HIVMA Key Advocacy Talking Points for Legislators
UPDATED: May 2018
Federal Funding for HIV Programs:
- For FY 2019 funding, support at minimum the FY 2018 funding levels for HIV/AIDS programs, plus:
- Increase of $24 million to Part C of the Ryan White program,
- Overall increase of $145.8 million to the Ryan White program,
- Increase of $95 million for CDC’s division of viral hepatitis to improve surveillance, screening, and prevention activities, including syringe service programs in response to the opioid epidemic,
- Overall increase of $303 million to CDC’s center for HIV, hepatitis, STD, TB prevention.
- Increase of $18 million to the HOPWA housing program at HUD.
- Urge Congress to reject the President’s budget request, specifically:
- Reject the $40 million cut to high-impact HIV prevention programs at CDC
- Reject the $34 million cut to eliminate AETCs in the Ryan White program
- Reject the $25 million cut to eliminate SPNS in the Ryan White program
- Reject the $170 million cut to the Minority AIDS Initiative
- Reject the $101 million cut to the Teen Pregnancy Prevention Program at HHS
- Reject the $45 million cut to the HOPWA program at HUD
- Tell your story: Describe how these federal programs support your work as an HIV provider or researcher and benefit your community and state.
- Download and share the full AIDS Budget & Appropriations Coalition FY 2019 request chart.
Ryan White HIV/AIDS Program:
- Tell your story: Describe how the Ryan White Program is important to your ability to provide cost effective comprehensive to patients without other sources of coverage and explain how this also benefits public health.
- HRSA’s Ryan White HIV/AIDS Program is a highly success public health program that provides comprehensive, multi-disciplinary care and improves health outcomes for people living with HIV.
- From 2010 to 2016, viral suppression increased among Ryan White patients from 70 percent to 85 percent, and racial/ethnic, age-based, and regional disparities have decreased. These figures are higher than the national average.
- While 80% of Ryan White clients have some type of health coverage, two-thirds of clients live at or below the federal poverty level, and without support face barriers to necessary services.
- Most insurance coverage does not key cover services that are important to people living HIV accessing and coordinating services. The Ryan White program fills in these gaps by paying insurance premiums, other cost sharing for health services, medications and case management to provide coverage completion.
- Maintaining access to HIV care and treatment is critical for people with HIV to stay healthy and suppress the level of the virus in their body to undetectable levels. Once detectable their risk of transmitting the virus drops to virtually zero.
HIV Research at the NIH:
- Tell your story: Explain the role of NIH-supported research in advancing HIV prevention, care and treatment and the impact of flat funding or cuts in HIV research funding.
- A decade of flat funding imperils discovery of the next game-changer in HIV research. Key priorities and opportunities include: Developing a vaccine and cure, improving implementation on the ground to better reach key populations, addressing health disparities, expanding prevention options for women, and responding to HIV & aging.
- How does NIH-supported research support the HIV workforce? These funding opportunities play a critical role in attracting and retaining physicians in infectious diseases and HIV. Without sustained funding, we will not have a new generation of infectious diseases and HIV researchers to continue to advance the field. Restricting research opportunities now will have a long-term impact on our country’s ability to prevent and treat deadly infections by limiting research discoveries and eroding infectious diseases workforce capacity.
Access to Healthcare Coverage:
- Tell your story: Explain how increased access to healthcare through Medicaid expansion and/or insurance marketplaces has improved the health outcomes of your patients.
- Protect access to affordable, high-quality and comprehensive health insurance and set aside legislative and administrative efforts that will destabilize the insurance non-group insurance market and result in increased premiums and cost sharing, reduce protections for people with pre-existing conditions, and increase the number of uninsured.
- Effective treatment improves not only individual health but reduces transmission of HIV to others, an important strategy to end the HIV epidemic.
- Prior to the Affordable Care Act, many people living with HIV were denied healthcare coverage or it was unaffordable. In most states, people with HIV did not qualify for Medicaid coverage until they became sick and disabled by AIDS.
- Tell your story: Explain how the opioid epidemic has impacted your clinic, your practice, the needs of your patients, and innovative ways that you bring people into care.
- CDC estimates that more than 220 counties in the U.S. are at risk for HIV outbreaks linked to injection drug use. A fully comprehensive response to the opioid epidemic addresses overdose mortality in addition to substance use and addiction treatment, mental health services, and prevention and treatment of opioid-related complications like infectious diseases.
- Expanding access to all effective prevention interventions, including syringe service programs, safe consumption sites, and comprehensive HIV, viral hepatitis and STI screening is important to reduce the spread of HIV and other infections among injection drug users. Funding to the CDC must be significantly increased and made flexible so that evidence-based strategies can be deployed locally to respond to the variety of infections due to opioid injection.
