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ADAPs, Latinos, ADAPs, Latinos, and HIV/AIDS and HIV/AIDS Infrastructure Infrastructure John Hellman John Hellman Director of Advocacy Director of Advocacy Latino Commission on AIDS Latino Commission on AIDS ADAP Advocacy Association 6th Annual Conference AIDS Drugs Assistance Programs: Renewing the Commitment June 7th, 2013

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Page 1: ADAPs, Latinos, and HIV/AIDS Infrastructure John Hellman Director of Advocacy Latino Commission on AIDS ADAP Advocacy Association 6th Annual Conference

ADAPs, Latinos, ADAPs, Latinos, and HIV/AIDS and HIV/AIDS InfrastructureInfrastructure

John HellmanJohn Hellman

Director of AdvocacyDirector of Advocacy

Latino Commission on AIDSLatino Commission on AIDS

ADAP Advocacy Association 6th Annual Conference

AIDS Drugs Assistance Programs: Renewing the Commitment

June 7th, 2013

Page 2: ADAPs, Latinos, and HIV/AIDS Infrastructure John Hellman Director of Advocacy Latino Commission on AIDS ADAP Advocacy Association 6th Annual Conference

Latino Commission on AIDSLatino Commission on AIDS Founded in 1990 to fight HIV/AIDS in at-Founded in 1990 to fight HIV/AIDS in at-

risk communities nationwide Shaped by risk communities nationwide Shaped by national AIDS advocate Dennis deLeon national AIDS advocate Dennis deLeon from 1994 to 2009from 1994 to 2009

Local , Regional and National Services Local , Regional and National Services in more than 40 States, Puerto Rico & in more than 40 States, Puerto Rico & the Virgin Islands.the Virgin Islands.

Long demonstrated history of building Long demonstrated history of building national, regional and local coalitionsnational, regional and local coalitions

Five core areas: Five core areas: Hispanic Behavioral Research Hispanic Behavioral Research

CenterCenter HIV Prevention & Health HIV Prevention & Health

PromotionPromotion Capacity Building Assistance Capacity Building Assistance

(CHANGE approach)(CHANGE approach) HIV Testing and Access to CareHIV Testing and Access to Care Health Policy & Community Health Policy & Community

Mobilization Mobilization

Picture by: bleacher + everard

Page 3: ADAPs, Latinos, and HIV/AIDS Infrastructure John Hellman Director of Advocacy Latino Commission on AIDS ADAP Advocacy Association 6th Annual Conference

“Of all of our national holidays, Independence Day is the one most intimately rooted in our common history and shared experience. Yet this year it arrives against a background of polarization, separation, and confrontation in the states and Washington alike. With municipal politics as the occasional exception, the pattern of solidifying agreement within the parties—and widening disagreement between them—is dominating our decisions at every level.”

Page 4: ADAPs, Latinos, and HIV/AIDS Infrastructure John Hellman Director of Advocacy Latino Commission on AIDS ADAP Advocacy Association 6th Annual Conference

GoalsGoals

Understand the vital role ADAPs will Understand the vital role ADAPs will continue to play for HIV positive continue to play for HIV positive LatinosLatinos

Consider our HIV/AIDS infrastructure Consider our HIV/AIDS infrastructure through a Latino-centric lensthrough a Latino-centric lens

Brainstorm strategies to address the Brainstorm strategies to address the post-ACA and post-CIR (?) landscape post-ACA and post-CIR (?) landscape for Latino HIV care for Latino HIV care

Page 5: ADAPs, Latinos, and HIV/AIDS Infrastructure John Hellman Director of Advocacy Latino Commission on AIDS ADAP Advocacy Association 6th Annual Conference

StructureStructure

HIV/AIDS TrendsHIV/AIDS Trends HIV/AIDS and LatinosHIV/AIDS and Latinos

– Foreign born vs. U.S. bornForeign born vs. U.S. born– Geographic concentrationGeographic concentration

Post-2014 ACA LandscapePost-2014 ACA Landscape– The impact of (not) implementationThe impact of (not) implementation

Possible Impact of CIRPossible Impact of CIR DiscussionDiscussion

Page 6: ADAPs, Latinos, and HIV/AIDS Infrastructure John Hellman Director of Advocacy Latino Commission on AIDS ADAP Advocacy Association 6th Annual Conference

HIV/AIDS TrendsHIV/AIDS Trends

Page 7: ADAPs, Latinos, and HIV/AIDS Infrastructure John Hellman Director of Advocacy Latino Commission on AIDS ADAP Advocacy Association 6th Annual Conference

HIV Infections in the USHIV Infections in the US

Page 8: ADAPs, Latinos, and HIV/AIDS Infrastructure John Hellman Director of Advocacy Latino Commission on AIDS ADAP Advocacy Association 6th Annual Conference

