tag:blogger.com,1999:blog-138084102024-03-05T07:17:53.526-08:00BEYOND AIDS FOUNDATIONBeyond AIDS Foundation is a non-profit organization dedicated to reversing the course of the HIV/AIDS epidemic through sound public health policy. It is tax-deductible, and donations support educational and research projects. <br><br>
Click <a href="http://www.beyondaids.org">HERE</a> to return to or visit the Beyond AIDS home page.Ronald P. Hattis, MD, MPHhttp://www.blogger.com/profile/03917713422765368391noreply@blogger.comBlogger40125tag:blogger.com,1999:blog-13808410.post-6518727354172249662023-11-10T10:00:00.000-08:002023-11-10T10:00:22.112-08:00PUBLIC HEALTH DEPARTMENTS HAVE OBLIGATION TO REACH OUT AND ASSIST PERSONS WITH NEWLY REPORTED HIV<p style="text-align: center;"><b><span style="font-size: medium;">INTRODUCTION: </span></b></p><p><span style="font-size: medium;"><b>The Beyond AIDS Foundation recommends that the following services be routinely and
consistently provided by public health departments upon receipt of a new HIV diagnosis
(a positive laboratory test report or a report by a provider). </b>These recommendations are
consistent with CDC surveillance and prevention grant expectations, but currently adherence
is not monitored as a condition for continued CDC funding. <i>They both serve the interests of the patient and help to fulfill the public health goal of preventing further infections. </i></span></p><p><span style="font-size: medium;">A published survey of state and territorial HIV/AIDS directors conducted by our Foundation
(<a href="https://guilfordjournals.com/doi/abs/10.1521/aeap.2019.31.1.82" target="_blank">https://guilfordjournals.com/doi/abs/10.1521/aeap.2019.31.1.82</a>) demonstrated <b>wide
discrepancies in actual practices among U.S. states and territories <i>and gaps in services in many locations</i>. </b><i>Such discrepancies and gaps, and the lack of monitoring for adherence to national guidelines by CDC, highlight the need for this policy.</i></span></p><p><b><span style="font-size: medium;">We encourage concurrence
with this policy by state and territorial HIV/AIDS directors and epidemiologists, city and
county public health officials, federal, state, and local communicable disease-related agencies,
local HIV/AIDS projects, state conferences of local health officers and of communicable
disease controllers, and others. </span></b></p><p><b><span style="font-size: medium;">On another page of our Website, below this policy statement, we have provided more detailed guidelines as a reference to
public health departments for developing their HIV outreach services after new HIV
diagnoses are reported (<a href="https://www.beyondaids.org/articles/ApprovedPolicies032023.pdf " target="_blank">https://www.beyondaids.org/articles/ApprovedPolicies032023.pdf</a>).</span></b></p><p style="text-align: center;"><b><span style="font-size: medium;">POLICY: </span></b></p><p><b><span style="font-size: medium;">When a new HIV diagnosis is reported by a laboratory or a provider, surveillance by public
health departments should either include or be seamlessly integrated with outreach and “case
management” services to prevent further transmission: </span></b></p><p></p><ul style="text-align: left;"><li><span style="font-size: medium;"><b>Initiation and facilitation of the HIV Care Continuum</b> (linkage to care, and
encouragement of maintenance of treatment to reach undetectable viral loads).
The achievement of undetectable viral loads both eliminates sexual
transmission and achieves the best clinical outcomes, and is therefore a major
public health objective. </span></li><li><span style="font-size: medium;"><b>Partner services</b> (contact tracing and partner notification) with referrals of
contacts for testing and counseling; best conducted by public health personnel
2
with or without the presence of the patient. Trusting the patient to notify
partners is not consistently reliable, and should only be used as a last resort and
when adherence can be verified </span></li><li><span style="font-size: medium;"><b>Referrals to other needed services</b> (substance abuse or mental health treatment,
housing, etc.) </span></li><li><span style="font-size: medium;"><b>Counseling/education on HIV infection and its prevention and treatment. </b>This
should include information that the patient does not yet have and is interested
in receiving. <b>Safe behaviors, protection of partners (e.g., condoms and PrEP),
and the</b> <b>benefits of rapid treatment initiation</b> are priority topics. </span></li><li><span style="font-size: medium;"><b>Obtaining information to accurately complete the morbidity reporting form.
