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Thursday, October 29, 2015

BEYOND AIDS 2015 LEGISLATIVE ACTIVITIES, AND THE CONTROVERSIAL ISSUE OF "DECRIMINALIZATION"

The following positions were adopted during 2015 by the Beyond AIDS Board of Directors.

A.     Federal:

HR 768 (Waters), would have required routine HIV testing in federal prisons with pre-and- post-test counseling. Beyond AIDS offered support if amended to delete requirements for pre-test counseling, and thus to be in accord with 2006 CDC recommendations. Rep. Waters has been introducing this bill every Congressional session since 2007, but has had no luck with it. As previously, this bill did not even get a committee hearing.

B.     California:

AB 521 (Nazarian), will require that HIV screening be routinely offered to hospital inpatients. The law already required similar offering of HIV screening by primary care physicians. The bill was sponsored by the AIDS Healthcare Foundation. Beyond AIDS added support. It passed, but was unfortunately vetoed.

AB 517 (Gallagher), would have required special parental information, and originally opt-in consent, for HIV and sex education in schools when delivered by outside educators. Beyond AIDS opposed the bill as written, but withdrew active opposition when the opt-in requirement deleted. Regardless, the bill did not pass.

An initiative sponsored by AIDS Health Care Foundation, would require condoms for adult film industry. Beyond AIDS has endorsed the initiative. Legislation on this topic has bogged down in the Legislature. Los Angeles County approved an initiative that applies only to that county, and is discussed in another blog post here. The initiative has apparently gathered sufficient signatures for the November 2016 ballot.

C.     Rhode Island:

H 5245 (Nardolilo/Ucci), would have established felony penalties for exposure to HIV without consent.  Beyond AIDS opposed the bill as written as too Draconian, but offered to work with the authors on a future bill with less severe penalties, proportionate to the risk imposed on the uninformed partner. This year's bill did not pass.

This is a highly controversial topic, even within Beyond AIDS. The organization recognizes that education and counseling succeed in modifying unsafe sexual and drug risk exposure by most infected persons, We also oppose certain inappropriate prosecutions that have occurred in some places. However, several Beyond AIDS Board members have encountered irresponsible persons who have recklessly or intentionally endangered others through unsafe activities, without even informing them. We therefore do not agree with the mantra "Take a test, risk arrest," used by those who want the actions of HIV-infected persons, however dangerous, to be totally immune to criminal liability.

An analogy offered by some Beyond AIDS members is that gun and automobile ownership and licensure are provided for by law, but that does not exempt the persons licensed from responsibility. If someone uses a gun for target practice or hunting, it is perfectly legal. But if a person shoots a gun at innocent people, or drives a car into a crowd, s/he will be appropriately prosecuted. Another analogy deals with sexual activity, irrespective of HIV or any STD. Consensual sex with a person of consent age is legal, but rape or sex with a minor is not.

Similarly, there is nothing criminal about being HIV positive. But endangering someone else's life through unsafe sex or needle-sharing, while having a high viral load (e.g., refusing to take medication), and without even informing the other person, is another matter.

What if condoms are used, or the infected person has an undetectable viral load, yet the partner is not informed in order to have the power to decline any small remaining risk? This issue will undoubtedly continue to be debated, and the perfect legal balance has not yet been defined. 


BEYOND AIDS CONDUCTS CONTINUING EDUCATION CONFERENCE ON HIV, AND ANNUAL MEETINGS, LOMA LINDA UNIVERSITY, NOVEMBER 15, 2015

   The following continuing education program was held on November 15, 2015, and was very successful. Slides from most of the presentations are posted on our Web site and you are welcome to download them:  http://www.beyondaids.org/resources.html

ADVANCES IN PREVENTION AND TREATMENT OF HIV

A FREE continuing education program, supported by Beyond AIDS Foundation and a grant from Gilead Corp.
Co-sponsored by the LLU Departments of Preventive and Family Medicine
Loma Linda University School of Medicine and Staff Development designate this Activity for 3.5 hrs., various credits*

