SFGN's Spirit Issue 2017

JUNE, 2017 • SouthFloridaGayNews.com • Vol. 7 Issue 1

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The Story of HIV-positive Asylum Seeker

Denis Davydov

Sean McShee

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he gay, HIV-positive asylum seeker, Denis Davydov has returned to San Jose, Calif., after 46 days of detention in Krome Detention Center in Miami. Customs and Border Protection (CBP) agents detained Davydov for overstaying his entry visa, despite his pending asylum status. His case has now been transferred to California, but his next court date remains unknown.

In Russia, Davydov had no access to HIV medicine for years. Others harassed him for being gay. He said, “I do not even want to think about what would happen to me, if I were sent back there.” In Krome, he again found dehumanizing conditions. “The guards called us by a number and our country of origin, like we were not even human beings. I was just 'Russia XYZ’,” Davydov reported.

Davydov came to the U.S. in September 2014 and applied for asylum in June 2015. The U.S. Citizenship and Immigration Services (USCIS) granted the 30-year-old Russian “pending asylum status.” This status allows him to stay in the U.S. even if his visa would expire, while USCIS evaluates his asylum claim.

People seeking asylum have to stay within the U.S. until their case is resolved. In early March, Davydov travelled to the U.S. Virgin Islands to go backpacking.

When on March 13 he tried to board his flight home to San Jose, Calif., CBP agents detained Davydov in Saint Thomas, USVI. At that time, he had physical documentation of his pending asylum status from the USCIS. The CBP charged Davydov with “overstaying his visa,” but USCIS had

Denis Davydov, Facebook.

granted him permission to stay in the U.S. while his case was pending. People with pending asylum status frequently “overstay” their visa. According to Immigration Equality (IE), the CBP agents had no legal grounds for detention as Davydov’s asylum case was still pending.

It is not clear what caused CBP to detain Davydov. Jackie Yodashkin of IE, reported that, prior to Davydov’s detention, CBP agents had not found his HIV meds. They also did not find gay porn or other gay “indicators.” Yodashkin indicated that Davydov speaks with an accent.

While Davydov could get his HIV meds at Krome, he developed a thrush-like condition. The doctor-on-duty told Davydov that he would have to see a specialist. After waiting six hours to see that specialist, he still received no medical treatment. The thrush-like condition has since cleared up.

Yodashkin said that IE currently represents 56 LGBT Russians seeking asylum in the U.S. Jamaica, Mexico, and Russia produce the largest numbers of asylum seekers in the U.S. Russian requests for asylum increased after 2013 when Russia passed its anti-LGBT propaganda law.

An unknown number of global migrants, refugees, and asylum seekers are LGBT or live with HIV. IE has secured asylum in the U.S. for 950 people as of May 2017. All are either LGBT or live with HIV infection. IE currently has another 680 clients seeking asylum. These 680 current clients either are LGBT or live with HIV. Conditions in Chechnya only increase the importance of LGBT and HIV refugee rights.

For information about Russian LGBT immigrants, visit the Facebook page of RUSA LGBT. For more information on Immigration Equality, please visit ImmigrationEquality.org To keep up with LGBT issues in Russia, please visit LGBTNet.org/en/Content/Our-contacts.

Follow Sean McShee on Twitter @SeanMcShee

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June 27 is National HIV Testing Day

national

This year’s theme ‘Test Your Way. Do It Today.’

Denise Royal

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ational HIV Testing Day has expanded in many areas to National HIV Testing Week. People nationwide and throughout South Florida are encouraged to learn their HIV status on June 27.

The Centers for Disease Control and Prevention (CDC), recommends everyone between the ages of 13 and 64 get tested for HIV at least once as part of routine health care.

People with certain risk factors should get tested more often.

Knowing one’s HIV status provides powerful information.

People who test positive for HIV can take medicines to keep them healthy and to greatly reduce their chance of passing HIV to others. But the only way to know for sure if someone has HIV is to get tested.

The 2017 federal theme is "Test Your Way. Do It Today."

Credit: Vic, Flickr.

The CDC is running a new national HIV testing and prevention campaign designed to motivate all adults to get tested for HIV and know their status—called Doing It .

South Floridians are urged to do¬ it—the rate of new HIV diagnoses in this area jumped to more than three times the national average in 2015, according to the CDC’s annual HIV Surveillance Report, which found that diagnoses in the Miami-Fort Lauderdale-West Palm Beach area in 2015 averaged about 38.8 cases per 100,000 people. Nationally, the rate of new HIV diagnoses in 2015 averaged 12.3 cases per 100,000 people, according to the CDC data, which is preliminary.

