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Obama AIDS panel bucks White House on drug funds

Resolution calls for $126 million ADAP emergency measure

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Members of the Presidential Advisory Council on HIV/AIDS this week called on President Obama and Congress to approve $126 million in emergency funds for the struggling AIDS Drug Assistance Program. (Photo by Pete Souza, courtesy White House)

President Obama’s newly appointed Presidential Advisory Council on HIV/AIDS adopted a resolution Tuesday urging the White House and Congress to do something they have been reluctant to do: approve $126 million in emergency funds for the struggling AIDS Drug Assistance Program.

The federal program, which is operated jointly with states, provides subsidies for life-saving anti-retroviral drugs needed by low-income people with HIV and AIDS who lack health insurance coverage.

Due to several developments, including sharp budget cuts by states, a record 1,924 people eligible to enroll in the program in 11 states have been placed on waiting lists as state ADAPs have run out of money to pay for the drugs, state officials have said. The waiting lists are expected to grow in the coming weeks and months.

AIDS activists have criticized the White House and Democratic leaders in Congress for not taking immediate steps to push the emergency funding this year, saying people on the waiting lists face possible life-threatening illnesses related to HIV without their medication.

More than 50 members of the House, including gay Reps. Barney Frank (D-Mass.) and Tammy Baldwin (D-Wis.) sent a petition to the White House earlier this year calling for $126 million in supplemental funds for ADAP in the current fiscal year.

The presidential AIDS panel, known as PACHA, adopted its resolution at a special conference call meeting Tuesday.

The conference call came after some PACHA members complained that the panel was distracted from adopting the resolution and addressing other important business at its previous in-person meeting at the White House in April by administration staffers who overly “stage managed” the meeting, according to insiders familiar with the panel.

The 24-member PACHA includes seven out gay members. It’s chaired by Dr. Helen Gale, a nationally recognized AIDS physician and former top official at the U.S. Centers for Disease Control & Prevention.

“I don’t think the PACHA is being stage managed, but I do think that it is being over handled,” said PACHA member Phill Wilson, executive director of the Black AIDS Institute in Los Angeles.

Wilson said it would be an exaggeration to characterize as a “rebellion” the call by PACHA members for a special meeting this week to vote on the ADAP resolution, as one source familiar with PACHA called it.

But he said PACHA members assigned to a subcommittee that monitors ADAP issues made it clear that it would be unacceptable for the advisory body to wait until its next regularly scheduled meeting in September to take up the ADAP issue.

Wilson and fellow PACHA member A. Cornelius Baker, former executive director of the National Association of People with AIDS and the Whitman-Walker Clinic, said the newly reconstituted PACHA appeared to be having some organizational and logistical problems.

Among other things, Baker and PACHA member Rosie Perez, actress and AIDS activist, expressed concern at the April meeting that White House officials arranged for the meeting to be held in an auditorium at the Eisenhower Executive Office Building next to the White House that was not conducive for members to conduct business.

Most of the first day of the two-day meeting in April was devoted to listening to comments by members of the public, including AIDS activists. Although a precedent for listening to public comments began under the Clinton administration, one AIDS activist attending the April meeting said it evolved into a “chaotic” town hall type meeting that prevented members — who were appointed for their expertise in various aspects of public health, medicine and public policy — from tackling issues such as ADAP.

Sessions on the second day were not open to the public, raising questions that administration staffers violated a federal law that requires all federal government advisory bodies to conduct business in public.

Christopher Bates, PACHA’s staff executive director, told activists who complained about the closed meeting that the session was limited to discussing “administrative” matters and no official business was conducted.

Wilson and Baker said this week that the White House and the Department of Health & Human Services, which has direct supervision over PACHA, were working to correct the problems, with the possibility that new meeting space would be found.

But new organizational and technical issues surfaced during Tuesday’s conference call when an audio muting mechanism prevented members of the public who were approved in advance to speak from being heard by Gale, who presided over the call.

When a roll call vote was taken on the ADAP resolution, some of the PACHA members also could not be heard, alerting the staff that a technical glitch kept the PACHA members’ phone on mute.