Treatment CascadeTreatment Cascade

Gardner, et al., 2011

Page 9: ADAPs, Latinos, and HIV/AIDS Infrastructure John Hellman Director of Advocacy Latino Commission on AIDS ADAP Advocacy Association 6th Annual Conference

~25% Unaware

of Infection

~75% Aware

of Infectio

n

PWHA: 1,039,000-1,185,000

New Sexual Infections Each Year: ~32,000

Accounting for:

~54% of

New Infections

~46% of New

Infections

Awareness of Serostatus Among People Awareness of Serostatus Among People with HIV: Estimates of Transmissionwith HIV: Estimates of Transmission

Source: R. Russell. Guidance to Integrating Affordable Care Act, National HIV/AIDS Strategy and Ryan White. Ryan White 2012 Grantee Meeting; AIDS 2006, 20:1447-50.

Page 10: ADAPs, Latinos, and HIV/AIDS Infrastructure John Hellman Director of Advocacy Latino Commission on AIDS ADAP Advocacy Association 6th Annual Conference

HIV/AIDS, ADAPs, HIV/AIDS, ADAPs, and Latinosand Latinos

Page 11: ADAPs, Latinos, and HIV/AIDS Infrastructure John Hellman Director of Advocacy Latino Commission on AIDS ADAP Advocacy Association 6th Annual Conference
Page 12: ADAPs, Latinos, and HIV/AIDS Infrastructure John Hellman Director of Advocacy Latino Commission on AIDS ADAP Advocacy Association 6th Annual Conference
Page 13: ADAPs, Latinos, and HIV/AIDS Infrastructure John Hellman Director of Advocacy Latino Commission on AIDS ADAP Advocacy Association 6th Annual Conference
Page 14: ADAPs, Latinos, and HIV/AIDS Infrastructure John Hellman Director of Advocacy Latino Commission on AIDS ADAP Advocacy Association 6th Annual Conference
Page 15: ADAPs, Latinos, and HIV/AIDS Infrastructure John Hellman Director of Advocacy Latino Commission on AIDS ADAP Advocacy Association 6th Annual Conference
Page 16: ADAPs, Latinos, and HIV/AIDS Infrastructure John Hellman Director of Advocacy Latino Commission on AIDS ADAP Advocacy Association 6th Annual Conference

Post-2014 ACA Post-2014 ACA LandscapeLandscape

Page 17: ADAPs, Latinos, and HIV/AIDS Infrastructure John Hellman Director of Advocacy Latino Commission on AIDS ADAP Advocacy Association 6th Annual Conference

17

Insurance and Care for PWHA

Source: R. Russell. Guidance to Integrating Affordable Care Act, National HIV/AIDS Strategy and Ryan White. Ryan White 2012 Grantee Meeting.

Page 18: ADAPs, Latinos, and HIV/AIDS Infrastructure John Hellman Director of Advocacy Latino Commission on AIDS ADAP Advocacy Association 6th Annual Conference

The Henry J. Kaiser Family Foundation, (2012). How the ACA changes pathways to insurance coverage for people with HIV. Retrieved from website: http://healthreform.kff.org/notes-on-health-insurance-and-reform/2012/september/how-the-aca-changes-pathways-to-insurance-coverage-for-people-with-hiv.aspx?CFID=567585223&CFTOKEN=74185225&jsessionid=6030aa207ae092ba6d8019601b655963616b

Page 19: ADAPs, Latinos, and HIV/AIDS Infrastructure John Hellman Director of Advocacy Latino Commission on AIDS ADAP Advocacy Association 6th Annual Conference

19The Henry J. Kaiser Family Foundation, (2012). How the ACA changes pathways to insurance coverage for people with HIV. Retrieved from website: http://healthreform.kff.org/notes-on-health-insurance-and-reform/2012/september/how-the-aca-changes-pathways-to-insurance-coverage-for-people-with-hiv.aspx?CFID=567585223&CFTOKEN=74185225&jsessionid=6030aa207ae092ba6d8019601b655963616b

Page 20: ADAPs, Latinos, and HIV/AIDS Infrastructure John Hellman Director of Advocacy Latino Commission on AIDS ADAP Advocacy Association 6th Annual Conference

Medicaid Expansion and Ryan Medicaid Expansion and Ryan WhiteWhite

Ryan White becoming payer Ryan White becoming payer of last resortof last resort– Relief to an increasingly Relief to an increasingly

underfunded Ryan White underfunded Ryan White ProgramProgram

– New investments in New investments in community-based carecommunity-based care

– Transitioning clients to Transitioning clients to MedicaidMedicaid

Today, 70% of Ryan White Today, 70% of Ryan White clients clients have insurancehave insurance and and rely on RW to supplement rely on RW to supplement limits in coveragelimits in coverage– Health insurance alone Health insurance alone

does not cover cost of HIV does not cover cost of HIV care or services needed to care or services needed to keep PWHA in treatmentkeep PWHA in treatment