“On national HIV testing day we should recognize that HIV testing is the first and most important step we can take to meet our personal health goals and to achieve

public health by working to and the HIV epidemic,” says Dr. Howard Grossman, a widely-recognized specialist in HIV medicine. “Testing for HIV should be as routine as screening people for blood pressure or checking them for diabetes. Ready access to testing is especially important for our brothers and sisters in communities of color and our transgender communities, groups that are disproportionately affected by the epidemic.”

Around 1.2 million people in the U.S. are living with HIV, and one in eight people don't know they have it.

Nearly 45,000 people find out they have HIV every year.

HIV testing is the gateway to prevention and care.

Studies have shown that providing antiretroviral therapy as soon as possible after diagnosis improves a patient’s health, reduces transmission and can eventually lead to undetectable viral loads of HIV. This model has been implemented in other cities, and is being piloted in Miami-Dade County. People who test negative have more prevention tools available today than ever before. People who test positive can take HIV medicines that can keep them healthy for many years and greatly reduce their chance of passing HIV to others.

According to Florida’s Department of Health, the state is a national leader in HIV testing with a wide-range of statewide services. The department provides high-quality HIV testing services using the latest testing technology at each of the 67 county health departments. In 2015, over 378,000 tests were conducted. Testing is also performed through private doctors' offices and other non-DOH testing sites.

“Today it’s harder to make an excuse for why a person hasn’t been tested for HIV,” said Lorenzo Lowe, Director of HIV Prevention at Compass, The Gay & Lesbian Community Center of Palm Beach County. “Thanks to millions of dollars from funding sources, testing is available in multiple cities and locations including your physician’s office. There are also websites and phone apps that can direct anyone to a testing site. Testing is free, it’s quick, it’s easy, so ‘just do it.’

Take the test and learn your status. It’s just that simple.”

Florida continues to lead the nation in the number of HIV tests conducted at over 1,500 publicly funded and registered sites. Many community centers, including the Pride Center in Wilton Manors, Compass in Lake Worth and Care Resource in Miami, have testing events from June 21 to June 27. For a total list of testing sites, view the health department’s interactive map at FLhiv.doh.state.fl.us/ClinicSearch/ClinicSearch.aspx.to.

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The Republican Health Care Plan Would

Devastate People With HIV Trump’s draconian proposed budget cuts and the House health care bill would also severely impact HIV prevention efforts

CNNMoney/Healthcare.gov

Benjamin Ryan POZ Magazine

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he verdict is in. The one-two punch of coverage was out of reach for too many President Donald Trump’s proposed people with HIV.” federal budget and the House The letter lavishes scorn on the bill (which Republican health care bill, if actually the Senate will apparently jettison in favor enacted, would deal a devastating blow to of starting from scratch) for its billions of people living with and at dollars of cuts to traditional risk for HIV. And while the Medicaid programs; phasing U.S. epidemic, which has out of the Affordable Care been steadily improving Act’s (ACA, or Obamacare) on many fronts in recent expanded Medicaid years, would take a major programs; erosion of key hit, the president’s proposed protections against healthcuts to global HIV funding plan-related discrimination could prove cataclysmic to that benefit people with developing nations.

HIV; and problematic An all-male gang of 13 changes to the formula for Republicans in the Senate determining subsidies for is now faced with the the premiums of private daunting task of adapting health plans obtained on the American Health Care the open, or “nongroup,” Act (AHCA) to appease market.

50 members of the Addressing the president’s Republicans’ slim 53-seat proposed 2018 fiscal year - Dana Van Gorder Executive Director of majority. In a recent joint budget, the grandly titled Project Inform letter to senators, 133 HIV “A New Foundation For organizations stressed that American Greatness,” Dana the bill that passed the House without a Van Gorder, executive director of Project single Democratic vote on May 4 “would Inform, says, “Donald Trump has shown return America to a time when health care complete and utter contempt for people

"Donald Trump has shown complete and utter contempt for people with and at risk for HIV.¨

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with and at risk for HIV. This proposal is so offensive that even conservative Republicans find it frightening, and it has only a modest chance of passing in its entirety. Still, as a reflection of the values of this administration, it is morally bankrupt and uncivilized.”

“President Trump’s heartless budget proposal explodes hard-fought and effective bipartisan public health policy in fighting HIV/AIDS,” says Senate Minority Leader Charles E. Schumer, a Democrat from New York. “This budget’s cruelty and counter productiveness is unparalleled, and Democrats will seek allies and fight tooth and nail to make sure this proposal doesn’t see the light of day in the Senate.”