- We need better surveillance that improves detection and response to injection-related infections. Additional funding is necessary for local public health departments to improve surveillance and identify communities at risk, ensure those at risk get tested and diagnosed with HIV, viral hepatitis, endocarditis, and other infections are connected with treatment resources.
- Additional resources are needed to build medical workforce capacity to directly address opioid-related infectious diseases. Expanding telemedicine will improve access to expert HIV, hepatitis C, and other infectious disease prevention, treatment, medication for addiction treatment, etc. Increased funding to expand training and education for medical providers on the frontlines, including ID specialists, is necessary to support the integration of holistic care for people needing treatment for substance use disorders and related infectious diseases.
HIV Medical Workforce:
- Tell your story: Explain why you became an HIV clinician or researcher, and the barriers to a well-trained and compensated workforce.
- Who is the HIV medical workforce? Infectious Diseases-trained physicians are the largest specialty represented among HIV medical providers representing 60% of the workforce. Internists, family medicine and other specialists also are critical to the HIV workforce. Physician assistants and nurse practitioners play an increasingly important role providing care to people living with HIV.
- Despite a growing number of people living with HIV, since 2011 there has been a decline in the number of physicians applying for ID fellowship program slots with nearly one-third of ID training programs going without fellows in 2016. Two issues discouraging residents from pursuing infectious diseases specialization are lower salaries relative to other physician specialties and high debt burden from medical school.
- CDC predicts a serious shortage of HIV medical providers relative to increased demand by 2019.
- Current reimbursement methodologies undervalue cognitive care relative to procedural-based care. A re-evaluation of reimbursement methodologies for evaluation and management services is needed along with targeted loan forgiveness for ID/HIV medical providers working with underserved patient populations, including those affected by hepatitis C, HIV and the opioid epidemic.
- Why does Medicaid matter for people living with HIV?
- Download and share this infographic on Medicaid’s role for people with HIV.
- Maintaining the federal commitment to the Medicaid program is critical to the more than 40% of people living with HIV in care who count on program for their healthcare coverage.
- Prior to the Medicaid expansion many people with HIV were not eligible for Medicaid coverage until they were sick and disabled by AIDS, no matter how poor they were.
- Most Medicaid beneficiaries who are able to engage in some form of work, attend school or care for a family member. Even with exceptions many of people who may be exempt from work requirements are likely to fall through the cracks due to administrative errors or challenges navigating the bureaucracy. People with HIV depend on Medicaid and access to healthcare in order to stay healthy and to be able to work. Jeopardizing their coverage is counterproductive and will cost more over the long-term.
- Tell your patients’ story:
Other Sexually Transmitted Infections:
- Download and share this infographic showing the national burden of STDs. You can also create our own state-specific infographic with CDC’s resources here.
- There is an urgent need to mount a much more aggressive response to the unprecedented rise in rates of STD cases across the country. The CDC reports that in 2016, there were 1.6 million cases of chlamydia, 470,000 new cases of gonorrhea, and almost 28,000 cases of primary and secondary syphilis.
- This STD crisis should be declared a national public health emergency. We will not be able to curtail these epidemics without a significant boost in the resources to stop the spread of STDs and enhance our preparedness for emerging threats such as drug-resistant gonorrhea.
- Support an FY 2019 budget request for a $50 million increase in STD funding to provide a jump-start for state and local health departments. Federal funding for State and local public health infrastructure and personnel is insufficient to allow for the necessary follow-up and partner services for the more than two million new STD cases, including HIV, that are reported annually.
- Download and share this fact sheet on the intersection of HIV and viral hepatitis.
- Between 2011 and 2014, there was a 250% increase in reported new hepatitis C infections, predominantly driven by increases among young white adults in rural areas with a history of injection drug use following use of oral prescription opioids
- What does viral hepatitis have to do with HIV? About a quarter of all people living with HIV are co-infected with hepatitis C. Because CDC is so under-resourced in the Division of Viral Hepatitis, a lack of effective surveillance, screening, and other prevention activities have hampered our ability to successfully address viral hepatitis and co-infection with HIV.
- There is a cure for hepatitis C, but too few have access to treatment. High drug costs and poor policies are restricting access to this life-saving treatment. Arbitrary coverage restrictions, such as requiring that a specialist provider be the treatment prescriber and requiring that patients are sober at time of treatment, are not supported by the latest science or treatment standards. Expanding access to hepatitis C treatment is important to prevent disease progression and death and to stop transmission. By limited access to treatment, we won’t be able to reverse current trends or effectively prevent new large-scale outbreaks.