adaps, latinos, and hiv/aids infrastructure john hellman director of advocacy latino commission on...
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ADAPs, Latinos, ADAPs, Latinos, and HIV/AIDS and HIV/AIDS InfrastructureInfrastructure
John HellmanJohn Hellman
Director of AdvocacyDirector of Advocacy
Latino Commission on AIDSLatino Commission on AIDS
ADAP Advocacy Association 6th Annual Conference
AIDS Drugs Assistance Programs: Renewing the Commitment
June 7th, 2013
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Latino Commission on AIDSLatino Commission on AIDS Founded in 1990 to fight HIV/AIDS in at-Founded in 1990 to fight HIV/AIDS in at-
risk communities nationwide Shaped by risk communities nationwide Shaped by national AIDS advocate Dennis deLeon national AIDS advocate Dennis deLeon from 1994 to 2009from 1994 to 2009
Local , Regional and National Services Local , Regional and National Services in more than 40 States, Puerto Rico & in more than 40 States, Puerto Rico & the Virgin Islands.the Virgin Islands.
Long demonstrated history of building Long demonstrated history of building national, regional and local coalitionsnational, regional and local coalitions
Five core areas: Five core areas: Hispanic Behavioral Research Hispanic Behavioral Research
CenterCenter HIV Prevention & Health HIV Prevention & Health
PromotionPromotion Capacity Building Assistance Capacity Building Assistance
(CHANGE approach)(CHANGE approach) HIV Testing and Access to CareHIV Testing and Access to Care Health Policy & Community Health Policy & Community
Mobilization Mobilization
Picture by: bleacher + everard
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“Of all of our national holidays, Independence Day is the one most intimately rooted in our common history and shared experience. Yet this year it arrives against a background of polarization, separation, and confrontation in the states and Washington alike. With municipal politics as the occasional exception, the pattern of solidifying agreement within the parties—and widening disagreement between them—is dominating our decisions at every level.”
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GoalsGoals
Understand the vital role ADAPs will Understand the vital role ADAPs will continue to play for HIV positive continue to play for HIV positive LatinosLatinos
Consider our HIV/AIDS infrastructure Consider our HIV/AIDS infrastructure through a Latino-centric lensthrough a Latino-centric lens
Brainstorm strategies to address the Brainstorm strategies to address the post-ACA and post-CIR (?) landscape post-ACA and post-CIR (?) landscape for Latino HIV care for Latino HIV care
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StructureStructure
HIV/AIDS TrendsHIV/AIDS Trends HIV/AIDS and LatinosHIV/AIDS and Latinos
– Foreign born vs. U.S. bornForeign born vs. U.S. born– Geographic concentrationGeographic concentration
Post-2014 ACA LandscapePost-2014 ACA Landscape– The impact of (not) implementationThe impact of (not) implementation
Possible Impact of CIRPossible Impact of CIR DiscussionDiscussion
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HIV/AIDS TrendsHIV/AIDS Trends
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HIV Infections in the USHIV Infections in the US
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Treatment CascadeTreatment Cascade
Gardner, et al., 2011
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~25% Unaware
of Infection
~75% Aware
of Infectio
n
PWHA: 1,039,000-1,185,000
New Sexual Infections Each Year: ~32,000
Accounting for:
~54% of
New Infections
~46% of New
Infections
Awareness of Serostatus Among People Awareness of Serostatus Among People with HIV: Estimates of Transmissionwith HIV: Estimates of Transmission
Source: R. Russell. Guidance to Integrating Affordable Care Act, National HIV/AIDS Strategy and Ryan White. Ryan White 2012 Grantee Meeting; AIDS 2006, 20:1447-50.
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HIV/AIDS, ADAPs, HIV/AIDS, ADAPs, and Latinosand Latinos
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Post-2014 ACA Post-2014 ACA LandscapeLandscape
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17
Insurance and Care for PWHA
Source: R. Russell. Guidance to Integrating Affordable Care Act, National HIV/AIDS Strategy and Ryan White. Ryan White 2012 Grantee Meeting.
