5 Big Details From the Leaked GOP Bill to Repeal Obamacare

People with chronic conditions or who need expensive meds could be more vulnerable. Here’s why.

February 28, 2017

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Despite Republicans’ nonstop talk about repealing and replacing the Affordable Care Act (ACA, or Obamacare), they have yet to present legislation to accomplish those goals. That doesn’t mean they haven’t been working on it. Politico obtained a draft of the bill. You can read all 106 pages of it here, but who has time to weed through that?

“It’s an unbelievably complex subject,” is how President Trump himself described it to the nation’s governors, according to CNN. “Nobody knew health care could be so complicated.”

Health care is expected to be one of many topics of discussion when Trump addresses a joint session of Congress Tuesday, February 28, at 9 p.m. ET.

But we’re not expecting a detailed analysis of the health care overhaul bill—at least not by Trump. What we do have at this point is a closer look of the leaked draft, thanks to STAT news, which broke down the legislation into five takeaways:

• It would overhaul Medicaid in significant ways. In fact, Medicaid expansion would be phased out, spending could be capped and individual states would have more control over what is covered. This could mean trouble for people with chronic conditions or who require newer, more expensive meds, such as the treatments for hepatitis C virus (HCV).

• It would end Obamacare’s mandate of what health insurance must cover. Under the proposal, states would decide what is covered. Health care advocates fear that mental health services and substance abuse treatment could be cut because, as STAT notes, “people with addiction issues are expensive to treat and therefore cover.”

• It would end the tax on pharmaceutical manufacturers. It also repeals taxes on health insurance plans, tanning beds and medical devices—money that, in the past, helped pay for Obamacare. STAT reports that to make up for the lost money, the draft bill would likely tax employer-based health insurance.

• It gives health plans more leeway to charge older people more. The draft bill does not allow health plans to discriminate against people because of preexisting conditions. Instead, older people may pay more. To ease this transition, the bill also gives older people a larger tax credit.

• It would repeal the Prevention and Public Health Fund. The bill does not include a replacement for the funds that go to prevention and public health activities.

Since this draft was leaked, several GOP Congress members have said they would not support it as is. “The draft legislation…risks continuing major Obamacare entitlement expansions and delays any reforms,” Representative Mark Walker said in a statement quoted in a different CNN article. “It kicks the can down the road in the hope that a future Congress will have the political will and fiscal discipline to reduce spending that this Congress apparently lacks.”

Representative Mark Meadows, chairman of the conservative House Freedom Caucus, told CNN he was against the refundable tax credits in the draft bill, describing them as a new “entitlement program.”

“So the headline is that the GOP is reducing subsidies to needy individuals when in fact, the growth of the taxpayer-subsidized reimbursements will actually increase. The total dollars that we spend on subsidies will be far greater,” Meadows told CNN. “So you can be a millionaire and not have employer-based health care and you're going to get a check from the federal government—I’ve got a problem with that.”

For a roundup of POZ articles on health care legislation, click #Obamacare.

  

Read more articles from POZ, here. 

Well-Treated HIV Is Still Associated With Vascular Abnormalities in the Brain

More research is needed into how the virus may affect cerebral small vessel disease, a leading cause of cognitive decline.

February 24, 2017

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Even when people with HIV are doing well on antiretroviral (ARV) treatment, they are apparently more likely to have certain abnormalities in blood vessels in the brain that are associated with cognitive decline. Further research is still needed, however, to bring greater clarity to how fully suppressed HIV may affect such abnormalities over time and give rise to age-related disorders.

Researchers from the French ANRS group conducted a large, multicenter cross-sectional study, known as EP51 MICROBREAK, of 456 people with HIV older than 49 who were taking effective ARV treatment and had a CD4 count of at least 350. They used cutting-edge MRI methods to assess abnormalities of white matter in the participants’ brains to look for evidence of cerebral small vessel disease (CSVD), a leading cause of cognitive decline in the general population.

Dominique Costagliola, PhD, of the Sorbonne presented findings from the study at the 2017 Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle.

HIV is associated with an increased risk of vascular disease (disease of the blood vessels), likely because of the chronic inflammatory state to which even well treated virus gives rise. Scientists are eager to determine whether HIV drives vascular disease in the brain in particular, possibly contributing to HIV-associated neurocognitive disorders (HAND).

Previous MRI-based research has found an association between HIV and abnormalities in the brain’s white matter, the regions of the organ that pass signals between neuron cell bodies located in the brain’s gray matter. Such white-matter abnormalities have been linked to CSVD as well as HAND.

In the MICROBREAK study, the participants were twice as likely to have CSVD compared with 154 HIV-negative control subjects despite the fact that those in the HIV-positive group were two years younger on average. The disparity was the widest among the youngest members of the study (50 to 53 years old) and narrowed so that participants older than 60 had similar CSVD rates regardless of HIV status. The people with HIV were also more likely to abstain from alcohol; 33.1 percent of those with HIV and 17.5 percent of those without reported never drinking.

Thirty-six percent of those without HIV and 52 percent of those with HIV had CSVD, including a respective 14 percent and 19 percent with severe CSVD.

