ABA HIV/AIDS Law and Practice Conference Offers Latest Trends in Legal and Policy Issues
The fifth ABA HIV/AIDS Law and Practice Conference brought together healthcare providers, case workers and social service professionals and lawyers to discuss how HIV-related law and policy affects their work. The following are selected highlights from the two-day event, which took place in Orlando, Fla., in conjunction with the American Bar Association 2010 Midyear Meeting.
AIDS approaches 30
Best of times, worst of times characterize efforts toward prevention, diagnosis, education, care and treatment
Fresh from his first meeting as executive director of the newly formed Presidential Advisory Council on HIV/AIDS, Christopher Bates spoke to the audience of AIDS activists, social workers and lawyers involved with issues during the fifth HIV/AIDS Law and Practice Conference in Orlando, Fla., on Feb. 3. He delivered messages of both hope and concern about the nearly 30-year-old AIDS epidemic. The conference is taking place in conjunction with the 2010 Midyear Meeting of the American Bar Association.
Bates, who is also the director of the Office of HIV/AIDS Policy in the U.S. Department of Health and Human Services, called this a difficult time, noting that although the country has a “great president…with all this movement forward,” Bates pointed to “war on two fronts, bailouts left and right, Americans unemployed” as causing a constraint on resources. And, he noted, “As the AIDS epidemic approaches 30 years, we really don’t have the final fixes, despite all the advances. [There are] incredible hills to cross in terms of HIV prevention.”
Bates shared his excitement about the development of a national strategic plan for AIDS and asked, “Can we bring about real change?” He said that he hoped that the plan would become an action document rather than one that collects dust. The plan is based in part on more than 20 town hall meetings – some conducted by the White House, some by his office – to gather feedback from communities across the country. He also mentioned the need for various government offices including Housing and Urban Development, Health and Human Services, plus the Departments of Labor and State to begin talking about HIV/AIDS with each other.
Testing of pregnant women, new treatment guidelines, removing the ban on HIV positive travelers and immigrants, and establishing the Institute of Medicine’s National Program for Hepatitis B and C were examples he cited as steps forward in the HIV/AIDS movement.
Much remains to be done
To broad chuckles, Bates said, “Sex is happening in America,” calling for comprehensive testing for people ages 13 to 64 because of the realities of what’s going on. “We need to get in front of this epidemic.”
To more laughs, he acknowledged that age 64 seems a bit arbitrary as the limit for sexual activity. “We are leaving out a whole bunch of folks. Didn’t we think there was going to be some consequence from Viagra?” Then, he noted the crisis of pregnancies among very young teens, who are often the victims of what amounts to statutory rape, given the ages of their older partners. ”Exhorting his audience to help move stigma away from the epidemic, he recommended making testing a routine part of diagnostic activities for people who want to know their complete health status. He acknowledged that many community health centers still do not test, nor do they provide care and treatment of those infected. In contrast, those centers receiving the recently extended Ryan White Act funds are doing the best job. “They are getting it; they are doing it,” said Bates, calling for a policy that would get others to improve testing and treatment too.
Beyond normalizing AIDS testing, Bates encouraged his colleagues to talk about it with a larger audience. He shared his experiences wearing the red AIDS ribbon. “At least once a month someone says, ‘I thought the cancer pin was pink?’” When that happens, he said, he seizes the teachable moment to tell them it stands for AIDS, explaining his role in helping to address the AIDS crisis.
Bates congratulated his colleagues on their hard work, but recognized the difficulty of their task and the hardships of the current economic climate. “The future does not look good. I wish I could paint a rosy picture.”
Health is a social justice issue, Dr. Georges Benjamin, executive director of the American Public Health Association, told participants at the fifth HIV/AIDS Law and Practice Conference, Benjamin explained that the issue encompasses public health matters, adequate insurance coverage, quality concerns and access to health care.
Benjamin talked about looking at health care on a population-wide basis, rather than individual basis, emphasizing that 16 percent of the country’s gross national product – $2 trillion – is consumed by health care.
Yet, he noted, for all that expenditure – sometimes twice as much per capita as other industrialized countries – the United States has some of the poorest results on certain quality of care indicators that other nations view as important, according to a study from the Commonwealth Fund. “We also have access problems, less provider availability, and we promote sick care versus well care,” he said.
According to Benjamin, the United States is the only industrialized nation in the world that does not guarantee health insurance as a matter of course. There are at least 46 million uninsured and another 16 million who are underinsured. And, he reported, studies have shown that coverage matters. For example, adults without insurance are less likely to be able to manage chronic conditions. Benjamin, a former emergency room doc said, “ERs are not the place to go for chronic care…if you had an arrow in your chest—we’re the place to go. [ERs] are the safety net for really sick people”
Not wishing to oversimplify the problem or the solution, Benjamin acknowledged, “Achieving individual health is a complex process,” and he said there are many factors that determine well-being, including genes and environment, as well as socioeconomic status, education and geography.
Benjamin broadened the discussion of health impact to a larger conversation of social justice, including equity and fairness, personal security and even national security. Good public health requires investment in prevention and moving from a sickness system to a wellness system. Good public health decisions, based on science, create community benefits and reduce morbidity and mortality. “We cannot fail,” he said. “The goal is to live a long, healthy productive life and have a very short, glorious ending.”
CDC leader outlines social and structural interventions against HIV/AIDS
Representing the Centers for Disease Control and Prevention at the fifth HIV/AIDS Law and Practice Conference in Orlando, Fla., Janet Cleveland, focused on evidence-based approaches and prevention as primary strategies for combating AIDS, particularly in communities most hard-hit by the epidemic.