As required by a federal advisory body statute, the conference call meeting was announced two weeks earlier in the Federal Register, which instructed people interested in speaking during a public comment period how to dial in to the call.

A technician facilitating the conference call eventually lifted the muting mechanism to allow everyone to speak. But shortly after that happened, someone apparently called the meeting to an end while the phone lines remained open. At least two callers expressed outrage that they were not allowed to speak, and several callers began their own discussion before someone terminated the conference call.

Before the confusion began, Gale announced the roll call vote had been completed and the resolution calling for the $126 million emergency ADAP funds had been approved.

Prior to the discussion and vote on the resolution, HHS official Deborah Parham told call participants the administration would allocate $17.5 million in Ryan White funds in August that states could use for their ADAP programs. She said additional Ryan White funds were available to help struggling states in their overall programs to assist people with HIV/AIDS.

HHS recognizes “the need to improve access to critical HIV/AIDS prescription drugs and we’re working to prevent and ultimately eliminate the need for ADAP waiting lists,” Parham told call participants. But she did not say whether the administration would agree to the $126 million emergency funding allocation for ADAP called for by the PACHA resolution.

President Bill Clinton created PACHA in the 1990s. President George W. Bush retained the panel and continued Clinton’s practice of naming several gays to serve on PACHA, including several gay Republican activists.

The Obama administration did not call any PACHA meetings in its first year in office, prompting some activists to ask if the new administration planned to retain the panel. But in February, the White House disclosed it had dismissed all PACHA members appointed by Bush and introduced what it called a “reconstituted” PACHA with 24 new members.

According to Jeff Crowley, director of the White House Office of National AIDS Policy, the new members were appointed by Health & Human Services Secretary Kathleen Sebelius with White House consultation.

At the first meeting Feb. 2, Sebelius administered the oath of office for members and said she and the White House would utilize PACHA as a “platform for the administration to share our plans and insights” on AIDS programs and proposals.

“Today, I’m pleased to have a new group of experts joining PACHA,” Obama said in a statement released at the February meeting. “And I look forward to hearing from the council about our continued efforts to prevent the spread of HIV infections in the United States and to provide care and treatment to people living with HIV/AIDS around the world.”

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Health

Gilead awards $5 million grant to HRC’s HIV and health equity programs

Money to support efforts to end the epidemic and combat stigma

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Human Rights Campaign headquarters in D.C.(Washington Blade photo by Michael Key)

The Human Rights Campaign was awarded a $5 million grant from drugmaker Gilead Sciences to expand the organization’s HIV and health equity programs, supporting efforts to end the HIV epidemic by 2030 while combatting stigma in Black and Latino communities.

Funds will be used over the next three years for the HRC Foundation’s HIV and Health Equity Program, its Historically Black Colleges and Universities Program, and its Transgender Justice Initiative, HRC said in a statement Wednesday announcing receipt of the award, which extends Gilead’s $3.2 million grant to the HRC Foundation in 2021.

The organization said its HIV and Health Equity Program plans to develop a “benchmarking tool for institutions that provide HIV services, helping better evaluate the quality of care and measure racially and socially inclusive approaches” while defining “best practices, policies and procedures to optimize HIV service provision for BIPOC LGBTQ+ communities.”

HRC President Kelley Robinson said, “Since the beginning of the HIV epidemic, racism and anti-LGBTQ+ discrimination have created dangerous hurdles for those seeking prevention or treatment.”

“With the generous support of Gilead Sciences, we’ll be able to continue providing critical
resources to help overcome these hurdles, especially focusing on Black and Latine communities in the U.S. South,” Robinson added. “We’ll also be able to expand our efforts, as we seek to remove institutional barriers often unknowingly created by HIV service providers. We must decrease the disparities that place an unnecessary burden on Black and Latine LGBTQ+ people and people living with HIV.”

Gilead Executive Vice President of Corporate Affairs and General Counsel Deborah Telman said the company “is committed to advancing health equity, particularly in Black communities and other communities of color that are disproportionately affected by HIV.”

“This grant will build on the impactful work HRC has done with community partners and HBCUs to increase awareness of HIV treatment and prevention options and reduce health disparities, combat discrimination and fight stigma,” Telman said.

