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AIDS and HIV

LA LGBT Center and LA County delay STD disaster

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It’s right there on the front page of the Los Angeles County Department of Public Health website in Director Dr. Barbara Ferrer’s welcoming message. “Public Health is committed to reducing health disparities through collaborations with a wide-range of partners. The Department strives to support policies, practices and programs that lead to healthier environments,” Ferrer writes.

But Ferrer’s behind-the-scenes contract maneuvering is threatening to sicken the LGBTQ community during burgeoning epidemics of sexually transmitted diseases (STDs). For over a year, the Public Health director and her team have been negotiating with the Los Angeles LGBT Center to provide continuous free STD and HIV testing, with the Division of HIV and STD Programs encouraging “sexually active people to get tested every 3 months.”

But on Jan. 27, the Center went public with what they claimed was Ferrer’s disingenuous defunding of their vital free core testing services, contrary to explicit orders from the Board of Supervisors last year to maintain and even expand STD services to at-risk communities.

Additionally, in a surprising break with public health precedent, after the new contract was issued, the Department of Public Health (DPH) announced that it will invoice community health partners for the County’s own lab costs. And, insult upon injury, they were told they would not be reimbursed for expenses going back to Jan. 1, 2020.

“For the Center, this means an additional $1.5 million of unfunded care that decimates almost the entire amount of funding provided by DPH,” the Center said in an angry press release. “This means the end of almost all free testing for gonorrhea, chlamydia, and syphilis at the Center, impacting an estimated 15,000 people.”

“At a time when all of us should be redoubling efforts to end these epidemics, the Department of Public Health and Dr. Ferrer are turning their backs on the LGBT community and their duty to protect the public health of all Angelenos,” Los Angeles LGBT Center CEO Lorri L. Jean said in the Jan. 27 press release. “We demand the Board of Supervisors take immediate action to restore care to those who need it most.”

“We do more testing and treatment work than all the County-run public health clinics combined and they are not required to hold bakes sales to cover costs. We are,” Center Chief of Staff Darrel Cummings, a longtime LGBTQ healthcare expert, tells the Los Angeles Blade.

At loggerheads over negotiations, the Center felt forced to pull the plug on free testing.

“As a result, starting tomorrow, the County will be responsible for ending almost all free STD testing at the Center, causing tens of thousands to go untested, undiagnosed, and untreated. This includes eliminating thousands of free HIV tests funded by DPH. At a time when we’ve made so much progress in the fight against HIV, this represents a direct assault on the LGBT community by DPH and Dr. Ferrer,” said Jean.

 Graphic of LA County Department of Public Health STD data courtesy Los Angeles LGBT Center

This was no mana-a-mana standoff. Using the County’s own data, the Center reported that “[o]ver the last five years, there has been a 98 percent increase in primary and secondary syphilis; 81 percent increase in gonorrhea; and 25 percent increase in chlamydia cases in Los Angeles County. Alarmingly, the epidemic disproportionately impacts communities hardest hit by health inequities and stigma, including young gay and bisexual men, women, people of color, and transgender people.”

“The ripple effect of the thousands of people who will now go untested and untreated will have dangerous repercussions for the LGBT community and all of Los Angeles,” said Dr. Ward Carpenter, the Center’s co-director of Health Services. “As funding cuts choke off these services, STD cases in Los Angeles will soar and it will cost millions of additional dollars in testing and treatment. These changes are short-sighted, dangerous to the public health, and bad for the taxpayers of Los Angeles County.”

One problem seems to be that Ferrer apparently has no cultural competence, as if she’s the Betsy DeVos of public health. She seems unaware that healthcare services provided by the Center and other LGBTQ/AIDS institutions exist because the need is great but minorities often do not trust government and government often ignores morality-laden problems mainstream society considers icky and controversial.

Two dozen supporters stand in front of the Gay Community Services Center, circa 1974. Courtesy of the ONE National Gay & Lesbian Archives at the USC Libraries.