Cleveland, deputy director HIV/AIDS Prevention at the CDC, told participants, “Prevention works and prevention is cost effective.”
Yet, she noted of the $24.8 billion currently available for HIV/AIDS care, research assistance and prevention, only 4 percent is allocated to prevention. “Imagine what we could do if 20 percent of the budget was devoted to prevention?
She outlined the accomplishments of the CDC’s expanded HIV testing intervention in 2007-2010, a program that has tested more than 1.4 million people. The intervention program identified more than 10,000 new cases with 80 percent of those cases now linked to care. In addition, the intervention supported the integration of HIV, STD, Hepatitis and TB prevention and identification efforts, according to Cleveland.
Recent social and structural interventions by the CDC, she said, include community-based, culturally sensitive social marketing campaigns to reach at-risk populations. Since the federal ban on needle exchange has been lifted, the CDC is working under the auspices of the Department of Health and Human Services to provide guidance on how to best use this particular strategy as part of its overall HIV prevention efforts. Further, the CDC is looking at the correlation of poverty, unemployment and homelessness to HIV status.
Although the CDC has found social and structural interventions have been effective, the fact remains that every 9.5 minutes someone in the U.S. is infected with HIV, leaving a huge education and prevention task ahead for public health officials and health care providers, she said.
Cleveland concluded by asking the audience what “laws, policies and regulations are needed to ensure a positive environment for HIV prevention?” She pointed out that the scope of affected areas is broad that encompasses equal access to employment, housing, education and public accommodations, as well as the decriminalization of HIV transmission, sex education in schools, HIV testing and testing in correctional institutions.
Multidisciplinary medical-legal partnerships help patients face various challenges
Dr. Barry Zuckerman, Boston pediatrician and passionate advocate for children at risk, highlighted the Medical-Legal Partnership program he founded 17 years ago at the recent HIV/AIDS Law and Practice Conference on Thursday during the ABA Midyear Meeting in Orlando, Fla.
Medical-legal partnerships team physicians and lawyers to help address problems that good medicine alone cannot solve. These partnerships may involve securing stable housing, supporting development of individualized education plans, navigating Medicaid, or resolving tenant/landlord disputes that affect an individual’s health, as examples.
For the assembled audience of lawyers, physicians, social workers and others involved with HIV/AIDS work, Zuckerman shared how the idea had first originated to bring lawyers into the health care setting. Nearly two decades ago, he expressed his frustration with a particular child’s case to a lawyer friend, who then asked, “What does the law say?” And that simple question forced him to admit he didn’t know what the law said, nor had he realized that the “law could be helpful to prevent people from falling through the cracks.” That simple exchange led to a powerful movement joining doctors and lawyers. Today there are more than 200 medical-legal partnerships throughout the country.
While most of these partnerships originally focused on children’s issues, quite a number have evolved to address chronic health conditions, including HIV/AIDS. For instance, in Albany, N.Y., the Albany Law School Health Law Clinic brings together the law school with Albany Medical Center, St. Peter’s Hospital and New York Oncology and Hematology. Through faculty-supervised representation of clients living with or affected by cancer or HIV, participating students acquire a broad range of practical lawyering skills while helping clients access necessary health care, obtain public benefits, secure or maintain stable housing, establish court-approved emergency plans for the future care of children and develop proxies that authorize health care agents to make health decisions.
In conclusion, Zuckerman outlined the impact that poverty has on every aspect of a child’s future from inadequate nutrition to increased stress that later could result in higher rates of cardiovascular disease, diabetes or depression.
But he is confident that teaming young lawyers and young physicians in partnerships for children at risk will help seed the pipeline for support among tomorrow’s medical and legal leaders. “Over time, as young doctors and young lawyers work together, down the road, when some of these lawyers become partners, we can really have an impact,” he said.
Ashe-Goins speaks at ABA HIV/AIDS law conference
Frances Ashe-Goins, the acting director of the Office of Women’s Health in the U.S. Department of Health and Human Services, says there must be help and health policy for women that enables them to “strive and survive.”
Ashe-Goins brought her powerful message to the closing dinner of the ABA AIDS Coordinating Committee’s HIV/AIDS Law and Practice Conference. A registered nurse, health educator and policy analyst, Ashe-Goins has worked on HIV issues since 1983.
While HIV is farther down on the list of causes of death in women, it cannot be ignored, Ashe-Goins stressed. It cannot be ignored because there are 1.8 million women experiencing domestic violence each year, and there is a link between violence and low self esteem, and the ability of abused women to ask their partners to use condoms.
Ashe-Goins said there needs to be a change in the way HIV-positive female victims of domestic violence are treated. She shared the story of a woman who went with her child to a domestic violence shelter in Washington, D.C., but when workers discovered the mother was HIV-positive, they refused to continue sheltering the woman and her child.
Services that provide help for HIV-positive people and victims of domestic violence must “work together to eradicate prejudice,” continued Ashe-Goins, and HIV-positive women continue to struggle with the question, “Will my children be taken away from me?”
Ashe-Goins also suggested that women would be better served if they could get all of their health care issues addressed in one place so they didn’t have to worry about seeing multiple doctors at various facilities on different days, making it more difficult to travel to and keep many appointments.
In addition, she said that since most women make the health care decisions in their families for their children and typically for their male partners, there need to be programs that deal with family needs.
“We can’t just leave it up to the women. We must get men involved. … We’re all in this together.”