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Health

New CDC data shows HIV infections dropped, but mostly among whites

Socioeconomic factor into disproportionate rates

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Data published Tuesday by the Centers for Disease Control and Prevention shows a significant decline in new HIV infections, but suggests the impact of prevention efforts was far less substantial for Black and Latino populations.

From 2017-2021, as rates of HIV testing, treatment and the use of pre-exposure prophylaxis (PrEP) medication rose, new cases dropped by 12 percent overall and by as much as 34 percent among gay and bisexual males aged 13-24.

The numbers show a “move in the right direction,” CDC Director Rochelle Walensky said in a press release.

However, when broken down by race, the CDC found new infections were down by 27 percent and 36 percent, respectively, among Black and Latino populations, compared with 45 percent of whites.

Similarly, by 2021 about one third of those who are considered eligible were taking PrEP for HIV prevention, but the CDC noted this number includes “relatively few Black people or Hispanic/Latino people” despite the significant increase in prescriptions up from just 13 percent in 2017.

“Longstanding factors, such as systemic inequities, social and economic marginalization and residential segregation,” Walensky noted, continue to act as barriers “between highly effective HIV treatment and prevention and people who could benefit from them.”

She added, “Efforts must be accelerated and strengthened for progress to reach all groups faster and equitably.”

Robyn Neblett Fanfair, acting director of the CDC’s Division of HIV Prevention, said that “At least three people in the U.S. get HIV every hour — at a time when we have more effective prevention and treatment options than ever before.”

“These tools must reach deep into communities and be delivered faster to expand progress from some groups to all groups,” she said.

The HIV+Hepatitis Policy Institute issued a press release following the CDC’s announcement of the new data, noting both the encouraging progress and need for improvement.

“It appears that our investments in HIV prevention are providing some positive results, but the persistent high number of new diagnoses and the low usage of PrEP among the communities most impacted by HIV point to the need for increased resources, particularly for a national PrEP program,” said the group’s executive director, Carl Schmid.

President Joe Biden’s FY24 budget requested $237 million for a national PrEP program along with $850 million to support the U.S. Department of Health and Human Services’ “Ending the HIV Epidemic in the U.S.” initiative.

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Health

Officials eye mpox prevention, vaccination initiatives for this summer’s LGBTQ events

New cluster of cases reported in Chicago

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Drs. Robert Fenton and Demetre Daskalakis, coordinator and deputy coordinator for the White House national mpox response, during a briefing in August 2022 (Official White House Photo by Cameron Smith)

Federal health agencies, in coordination with their state and local counterparts and community partners, are exploring opportunities to offer mpox prevention initiatives and vaccinations at LGBTQ events this summer, Dr. Demetre Daskalakis said on Thursday.

Daskalakis, the deputy coordinator for the White House’s national mpox response, described these deliberations in response to a question from the Washington Blade during a media telebriefing on mpox that was hosted by the Centers for Disease Control and Prevention.

The CDC on Monday issued a Health Alert Network Health Update on the potential risk for new mpox cases.

Since the peak of about 460 cases per day in August 2022, new cases have steadily declined, but following the cluster recently reported in the Chicago area, the update warns, “spring and summer season in 2023 could lead to a resurgence of mpox as people gather for festivals and other events.”

“We have the vaccine, and we have organizations that are willing to do it,” Daskalakis said during Thursday’s call, adding that resources are available and can be deployed flexibly because they are built into existing “HIV and STI funding to allow for this work.”

And the Mpox Crisis Response Cooperative Agreement, Daskalakis said, “provides even more resources locally for such efforts.”

Daskalakis and CDC Mpox Response Incident Manager Dr. Christopher R. Braden also briefed reporters on findings from new studies on the efficacy of the JYNNEOS vaccine for the prevention of mpox.

That data, per the CDC’s Morbidity and Mortality Weekly Report, reveals that “Among gay, bisexual, and other MSM and transgender adults aged 18-49 years, two doses of the JYNNEOS vaccine were 86 percent effective against mpox, indicating substantial protection against mpox.”

Additionally, “All routes of vaccine administration provided similar protection.”

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