The HIV-positive group had more risk factors for vascular disease besides living with the virus, including high blood pressure, cholesterol and triglycerides and a history of cardiovascular disease. But even after the researchers controlled for such factors, the apparent differences in CSVD rates persisted. Those with HIV were 2.3 times more likely to have CSVD. There was no statistically significant difference in the severe CSVD rates based on HIV status, meaning they could have occurred by chance.

Among those with HIV, risk factors associated with CSVD included being 54 and older, having high blood pressure and having a lowest-ever CD4 count below 200. Those who were not men who have sex with men were more likely to have CSVD, a phenomenon Costagliola said was likely driven by differences in socioeconomic status.

The investigators concluded that their research strengthened the body of evidence supporting the association between HIV and brain injury. However, because they did not follow their study subjects over time, they could not fully address how HIV might accelerate aging in the brain. They also believe their findings suggest that people with HIV younger than 60 may be at higher risk for CSVD than their HIV-negative peers, although the reasons for this disparity in risk remain unclear.

A separate study presented at CROI actually found that, at least over a two-year period, well-treated HIV was not associated with an acceleration in the decline in measures of brain injury or cognitive function.

The MICROBREAK study authors advise clinicians caring for people with HIV to identify and seek to mitigate risk factors for vascular disease among them, such as smoking and high blood pressure, and to be vigilant for symptoms of CSVD.

To see a webcast of the conference presentation, click here.

Read more articles from POZ, here.

  

PEPFAR Trumps Politics: U.S. Advocates Push to Save Global AIDS Funding

Global AIDS activists protest a U.N. High-Level Meeting on Ending AIDS. Courtesy of Health Gap

February 22, 2017 • By Casey Halter

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The battle to save the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is already well under way, just one month after President Donald J. Trump’s inauguration and his almost immediate reinstatement of the country's global gag order on foreign funding for comprehensive sexual health services.

The global gag rule, also known as the Mexico City Policy, is a Reagan-era executive order originally announced in 1984 (at the 2nd International Conference on Population in Mexico City) which restricts any foreign nongovernmental organization, or NGO, that receives U.S. funding from using any money to provide abortions, refer their clients to abortion services or advocate for women’s right to choose in their own countries.

Since then, the controversial rule has become a political volleyball between the Republican and Democratic parties. The rule was rescinded by President Bill Clinton in 1993, reinstated by President George W. Bush in 2001 and once again revoked by President Barack Obama via executive order in 2009.

Therefore, when President Trump reinstated the rule on his first day in office in
2017, it didn’t exactly come as a surprise to those working in the global health services arena. So why are AIDS advocates up in arms about it?

A deeper look into the president’s day 1 executive order reveals some highly unsettling potentialities for the future of global AIDS funding.

Below, we break down Trump’s iteration of the global gag order — and detail how the efforts of politicians, celebrities, activists and citizens can ensure that the groundbreaking PEPFAR does not get cut by the new administration.

***

“The conditions of the global gag rule are even more stringent now than they were in past iterations of it,” says Diederik Lohman, acting director of the Health and Human Rights Division at Human Rights Watch (HRW), one of several international advocacy organizations that have spoken out over the last few weeks in support of PEPFAR.

Advocates like Lohman are quick to point out that before now, the Mexico City Policy had never been applied to any U.S. money set aside to combat HIV/AIDS. However, on January 25, President Trump signed what appears to be an amped-up version of the Reagan-era order that global health advocates worry could vastly expand its reach to a wide array of health care programs—including PEPFAR, family planning service providers and women’s health clinics around the world.

While it is still largely unclear how the program will be affected under the new administration, many organizations, including The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), The Bill and Melinda Gates Foundation, The Elizabeth Taylor AIDS Foundation (ETAF), Housing Works, Until There’s A Cure and the Elton John AIDS Foundation (EJAF), among others, have already spoken out on social media to demand its continued funding.

Here’s why: According to Lohman, past versions of the Mexico City Policy applied only to NGOs seeking to receive special U.S. family planning funding—about $600 million worth of foreign aid. But President Trump specifically changed the wording in his 2017 executive order to extend the abortion gag to all global health funding. That means $9.5 billion worth of foreign aid could now be subject to strict rules that allow the U.S. government to pull its support from any NGO that has provided so much as a referral to any woman seeking to terminate her pregnancy.

“We’re obviously really concerned about what it will mean for groups that are involved in HIV prevention work,” says Lohman, particularly since many of these organizations also provide comprehensive sexual health services and education to their clients. “It could also affect many programs that are not just involved in the provision of abortion services but much more generally in family planning and supporting women with sexual and reproductive health issues.”

The global advocacy community’s support of PEPFAR — which provides $15 billion in funding for HIV testing, treatment, prevention and health care to resource-limited countries every five years — hinges on the fact that the program has proved to be one of the most effective means of curtailing HIV/AIDS in the history of the epidemic. 

According to PEPFAR’s 2017 annual report to Congress, the global endowment initiative currently provides antiretroviral (ARV) treatment to an estimated 11.5 million people with HIV worldwide. Thanks to PEPFAR, nearly 2 million babies with HIV-positive mothers in developing nations have been born virus-free since the early 2000s, and nearly 220,000 health care workers have been trained to help combat the global AIDS crisis. The program has also been credited with a 51 to 76 percent decline in new HIV infections in countries like Malawi, Zambia and Zimbabwe.

