the House aide deferred to the White House on why the provision wasnā€™t included in the final bill. A White House spokesperson declined to comment.

Although the LGBT and HIV/AIDS provisions unique to the House legislation werenā€™t included in the reconciliation package, the final bill has one provision aimed to help to HIV/AIDS community that was included in both the House and Senate versions of the legislation.

The language would enable AIDS Drug Assistance Program expenditures to count toward out-of-pocket expenses under Medicare Part D. People with HIV/AIDS on Medicare who receive help purchasing HIV drugs would thus have a lightened burden for other prescription drug costs.

Other provisions in the final bill ā€” less explicitly directed at people with HIV/AIDS ā€” would assist people living with the disease.

The final health bill eliminates discrimination based on health status or pre-existing conditions, such as HIV/AIDS. Additionally, the bill expands Medicaid eligibility for people with incomes below 133% of the federal poverty level, allowing more low-income people with HIV to access Medicaid and its prescription drug coverage.

Although the House LGBT provisions were missing from the final bill, advocates on Capitol Hill pledged to work to pass this language through other legislative vehicles.

In a statement, Jerilyn Goodman, spokesperson for lesbian Rep. Tammy Baldwin (D-Wis), an advocate of the LGBT legislative language, said the lawmaker looks forward to passing the health care bill and pursuing ā€œevery available option to pass the other LGBT provisions.ā€

In a message on the Human Rights Campaign web site, Brian Moulton, HRCā€™s chief legislative counsel, said his organization was ā€œdeeply disappointedā€ the LGBT language was omitted. Still, he noted that HRC would continue working for the provisions.

ā€œWhile we are saddened that the House has abandoned provisions that would make care more accessible and affordable to our community, we recognize that the health reform measure will still help all Americans, including LGBT people,ā€ he said. ā€œImportant reforms like eliminating pre-existing condition limitations and expanding Medicaid will significantly impact people living with HIV and AIDS.ā€

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US contributes more than $90 million to fight mpox outbreak in Africa

WHO and Africa CDC has declared a public health emergency

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The U.S. has contributed more than $90 million to the fight against the mpox outbreak in Africa. (Photo courtesy of the Centers for Disease Control and Prevention)

The U.S. has contributed more than $90 million to the fight against the mpox outbreak in Africa.

The U.S. Agency for International Development on Tuesday in a press release announced “up to an additional” $35 million “in emergency health assistance to bolster response efforts for the clade I mpox outbreak in Central and Eastern Africa, pending congressional notification.” The press release notes the Biden-Harris administration previously pledged more than $55 million to fight the outbreak in Congo and other African countries.

“The additional assistance announced today will enable USAID to continue working closely with affected countries, as well as regional and global health partners, to expand support and reduce the impact of this outbreak as it continues to evolve,” it reads. “USAID support includes assistance with surveillance, diagnostics, risk communication and community engagement, infection prevention and control, case management, and vaccination planning and coordination.” 

The World Health Organization and the Africa Centers for Disease Control and Prevention last week declared the outbreak a public health emergency.

The Washington Blade last week reported there are more than 17,000 suspected mpox cases across in Congo, Uganda, Kenya, Rwanda, and other African countries. The outbreak has claimed more than 500 lives, mostly in Congo.Ā 

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Mpox outbreak in Africa declared global health emergency

ONE: 10 million vaccine doses needed on the continent

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The declaration of a public health emergency over an mpox outbreak in Africa has prompted calls for additional vaccine doses for the continent. (Photo courtesy of the Centers for Disease Control and Prevention)

Medical facilities that provide treatment to gay and bisexual men in some East African countries are already collaborating with them to prevent the spread of a new wave of mpox cases after the World Health Organization on Wednesday declared a global health emergency.

