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GLAA submits testimony on HIV/AIDS Administration
GAY AND LESBIAN ACTIVISTS ALLIANCE OF WASHINGTON
Fighting for Equal Rights Since 1971
P. O. Box 75265
Washington, D.C. 20013
March 17, 2005
The Honorable David Catania
Chairman
Committee on Health
Council of the District of Columbia
1350 Pennsylvania Avenue, N.W.
Washington, D.C. 20004
Dear Mr. Catania:
Please let this letter serve as the official statement of the Gay and Lesbian Activists Alliance of Washington, D.C. (GLAA) for the record of your committee’s March 17, 2005 Oversight and Performance hearings for the HIV/AIDS Administration (HAA). I regret that I am unable to present this statement in person.
HAA’s Website
Since the oversight hearing on March 3, HAA has made a significant step forward in creating a website (http://dchealth.dc.gov/about/index_hiv_services.shtm), with the technical help of the Office of the Chief Technology Officer (OCTO). We appreciate all that you and your staff have done to make this a reality. The lack of an HAA website, on the otherwise extensive District of Columbia site was representative of the secrecy that has permeated the agency over the past decade. This site is an excellent symbol of the new openness in that office. We look forward to the continued expansion of the site, and greater openness and accountability of HAA’s activities.
Contract Compliance and Oversight
Under the previous HAA administration, there was a complete lack of contract compliance and oversight. While every dollar has to be accounted for, there is no corresponding accountability of the utilization, effectiveness, or suitability of programs funded by HAA grants and contracts.
We see this particularly in the prevention efforts. A GLAA member who attended Whitman Walker’s G-Net programs "Cookies and Sex," and "Sacred Sexuality" found the sessions worthless and sparsely attended. Us Helping Us has run ads targeting men on the "down low" in gay newspapers. The down low, or DL, in this context refers to men who have sex with men but who do not identify as gay, while usually also having a wife or girlfriend. This is a group that clearly needs to be targeted for prevention efforts, but advertising in gay newspapers has to be among the least cost-effective means of reaching people who shun the gay community. These are only two examples of poorly conceived and planned programs, and I don’t mean to suggest that those health organizations are any less effective than others.
While HAA grantees and contractors may have effective prevention efforts, we have no evaluation of their programs, their efficacy, utilization, or evidence that they in fact prevent transmission of HIV. We simply don’t know, because we haven’t tried to find out.
Similar performance evaluations need to be made of all contracts and grants. Without evaluation, we simply don’t know what works, and what should we should spend money on and what we should abandon. Program evaluation should be a required part of every contract, and a priority for Lydia Watts and HAA.
Prioritizing Targeted Populations for Prevention
In September of 2003, an objective analysis of target populations prioritized prevention needs. This analysis strikes us as entirely reasonable and appropriate.
|
Population |
Rank |
|
Injection Drug Users |
1 |
|
Black Heterosexual Females |
2 |
|
Adolescents and Young Adults |
3 (tie) |
|
Black MSM |
3 (tie) |
|
Black Heterosexual Males |
4 |
|
White MSM |
5 |
|
Latino, Asian and Pacific Islander MSM |
6 |
|
Pregnant Women at-risk / HIV-Positive |
Sub-target of heterosexual women |
|
Persons Living with HIV/AIDS |
7 |
|
Latino Heterosexual Females |
8 |
|
Latino Heterosexual Males |
9 |
|
Older Adults |
10 |
|
Special Populations |
|
|
Incarcerated/ex-offenders |
1 |
|
Commercial Sex Workers |
2 (tie) |
|
Transgendered Persons |
2 (tie) |
|
Immigrants |
3 |
|
Blind & Disabled |
4 |
|
Deaf & Hard of Hearing |
5 (tie) |
|
Homeless |
5 (tie) |
|
Chronically Mentally Ill |
6 |
Source: District of Columbia HIV Prevention Two Year Plan 2003-2004
[http://dchealth.dc.gov/services/administration_offices/hiv_aids/pdf/Section4_Prioritization.shtm]
However, "The CDC's 2003-2008 HIV Prevention Community Planning Guidance requires that HIV prevention community planning groups ‘prioritize HIV-infected persons as the highest priority population for appropriate prevention services.’"
This interjection of political objectives into the process distorted the actual community needs. HAA, while not violating federal funding requirements, needs to find ways to continue to target those populations that are objectively most in need.
Injection Drug Users would be best served with a fully funded needle exchange program, but while the Congressional funding ban remains in place, educational, health, and outreach programs could be better funded.
Lydia Watts appears to be taking action to better address prevention efforts in the Heterosexual Black Female population. In the same fashion, more emphasis needs to be directed towards the transgender community.
Transgender people in D.C. are disproportionately poor and outside of our health care system. Incidence of HIV infection is greater than 25%. Prostitution is a not uncommon profession as discrimination and sex-transitioning keeps many transgender people out of stable employment. This is a serious HIV transmission vector that has been largely overlooked, and downplayed by HAA because of the relatively small number of transgender people. HAA must make medical care for transgender people a priority. This will bring transgender people into the mainstream of medical care and access and reduce a major HIV transmission vector.