“A significant reduction in funding for PEPFAR would have disastrous consequences for access to antiretroviral treatment,” says Lohman. “I think it’s important for organizations like Human Rights Watch to be looking at what happens as a result of this policy change and articulate what the consequences are in order to hammer home the message that this was a really ill-advised policy step.”

Trump’s order to broaden the Mexico City Policy to such an extent has also raised eyebrows within the Republican administration itself. The global HIV/AIDS program has traditionally enjoyed very strong bipartisan support in the U.S. government. In fact, the program was originally instated by President George W. Bush and approved by a Republican-led Congress in 2003. At the time, President Bush specifically exempted PEPFAR from Reagan’s global gag order, as it was widely understood—even in conservative Christian circles—that it would have been impossible to treat HIV/AIDS in the developing world if the abortion order were applied.

At the time, Vice President Mike Pence, then serving in the House of Representatives, vocally supported PEPFAR; he supported it again in 2008 when the program was reauthorized by legislators of both parties.

More recently, U.S. Senate Majority Leader Bill Frist (R-Tenn.,), a trained physician, published an op-ed in The New York Times, titled “The Case for Keeping America’s AIDS Relief Plan,” that specifically called on the new administration not to cut PEPFAR funding under the global gag order. In addition to laying out the program’s endless health benefits, Frist pointed out that distributing emergency aid to countries in crisis has conferred national security benefits in the form of increased stability (from 2004 to 2013, political instability and violence fell by 40 percent in countries that received PEPFAR assistance versus just 3 percent in similar countries that did not). Frist went on to call the program “the greatest humanitarian effort undertaken by the United States in more than 60 years.” 

“Being out in front of this and making sure that there is a critical mass of both Republicans and Democrats saying this is a piece of international work that we do not want to see touched is really important,” says Lohman, speaking on behalf of Human Rights Watch. “We’re obviously going to be monitoring how the discussions develop.” 

***

So what has President Trump said so far about PEPFAR and its relation to the global gag rule? Not much, according to other HIV advocates who since November’s election have also been watching closely for signs regarding the new administration’s plans for global AIDS funding.

“The last several months have been a very challenging and unsettling period,” says Mitchell Warren, executive director at AVAC, a New York City–based international nonprofit that works to accelerate the development of HIV prevention options to populations around the world. 

“Everybody within our agencies, within implementing partners, within the advocacy community, still don’t know what the details [of Trump’s global gag order] mean. No one knows how intentional the expansion was, and no one knows what enforcement will look like.”

On the campaign trail, Trump appeared to support the global AIDS program. Last summer, when asked at a rally in New Hampshire whether he would double the number of people receiving treatment under PEPFAR, the future president was quoted as saying: “Those are good things—fighting Alzheimer’s and AIDS. We are so close on some of them. On some of them, honestly, with all the work done, which has not been enough, we’re not very close. The answer is yes. I believe strongly in that, and we are going to lead the way.” 

That said, it is unclear whether Trump truly understood the question, as PEPFAR does not provide any international support for Alzheimer’s disease research or treatment. 

On another potentially positive note for the program, just before his inauguration, President Trump also announced that Ambassador Deborah Birx, the U.S. global AIDS coordinator and head of PEPFAR, was going to be one of the few political Obama appointees to remain at the helm of her governmental organization during the White House transition.

“That was certainly a ray of hope for us working in this field, because Ambassador Birx has done a remarkable job at reorienting the program and following the data,” says Warren. “The best sign we could get in the short term would be formally nominating her and appointing her to a full tenure as ambassador.”

Other auspicious signs from the new administration include praise for PEPFAR via Trump’s newly appointed secretary of state, Rex Tillerson. At the former Exxon Mobil CEO’s confirmation hearing, he reportedly called the program “a model for us to look to as we’re thinking about other ways in which to project America’s values.”

Tillerson’s statement also hints at a business agenda. As several recent global health studies have shown, PEPFAR not only saves lives but it’s also a really great strategy for promoting U.S. business interests in Africa.

However, HIV advocates like Warren have also witnessed a darker side to Trump’s approach to PEPFAR over the last few months, casting major doubt on the administration’s true intentions for the program.

As detailed in a New York Times report also published in January, transition staff sent out a series of leading questions to the U.S. State Department that seemed highly skeptical of the global AIDS program, asking, for example, “Is PEPFAR worth the massive investment when there are so many security concerns in Africa?” and “Is PEPFAR becoming a massive, international entitlement program?” 

“I’m not sure any of us do well trying to predict anything in the current environment,” says Warren when asked about predictions on where global AIDS funding is headed under President Trump. “But I can predict this: If we do not see the new U.S. administration provide sustained commitment and leadership to PEPFAR, we will not end the epidemic.” 

Regardless of what the Trump administration decides to do with the program, it’s clear that the United States faces a long road in its fight against global HIV/AIDS. According to the latest stats from the United Nations, an estimated 37 million people are living with HIV worldwide, and only 18.2 percent are currently receiving ARV treatment.

Meanwhile, global health advocates continue to argue online, to their local politicians and to their allies in Congress and the new administration: If President Trump does indeed want America to “lead the way” in ending the global HIV epidemic, keeping PEPFAR could quite possibly be the businessman’s best investment.

Read more articles from POZ, here.