Officially rejected as criminals by the federal and state governments, stigmatized LGBTQ people found ways to take care of themselves and each other after Stonewall and Gay Liberation. For instance, it was Hugh Rice, head of the LA Gay Community Center’s STD Clinic, who in 1979 first discovered what would turn out to be AIDS in gay men lined up for their antibiotic STD prevention shots.

                      (Screen grab of AIDS story in Frontiers Magazine)

But unlike the usual gay bashings and grating ugly discrimination, AIDS was mysteriously fatal. Third District Supervisor Ed Edelman fought for County funding as AIDS decimated LA gays but it took ACT UP/LA to scream and rudely protest to get funding to help dying friends, lovers and family members a decade later.

               ACT UP/LA protesters (Photo by Karen Ocamb)

Ferrer seems to have no concept of that history nor ongoing societal discrimination – nor does she seem to care. How else explain her flouting HIV and STD Programs Director Mario J. Perez’s analysis and recommendations in his Oct. 9, 2019 memo regarding the County’s 2018 STD Snapshot?

For instance, his memo says methamphetamine use, “which is associated with sexual behaviors that increase risk for STDs, may be a driving factor in LAC’s STD epidemic.” His first recommendation: “Improve early detection of cases through testing of at-risk populations.”

“We have been trying to work with Dr. Ferrer and DPH for more than a year to find strategic solutions to these issues. We have been sounding the alarm, yet, even as the devastating impacts of these funding changes became apparent, Dr. Ferrer has refused to meet with us directly. The Board of Supervisors needs to act immediately and take responsibility where Dr. Ferrer has failed,” said Jean.

After the Center went public, the LA LGBTQ community screamed very loudly, very quickly. Like her Third District predecessors, out Supervisor Sheila Kuehl heard them.

“I share people’s concern about this issue,” Kuehl told the Los Angeles Blade. “The high local rates of STDs are not acceptable, which is why I and my colleagues voted over a year ago to invest an additional $5 M of local resources to combat STDs.  We only recently heard about these proposed funding cuts.  We are working closely with the Center and the Department of Public Health to resolve the issue and ensure that the Center can continue to serve a vital role in the County’s system of free STD testing and treatment services.”

But while appreciated, Kuehl, too, misses the point. “It’s important to understand that the funding and public health leadership has not kept pace with this rapidly growing epidemic period,” Cummings says, as if trying to quiet the scream in his own head. “Even when Sheila says, ‘We added $5 million last year,’ that’s really true and that was really good –but it was nowhere near the amount of money to meet the County-wide need.”

The Jan. 27 public protest worked – but only, apparently, because the jammed phone lines meant Ferrer couldn’t stay on top of the first case of the “novel coronavirus” in LA. A critical temporary patch was put on the wound until the end of March but there’s no permanent solution.

“The Los Angeles LGBT community saved the day. From phone calls to tweets and emails, their voices were heard and ultimately saved these vital services for our community,” Jean said in a jubilant press release. “It’s a potent reminder of the strength, tenacity, and resilience of our community.”

But how did this happen – in the middle of STD epidemics?

It started with that 2007/2008 recession. The financial crisis had hard-to-fix ripple effects, though some feel that for Ferrer to cry poor more than a decade later with a $billion-dollar budget is more of an excuse than reality.

Additionally, when Ferrer met with the Center a year and a half ago and claimed, “We don’t have any money,” the Center’s public policy staff put together a coalition and led the successful effort to get $17 million in the state budget specifically for STD services statewide.

“They needed our help, so we swung into action,” Jean tells the Los Angeles Blade.

Los Angeles LGBT Center CEO Lorri Jean at opening of West Hollywood clinic (Photo courtesy Los Angeles LGBT Center)

Still, the Center got stiffed.

“The County awards us an amount of money to do X number of testing and treatment services. Because we’re so good at what we do and because more and more people in our community increasingly want to come to us for these services, we blow through that contract ceiling about midway through the year,” Cummings explains.

“And then we go back to the County and we ask this fundamental question, which we need to be asking them all the time, which is: ‘Do you want, as a public health function, to continue testing, diagnosing people and treating people or don’t you? Because if you do, there’s got to be more money to cover those costs.’ Every year they, one way or the other, have figured out how to put enough dollars, in addition to our contract, to keep this going — even though we put more private dollars in every year, as well,” Cummings says.