(Requests for comments from numerous Republican Senators on the HIV-related impact of the president’s budget and the AHCA went unanswered.)

The May 24 release of the nonpartisan Congressional Budget Office (CBO) report estimating the AHCA’s impact sent a bruising message that, compared with projections based on the current health care law, 14 million fewer Americans would have health insurance in 2018, a figure that would swell to 19 million by 2020 and 23

million by 2026. (These projections do not factor in the president’s proposed budget cuts that affect health care.) In 2026, the estimated number of uninsured people younger than 65 (and therefore largely ineligible for Medicare) would be 51 million, compared with a projected 28 million if Obamacare were left intact.

This loss of health insurance would disproportionately affect older people with lower incomes, in particular those between 50 and 64 years of age with incomes below 200 percent of the federal poverty level (FPL), or $24,120 for individuals.

Given demographic trends, such a bias against late-middle-aged people with chronic health conditions would likely have a considerable impact on the aging U.S. HIV population, which tends to be lower income. While just one third of those living with the virus were 50 or older in 2010, that proportion is expected to rise to one half by 2020. Currently, only a sliver of U.S. residents with HIV are 65 or older and therefore have access to Medicare (neither the president’s budget nor the AHCA target that program). Even by 2030, only a fifth of the HIV population is expected to be in their senior years.

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How the budget and the AHCA target Medicaid: If enacted, the president’s budget and the AHCA would set in motion cuts to Medicaid so drastic that by 2027 federal spending on the program would be an estimated one half of what it is today, even without accounting for inflation. Over the next decade, the health care legislation would slash $834 billion from Medicaid while Trump’s budget proposes axing $627 billion in support for the program; the potential overlap between those two figures remains hazy.

Medicaid is the primary source of insurance coverage for people with HIV in the United States. According to the Kaiser Family Foundation, in 2014, 42 percent of U.S. residents in medical care for HIV were on Medicaid, a figure that rose from 36 percent in 2012 thanks to the expansion of Medicaid in states that opted to do so under the ACA. (Compared with the highly restrictive traditional state Medicaid programs, expanded state Medicaid programs have a simple cutoff for admission: having an income below 138 percent of FPL, or $16,643 for an individual.) By comparison, 30 percent of those in HIV care were privately insured in 2014, 14 percent were uninsured, 8 percent had Medicare, and 6 percent had some other form of health coverage.

The House health care plan would also forbid any new states from receiving federal matching for expanded Medicaid programs (32 states plus Washington, DC, have adopted expanded Medicaid since 2014). And starting in 2020, the federal government would cease providing matching funding to states for new enrollees to existing expanded Medicaid programs. Meanwhile, participation in such programs would likely ultimately wither under attrition because federal matching would end for any enrollee who experienced a gap in expanded Medicaid coverage of a month or more.

In states that expanded Medicaid, steadily doing away with the program would reintroduce a health care catch-22

of the pre-ACA era, in which someone with HIV typically had to have AIDS (and therefore a disability designation) before Medicaid could cover them and provide the antiretrovirals (ARVs) that would have spared them from a depleted immune system in the first place.

And then there's private insurance: Starting in 2020, the AHCA would end the progressive income-based subsidies available for nongroup private insurance plans—non-employer-based insurance purchased on the open market. In their place would come an age-based system of federal subsidies—tax credits that would phase out for those with incomes between $75,000 and $115,000. The credits would increase from $2,000 annually for individuals up to age 29 to $4,000 annually for those age 60 and older. Levels of premium assistance would also no longer vary regionally according to differences in plan costs across the country.

Beginning in 2018, insurers would be permitted to charge premiums five times greater for older individuals compared with younger ones, stretching the current permitted ratio of three to one.

A surcharge up to 30 percent more in premium costs for the first year of a nongroup health plan would hit those applying for coverage who experienced a 63-day-plus gap in health coverage during the previous year. According to Andrea Weddle, executive director of the HIV Medicine Association, this bump in cost “is likely to make health care coverage unaffordable for many people with HIV who have a gap in coverage.”

States could otherwise apply for a waiver permitting insurers to adjust the cost of health plan premiums based on an individual’s health status and his or her expected health care costs—a process known as medical underwriting—for those who fail to prove they had continuous health coverage for the previous 12 months.

“The AHCA provision that punishes people with chronic diseases for lapses in

"The AHCA provision that punishes people with chronic diseases for lapses in their coverage, something people living with HIV often have no control of, is immoral and humane.¨ - Barbara Lee (D-CA13)

their coverage, something people living with HIV often have no control of, is immoral and humane,” says Representative Barbara Lee, a California Democrat and longtime friend to the HIV cause.