Could Shirtless Photos Lead People to Get an HIV Test?

Eight out of ten counties in the United States that are most vulnerable to HIV are in Kentucky according to a new campaign.

By Savas Abadsidis

 

February 26 2017

 

 

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As part of an AIDS Volunteers Inc. (AVOL) campaign seeking to get more African Americans to test for HIV, the University of Kentucky Special Collections Research Center is hosting an exhibit titled "#uncoverHIV." The story was reported by University of Kentucky where the images are being featured as a gallery show.

The free public exhibit, is on display through March 13, 2017. The "#uncoverHIV" exhibit has eight images that feature shirtless African-American models whose faces are covered. The sexy campaign was photographed by Brett Barnett of Lexington, Kentucky. Each image contains facts and statistics about HIV. 

 

“The models in the photographs are shirtless because often people have sex without ever talking about HIV or discussing condom usage. The exhibit is a symbolic uncovering of the stigma that has created a culture of silence where people are unable to talk about their status or get tested,” said Barnett.

Founded in 1987, AVOL is a nonprofit organization that provides services to those living with and affected by HIV/AIDS as well as prevention education and outreach to 72 counties in Central and Eastern Kentucky. 

Check out the campaign here.

Read more articles from PLUS, here.
 

The Unspoken Horror of Incarcerated LGBT People

A new study finds a disproportionate number of LGBT people in America's prisons — and many of them are subjected to abuse while there.

By Lara Stemple and Ilan H. Meyer

 

February 23 2017

 

 

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In the past few years, bipartisan attention has helped shed light on the overincarceration of nonviolent offenders, and researchers have long known that low-income, black, and Latino people are disproportionately imprisoned. Our study, released this month in the American Journal of Public Health, reveals a startling new fact: The incarceration rate of lesbian, gay, and bisexual people is three times greater than that of American adults generally.

We found that 1,882 per 100,000 lesbian, gay, and bisexual people are incarcerated, compared with 612 per 100,000 U.S. residents aged 18 and older. The nationwide incarceration rate of LGB people was previously unknown, and the large difference is striking. 

 

Data came from the National Inmate Survey (2011-2012) conducted by the Bureau of Justice Statistics in U.S. prisons and jails, as mandated by the Prison Rape Elimination Act. Our new analysis of this data showed that not only are sexual minority persons more likely to be held and to receive longer sentences, they are also more likely to experience harm while inside. Compared with straight inmates, sexual minority inmates are more likely to be sexual victimized behind bars. For example, gay and bisexual men in prison are more than six times as likely to be sexually assaulted by a staff member or inmate than straight men.

The over-incarceration phenomenon is particularly acute among women inmates. Thirty-three percent of women in prison and 26 percent of women in jail identify as lesbian or bisexual — yet only 3.4 percent of women in the general U.S. population are lesbian or bisexual. Gay and bisexual men made up 5.5 percent of men in prison and 3.3 percent of men in jail, compared to 3.6 percent of men who identify as gay or bisexual in the general population. (Our forthcoming research looks at incarcerated transgender persons.)

What’s causing the disproportionate incarceration? Other research shows that prejudice may be to blame. Growing up, sexual minorities are more likely to experience family rejection and community marginalization, which can create pathways to substance abuse, homelessness, and detention. Criminal justice profiling of sexual minorities as more likely to engage in sex work or to commit sex crimes can lead to overpolicing. For women, powerful gender stereotypes are likely at play. To the extent that sexual minority women defy norms and are labeled as aggressive or masculine, individuals or institutions may unfairly find them more deserving of punishment.
The biases continue behind bars. For instance, we found that sexual minority inmates are more likely to experience solitary confinement. While sometimes purportedly done for the inmate’s protection, the institutional segregation of inmates is also used as punishment. In either case, the deprivation is severe. Exclusion from programming, 23-hour lockdown, and a lack of family visits and other human contact harm the mental health of those who endure it. Compounding matters, sexual minority inmates are more likely to have experienced childhood sexual abuse than straight inmates. Perhaps unsurprisingly, then, our research also found greater psychological distress among LGB inmates.

In sum, higher rates of incarceration, longer sentences, widespread sexual victimization, disproportionate isolation, and poor mental health outcomes urgently require a rethinking of current health and criminal justice approaches to this population.

In this particular political moment, we hope Americans will find increased concern for the vulnerable among us. Race, class, and sexual orientation serve to privilege some and disadvantage others. Perhaps nowhere is this truer than when we look closely at who is serving time in our country’s prisons and jails and how we treat marginalized individuals who are more likely to be there.

LARA STEMPLE and ILAN H. MEYER are scholars at the the Williams Institute and coauthors of Incarceration Rates and Traits of Sexual Minorities in the United States: National Inmate Survey, 2011–2012.

Read more articles from the Advocate, here.
 

A Focus on Mental Health Vastly Improves HIV Treatment Programs

HIV and depression seem to come as an item, especially for those newly diagnosed. 

By David Artavia

 

February 22 2017

 

 

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If HIV treatment programs implement better care for depression and other mental health disorders, we are likely to see improved outcomes, especially among young adults. 

Nearly 22 percent of people living with HIV will be diagnosed with major depression, and as a result it keeps them from taking their meds. As reported by AIDS Map, people dealing with chronic health conditions, including HIV, are more likely to have untreated depression as well. 