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The Henry J. Kaiser Family Foundation, (2012). How the ACA changes pathways to insurance coverage for people with HIV. Retrieved from website: http://healthreform.kff.org/notes-on-health-insurance-and-reform/2012/september/how-the-aca-changes-pathways-to-insurance-coverage-for-people-with-hiv.aspx?CFID=567585223&CFTOKEN=74185225&jsessionid=6030aa207ae092ba6d8019601b655963616b
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19The Henry J. Kaiser Family Foundation, (2012). How the ACA changes pathways to insurance coverage for people with HIV. Retrieved from website: http://healthreform.kff.org/notes-on-health-insurance-and-reform/2012/september/how-the-aca-changes-pathways-to-insurance-coverage-for-people-with-hiv.aspx?CFID=567585223&CFTOKEN=74185225&jsessionid=6030aa207ae092ba6d8019601b655963616b
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Medicaid Expansion and Ryan Medicaid Expansion and Ryan WhiteWhite
Ryan White becoming payer Ryan White becoming payer of last resortof last resort– Relief to an increasingly Relief to an increasingly
underfunded Ryan White underfunded Ryan White ProgramProgram
– New investments in New investments in community-based carecommunity-based care
– Transitioning clients to Transitioning clients to MedicaidMedicaid
Today, 70% of Ryan White Today, 70% of Ryan White clients clients have insurancehave insurance and and rely on RW to supplement rely on RW to supplement limits in coveragelimits in coverage– Health insurance alone Health insurance alone
does not cover cost of HIV does not cover cost of HIV care or services needed to care or services needed to keep PWHA in treatmentkeep PWHA in treatment
– Role of Ryan White likely to Role of Ryan White likely to continuecontinue
Source: hivhealthreform.org
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Post Implementation of the ACA: Post Implementation of the ACA: Remaining UninsuredRemaining Uninsured
Undocumented immigrantsUndocumented immigrants Legal immigrants within 5 year banLegal immigrants within 5 year ban Individuals exempt from the mandate who Individuals exempt from the mandate who
choose to not be insured (e.g., because choose to not be insured (e.g., because coverage not affordable)coverage not affordable)
Individuals subject to the mandate who do Individuals subject to the mandate who do not enroll (and are therefore subject to the not enroll (and are therefore subject to the penalty)penalty)
Individuals who are eligible for Medicaid but Individuals who are eligible for Medicaid but do not enrolldo not enroll
Source: R. Russell. Guidance to Integrating Affordable Care Act, National HIV/AIDS Strategy and Ryan White. Ryan White 2012 Grantee Meeting.
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Possible Impact of Possible Impact of Comprehensive Comprehensive
Immigration ReformImmigration Reform
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S. 774 The Border Security, S. 774 The Border Security, Economic Opportunity, and Economic Opportunity, and
Immigration Modernization Act Immigration Modernization Act of 2013 of 2013
Passed the SenatePassed the Senate Low-income people granted RPI status Low-income people granted RPI status
would have to wait, at a minimum, 13 to would have to wait, at a minimum, 13 to 15 years to become eligible for federal 15 years to become eligible for federal means-tested public benefit programsmeans-tested public benefit programs
RPIs will have a minimum 10-year wait RPIs will have a minimum 10-year wait before they will be able to buy before they will be able to buy affordable health insurance under the affordable health insurance under the ACAACA
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CIR in the House of CIR in the House of RepresentativesRepresentatives
Bipartisan talks failed – one of the Bipartisan talks failed – one of the issues re: health care accessissues re: health care access
Speaker John Boehner will not Speaker John Boehner will not consider Senate billconsider Senate bill
Republican/House bill will likely have Republican/House bill will likely have more restrictions, may not have more restrictions, may not have pathway to citizenshippathway to citizenship
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DiscussionDiscussion
How are these policy issues How are these policy issues impacting work in your state?impacting work in your state?
In an endlessly polarized political In an endlessly polarized political environment, how can we strategize?environment, how can we strategize?
How can we centralize HIV positive How can we centralize HIV positive Latinos in our overall HIV/AIDS Latinos in our overall HIV/AIDS strategy?strategy?
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Thank you!Thank you!
Phone: 646-375-4415Phone: 646-375-4415
Email: Email: [email protected]@latinoaids.org