Local
Will health reform make AIDS groups obsolete?
HIV clinics face new competition as clients obtain insurance by 2014
‘Health care reform has been a real motivator around us improving the quality of what we do because we know we’re going to have to get better,’ said Don Blanchon, executive director of Whitman-Walker Clinic. (Washington Blade photo by Michael Key)
When the AIDS epidemic burst on the scene in the 1980s, a cadre of volunteers –many from the LGBT community — emerged to provide compassionate and dedicated care for the sick and dying, services that government agencies and existing charitable groups were not providing.
Since that time, the mostly volunteer-driven, community-based AIDS clinics and advocacy groups created back then have evolved into professionally run facilities receiving millions of dollars in state and federal funds. Like the Whitman-Walker Clinic in D.C., many of the clinics and advocacy groups provide a vast array of services for people with HIV and AIDS, most of whom can’t afford private health insurance.
But in March, Congress approved and President Obama signed into law a sweeping health care reform measure called the Patient Protection and Affordable Care Act. Obama administration officials say it will result in more than 94 percent of all Americans being covered by some form of private or public health insurance by 2014.
Although most AIDS activists and officials with local and national AIDS organizations have hailed the health care reform measure as an unprecedented benefit to people with HIV and AIDS, some believe the law could prompt large numbers of patients to leave the community-based clinics and seek medical care elsewhere.
With a possible loss of clients, community AIDS clinics would be in jeopardy of losing government funding, which is based on the number of clients served. It would be ironic, some have said, if the benefits of healthcare reform result in the closing of community institutions that have served people with AIDS during a time of need.
“The LGBT community and people living with HIV are going to have options that they may not have now,” said Don Blanchon, executive director of the Whitman-Walker Clinic, which has served people with HIV and AIDS since the epidemic began.
“And so for us, health care reform has been a real motivator around us improving the quality of what we do because we know we’re going to have to get better,” Blanchon said. “We know at some point in time almost every District resident is going to have some type of public or private insurance, which means they, in theory, are going to be able to go to a lot of different places for their care.”
Blanchon noted that a financial crisis that Whitman-Walker faced four years ago forced it to take steps that have placed it in an excellent position to flourish under the health care reform law. The Clinic’s board hired Blanchon, a managed care expert, to help the Clinic survive at a time when private donations and fundraising efforts were faltering.
With the board’s full approval and over the objections of some of the Clinic’s longtime supporters and volunteers, Blanchon transformed the Clinic from a volunteer model operation into a managed care type facility with the status known as a “federally qualified health center look alike.”
According to Blanchon and other Clinic officials, the new status enables the Clinic to accept a greater number of Medicaid patients as well as patients with a wide range of private health insurance. Patients covered by these programs allow the Clinic to obtain reimbursement for its services by doctors, its own pharmacy, and other service providers, eliminating the need to rely more on private donors.
Unlike other community-based AIDS clinics, Whitman-Walker will be in an excellent position to take on new patients or retain its existing ones as the new health care reform measure enables the majority of patients to obtain private insurance or Medicaid.
Under the Patient Protection and Affordable Care Act, all lower income individuals, including people with HIV, will be eligible for Medicaid coverage if they fall below 133 percent of the federal poverty level, where an individual has an income of about $15,000 a year or lower.
Under current federal law, low-income people with full-blown AIDS are already eligible for Medicaid coverage. For years, Congress has declined to pass legislation proposed by AIDS advocacy groups calling for Medicaid coverage for low-income people with HIV, with the intent of providing medical services to prevent them from advancing to AIDS.
The new law makes that legislation unnecessary after 2014, when the Medicaid provision takes effect.
Jeffrey Crowley, director of the White House Office of National AIDS Policy, calls the Patient Protection and Affordable Care Act one of the nation’s most significant advances for the care and treatment for people with HIV/AIDS.
“It will fundamentally expand access to insurance coverage for people living with HIV,” he said. “Much of that will be through the mandatory expansion of the Medicaid program.”
He said that similar to all Americans, people with HIV will also be eligible for private insurance coverage through a variety of options based on their income. Among the options will be the purchase of insurance coverage through competitive insurance exchanges. He noted that by 2014, no insurance company can deny coverage based on pre-existing conditions such as HIV or other illnesses.
Keith Maley, a spokesperson for the U.S. Department of Health and Human Services, which will administer most of the provisions of the new health care law, said people with HIV and other illnesses could be immediately eligible for private insurance coverage through high-risk pools.