So why haven’t more HIV treatment programs implemented better mental health care? 

As Dr. Pamela Collins of the National Institute of Mental Health pointed out to the Conference on Retroviruses and Opportunistic Infections last week, the relationship between mental health disorders and HIV works in both directions.

While mental disorders can be a risk factor to getting exposed to HIV, those who are just diagnosed are also at risk for depression as they learn to adjust and live with the social stigma attached to the virus. 

Nearly 15 percent of adults and 26 percent of adolescents living with HIV said that depression, anxiety, or the feeling of being overwhelmed can keep them from taking their meds, a study published in PLOSH Medicine revealed. 

Because HIV and mental health come with their own assigned social stigma, it makes it even harder for those living with either (or both) to find support, which is why it’s important for HIV treatment providers to supply care simultaneously. 

One pilot study in Cameroon saw an improvement in their HIV-positive participants after providing HIV clinical services with a team of mental health professionals to work side by side. 
Within a few months, patients dealing with HIV and depression not only saw vast improvement, many of them saw an improved T-cell count and a more suppressed viral load in the process. 

“Integrating care for mental disorders and HIV is feasible,” Collins said. “This means making the screening and treatment of mental disorders a normative part of HIV care. Consensus needs to be achieved on who delivers services – nurses, adherence counselors, community health workers, peers or other groups. People seeking services, healthcare providers, managers and policymakers need to be involved in decision making about service integration.” 

Read more articles from PLUS, here.

 

Research Suggests HIV Treatment May Prevent Accelerated Brain Aging

Cognitive decline has been a major concern for people living with HIV as they age.

February 23, 2017


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It is possible that antiretroviral (ARV) treatment of HIV may combat the apparent effect the virus has on brain aging and associated cognitive decline.

Researchers in the ongoing COBRA study in academic centers in London and Amsterdam recruited 134 HIV-positive participants on successful ARV treatment with an average age of 57.4 and closely matched them with a control group of 79 HIV-negative individuals. (A respective 120 and 76 of them completed follow-up.) They presented interim findings about the results of two years of cutting-edge MRI-based tests and neuropyschometric testing at the 2017 Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle.

The COBRA study is in line with another presented at CROI that found that HIV is associated with brain injury. In the case of this study, this meant smaller gray matter, abnormal white matter microstructure and the finding that the participants living with HIV had worse cognitive performance compared with their peers who did not have virus. Because the other study did not follow participants over time as COBRA did, it could not, however, determine how brain injury might progress among people with HIV, in particular those on fully suppressive ARV treatment.

During the two years of follow-up, the COBRA researchers did not see any excess decline in any of the measures of brain injury or cognitive function among the HIV-positive participants compared with the control group. Participants in both groups experienced about a 1 percent annual decline in brain volume.

  

Read more articles from POZ, here. 

PEPFAR Trumps Politics: U.S. Advocates Push to Save Global AIDS Funding

Global AIDS activists protest a U.N. High-Level Meeting on Ending AIDS.                                       Courtesy of Health Gap

February 22, 2017 • By Casey Halter

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The battle to save the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is already well under way, just one month after President Donald J. Trump’s inauguration and his almost immediate reinstatement of the country's global gag order on foreign funding for comprehensive sexual health services.

The global gag rule, also known as the Mexico City Policy, is a Reagan-era executive order originally announced in 1984 (at the 2nd International Conference on Population in Mexico City) which restricts any foreign nongovernmental organization, or NGO, that receives U.S. funding from using any money to provide abortions, refer their clients to abortion services or advocate for women’s right to choose in their own countries.

Since then, the controversial rule has become a political volleyball between the Republican and Democratic parties. The rule was rescinded by President Bill Clinton in 1993, reinstated by President George W. Bush in 2001 and once again revoked by President Barack Obama via executive order in 2009.

Therefore, when President Trump reinstated the rule on his first day in office in
2017, it didn’t exactly come as a surprise to those working in the global health services arena. So why are AIDS advocates up in arms about it?

A deeper look into the president’s day 1 executive order reveals some highly unsettling potentialities for the future of global AIDS funding.

Below, we break down Trump’s iteration of the global gag order — and detail how the efforts of politicians, celebrities, activists and citizens can ensure that the groundbreaking PEPFAR does not get cut by the new administration.

***

“The conditions of the global gag rule are even more stringent now than they were in past iterations of it,” says Diederik Lohman, acting director of the Health and Human Rights Division at Human Rights Watch (HRW), one of several international advocacy organizations that have spoken out over the last few weeks in support of PEPFAR.

Advocates like Lohman are quick to point out that before now, the Mexico City Policy had never been applied to any U.S. money set aside to combat HIV/AIDS. However, on January 25, President Trump signed what appears to be an amped-up version of the Reagan-era order that global health advocates worry could vastly expand its reach to a wide array of health care programs—including PEPFAR, family planning service providers and women’s health clinics around the world.

While it is still largely unclear how the program will be affected under the new administration, many organizations, including The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), The Bill and Melinda Gates Foundation, The Elizabeth Taylor AIDS Foundation (ETAF), Housing Works, Until There’s A Cure and the Elton John AIDS Foundation (EJAF), among others, have already spoken out on social media to demand its continued funding.