According to Weddle, people with a preexisting condition like HIV, “whose employment status or ability to maintain coverage may fluctuate due to their condition,” would be among those “most at risk for being subject to the premium penalty or being charged higher premiums based on their health status.”

A second optional waiver would allow states to rewrite the roster of essential health benefits (EHBs) that Obamacare has dictated private insurers must provide to consumers. These include coverage for prescription drugs, hospital inpatient care, chronic disease management, preventive services such as HIV testing, and mental health and substance abuse treatment.

According to a recent National Association of State & Territorial AIDS Directors (NASTAD) brief, plans in states that axed key EHBs could leave people with HIV “with health insurance that does very little to provide meaningful access to care and treatment.”

The CBO estimates that states covering one sixth of the U.S. population would opt for both the medical underwriting and EHB waivers. Consumers in these states would likely be able to choose between medically underwritten plans or community-rated

plans, with prices geared to their geographic area and smoking status.

In these states, the CBO predicts, the cost of community-rated plans would rise such that people with preexisting conditions who have had a gap in insurance coverage “would ultimately be unable to purchase comprehensive nongroup health insurance at premiums comparable to those under current law, if they could purchase it at all.”

For those with high health care costs who do maintain coverage with a private plan, out-of-pocket costs would likely increase the most in these states compared with those that sought fewer changes to state health care regulations.

States accounting for about half the U.S. population would apply for neither waiver, the CBO predicts. In those states, average premiums in 2026 would be an estimated 4 percent lower than they would be with current law. However, because starting in 2019 insurers could charge more for older people, those approaching age 65 would face steeper costs.

The remaining one third of the population would live in states that the CBO projects would make moderate changes to health care market regulations. Thanks to policies offering fewer benefits, premiums would be about 10 to 30 percent lower in 2026, depending on the area of the country, than they would be under current law. Younger people would reap greater savings.

The CBO report breaks down projections CONTINUED ON NEXT PAGE ▶ 6.21.2017 •

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◀ Continued from previous page

of what 21-, 40- and 64-year-old individuals relative pittance in the face of a probable would pay in annual insurance premiums heavy need for such alternatives. for nongroup plans in 2026 if the current Last, even if any health care legislation law persisted or if under the AHCA these is doomed to die in the Senate, the overall individuals lived in a state that either did morass engulfing the future of U.S. health not seek waivers for market regulations or care policy “has the effect of potentially sought moderate changes. destabilizing the market,” according to For an individual with no spouse or Jennifer Kates, PhD, the director of global dependents making 450 percent of FPL health and HIV policy at the Kaiser Family ($68,200), average premiums under the Foundation. With insurers currently in AHCA would wind up substantially cheaper the process of setting the prices for 2018 in 2026 than with Obamacare for 21-and Obamacare nongroup private plans, 40-year-olds while costs would remain Trump’s refusal to indicate whether he in the same ballpark for the 64-year-olds will exercise his executive authority to cut regardless of the health care legislation in off federal subsidies for private insurance place. premiums, may ultimately drive up next As for those with an income at 175 year’s premiums. percent of FPL ($26,500), average annual premiums in 2026 would be $1,700 with A Safety net: the Obamacare still in place, regardless of Ryan White CARE Act their age. Under the AHCA, in the states seeking no waivers or moderate health care On the bright side, the Ryan White CARE regulation changes, 21-year-olds would Act, a federally funded program established see respective annual premiums of $1,750 in 1990 that has long benefited from and $1,250; 40-year-olds would experience bipartisan backing, would remain a vital slight relative rises of a respective $2,900 safety net providing financial support for and $2,100; and the 64-year-old’s costs the care and treatment of people with HIV would skyrocket compared with those who lack insurance or are underinsured. under the ACA to a respective $16,100 and Fortunately, Trump has spared the $13,600—amounting to more than half divisions of Ryan White that provide their income. care and treatment benefits from The report also stresses that reductions significant proposed cuts. However, in EHB protections could substantially raise according to Wendy Armstrong, MD, the out-of-pocket costs, particularly for mental chair of the HIV Medicine Association, health and substance abuse care, both of “Ryan White has been essentially flat which are integral funded, or not keeping up with to the wraparound inflation, for many years.” The services that many program, she says, is “stretched "Ryan White significantly, and a greater people living with and at risk for HIV need patient influx into that system has been for optimum health. will stretch the program even essentially more.”