WHEN:    Sunday, November 15, 2015, 8:00a.m. to 12:30 p.m.  (Beyond AIDS business meetings to follow**)
WHERE: Loma Linda University, Cutler Amphitheater, attached to Evans Hall/Center for Health Promotion,
24785 Stewart St., Loma Linda, CA 92350; SW corner of Anderson and Stewart (see map)
Directions: I-10 to Anderson, S. to Stewart.  Enter from south side of building (away from Stewart St.).
PARKING: Lot U, Stewart and Anderson, NE, kitty-corner from amphitheater. No charge, no permit needed, 8-5.
REGISTRATION: No charge (except for food (tea and continental breakfast at cost of $5, payable on site). Advance reservation is required for slides/food (deadline 11/10/15).  Donations to Beyond AIDS Foundation (tax-deductible), &/or Beyond AIDS membership ($50, $25 student/resident) welcomed.
*For CEU, NCHEC, dietetic, APA, etc. (but not physician CME), register at: https://CE.llu.edu. Search for course by calendar date, find November 15, add to “shopping cart”; open account if none.
Physicians, others not using above registration method, and for all to reserve food and/or afternoon meeting, send email  to: foundation@beyondaids.org. Include in message: 1) Name, 2) Phone #, 3) Address, 4) Email, 5) Is CME credit requested?  6) Are morning refreshments ($5) requested?  7) Will you stay for boxed lunch (vegetarian, $12.50) and/or afternoon Beyond AIDS business meeting 1:00-3:00 p.m.? (See below.)

SCHEDULE:
8:00 a.m.       Registration and Continental breakfast (reserve as above)
8:40 a.m.       Welcome: Roger Woodruff, MD, Chair, Family Medicine and Interim Chair, Preventive Medicine, Loma Linda University; and Deanna Stover, PhD, RN, President, Beyond AIDS Foundation

PART 1:         HIV PREVENTION STRATEGY AND TESTING
8:45 a.m.       The 2015 update to National HIV/AIDS Strategy and the HIV Care Continuum: Ronald Hattis, MD, MPH (LLU)
9:10 a.m.       HIV prevention in the real world: A survey of state AIDS directors: Richel Strydom, MD (LLU Preventive Medicine resident, BAF fellow):  
9:30 a.m.       Use of social media to promote HIV self-testing: Jeffrey Klausner, MD, MPH (UCLA)
9:55 a.m.       HIV testing and the law in California; and tools to aid compliance: Ronald Hattis, MD, MPH (LLU)
10:15 a.m.     BREAK

PART 2:         HIV TREATMENT AND PROPHYLAXIS
10:30 a.m.     HIV treatment, the "Restaurant Menu" approach: Ronald Hattis, MD, MPH (LLU)
10:50 a.m.     Pre-exposure prophylaxis (PrEP) in high-burden jurisdictions: Jeffrey Klausner, MD, MPH (UCLA)
11:15 a.m.     Work-related HIV exposures, including case examples; Post-exposure prophylaxis (PEP) protocol, and application to the adult film industry: Denise Bleak, RN, PHN
11:40 a.m.     Hepatitis C, HIV, and Public Policy: Monica Sweeney, MD, MPH (SUNY Downstate)
12:05 p.m.     Panel on what strategies work best to treat, control, and reverse the HIV epidemic: Jeff Klausner, Ron Hattis, Richel Strydom, Monica Sweeney, Denise Bleak
12:30 p.m.     ADJOURN

**1:00-3:00 p.m. Beyond AIDS Annual Meeting for members, Suite 204, Evans Building (attached); lunch $12.50

Target Audience
Physicians, Public Health Professionals, Nurses, AllieHealth Professionals

Disclosure Statement: This program has been planned and implemented in accordance with ACCME essentials and standards.  The Loma Linda University School of Medicine Office of Continuing Medical Education relies on its CME faculty to provide program content that is free of commercial bias.  Therefore, in accordance with ACCME standards, any faculty and/or provider industry relationships will be disclosed and resolved (none have been reported). 


* Continuing Education Credits:
Upon successful completion, the participant will be awarded 3.5
contact hours of continuing education credit.



CME Accreditation Statement: The Loma Linda University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Loma Linda University School of Medicine designates this Live Activity for a maximum of 3.5 AMA PRA Category 1 Credits TMPhysicians should claim only the credit commensurate with the extent of their participation in the activity.