Here’s why: According to Lohman, past versions of the Mexico City Policy applied only to NGOs seeking to receive special U.S. family planning funding—about $600 million worth of foreign aid. But President Trump specifically changed the wording in his 2017 executive order to extend the abortion gag to all global health funding. That means $9.5 billion worth of foreign aid could now be subject to strict rules that allow the U.S. government to pull its support from any NGO that has provided so much as a referral to any woman seeking to terminate her pregnancy.

“We’re obviously really concerned about what it will mean for groups that are involved in HIV prevention work,” says Lohman, particularly since many of these organizations also provide comprehensive sexual health services and education to their clients. “It could also affect many programs that are not just involved in the provision of abortion services but much more generally in family planning and supporting women with sexual and reproductive health issues.”

The global advocacy community’s support of PEPFAR — which provides $15 billion in funding for HIV testing, treatment, prevention and health care to resource-limited countries every five years — hinges on the fact that the program has proved to be one of the most effective means of curtailing HIV/AIDS in the history of the epidemic. 

According to PEPFAR’s 2017 annual report to Congress, the global endowment initiative currently provides antiretroviral (ARV) treatment to an estimated 11.5 million people with HIV worldwide. Thanks to PEPFAR, nearly 2 million babies with HIV-positive mothers in developing nations have been born virus-free since the early 2000s, and nearly 220,000 health care workers have been trained to help combat the global AIDS crisis. The program has also been credited with a 51 to 76 percent decline in new HIV infections in countries like Malawi, Zambia and Zimbabwe.

“A significant reduction in funding for PEPFAR would have disastrous consequences for access to antiretroviral treatment,” says Lohman. “I think it’s important for organizations like Human Rights Watch to be looking at what happens as a result of this policy change and articulate what the consequences are in order to hammer home the message that this was a really ill-advised policy step.”

Trump’s order to broaden the Mexico City Policy to such an extent has also raised eyebrows within the Republican administration itself. The global HIV/AIDS program has traditionally enjoyed very strong bipartisan support in the U.S. government. In fact, the program was originally instated by President George W. Bush and approved by a Republican-led Congress in 2003. At the time, President Bush specifically exempted PEPFAR from Reagan’s global gag order, as it was widely understood—even in conservative Christian circles—that it would have been impossible to treat HIV/AIDS in the developing world if the abortion order were applied.

At the time, Vice President Mike Pence, then serving in the House of Representatives, vocally supported PEPFAR; he supported it again in 2008 when the program was reauthorized by legislators of both parties.

More recently, U.S. Senate Majority Leader Bill Frist (R-Tenn.,), a trained physician, published an op-ed in The New York Times, titled “The Case for Keeping America’s AIDS Relief Plan,” that specifically called on the new administration not to cut PEPFAR funding under the global gag order. In addition to laying out the program’s endless health benefits, Frist pointed out that distributing emergency aid to countries in crisis has conferred national security benefits in the form of increased stability (from 2004 to 2013, political instability and violence fell by 40 percent in countries that received PEPFAR assistance versus just 3 percent in similar countries that did not). 

Frist went on to call the program “the greatest humanitarian effort undertaken by the United States in more than 60 years.” 

“Being out in front of this and making sure that there is a critical mass of both Republicans and Democrats saying this is a piece of international work that we do not want to see touched is really important,” says Lohman, speaking on behalf of Human Rights Watch. “We’re obviously going to be monitoring how the discussions develop.” 

***

So what has President Trump said so far about PEPFAR and its relation to the global gag rule? Not much, according to other HIV advocates who since November’s election have also been watching closely for signs regarding the new administration’s plans for global AIDS funding.

“The last several months have been a very challenging and unsettling period,” says Mitchell Warren, executive director at the AIDS Vaccine Advocacy Coalition (AVAC), a New York City–based international nonprofit that works to accelerate the development of HIV prevention options to populations around the world. “Everybody within our agencies, within implementing partners, within the advocacy community, still don’t know what the details [of Trump’s global gag order] mean. No one knows how intentional the expansion was, and no one knows what enforcement will look like.”

On the campaign trail, Trump appeared to support the global AIDS program. Last summer, when asked at a rally in New Hampshire whether he would double the number of people receiving treatment under PEPFAR, the future president was quoted as saying: “Those are good things—fighting Alzheimer’s and AIDS. We are so close on some of them. On some of them, honestly, with all the work done, which has not been enough, we’re not very close. The answer is yes. I believe strongly in that, and we are going to lead the way.” 

That said, it is unclear whether Trump truly understood the question, as PEPFAR does not provide any international support for Alzheimer’s disease research or treatment. 

On another potentially positive note for the program, just before his inauguration, President Trump also announced that Ambassador Deborah Birx, the U.S. global AIDS coordinator and head of PEPFAR, was going to be one of the few political Obama appointees to remain at the helm of her governmental organization during the White House transition.

“That was certainly a ray of hope for us working in this field, because Ambassador Birx has done a remarkable job at reorienting the program and following the data,” says Warren. “The best sign we could get in the short term would be formally nominating her and appointing her to a full tenure as ambassador.”