The collaboration, both in Uganda and Kenya, comes amid WHO’s latestĀ reportĀ released on Aug. 12, which reveals that nine out of every 10 reported mpox cases are men with sex as the most common cause of infection.Ā 

The global mpox outbreak report ā€” based on data that national authorities collected between January 2022 and June of this year ā€” notes 87,189 of the 90,410 reported cases were men. Ninety-six percent of whom were infected through sex.

Sexual contact as the leading mode of transmission accounted for 19,102 of 22,802 cases, followed by non-sexual person-to-person contact. Genital rash was the most common symptom, followed by fever and systemic rash.

The WHO report states the pattern of mpox virus transmission has persisted over the last six months, with 97 percent of new cases reporting sexual contact through oral, vaginal, or anal sex with infected people.Ā 

ā€œSexual transmission has been recorded in the Democratic Republic of Congo among sex workers and men who have sex with men,ā€ the report reads. ā€œAmong cases exposed through sexual contact in the Democratic Republic of the Congo, some individuals present only with genital lesions, rather than the more typical extensive rash associated with the virus.ā€

The growing mpox cases, which are now more than 2,800 reported cases in at least 13 African countries that include Kenya, Uganda, Rwanda, and prompted the Africa Centers for Disease Control and Prevention this week to declare the disease a public health emergency for resource mobilization on the continent to tackle it.

ā€œAfrica has long been on the frontlines in the fight against infectious diseases, often with limited resources,” said Africa CDC Director General Jean Kaseya. “The battle against Mpox demands a global response. We need your support, expertise, and solidarity. The world cannot afford to turn a blind eye to this crisis.ā€ 

The disease has so far claimed more than 500 lives, mostly in Congo, even as the Africa CDC notes suspected mpox cases across the continent have surged past 17,000, compared to 7,146 cases in 2022 and 14,957 cases last year. Ā Ā 

ā€œThis is just the tip of the iceberg when we consider the many weaknesses in surveillance, laboratory testing, and contact tracing,ā€ Kaseya said.  

WHO, led by Director General Tedros Adhanom Ghebreyesus, also followed the Africa CDCā€™s move by declaring the mpox outbreak a public health emergency of international concern.

The latest WHO report reveals that men, including those who identify as gay and bisexual, constitute most mpox cases in Kenya and Uganda. The two countries have recorded their first cases, and has put queer rights organizations and health care centers that treat the LGBTQ community on high alert.Ā 

The Uganda Minority Shelters Consortium, for example, confirmed to the Washington Blade that the collaboration with health service providers to prevent the spread of mpox among gay and bisexual men is ā€œnascent and uneven.ā€ 

ā€œWhile some community-led health service providers such as Ark Wellness Clinic, Children of the Sun Clinic, Ice Breakers Uganda Clinic, and Happy Family Youth Clinic, have demonstrated commendable efforts, widespread collaboration on mpox prevention remains a significant gap,ā€ UMSC Coordinator John Grace stated. ā€œThis is particularly evident when compared to the response to the previous Red Eyes outbreak within the LGBT community.ā€

Grace noted that as of Wednesday, there were no known queer-friendly health service providers to offer mpox vaccinations to men who have sex with men. He called for health care centers to provide inclusive services and a more coordinated approach.

Although Grace pointed out the fear of discrimination ā€” and particularly Uganda’s Anti-Homosexuality Act ā€” remains a big barrier to mpox prevention through testing, vaccination, and treatment among queer people, he confirmed no mpox cases have been reported among the LGBTQ community.

Uganda so far has reported two mpox cases ā€” refugees who had travelled from Congo.

ā€œWe are for the most part encouraging safer sex practices even after potential future vaccinations are conducted as it can also be spread through bodily fluids like saliva and sweat,ā€ Grace said. 

Grace also noted that raising awareness about mpox among the queer community and seeking treatment when infected remains a challenge due to the historical and ongoing homophobic stigma and that more comprehensive and reliable advocacy is needed. He said Grindr and other digital platforms have been crucial in raising awareness.