Those eligible for the immediate coverage must show that they have had no health insurance coverage for six consecutive months, have a chronic health condition, and are not eligible for employer provided insurance or Medicaid.
Crowley noted that the new law has other immediate benefits for people with HIV and other chronic health conditions. As of July 1, private health insurers can no longer use a rescission, a practice that cancels a policy when someone gets sick and needs expensive treatment.
He said the law also immediately prohibits insurers from imposing a lifetime “cap” on insurance benefits. Annual limits on coverage or benefits will end in 2014, he said.
Crowley, a gay man who previously worked for the National Association of People with AIDS before joining the White House staff, said he expects most community-based AIDS clinics and local and national AIDS advocacy organizations to continue to exist after the health care law is fully implemented in 2014. However, he said most will have to change the way they do business.
“I think we know from our experience with HIV that we’ve built up a great HIV workforce,” he said. “We have a lot of expertise. I want to make sure as we build and expand an insurance system through the Affordable Care Act that these HIV medical providers are making sure that they’re part of this new system.”
“Some of them might only receive funding through the Ryan White programs, and I would say they need to look at their future and say that they need to be part of the new insurance system,” he said. “But there’s no question that we’re going to need their expertise and commitment at providing medical care going forward.”
Crowley’s reference to the Ryan White CARE Act, the largest existing federal program created to provide care for low-income people with HIV/AIDS, is expected to change significantly following the full implementation of the Patient Protection and Affordable Care Act, according to officials with a number of national AIDS groups.
Nearly everyone, including Crowley, agrees that the Ryan White program should remain, but most likely in a scaled back form. Congress passed the act in the 1990s as a means of helping cities and states that were grappling with the enormous burden of providing care for people with HIV/AIDS who lacked health insurance coverage and were overwhelming local and state hospitals and health care facilities.
Carl Schmid, director of federal affairs for the AIDS Institute, a national advocacy organization; Michael Weinstein, executive director of the AIDS Healthcare Foundation, the nation’s largest AIDS-related medical care provider; and Jose Zuniga, executive director of the International Association of Physicians in AIDS Care, each said they believe the Ryan White program will be needed for at least some services the new law does not provide.
“It will not solve all of our access issues,” said Schmid of the new health care measure.
Weinstein said that state programs to expand health insurance have been slow to enroll as many people as expected for a variety of reasons, some bureaucratic in nature.
“So I wouldn’t expect an overnight change in 2014,” he said, pointing to a need to keep the Ryan White program operating for some time after 2014.
Weinstein said that in some states, including California, Medicaid reimbursement for medical services is far lower than that provided by private insurance companies. He predicted that people with HIV or AIDS who obtain coverage under the new law through Medicaid might be turned away by private doctors who declined to take all Medicaid patients.
“The reimbursement that we receive from Medicaid or from private insurance is far below our cost and far below what we get from Ryan White,” he said of the AIDS Healthcare Foundation. “So we will suffer a hit in that regard as well as most providers.”
Weinstein said his organization has a wide variety of income streams and the lower reimbursements under the new law “won’t be a fatal blow to us.”
Blanchon of Whitman-Walker said the benefits of the new law greatly outweigh its possible shortfalls.
“Health care reform is going to be a real help to our patients and clearly to the Clinic because more of our patients are going to be insured under more comprehensive benefit programs,” he said.
“And what that means at the end of the day is the Clinic is not going to have to shell out as much free care. So we’re going to be in a position to be able to offer more services to more patients and keep them healthy, and ultimately that’s what we’re here for.”
District of Columbia
HIV/AIDS activists block intersection near White House
World AIDS Day provided backdrop for calls to fully fund PEPFAR
Upwards of 100 HIV/AIDS activists on Monday blocked an intersection near the White House and demanded the Trump-Vance administration fully fund PEPFAR.
Housing Works, Health GAP, Treatment Action Group, AIDS United, ACT UP Philadelphia, and the National Minority AIDS Council organized the protest that took place at the intersection of 16th and I Streets, N.W. The activists then marched to Lafayette Park.
(Washington Blade video by Michael K. Lavers)
(Washington Blade video by Michael K. Lavers)
Activists since the Trump-Vance administration took office in January have demanded full PEPFAR funding.
Secretary of State Marco Rubio Jan. 28 issued a waiver that allowed PEPFAR and other “life-saving humanitarian assistance” programs to continue to operate during the freeze on nearly all U.S. foreign aid spending. HIV/AIDS service providers around the world with whom the Washington Blade has spoken say PEPFAR cuts and the loss of funding from the U.S. Agency for International Development, which officially closed on July 1, has severely impacted their work.