Other auspicious signs from the new administration include praise for PEPFAR via Trump’s newly appointed secretary of state, Rex Tillerson. At the former Exxon Mobil CEO’s confirmation hearing, he reportedly called the program “a model for us to look to as we’re thinking about other ways in which to project America’s values.”

Tillerson’s statement also hints at a business agenda. As several recent global health studies have shown, PEPFAR not only saves lives but it’s also a really great strategy for promoting U.S. business interests in Africa.

However, HIV advocates like Warren have also witnessed a darker side to Trump’s approach to PEPFAR over the last few months, casting major doubt on the administration’s true intentions for the program.

As detailed in a New York Times report also published in January, transition staff sent out a series of leading questions to the U.S. State Department that seemed highly skeptical of the global AIDS program, asking, for example, “Is PEPFAR worth the massive investment when there are so many security concerns in Africa?” and “Is PEPFAR becoming a massive, international entitlement program?” 

“I’m not sure any of us do well trying to predict anything in the current environment,” says Warren when asked about predictions on where global AIDS funding is headed under President Trump. “But I can predict this: If we do not see the new U.S. administration provide sustained commitment and leadership to PEPFAR, we will not end the epidemic.” 

Regardless of what the Trump administration decides to do with the program, it’s clear that the United States faces a long road in its fight against global HIV/AIDS. According to the latest stats from the United Nations, an estimated 37 million people are living with HIV worldwide, and only 18.2 percent are currently receiving ARV treatment.

Meanwhile, global health advocates continue to argue online, to their local politicians and to their allies in Congress and the new administration: If President Trump does indeed want America to “lead the way” in ending the global HIV epidemic, keeping PEPFAR could quite possibly be the businessman’s best investment.

Read more articles from POZ, here.

Former Olympic Equestrian Cleared of Not Disclosing His HIV Status

Courtesy of Darren Chiacchia

In 2010, Darren Chiacchia was arrested in Florida, where it’s a felony to have sex without informing partners you have HIV.

February 22, 2017

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Former U.S. Olympic equestrian Darren Chiacchia has been cleared of all charges in Florida of having sex without disclosing that he has HIV. According to a press release by his attorney Paul Guilfoil, the prosecutors reviewed the evidence and decided to dismiss the case.

Chiacchia’s legal problems go back to 2009, when a man tried to have him arrested in New York, then Kentucky and finally Florida for allegedly not informing him that Chiacchia was HIV positive and thus exposing him to HIV. Failure to disclose is a felony in Florida.

The legal battles lasted several years. To complicate the situation, Chiacchia had suffered a traumatic brain injury after a fall from a horse in 2008, diminishing his ability to take care of himself.

“Chiacchia and many others fervently believe,” reads the press statement, “that no one should be the target of false criminal allegations or charges that rely upon antiquated and constitutionally over-broad punishment for any citizen—especially those who suffer from a disability making it difficult or impossible for them to defend themselves.

“Perhaps the only positive outcome of this tragic mess is the fact that Chiacchia has become increasingly active in supporting change to HIV laws. Across the country these statutes tend to discourage testing for and treatment of the virus. Medical science continues to improve the details of HIV identification and treatment.”

Read more articles from POZ, here. 

“Love Your Enemies”: Expanding Our Hearts Through Compassion

Image: Stock Photo from 123rf.com by hriana.

 “Love your enemies.”

 by Lindsey Paris-Lopez

February 20, 2017

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I’m reflecting on this, the hardest of Jesus’s commandments, as I grieve my own nation’s policies of war, exclusion, vengeance and cruelty, policies envisioned through the lens of enmity.

The lens of enmity warps our vision, inverting it so that the outside world is obscured by our inward fears. It contorts the human faces in front of us into monsters. It magnifies our own pain and obstructs that of others. It blinds us with lies.

Blinded by enmity, our nation terrorizes children out of playing outside on sunny days by flying death robots through the Middle Eastern skies. Blinded by enmity, we shut our doors to those whose countries we bomb with impunity. Blinded by enmity, we condemn children to school-to-prison pipelines. Blinded by enmity, we round up undocumented immigrants for deportation.

To truly contemplate how much of our policy is built on a perspective of enmity is both mind-numbing and heartbreaking. Over half of our discretionary budget is dedicated to defense – protection from “others” – despite the fact that investment in war robs from potential budgets that could promote peace and prosperity through education, infrastructure, and healthcare, despite the fact that war and war machines are rendering our planet uninhabitable, and despite the fact that war fuels the cycle of violence and hostility that further erodes our safety. Beyond war, militarized police and the prison industrial complex are hallmarks of a culture that builds and feeds upon enmity. Weapons are among the chief exports of the United States, which sells more instruments of death to more countries than any other nation in the world. Even international alliances are premised upon mutual enmity of others. Such a culture of enmity shapes a subconscious fear and distrust of our fellow human beings, brothers and sisters in God.

Enmity builds walls around hearts, around nations, forming constrictive identities. When we identify ourselves over and against others, we narrow the possibility of who we can be. We are all formed in relationship, but when that relationship is hostility and exclusion, we close ourselves off from learning and growing. Instead of letting others awaken ideas and understandings within us, opening our minds and hearts, we form identities over and against caricatures and stereotypes of people we don’t really know. We may also experience hostility on their part, mirrored back to us in the self-perpetuating cycle of enmity. It is a suffocating cycle, choking out room for love.