Additionally, benefits no longer deemed It wasn’t so long ago that people flat funded, with essential by a state HIV died while wait-listed or not might wind up subject for drug coverage from Ryan to annual or lifetime White’s AIDS Drug Assistance keeping benefit caps—a policy Program (ADAP)—at its peak, the up with shift that could hit cumulative list stretched to 9,000 people who take people—because they lived states inflation, expensive prescription with slimmer matching budgets for many drugs such as ARVs. to the program.

The AHCA would The president’s 2018 budget years.¨ establish a fund of would, however, eliminate two - Wendy Armstrong, MD $123 billion (spread Ryan White programs entirely: HIV Medicine Association over nine years) for the AIDS Education and so-called high-risk Training Centers (AETC), which pools to subsidize coverage for people shut receives $34 million annually to provide out of the insurance market because of vital training for physicians in caring for preexisting conditions. But such a source of people with HIV; and the Special Projects health care coverage has a notorious history of National Significance (SPNS), which of inadequacies, including high costs to the develops innovative models of care for the consumer. Furthermore, experts consider HIV population with an annual budget of the AHCA’s funding for high-risk pools a $25 million.

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Additional cuts and effects: Driving down insurance rolls could also greatly compromise efforts to prevent HIV transmission. Recent innovative local efforts to reduce new-infection rates in places such as San Francisco and New York City lean upon the Obamacare-finessed ease of insurance access. This benefit helps ensure that an increasing proportion of those living with the virus are on ARVs and have an undetectable viral load, thus likely all but eliminating their risk of transmitting the virus to others. Additionally, the ACA likely fuels access to PrEP for those at risk of HIV. Additional proposed HIV-related cuts in Trump’s 2018 fiscal year proposal include: eliminating the entire $54 million budget for the Secretary of Health and Human Services Minority AIDS Initiative (MAI) Fund; a 15 percent, $17 million cut from the Substance Abuse and Mental Health Services Administration’s MAI budget; axing 7 percent of the budget, or $26 million, for the Housing Opportunities for People with AIDS (HOPWA) program at the U.S. Department of Housing and Urban Development; a 14 percent, $22.3 million cut to sexually transmitted infection prevention efforts at the CDC just as STI rates are rising; and a one-year elimination of federal funds to Planned Parenthood, which is a major source of HIV testing and prevention services nationwide.

The National Institutes of Health (NIH) would incur a $7.2 billion annual cut,

seeing its budget drop by 22 percent. This includes an 18 percent, $550 million cut to HIV research efforts. Such an elimination of funds would likely have a considerable impact on the global epidemic, possibly resulting in scaled-back research into numerous important avenues, including the quest for HIV vaccines and cure methods.

Calling the president’s budget “heinous,” Representative Barbara Lee says its passage “would abdicate U.S. leadership in the fight to cure HIV/AIDS on the global stage and gut efforts to combat HIV in the world’s poorest countries.”

Indeed, with the United States by far the greatest funder of international HIVrelated aid, Trump has proposed slashing the nation’s annual $6 billion budget for such efforts by $1.1 billion, or about 20 percent. According to amfAR, The Foundation for AIDS Research, the $225 million cut to the President’s Emergency Plan for AIDS Relief (PEPFAR) alone would drive 250,000 people off HIV treatment and orphan 78,000 children.

Finally, the CDC would incur a $149 million cut to its annual HIV prevention budget, a 20 percent drop. Considering that CDC dollars are responsible for a majority of HIV prevention expenditures in the United States, such a hit would compromise the ability to control the epidemic just as recent so-called high-impact efforts on the part of the CDC were apparently starting to bear fruit, helping drive down rates of new HIV infections 18 percent in six years.

From POZ.com, June 2, 2017. Reprinted with permission. Copyright 2017 CDM Publishing, LLC. Paul Ryan during the healthcare vote.

Photo Credit: CNN.

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June Report from SFAN Sean McShee The South Florida AIDS Network (SFAN) functions as the networking and advisory body for the Florida Department of Health (FL-DOH) Ryan White Care (RWC) program in Broward County. Newcomers and visitors are welcome to its meetings.

K

im Saiswick, chair of the Florida Comprehensive Planning Network (FCPN), provided SFAN with a report of the most recent FCPN meeting. FCPN has functioned as the statewide advisory body for the FL-DOH RWC program. Now that Florida has integrated its HIV prevention and treatment planning, FCPN has changed. HIV service providers, prevention workers, advocates, and the FL-DOH now exchange information and feedback at FCPN meetings.

Report from FCPN During 2016, males made up 76 percent of ADAP clients, and females 23 percent. Five ADAP clients were transgender males and 184 were transgender females.