  • Loma Linda University Medical Center Office of Staff Development is approved by the American Psychological Association to sponsor continuing education for psychologists. LLUMC Office of Staff Development maintains responsibility for this program and its contents. This event meets the qualifica‐ tions for 3.5 hours of continuing education credit for psychologists as required by the American Psychological Association
  • Loma Linda University Medical Center, Staff Development is a Continuing Professional Education Accredited Provider with the Commission on DieteticRegistration. Registered dietitians and dietetic technicians, registered will receive 3.5 continuing professional education units for completion of this program.
  • Loma Linda University School of Public Health has been designated as a provider of Category 1 continuing education contact hours in health education the National Commission for Health Education credentialing Inc (NCHEC) Provider # CA0024. This program has been approved for 3.5 hours of continuing education.
  • Loma Linda University Medical Center Staff Development is authorized by the California State Board of Registered Nursing to offer this course for 3.5 contact hours. (Provider #00239)
  • This course meets the qualifications for 3.5 continuing education credits by the American Nursing Credentialing Center (ANCC).
  • Respiratory Care Practitioners reciprocate with Provider #00239.
  • Behavioral Health Professionals reciprocate with APA.

DISCLOSURE STATEMENT: This program has been planned and implemented in accordance with ACCME essentials and standards.  The Loma Linda University School of Medicine Office of Continuing Medical Education relies on its CME faculty to provide program content that is free of commercial bias.  Therefore, in accordance with ACCME standards, any faculty and/or provider industry relationships will be disclosed and resolved.

                                                                                                                                                                                                                             

Tuesday, January 13, 2015

ANNUAL MEETINGS APPROVE HIV STRATEGY, PRESENTED TO GOVERNMENT LEADERS

Annual Meetings of Beyond AIDS, and of the Beyond AIDS Foundation Board, on October 19, 2014 were based at the Club Quarters Hotel in Washington, DC, with call-ins from around the country.

James Sherry, Adriana Andaluz, Ron Hattis, Frank Judson, and Marsha Martin (L to R) at Beyond AIDS meeting
 LEGISLATION

Legislative successes were presented, including three bills passed and signed into law in California; a fourth passed the legislature but was vetoed. For more details, see the report on recent legislation. In New York State, regulations were approved that expanded the ability to test for HIV without written consent, except in correctional facilities, satisfying most of the concerns of our organization about limitations of a previous law limited to rapid testing. Beyond AIDS will also look into cutbacks in HIV prevention at the state level that occurred during the recession and have not been restored.

RESEARCH

A progress report on ongoing data analysis of deficiencies of partner notification in California was presented by Deanna Stover (calling in from California). This was a project that had involved the assistance of Beyond AIDS fellow Jyoti Sapkota.

AWARDS

The Foundation Board meeting each year considers which individual or agency deserves to receive the prestigious Beyond AIDS "Nettie" award for setting an outstanding example in HIV/AIDS control and prevention. The Board this time selected Dr. Bernard Branson, an expert on the use of laboratory testing for HIV surveillance and prevention, who is retiring from a career at the Centers for Disease Control and Prevention.

The Board also approved plaques for California Assembly Member Rob Bonta, and his Legislative Director, Amy Alley, in recognition of their dedicated work and persistence in passing Beyond AIDS-supported legislation to provide condoms in prisons.

HIV PREVENTION STRATEGY AND POLICY

A plan for revising and updating the National HIV/AIDS Strategy (NHAS), which had been developed by the Scientific Committee, was officially approved by the Foundation Board. This plan is posted on the Beyond AIDS Web site, along with a comparison with the 2010 NHAS and the 2013 Presidential Initiative on the HIV Care Continuum. The current NHAS was developed prior to the incorporation of "treatment as prevention" as a major part of national strategy, so it is not up to day. The Beyond AIDS plan also includes expanded surveillance to help track and assist patients and providers in initiating and maintaining effective treatment that can almost eliminate HIV transmission.
Drs. Frank Judson, Ron Valdiserri, and Ron Hattis 
at HHS headquarters, Washington, DC
Ron Valdiserri, Timothy Harrison from HHS (L),
                       Ron Hattis, Leith States from Beyond AIDS (R)


The following day, October 20, a Beyond AIDS delegation consisting of President Ron Hattis, Board members Franklyn Judson and Adriana Andaluz Marsha Martin, and Leith States (who had helped to develop the plan as a fellowship project) presented this plan at the office of the Deputy Assistant Secretary for Health, Dr. Ron Valdiserri, at Health and Human Services (HHS) headquarters. Other participants from HHS included Kaye Hayes, Timothy Harrison, and Andrew Forsythe. The Beyond AIDS delegation requested that the organization's proposals be passed on to the Office of National AIDS Policy, the Presidential Advisory Council on HIV/AIDS, the Health Resources and Services Administration (HRSA), and CDC.