“So the original contract amount may stay the same, but the actual amount of money that the County has put in has increased incrementally over the years – but it has not kept pace with the epidemics.”

In other words, the contract awards have been flat funded. But because of the epidemics, they blow their funding cap after six months. The County tells them to continue providing services, for which they are incrementally given more money each year. But it’s not enough.

“Which is why we have started to subsidize those programs — and now we’re up to the tune of over a million dollars,” says Jean. “We felt like, ‘Okay, we can handle a little bit of this,’ and we didn’t want to abandon our community because when we stop testing people for STDs, that means we’re also not catching new HIV infections, and we are catching two to three new HIV infections a week in this testing program,” Jean says.

STD testing at Jeffrey Goodman Special Care Clinic (Photo courtesy Los Angeles LGBT Center)

“80% of the people who we’re testing in this program are asymptomatic,” Jean says. “So that means that they don’t know that they have an STD, and if they couldn’t get tested with us — because they trust us and they’re used to coming to us on a regular basis, they know it’s easy, they know it’s free, there’s no barrier, in and out, and they have peace of mind — if they have to start now paying and if they have insurance, billing their insurance, all of those things, then they’re not going to get tested. They’re not going to have the same incentive and they’re going to be out there spreading disease.”

Like AIDS in the 80s, it became another collision of dollars versus  disease.

“It was not financially sustainable to continue seeing so many more STDs that we were seeing, double the number of syphilis cases. Just crazy, crazy increases,” says Carpenter. “So we went to the Board of Supervisors and pled our case — which we believe is not just our case, but the case for the entire County of Los Angeles that we need to take better care of this looming epidemic — that they needed to step up in the County.”

But about nine months ago came the new, inexplicable RFP (Request For Proposals).

“The thing that put us over the edge this time is that for 40 years, the County has required us to submit sexually transmitted infection labs to particular providers because they are monitoring this as a public health disease control matter. And they have paid for those costs for 40 years,” Jean says.

“This time, they put out the RFP — they never said a peep in the RFP about 40 years of practice is going to change — so we submitted our proposals based upon the presumption that it was going to continue as it has for 40 years. And there was nothing in the RFP that said it wouldn’t. So, we got our grant, and the crazy thing they did in this RFP is say only one site per organization.

“So we’re like flipped out. What are we going to do? We’ve got West Hollywood and we’ve got the Jeffrey Goodman Special Care Clinic, and they both test the same amount of people. A ton,” Jean says. “So we chose to ask for funding for West Hollywood and we asked for a lot more than what we’d gotten before, because we knew that the Board of Supervisors was supportive of not only maintaining levels of service, but increasing them as the epidemics demand. And so we asked for what we thought was closer to what we really needed. And then we went to the bidder’s conference and we raised all these issues.”

However, Jeans says, while the County staff admitted they didn’t realize the impact and acknowledged they’d made a mistake, “they’ve been unwilling to correct the mistake in all these conversations.”

The Center started making plans to shut down free testing services and go public, giving Ferrer ample warning.

“We’re not going to go away with our tail between our legs. We’re going to take it to our community because we don’t think this is what the Board of Supervisors wants. We know this is not what our community wants. We know that this is not in the best interest of public health,” says Jean.

DPH did not respond to several requests for comment from the Los Angeles Blade.

But Cummings anticipated their rebuttal.

“Barbara will rebut by saying that the center got a very sizable award this year and that is true,” Cummings says. “But here’s what’s important. They funded four different categories. The first category is core services. That is the actual testing and treatment. The way we do it now, low barrier testing and treatment. That, in fact, was cut more than 50% from what we received last year. The other three categories that were funded, and for us that is a funding in the amount of 1.5 million, were for programs that have never been done before. So these are all good programs to be funded, but failure to find the core services makes everything else irrelevant.”