Florida-DOH has set an ambitious goal. After six months in ADAP, 90 percent of ADAP clients should achieve viral suppression. Only those ADAP clients with health insurance, however, were able to achieve this goal.

Successful HIV treatment consists of viral suppression, defined as having less than 200 viral copies per milliliter of blood. It maintains the ADAP client’s health and significantly minimizes transmission risk. At present, no consensus exists about transmission risk for people with a suppressed viral load. A growing number of researchers, providers, and advocates have argued that a consistently suppressed viral load prevents transmission.

Saiswick discussed the Florida Patient Needs Assessment. Respondents reported the following unmet needs: dental/oral health care, case management, health insurance, food-bank, and housing assistance. When compared with the previous needs assessment, the number of people unsure of where to get services had doubled.

People at FCPN also discussed the statewide rollout of Test and Treat programs. Under this program, people can choose to begin HIV treatment within 24-hours of receiving an HIV-positive test result. Six metropolitan areas in Florida have the highest HIV rates: Broward, Jacksonville, MiamiDade, Orlando, Tampa, and West Palm Beach. All

six areas now have functioning Test and Treat Programs.

Test and Treat programs in South Florida At FCPN, Karen Villamiazar reported that 38 out of 50 clients in the Miami-Dade Test and Treat program have achieved viral suppression. Clients averaged 58 days to achieve viral suppression. This program identified five acute HIV cases. All five have now suppressed the virus.

The acute HIV phase occurs immediately after initial infection and presents the greatest risk for HIV transmission.

Janelle Traveras presented preliminary data from Broward’s Test and Treat program. From May 1 to May 26, sixty-six people had enrolled in its program.

HIV testing diagnosed thirty new cases of HIV infection. Thirty-six had been previously diagnosed, but were out-of-treatment at the time of testing.

Taveras announced that Broward DOH would be hiring PrEP Navigators. These navigators will help people seeking PrEP to obtain it. In addition, these navigators can link people at high risk for HIV infection to other needed services.

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Broward RWC Neil Walker, Broward-RWC, reported that Broward-RWC had 5 percent of its budget left unspent by the end of FY2016. Broward-RWC will not have to return this amount.

Walker also reported that enrollment in Broward-RWC declined in FY 2016 by 8.5 percent.

He attributed this to increased enrollment in ACA insurance programs. Broward-RWC clients had a viral suppression rate of 81 percent.

Announcements June 24 from 11 a.m. to 3:00 p.m. The Unity Day Health Fair at Williams Memorial CME Church, 644-646 NW 13 Terraces, Fort Lauderdale.

June 27 is National HIV Testing Day. Next SFAN Meeting: Friday, July 14, 2017 at 10 a.m., at the Holy Cross Healthplex, 1000 NE 56th Street, Ft. Lauderdale. SFAN welcomes newcomers.

News, comm en ry, inte entertata inment rviews,

Saturday 7PM-8PM on 850AM WFTL Streaming live on www.850WFTL.com, or by downloading the 850 WFTL mobile app

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Florida May Hold the key to

HIV-Funding for Africa Sean McShee

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rump’s proposed budget for Fiscal Year 2018 (FY18) includes cuts of $1.08 billion in global AIDS funding. On June 6, Hilary McQuie of HealthGAP spoke at the World AIDS Museum about those cuts. She spoke about how they would affect HIV in African countries.

Florida has a critical role in whether those proposed cuts become reality. It has several key “players” on relevant committees: Sen Marco Rubio (R-FL), Rep. Mario Diaz-Balart (R-Miami), and Rep Tom Rooney (R-SW Florida). McQuie urged attendees to contact those three to stop these proposed cuts.

Between 37 and 40 million people worldwide live with HIV. About 70 percent of them live in African countries. In African countries, more straight people live with HIV than gay and bi men do. When HIV strikes straight people during their child-raising years, it leaves many orphans in its wake. Millions of potential orphans could destabilize resource-poor countries. Only outside funds could stave off disaster.

According to McQuie, two major sources provide most of these funds: The President's Emergency Plan for AIDS Relief (PEPFAR) and The Global Fund to Fight AIDS, Tuberculosis, and Malaria (GF). The second Bush administration and the Black Congressional Caucus jointly developed PEPFAR. The GF also began in the early 2000s as a public-private partnership.

Global HIV-funding decreased during the 2008 great recession. It has yet to recover. Decreased funding coincided with breakthroughs that allowed people to see an end to the epidemic.

These breakthroughs include antiretroviral therapy (ART), access to inexpensive, generic ART, effective prevention of mother-to-child-transmission, PEP, PrEP, and programs for voluntary male circumcision. Decreased funding reduced the potential benefit of those breakthroughs.