“Love your enemies.”

How is this possible?

I think the Sermon on the Mount, culminating in Jesus’s command to love our enemies, subtly reshapes our perspective of enmity by infusing us with compassion. Those on the underside of oppression are comforted by Jesus’s proclamation of blessing because it is assurance that there is no divine justification, no Godly ordination, of their suffering. God does not proclaim winners at the expense of losers, but instead extends love and mercy to the outcast and marginalized. In Christ, God directs our attention to the overlooked and discounted (and those of us who are among the overlooked and discounted are the most honored members of the body). By orienting us toward those who suffer – the poor, the meek, those who mourn – God calls us to more than recognition of their full humanity. God calls us to relationship. In relationship with those who experience oppression or marginalization, those of us who have advantage or privilege may come to recognize our participation in unjust systems and work for change, for reconciliation and restoration and peace on a foundation not of conquest, but of justice.

Those of us with white privilege, for example, would come to understand how generations of de facto segregation built upon the lie of white supremacy at the foundation of our culture influence a subconscious fear that fuels discrimination, a school-to-prison pipeline, and police shootings of African Americans as we build meaningful friendships across racial divides. We would see how a lifestyle of consumption leads to environmental racism as pipelines are built through poor, minority communities and pollution-producing plants are set up in areas that have little political or financial recourse. Friendships with refugees and immigrants might help us to understand how our wars on drugs or terror devastate communities and render nations dangerous or uninhabitable. Building friendships with those on the underside of our privilege not only helps us reflect on how we participate in systems of injustice, but also opens us to listening and learning so that we may find ways to live more just lives.

In the Sermon on the Mount, Jesus leads us from recognition of the victim in the Beatitudes to recognition of our own sin before giving us the command to love our enemies. When we can see how we participate in systems that harm others, we become more aware of our own need for forgiveness. This naturally leads us to an awareness of the need to forgive those who oppress or hurt us. An orientation of compassion leads naturally to self-reflection, repentance, and forgiveness. It helps us to love our enemies by helping us to see, and turn from, the ways in which we act as enemies.

When Jesus says, “Love your enemies,” I think he means, “Let love heal your enmity, so that you do not act as an enemy to others. Make a space of forgiveness so your enemies may become your friends.”

A reorientation from enmity to compassion would change everything. Contours of identity – be they color, gender, sexuality, nationality, religion, or ideology –  would no longer be walls of exclusion but threads that bind us together in the diverse and beautiful tapestry of humanity. Our hearts, long diseased by fear and distrust, would expand and heal in relationship and love.
A spirit of enmity is destroying us. Only following Jesus’s command to love our enemies can we be saved from our own hostility and brought to the fullness in which we are meant to live with each other and with God.

Read more articles from Patheos, here.  

PUT ON THE ARMOR OF LIGHT

Prayer Requests/ Praise Reports/Glorify the Lord

  

From: RAINBOW PASTOR DAVID

 

Tuesday, February 21, 2017

 

 

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"To ALL my LGBTQ brothers and sisters of faith, it is time to PUT ON THE ARMOR of LIGHT and FIGHT BACK AGAINST the EVIL AGENDA of the WHITE HOUSE and the "CHRISTIAN" RIGHT who think they are GOD'S VOICE. We know from reading the WORD of GOD, that GOD LOVES ALL HIS CREATION and HE will STAND with those who are being BULLIED and FIGHT WITH THEM. WE WILL BE VICTORIOUS against ALL HATEFUL LEGISLATION against the LGBTQ COMMUNITY that would try to DRIVE US into SILENCE. It is TIME FOR WAR ONCE AGAIN to KEEP OUR RIGHTS AND FREEDOMS as AMERICANS and HUMANS, who were CREATED in the IMAGE OF GOD!!!"

#TheResistance is RISING with a MIGHTY ROAR!!!

PUT ON THE ARMOR OF LIGHT. To wear this bright, protective covering, you have to put aside deeds of darkness. You live in a world where darkness is prevalent all around you. You need My Light-armor to help you see things clearly--protecting you from being led astray by the worldliness that surrounds you.

 

I want you to walk in the Light with Me. Make every effort to live close to Me, aware of My loving Presence. Just as you put clothes on your body, you can also clothe yourself with Me. Such nearness to Me will help you make good decisions. Sometimes, though, you will make bad choices that lead you into sin. Do not despair when this happens. Because I am your Savior, I have made provision for all your sin. Moreover, the blood I shed on the cross cleanses you and keeps you walking in the Light.

 

If you confess your sins, I forgive you and cleanse you from all unrighteousness. I am faithful and just, and I delight in your nearness to Me.

 

The night is nearly over; the day is almost here. So let us put aside the deeds of darkness and put on the armor of light. Romans 13:12

 

But if we walk in the light as He is in the light, we have fellowship with one another, and the blood of Jesus Christ His Son cleanses us from all sin. 1 John 1:7 (NKJV)

 

Rather, clothe yourselves with the Lord Jesus Christ, and do not think about how to gratify the desires of the flesh. Romans 13:14

 

If we confess our sins, He is faithful and just to forgive us our sins and to cleanse us from all unrighteousness. 1 John 1:9 (NKJV)

 

Blessings and Peace to all,

Rainbow Pastor David Moorman

 

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