In fact, Cummings says, “if you want to do a real comprehensive public health approach to a tremendous set of epidemics, then you employ all these things simultaneously — but you fund them properly. The answer to what is going on right now is dramatically expanding them. And then we employ a variety of other tactics and programs that increase our ability to reach people who need to be tested and treated. That will then stop the spread of the epidemics.

“The right approach here is expansive and it’s comprehensive and it’s County-wide,” says Cummings. “But it is cheaper than letting these epidemics continue to soar as they are and it’s immoral as a public health matter.”

 

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AIDS and HIV

HBCUs receive millions to address HIV inequalities in South

“We believe that education and advocacy will enable us to identify new strategies that will make an impact on infection rates”

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Photo courtesy of Morehouse College/Facebook Chase Brathwaite; Class of' 24, a rising junior sociology major in gender & families pre-med

FOSTER CITY, Calif. – Two Southern historically Black colleges (HBCUs) will receive millions of dollars from biopharma giant Gilead Sciences Inc. to address the HIV epidemic in the region, which has become the epicenter of the virus in the U.S.

The Foster City, Calif.-based company will announce Wednesday $4.5 million for programs at Morehouse College in Atlanta and Xavier University of Louisiana in New Orleans to address structural barriers Black people face in getting HIV testing, treatment and ongoing care, officials told the Los Angeles Blade. Gilead is a leader in HIV treatments. 

The South has become the epicenter for HIV in the country, according to the U.S. Centers for Disease Control and Prevention (CDC). It also “lags behind in providing quality HIV prevention services and care,” the agency said. 

Though cases have dropped in recent years, the region continues to have the country’s highest rate of new HIV diagnoses – sitting at 15.2 per 100,000 people in 2019, according to the CDC. Most cases occur in Black men who have sex with men

The Gilead donations will go toward addressing HIV inequities and closing gaps in care in Atlanta, New Orleans and Baton Rouge, La., officials said. Specifically, according to the announcement, the $4.5 million will help the HBCUs: 

  • Increase access and utilization of culturally competent healthcare to Black people impacted by the HIV epidemic. 
  • Gain insight into the disruption of the healthcare delivery system due to COVID-19 in the Black community and realigning HIV services in the current climate.
  • Provide training focused on culturally competent HIV care. 
  • Engage early with experienced clinicians practicing in Black communities in the three cities.

The Satcher Health Leadership Institute at Morehouse School of Medicine will receive $2.5 million and the Center for Minority Health and Health Disparities Research and Education at Xavier University of Louisiana’s College of Pharmacy will get $2 million over three, a Gilead official said. The company said there is a potential to continue funding and expanding the project based on the outcomes.

Rashad Burgess, vice president of advancing health and Black equity at Gilead, said the drugmaker landed on the two schools because the two “have been leading efforts ensuring positive health outcomes and advancing health equity for Black communities in the U.S. South, across the nation and around the globe.”

“Both schools also have a track record of results,” he said. 

Xavier, a Catholic institution, and Morehouse, a men’s school, have made recent strides with the LGBTQ community. Last year, Xavier hosted its first ever Pride week, which students heralded as a “big deal.” In 2019, Morehouse said it would open admissions to transgender men. (The school still bans anyone who identifies as a woman from enrolling.)

Jareese Stroud, project director of the Satcher Health Leadership Institute in the Morehouse School of Medicine, said strategic partnerships like Gilead’s “are critical to improving health outcomes among Black Americans.” 

In a statement to the Blade, Kathleen Kennedy, dean of the Xavier University of Louisiana College of Pharmacy, added: “We believe that education and advocacy will enable us to identify new strategies that will make an impact on infection rates and the overall health care of patients living with HIV and AIDS.”

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AIDS and HIV

HIV speeds up body’s aging within three years after initial infection

Living with HIV infection is associated with early onset of aging-related chronic conditions, sometimes described as accelerated aging

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An immune cell infected with HIV (Photo Credit: National Institute of Allergy & Infectious Diseases (NIAID))

LOS ANGELES – A study published by researchers from the division of hematology and oncology at the David Geffen School of Medicine at UCLA at the end of June revealed that HIV has an “early and substantial” impact on aging in infected people, accelerating biological changes in the body associated with normal aging within just two to three years of infection.