McQuie reported that research indicates a path to controlling HIV in Africa by 2030. In order to do so, African countries would have to achieve the “90/90/90 goals” by 2020. The “90/90/90 goals” have three sequential components. The first would be to diagnose HIV in 90 percent of those infected. The second would be to prescribe ART to 90 percent of those diagnosed. The third would be to suppress the virus in 90 percent of those taking ART. Out of 54 countries in Africa, 21 receive PEPFAR funding. According to UNAIDS, in African PEPFAR countries, annual HIV related deaths decreased by 227,100 between 2010 and 2015.

Among these countries, 14 reported decreased HIV-related deaths, and five reported increased deaths. Ethiopia and Nigeria failed to report data.

In half of the PEPFAR African countries, 57 percent or more of those diagnosed with HIV are receiving ART. Botswana reported 78 percent and Rwanda reported 79 percent receiving ART. Despite poverty, African countries are making major progress against HIV. That progress depends on global HIV-funding and access to inexpensive generic antiretrovirals.

LGBT HIV Issues in Africa Heterosexual transmission drives the HIV in Africa. Gay and bi African men, however, have higher infection rates than heterosexuals do. Global HIV researchers use the label “key populations” for stigmatized groups like LGBT people, drug users, and sex workers. Outside funding can ensure access to services for key populations despite stigmatization.

Hostility to LGBT people varies among African countries. Uganda’s infamous “AntiHomosexuality Act of 2014” has earned it the dubious distinction of most hostile. In contrast, South Africa became the first African country to recognize same-sex marriage in 2006, nine years before the US did.

South Africa has one of the most pro-LGBT political cultures in the world. It arose from grass roots activism led by LGBT people of color. These cuts pose the greatest risk to LGBT Africans.

HIV in African countries differs from HIV in the US. The shared suffering, however, can provide a way to break out of narrow nationalism.

To learn more about HealthGAP, please visit HealthGap.org 26

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SFGN's HIV/AIDS News Source

STIs Beyond HIV Sean McShee

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s HIV becomes a more manageable disease, the difference in severity between its outcome and that of other sexually transmitted infections (STIs) also decreases. Syphilis, hepatitis C, and human papilloma virus (HPV) all pose serious health risks. Syphilis can damage the heart, the brain, and nervous system. From 1996 to 2016, diagnoses of infectious syphilis in Broward increased by 906 percent. Hep C can lead to liver cancer. HPV can lead to anal cancer. All can lead to death.

Science has developed STI services other than testing and treating. These new services include HIV pre-exposure prophylaxis (PrEP), HIV post-exposure prophylaxis (PEP), and vaccines for hepatitis A, hepatitis B, and HPV. Someone with an STI may be a good candidate for PrEP. Given this new STI environment, SFGN investigated STI services other than HIV testing in Broward County. A Google search identified agencies offering STI services in Broward. A phone/e-mail survey followed, to clarify the services provided.

This investigation had two criteria for inclusion. Agencies had to accept walk-ins.

Services had to be free, or have a sliding-scale/ donation fee structure. Seven agencies met these criteria. Other agencies may provide some STI services, but they failed to meet the criteria or appear in the Google search.

HIV PEP Care Resource and all three AIDS Healthcare Foundation (AHF) sites (Wilton Dr, Sunrise, and SE 3rd Ave.) offer PEP. As someone has to begin PEP within 72 hours of exposure, weekend access is critical.

The AHF sites on Wilton Drive and Sunrise are open Saturday and Sunday for people who need PEP over the weekend.

HIV PrEP Care Resource and the Edgar Mills Health Center offer PrEP to people testing positive for another STI. All other agencies will refer out for PrEP.

Hepatitis A, Hepatitis B, and Hepatitis C The Edgar Mills Health Center offers hepatitis A and hepatitis B vaccines. All three AHF clinics, Broward House, Care Resource, the Edgar Mills Health Center, and Latinos Salud offer testing for hepatitis C. HPV vaccine Care Resource and the Edgar Mills Health Center offer the HPV vaccine.

Herpes If a sore is present, all three AHF clinics will test for herpes. The Edgar Mills Health Center also offers a test for herpes.

Syphilis All three AHF clinics, Broward House, Care Resource, the Edgar Mills Health Center, and Latinos Salud offer syphilis tests.

Gonorrhea and Chlamydia These bacterial STIs can occur in the penis, throat, rectum, and vagina. In order to diagnose these STIs, clinics have to perform separate penile, oral, rectal, and vaginal tests.