Funding Priorities
The AIDS Drug Assistance Program (ADAP) is a crucial program to ensure that people who are under 400% of the poverty level, but who do not qualify for Medicaid, can get the lifesaving medications that they need. We are quite fortunate that there is not a waiting list to get access to these medications. No one should have to wait to get these crucial medications.
In the past year, we have finally implemented the 1115 waiver, which allows approximately 240 of the 1500 people currently enrolled in ADAP to qualify for Medicaid. It is unclear how we can better utilize the expanded capacity in ADAP. While we may eventually have more people in need of ADAP, we need a short-term plan. It would be quite acceptable to return the unused funds to the federal government and receive less in the future if that meant that ADAP waiting lists in other parts of the country could be eliminated or at least reduced. Alternatively, we could try to identify more people that are eligible but not yet enrolled, change the eligibility to allow more people to qualify for the program, or expand the number of drugs in the formulary. A removal of the restrictions on Fuzeon would be particularly important as it is a crucial drug for people who have exhausted other antiviral medications. [http://dchealth.dc.gov/services/administration_offices/hiv_aids/pdf/ADAP_Drugs_Available.shtm]
We need to be sure that we have appropriate funding priorities.
- Medications and medical care, such as doctor visits, and laboratory tests should be our top priority. That is what will keep people alive.
- Basic needs, such as food and housing are likewise important, but they also have other funding sources.
- Home healthcare has been severely lacking in D.C., and that is an area that needs to be addressed.
- Prevention, especially needle exchange programs, is important, but as discussed above, we need to evaluate what works before spending more money in this area.
- We do not need to spend our limited funds on massages, and other "holistic" services at the expense of pressing needs. Massage is very nice, and I enjoy it, but no one should be getting a free massage when others need medicine and medical care.
Failure to spend the appropriate federal funds that we have is a serious problem that need intensive oversight and accountability. The more than $3,000,000 that needed to be returned last year is unconscionable. If we really can’t use it, then we shouldn’t tie it up and deprive other areas from providing medicine and medical care from others.
Cost Savings
D.C. needs to take advantage of all of the federal dollars that we can to provide the best possible care to as many people as possible. Here are two programs of which we are not taking full advantage.
Presumptive Supplemental Security Income (SSI) based on HIV infection is an underutilized, federally funded program run by the Social Security Administration. It provides eligible applicants with a time limited (6 months) cash benefit of $564 a month as well as access to full Medicaid benefits. The program is designed to provide income to people who are applying for SSI coverage and who exhibit clear signs of HIV related disability. This benefit is provided to help ease the financial burden created by the often lengthy SSI application and approval process. Currently, people with HIV who are in the process of applying for SSI are being directed to the city's Interim Disability Assistance program (IDA). IDA provides a much smaller benefit and, as opposed to Presumptive SSI, it has to be repaid. IDA is further limited in comparison to Presumptive SSI because it doesn't provide Medicaid coverage. Even worse, IDA is funded by 100% local dollars and is under constant financial pressure. The District has a vested interest in increased utilization of Presumptive SSI. More people using Presumptive SSI means fewer people on IDA. This could help to relieve the financial stressors that impact the IDA every year. The District's Income Maintenance Administration should negotiate with the Social Security Administration to increase the use of this program.
Medicaid Prescription drug pricing does not take advantage of the District’s unique non-state status. Currently the District's Medicaid program receives the typical Medicaid rebate for prescription drugs. The District, however, has an important and underutilized advantage over other jurisdictions. The District has the ability to purchase prescription medication through the Department of Defense (DOD), which is afforded the lowest drug prices in the U.S. This is a significant bargaining chip that should be leveraged by the Medical Assistance Administration to negotiate for much larger discounts and higher rebates. The District, for example, could tell manufacturers that if it doesn't receive a lower rebate then it will pick the 10 most expensive drugs most commonly distributed under the program and purchase them through the DOD. Savings from using the best-price practices of the District's Medicaid program should be redirected into better use of HIV primary care or in the development of new Medicaid waivers.
GLBT Health Coordinator
Although we do not yet know what the newly created position of GLBT health coordinator is expected to do, an advocate and point person in a service agency such as the Department of Health potentially could do some good, much as the Metropolitan Police Department’s Gay and Lesbian Liaison Unit has had an enormous positive impact on the community and the police force. However, Ivan Torres, recently appointed to this position, should have long ago been fired from HAA for the gross incompetence and outright criminal activities in HAA under his leadership. Torres has repeatedly obstructed and lied to GLAA for many years. Firing Torres would be the final step in cleaning out the corrupt leadership of HAA.
Conclusion
While there is still much work to be done, we are very pleased with the recent creation of the Committee on Health, and the selection of Councilmember David Catania as chair. The aggressive oversight of the Department of Health—and the HIV/AIDS Administration in particular—is a much needed breath of fresh air. We are also pleased with the appointment of Lydia Watts who, while still learning the intricacies of the system, has made numerous positive steps to improve HAA and make it responsive, open and accountable to the community.
Sincerely,
Bob SummersgillTreasurer and Health Policy Advocate