“Our work demonstrates that even in the early months and years of living with HIV, the virus has already set into motion an accelerated aging process at the DNA level,” said lead author Elizabeth Crabb Breen, a professor emerita at UCLA’s Cousins Center for Psychoneuroimmunology and of psychiatry and biobehavioral sciences at the David Geffen School of Medicine at UCLA. “This emphasizes the critical importance of early HIV diagnosis and an awareness of aging-related problems, as well as the value of preventing HIV infection in the first place.”

According to the results of the study published in the Cell Press open source journal iScience, the findings suggest that new HIV infection may rapidly cut nearly five years off an individual’s life span relative to an uninfected person.

The study’s authors noted that despite a significant increase in life expectancy because of treatment regimes now available to patients, there is mounting evidence that living long-term with Human Immunodeficiency Virus (HIV) and antiretroviral therapy, even when clinically well-controlled, is associated with an earlier than expected onset of chronic conditions such as heart and kidney disease, frailty, and neurocognitive difficulties.

The research team analyzed stored blood samples from 102 men collected six months or less before they became infected with HIV and again two to three years after infection. They compared these with matching samples from 102 non-infected men of the same age taken over the same time period.

The UCLA team said that this study is the first to match infected and non-infected people in this way. All the men were participants in the Multicenter AIDS Cohort Study, an ongoing nationwide study initiated in 1984.

“Our access to rare, well-characterized samples allowed us to design this study in a way that leaves little doubt about the role of HIV in eliciting biological signatures of early aging,” said senior author Beth Jamieson, a professor in the division of hematology and oncology at the Geffen School. “Our long-term goal is to determine whether we can use any of these signatures to predict whether an individual is at increased risk for specific aging-related disease outcomes, thus exposing new targets for intervention therapeutics.”

The researchers noted some limitations to the study. It included only men, so results may not be applicable to women. In addition, the number of non-white participants was small, and the sample size was insufficient to take into consideration later effects of highly active antiretroviral treatment or to predict clinical outcomes.

There is still no consensus on what constitutes normal aging or how to define it, the researchers wrote.

The full study is available here: (Link)

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AIDS and HIV

U.S. announces more funding for HIV/AIDS fight in Latin America

Jill Biden made announcement on Saturday in Panama

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Former Panamanian first lady Lorena Castillo and UNAIDS in 2017 launched a campaign to fight discrimination against Panamanians with HIV/AIDS. Panama will receive $12.2 million in new PEPFAR funding to further combat the HIV/AIDS epidemic in Latin America. (Washington Blade photo by Michael K. Lavers)

PANAMA CITY — First lady Jill Biden on Saturday announced the U.S. will provide an additional $80.9 million to the fight against HIV/AIDS in Latin America.

Biden during a visit to Casa Hogar el Buen Samaritano, a shelter for people with HIV/AIDS in Panama City, said the State Department will earmark an additional $80.9 million for President’s Emergency Plan for AIDS Relief-funded work in Latin America. A Panamanian activist with whom the Washington Blade spoke said LGBTQ+ people were among those who met with the first lady during her visit.

Pope Francis visited the shelter in 2019.

“I’m glad we have the opportunity to talk about how the United States and Panama can work together to combat HIV,” said the first lady.

Michael LaRosa, the first lady’s spokesperson, noted Panama will receive $12.2 million of the $80.9 million in PEPFAR funding.

“This funding, pending Congressional notification, will support expanded HIV/AIDS services and treatment,” said LaRosa.

UNAIDS statistics indicate an estimated 31,000 Panamanians were living with HIV/AIDS in 2020. The first lady’s office notes the country in 2020 had the highest number of “newly notificated cases of HIV/AIDS” in Central America.

The first lady visited Panama as part of a trip that included stops in Ecuador and Costa Rica.

The Summit of the Americas will take place next month in Los Angeles. The U.S. Agency for International Development and PEPFAR in April announced they delivered more than 18 million doses of antiretroviral drugs for Ukrainians with HIV/AIDS.

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