The declarations of mpox as a global health emergency have already attracted demand for global leaders to support African countries to swiftly obtain the necessary vaccines and diagnostics.

ā€œHistory shows we must act quickly and decisively when a public health emergency strikes. The current Mpox outbreak in Africa is one such emergency,ā€ said ONE Global Health Senior Policy Director Jenny Ottenhoff.

ONE is a global, nonpartisan organization that advocates for the investments needed to create economic opportunities and healthier lives in Africa.

Ottenhoff warned failure to support the African countries with medical supplies needed to tackle mpox would leave the continent defenseless against the virus.  

To ensure that African countries are adequately supported, ONE wants governments and pharmaceutical companies to urgently increase the provision of mpox vaccines so that the most affected African countries have affordable access to them. It also notes 10 million vaccine doses are currently needed to control the mpox outbreak in Africa, yet the continent has only 200,000 doses.

The Blade has reached out to Ishtar MSM, a community-based healthcare center in Nairobi, Kenya, that offers to service to gay and bisexual men, about their response to the mpox outbreak. 

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White House urged to expand PrEP coverage for injectable form

HIV/AIDS service organizations made call on Wednesday

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Apretude is a long-lasting PrEP injection that has proven to be significantly more effective at reducing the risk of sexually-acquired HIV. (Photo courtesy of ViiV Healthcare)

A coalition of 63 organizations dedicated to ending HIV called on the Biden-Harris administration on Wednesday to require insurers to cover long-acting pre-exposure prophylaxis (PrEP) without cost-sharing.

In a letter to Chiquita Brooks-LaSure, administrator of the Centers for Medicare and Medicaid Services, the groups emphasized the need for broad and equitable access to PrEP free of insurance barriers.

Long-acting PrEP is an injectable form of PrEP that’s effective over a long period of time. The FDA approved Apretude (cabotegravir extended-release injectable suspension) as the first and only long-acting injectable PrEP in late 2021. It’s intended for adults and adolescents weighing at least 77 lbs. who are at risk for HIV through sex.

The U.S. Preventive Services Task Force updated its recommendation for PrEP on Aug. 22, 2023, to include new medications such as the first long-acting PrEP drug. The coalition wants CMS to issue guidance requiring insurers to cover all forms of PrEP, including current and future FDA-approved drugs.

“Long-acting PrEP can be the answer to low PrEP uptake, particularly in communities not using PrEP today,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “The Biden administration has an opportunity to ensure that people with private insurance can access PrEP now and into the future, free of any cost-sharing, with properly worded guidance to insurers.”

Currently, only 36 percent of those who could benefit from PrEP are using it. Significant disparities exist among racial and ethnic groups. Black people constitute 39 percent of new HIV diagnoses but only 14 percent of PrEP users, while Latinos represent 31 percent of new diagnoses but only 18 percent of PrEP users. In contrast, white people represent 24 percent of HIV diagnoses but 64 percent of PrEP users.

The groups also want CMS to prohibit insurers from employing prior authorization for PrEP, citing it as a significant barrier to access. Several states, including New York and California, already prohibit prior authorization for PrEP.

Modeling conducted for HIV+Hep, based on clinical trials of a once every 2-month injection, suggests that 87 percent more HIV cases would be averted compared to daily oral PrEP, with $4.25 billion in averted healthcare costs over 10 years.

Despite guidance issued to insurers in July 2021, PrEP users continue to report being charged cost-sharing for both the drug and ancillary services. A recent review of claims data found that 36 percent of PrEP users were charged for their drugs, and even 31 percent of those using generic PrEP faced cost-sharing.

The coalition’s letter follows a more detailed communication sent by HIV+Hepatitis Policy Institute to the Biden administration on July 2.

Signatories to the community letter include Advocates for Youth, AIDS United, Equality California, Fenway Health, Human Rights Campaign, and the National Coalition of STD Directors, among others.

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