All three AHF clinics, Broward House, Care Resource, the Edgar Mills Health Center, and Latinos Salud offer penile tests for gonorrhea and chlamydia. All these clinics, except for Latinos Salud, offer vaginal testing for gonorrhea and chlamydia. All three AHF clinics offer rectal and oral tests for gonorrhea and chlamydia.

Gonorrhea and chlamydia in the rectum or throat often produce few symptoms. STIs in the rectum or throat, however, can end up in somebody else’s penis. Control of these STIs among gay and bi men logically requires gonorrhea and chlamydia testing and treatment in the rectum and throat.

Ever since the early 80’s, HIV has loomed as the monster STI, but things have changed since then. For an unknown number of gay and bi men, monogamy is optional. Some of us only know the first names or screen handles of our sexual partners. In this context, regular STI testing may be the only way to control STIs. Gay and bi men probably should begin to think about STIs in new ways.

Walk-in STD clinics in Broward County that are Free, Donation, or Sliding Scale AIDS Healthcare Foundation Broward Wellness Center (AIDS Healthcare Foundation) AIDS Healthcare Foundation / Wellness Center (Wilton Manors) Broward House Incorporated Client Services Care Resource DOH-Broward Family Planning and Immunization Clinic: Edgar Mills Health Center Latinos Salud

1785 E Sunrise Blvd 700 SE 3rd Ave 2097 Wilton Drive

954-462-9442 954-767-0273 954-358-5580

2800 N Andrews Ave 871 W Oakland Park Blvd 900 NW 31st Avenue

954-568-7373 954-567-7141 954-467-4700

2330 Wilton Dr.

954-765-6239

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Three South Florida Scientists Awarded Grant for HIV Research Denise Royal

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hree South Florida scientists on the front line in the HIV/AIDS battle have been given $25,000 grants to further their research. Scientists at the University of Miami, Florida International University and Broward Health are the proud recipients of the grants from The Campbell Foundation.

The Campbell Foundation’s mission is to eradicate HIV and AIDS in our lifetime through education, prevention and research. Now in its 22nd year, the Campbell Foundation has given away $10.4 million, with about $1.2 million going to direct services. The nonprofit has been funding cutting-edge research into a cure for HIV since its creation by the late Richard Campbell Zahn, the chemist who developed Herpecin-L Lip Balm for the treatment of cold sores and fever blisters.

One of the recipients is Dr. Maria L Alcaide of the Miami Center for AIDS Research (CFAR) at University of Miami. Her HIV research has been published in dozens of medical journals.

Her grant will be used for a mentoring program with the aim of attracting, supporting and encouraging young investigators to the field of HIV research.

The $25,000 grant will be used to create a mentoring workshop, which will provide tools for mentors and mentees from academic institutions in South Florida. These workshops have been proven to encourage and support the development of the next generation of HIV scientists.

“South Florida is unique and we have a lot of challenges. Creating a pool of young investigators who focus on research in our region is crucial to ending the HIV epidemic in our area,” Alcaide said in a written statement.

HIV prevention is the goal of a team of researchers at the Broward Health Comprehensive Care Center in Fort Lauderdale.

The center provides primary care services to those affected by HIV/AIDS. The center

provides cutting edge treatment and care annually to more than 1,800 clients affected by HIV/AIDS. The Campbell Foundation grant will be used to get high-risk HIV-negative women on anti-HIV medication (i.e. PrEP) to prevent new infections.

“If you really want to eradicate this disease, then you have to look at the other side of the equation and that is: How do we prevent people from getting infected in the first place?” said grant recipient Dr. Farouk Meklat, in a written statement, who will be conducting the study.

“We want to prevent those who are most vulnerable and at risk from becoming HIV positive."

HIV positive people face a lifetime of having to take antiretroviral medication daily.

For some, remembering to take it becomes difficult. Missing medication can result in the loss of therapeutic effectiveness, and more dangerously, the formation of a medicationresistant strain of HIV. Grant recipient Dr. Rahul Jayant, a researcher at FIU, is looking to develop a long-lasting antiretroviral medication.

“We already have developed a longactive nanoformulation, which can release antiretroviral drugs over a one-week period using our U.S. patented nanotechnology approach. Now, with the generous help from The Campbell Foundation, we will be working toward the development of single-dose formulation that can release the ARV drugs up to one month,” said Dr. Jayant in a written statement.

Many HIV patients tend to lose memory.

This is particularly true with older HIV patients or those who are drug abusers. So the hope is a longer-lasting medication will help patients better adhere to their regimens.

You can learn more about The Campbell Foundation at CampbellFoundation.net.