– Role of Ryan White likely to Role of Ryan White likely to continuecontinue

Source: hivhealthreform.org

Page 21: ADAPs, Latinos, and HIV/AIDS Infrastructure John Hellman Director of Advocacy Latino Commission on AIDS ADAP Advocacy Association 6th Annual Conference

Post Implementation of the ACA: Post Implementation of the ACA: Remaining UninsuredRemaining Uninsured

Undocumented immigrantsUndocumented immigrants Legal immigrants within 5 year banLegal immigrants within 5 year ban Individuals exempt from the mandate who Individuals exempt from the mandate who

choose to not be insured (e.g., because choose to not be insured (e.g., because coverage not affordable)coverage not affordable)

Individuals subject to the mandate who do Individuals subject to the mandate who do not enroll (and are therefore subject to the not enroll (and are therefore subject to the penalty)penalty)

Individuals who are eligible for Medicaid but Individuals who are eligible for Medicaid but do not enrolldo not enroll

Source: R. Russell. Guidance to Integrating Affordable Care Act, National HIV/AIDS Strategy and Ryan White. Ryan White 2012 Grantee Meeting.

Page 22: ADAPs, Latinos, and HIV/AIDS Infrastructure John Hellman Director of Advocacy Latino Commission on AIDS ADAP Advocacy Association 6th Annual Conference
Page 23: ADAPs, Latinos, and HIV/AIDS Infrastructure John Hellman Director of Advocacy Latino Commission on AIDS ADAP Advocacy Association 6th Annual Conference
Page 24: ADAPs, Latinos, and HIV/AIDS Infrastructure John Hellman Director of Advocacy Latino Commission on AIDS ADAP Advocacy Association 6th Annual Conference
Page 25: ADAPs, Latinos, and HIV/AIDS Infrastructure John Hellman Director of Advocacy Latino Commission on AIDS ADAP Advocacy Association 6th Annual Conference

Possible Impact of Possible Impact of Comprehensive Comprehensive

Immigration ReformImmigration Reform

Page 26: ADAPs, Latinos, and HIV/AIDS Infrastructure John Hellman Director of Advocacy Latino Commission on AIDS ADAP Advocacy Association 6th Annual Conference

S. 774 The Border Security, S. 774 The Border Security, Economic Opportunity, and Economic Opportunity, and

Immigration Modernization Act Immigration Modernization Act of 2013 of 2013

Passed the SenatePassed the Senate Low-income people granted RPI status Low-income people granted RPI status

would have to wait, at a minimum, 13 to would have to wait, at a minimum, 13 to 15 years to become eligible for federal 15 years to become eligible for federal means-tested public benefit programsmeans-tested public benefit programs

RPIs will have a minimum 10-year wait RPIs will have a minimum 10-year wait before they will be able to buy before they will be able to buy affordable health insurance under the affordable health insurance under the ACAACA

Page 27: ADAPs, Latinos, and HIV/AIDS Infrastructure John Hellman Director of Advocacy Latino Commission on AIDS ADAP Advocacy Association 6th Annual Conference

CIR in the House of CIR in the House of RepresentativesRepresentatives

Bipartisan talks failed – one of the Bipartisan talks failed – one of the issues re: health care accessissues re: health care access

Speaker John Boehner will not Speaker John Boehner will not consider Senate billconsider Senate bill

Republican/House bill will likely have Republican/House bill will likely have more restrictions, may not have more restrictions, may not have pathway to citizenshippathway to citizenship

Page 28: ADAPs, Latinos, and HIV/AIDS Infrastructure John Hellman Director of Advocacy Latino Commission on AIDS ADAP Advocacy Association 6th Annual Conference

DiscussionDiscussion

How are these policy issues How are these policy issues impacting work in your state?impacting work in your state?

In an endlessly polarized political In an endlessly polarized political environment, how can we strategize?environment, how can we strategize?

How can we centralize HIV positive How can we centralize HIV positive Latinos in our overall HIV/AIDS Latinos in our overall HIV/AIDS strategy?strategy?

Page 29: ADAPs, Latinos, and HIV/AIDS Infrastructure John Hellman Director of Advocacy Latino Commission on AIDS ADAP Advocacy Association 6th Annual Conference

Thank you!Thank you!

Phone: 646-375-4415Phone: 646-375-4415

Email: Email: [email protected]@latinoaids.org