The State Department in September announced PEPFAR will distribute lenacapavir in countries with high prevalence rates. The first doses of the breakthrough HIV prevention drug arrived in Eswatini and Zambia last month.
The New York Times in August reported Office of Management and Budget Director Russell Vought “apportioned” only $2.9 billion of $6 billion that Congress set aside for PEPFAR for fiscal year 2025. (PEPFAR in the coming fiscal year will use funds allocated in fiscal year 2024.)
Bipartisan opposition in the U.S. Senate prompted the Trump-Vance administration in July withdraw a proposal to cut $400 million from PEPFAR’s budget. Vought on Aug. 29 said he would use a “pocket rescission” to cancel $4.9 billion for HIV/AIDS prevention and global health programs and other foreign aid assistance initiatives that Congress had already approved.
“Russell Vought, director of the Office of Management and Budget, has defied the appropriations authority of Congress, slashing the budget for the program despite full funding enacted by lawmakers, stealing $1.6 billion despite the direction of Congress that PEPFAR be fully funded,” notes a press release that detailed Monday’s protest. “As a result, lifesaving treatment and prevention programs have closed across dozens of sub-Saharan African countries, while Vought has refused to release money ringfenced by Congress to save lives.”
Monday’s protest coincided with World AIDS Day.
The White House has not publicly acknowledged World AIDS Day. A State Department directive the New York Times obtained last week mandated employees and grantees “to refrain from messaging on any commemorative days, including World AIDS Day.”
“Trump thinks by banning commemoration of World AIDS Day, he can hide from the death and destruction that he’s causing around the world,” said Health GAP Executive Director Asia Russell in Lafayette Square. “But we’re here to say, we can see him. We see him stealing medicine, stealing support services, stealing HIV testing, stealing life-saving care from communities all around the world suffering and dying without access.”
The Clinton Health Access Initiative in a report it published last month said more people with HIV or are at risk of contracting the virus because of “HIV treatment and prevention cascades” during the first half of 2025. Specific figures include:
• 3.4 million fewer adults tested for HIV
• 24,000 fewer infants tested for HIV
• A 22 percent decline in new HIV diagnoses due to a reduction in testing among the most vulnerable, highest-risk people
• An 8 percent decline in people living with HIV receiving CD4 tests to diagnose advanced HIV disease
• 2,000 fewer infants and children with HIV started on life-saving medication
• A 37 percent reduction in PrEP initiations for people at risk for HIV
• 26,000 fewer infants and children on antiretroviral medications
• A 5 percent reduction in adults starting antiretroviral medications
• A 10 percent increase in people living with HIV disengaging from treatment
The Clinton Health Access Initiative also said more children around the world will die “due to undiagnosed and un- or under-treated HIV infection” if “these trends persist.”
The Human Rights Campaign Foundation in its 2025 Annual LGBTQ+ Community Survey notes more than 20 percent of adults said “policies the federal government have made accessing HIV prevention and treatment care more difficult in the last year.” The report indicates 30 percent of respondents identify as LGBTQ.
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Congratulations to RODRIGO HENG-LEHTINEN on his new role as Trevor Project Senior Vice President of Public Engagement Campaigns. On accepting the position, he said, “My mission has long been to stop LGBTQ, and especially trans, people from being perceived as political footballs and start getting us seen as real people – your friends, your families, your neighbors. Now I get to focus on that 100% at The Trevor Project.”
Prior to this, he was executive director, Advocates for Trans Equality (A4TE), where he co-led the merger of two national transgender rights organizations, NCTE and TDLEF, to create the new organization. He had served as executive director of the National Center for Transgender Equality, leading that organization through a period of growth, restoring organizational size and stability. He had served as deputy executive director prior to that. Previously he served as vice president of Public Education, Freedom for All Americans, where he led a successful campaign for transgender nondiscrimination protections in New Hampshire. He oversaw a full range of legislative lobbying, field organizing, and communications strategies and oganized a leadership coalition, established structure, and divided roles for key committees of 17 state and national partner organizations and local activists.
Heng-Lehtinen conducted English-language interviews with outlets such as The New York Times, CNN, MSNBC, and Politico. He planned a Transgender Leadership Summit for the Transgender Law Center and served as Development & Donor Services Assistant, Liberty Hill Foundation. He earned his bachelor’s degree in Latin American Studies from Brown University.
Local
D.C., Va., Md. to commemorate World AIDS Day
Cathedral of St. Matthew the Apostle will hold a Mass, candlelight prayer vigil
The D.C. area will observe World AIDS Day on Dec. 1 through a variety of community events.
Established by the World Health Organization in 1988, World AIDS Day aims to raise awareness about HIV/AIDS and honor the individuals affected by the epidemic. The global theme for 2025 is “overcoming disruption, transforming the AIDS response.”
Washington
DC Health will host a World AIDS Day event at the Martin Luther King, Jr. Library from noon to 9 p.m on Dec. 1. Attendees can expect live performances, free food and free HIV testing.
The all-day event will also feature community resources from DC Health, DC Public Library, DC Health Link, Serve DC, and the Mayor’s Office of LGBTQ Affairs.
The Lily and Earle M. Pilgrim Art Foundation is partnering with Visual AIDS, a New York-based non-profit that uses art to fight AIDS, to reflect on World AIDS Day with a film screening on Dec. 1.
The David Bethuel Jamieson Studio House at Walbridge in Mount Pleasant will premiere “Meet Us Where We’re At,” an hour-long collection of six videos. The free screening highlights the complexity of drug use in intersection with the global HIV epidemic.
The videos, commissioned by artists in Brazil, Germany, Nigeria, Puerto Rico and Vietnam, showcase the firsthand experience of drug users, harm reduction programs, and personal narratives. The program intends to showcase drug users as key individuals in the global response to HIV.
In addition to streaming the videos, the event will include an evening potluck and conversation led by Peter Stebbins from 6-8 p.m.
The Cathedral of St. Matthew the Apostle will hold a 5:30 p.m. Mass and candlelight prayer vigil at 6 p.m. in honor of World AIDS Day on Dec. 1. The event is open to all and includes a subsequent reception at 6:30 p.m.
The Capital Jewish Museum is hosting a speaker series on Dec. 2 from 6:30-8 p.m. that explores the response to AIDS within the Jewish community. Speakers include LGBTQ psychiatrist Jeffrey Akman, physician assistant Barbara Lewis and Larry Neff, lay service leader at Bet Mishpachah, a synagogue founded by LGBTQ Washingtonians. Heather Alt, deputy director of nursing at Whitman-Walker Health, will moderate the event.
The program is free for museum members. General admission is $10 and Chai tickets, which help subsidize the cost of general admission, are $18. Tickets include access to LGBT Jews in the Federal City, a temporary exhibition that collectively explores Washington, Judaism, and LGBTQ history. The exhibition is on view through Jan. 4, 2026.
Virginia
Alexandria Mayor Alyia Gaskins and local residents will commemorate World AIDS Day on Dec. 1 at the Lee Center.
The event, which is free to attend, will include music, choir performances, educational moments and more. The commemoration will be held from 6:30-8:30 p.m.
Maryland
The Frederick Center will host talks, tabling and a raffle in honor of World AIDS Day. The Frederick County Health Department will conduct free HIV testing.
The event, which is free to attend, will be held on Nov. 30 from 1-4 p.m. The Frederick County Health Department always offers free, walk-in HIV testing on Tuesdays and Fridays from 9 a.m. to 3 p.m.
The Prince George’s County Alumnae Chapter of Delta Sigma Theta Sorority will host a community day of awareness in honor of World AIDS Day on Dec. 6 from 1 a.m. to 2 p.m. The free event will feature free, confidential HIV testing, private talks with medical professionals and health workshops.
The event will be held at Suitland Community Center in Forestville and will include breakfast and snacks.
Damien Ministries is commemorating World AIDS Day on Dec. 1 through the grand opening of the We the People Community & Wellness Collaborative. The event, held at 11:30 a.m. at 4061 Minnesota Avenue, N.E., is free to attend.
Damien Ministries is a faith-based non-profit committed to supporting those with HIV/AIDS.
Begin Anew, a Baltimore non-profit that provides education, outreach and resources to improve public health, wellness and economic stability, is hosting its 4th Annual World AIDS Day Community Celebration on Dec. 1 alongside community partners.
Hosted at the University of Maryland BioPark from noon to 3 p.m., the program will feature keynote speaker Jason E. Farley of the Johns Hopkins School of Medicine. The celebration will also dedicate awards to local heroes focused on fighting HIV/AIDS and promoting health equity.
The free event includes lunch, live entertainment and networking opportunities with health advocates and partners.
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