</b>This is important to the local jurisdiction, state, and CDC for monitoring the
epidemic, but does not in itself interrupt transmission or result in treatment,
and therefore should not be the sole objective when following up on new
reported diagnoses. </span></li></ul><p></p><p><span style="font-size: medium;">These services can be provided by communicable disease investigators if they receive
adequate training. Some jurisdictions may assign other staff, such as public health nurses or
health educators. These staff may be assigned as case managers, so that there is consistent
follow-up by a worker who has already established rapport and knows the patient. </span></p><p><span style="font-size: medium;"><b>When a public health department receives a new positive HIV test result, there should
be immediate outreach.</b> If the test was ordered by a medical provider, there are advantages to
contacting the provider first. The provider’s office can frequently provide information
regarding reaching the patient, completing the morbidity reporting form, known partners,
acute transmission risks such as history of needle sharing, comorbidities including mental
illness and substance abuse, homelessness, and whether the provider can offer immediate
initiation of therapy, has already made arrangements for referral or consultation regarding
HIV care, or is willing to delegate referral for treatment initiation to the public health
department or designee. </span></p><p><span style="font-size: medium;"><b>Following the communication with the provider, or if there is no provider associated
with the test, the public health department should make every possible effort to contact
the patient directly. In-person meetings have the advantage of establishing trust and
rapport. </b>Virtual meetings may be next best, and in some cases, the only opportunity to see
each other. </span></p><p><span style="font-size: medium;"><b>The same four bulleted priorities listed above should be discussed with the patient,
emphasizing rapid linkage to care and partner services.</b> A follow-up contact a few weeks later,
should help verify that linkage actually occurred. Subsequently, monitoring of periodic lab
reports, particularly of viral load, should be done to determine whether the patient is
maintaining treatment and that the viral load is approaching undetectable levels. The patient, medical provider, and in some cases the laboratory should be contacted if these test results are
not being regularly reported. </span></p><p><span style="font-size: medium;">If a patient is found to live outside of the jurisdiction of the public health department, the
appropriate department in the jurisdiction of residence should be informed of the case, so that
services can be initiated.</span></p>Ronald P. Hattis, MD, MPHhttp://www.blogger.com/profile/03917713422765368391noreply@blogger.com0tag:blogger.com,1999:blog-13808410.post-37646110980807863062023-07-24T19:04:00.014-07:002023-11-09T11:28:10.329-08:00BENEFITS OF HIV PARTNER SERVICES EXPLAINED, DEFICIENCIES IDENTIFIED, IN PUBLISHED LETTER FROM BEYOND AIDS FOUNDATION<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEghXd93wwfTm5sndFri_TroI_InVjgmNITC2uXsAH7PZhrn_hwMLkvNYd4jqDEwkZsO4p7BUzl6-MWh2FdPLOWC4C0ZE0Z-MYx2TDsLR7uI-qcrxqwF_pMYlSgrjGpxhHrMV5VUsf3QtwDFu3ABZbYi286iUAMwcwjl7rSXRJd_1yAXX3wlbYHYdg/s272/BA%20Web%20logo.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="196" data-original-width="272" height="145" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEghXd93wwfTm5sndFri_TroI_InVjgmNITC2uXsAH7PZhrn_hwMLkvNYd4jqDEwkZsO4p7BUzl6-MWh2FdPLOWC4C0ZE0Z-MYx2TDsLR7uI-qcrxqwF_pMYlSgrjGpxhHrMV5VUsf3QtwDFu3ABZbYi286iUAMwcwjl7rSXRJd_1yAXX3wlbYHYdg/w201-h145/BA%20Web%20logo.jpg" width="201" /></a></div><p class="MsoNormal" style="margin-bottom: 0in; text-align: center;"></p><p class="MsoNormal" style="text-align: left;"><!--[if gte mso 9]><xml>
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</p><p class="MsoNormal"><span style="font-family: ""serif"","serif";">A letter from
our organization to the journal Sexually Transmitted Diseases on the topic of
HIV partner services (contact tracing, partner notification and testing,
result-specific follow-up, and other appropriate services), has been published
in the <a href="https://journals.lww.com/stdjournal/fulltext/2023/08000/additional_public_health_benefits_of_hiv_partner.16.aspx" target="_blank">August2023 issue</a>. The letter, authored by Ronald Hattis, Gary Richwald, Jeffrey
Klausner, and Deanna Stover, had been unanimously approved by our Board, with
favorable input from responding members of our Scientific Committee.</span></p>
<p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: left;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">In
the letter, we commended an article in the journal by Williams et al.,<sup>1</sup>
which documented that partner services detect undiagnosed HIV infections. However,
we pointed out four additional public health benefits of HIV partner services
that were not mentioned in that article:<o:p></o:p></span></p>
<p></p><blockquote style="border: medium; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p class="MsoNormal" style="margin-bottom: 0in; text-align: center;"></p><p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: left;"><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; line-height: 115%; text-indent: -0.25in;">1.<span style="font-family: "Times New Roman"; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 7pt; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variation-settings: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; line-height: 115%; text-indent: -0.25in;">Many
identified partners of a newly diagnosed person with HIV infection, who test
positive, are themselves likely to have been recently infected. Initiating
treatment for such individuals can both provide the earliest opportunity to prevent
additional infections, and achieve the best clinical outcomes.<sup>2</sup></span></p><p></p><p class="MsoNormal" style="margin-bottom: 0in; text-align: center;"></p><p class="MsoListParagraphCxSpMiddle" style="text-align: left;"><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; line-height: 115%; text-indent: -0.25in;">2. </span><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; line-height: 115%; text-indent: -0.25in;">One
of the contacts may be the source of infection, likely an undiagnosed and untreated
person with a high viral load, and capable of causing further infections.
Testing and treating such an individual is a high priority for prevention.</span></p><p></p><p class="MsoNormal" style="margin-bottom: 0in; text-align: center;"></p><p class="MsoListParagraphCxSpMiddle" style="text-align: left;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><o:p> </o:p></span><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; line-height: 115%; text-indent: -0.25in;">3. Partners who test negative for HIV infection have been exposed to the virus, and without
intervention such exposure may continue. They, too, are a high priority for
prevention. Increased attention to at-risk HIV-uninfected individuals,
including safer sex counseling and referrals for PrEP, is consistent with CDC’s
new “status neutral” initiative.<sup>3</sup></span></p><p></p><p class="MsoNormal" style="margin-bottom: 0in; text-align: center;"></p><p class="MsoListParagraphCxSpMiddle" style="text-align: left;"><span style="text-indent: -0.25in;">4. </span><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; line-height: 115%; text-indent: -0.25in;"> Partners can be referred for additional
appropriate services, such as screening for syphilis and other STIs along with
HIV testing, and linkage of any such infections detected to treatment. Those
partners who test positive for HIV can also be provided with access to primary
care, housing, Medicaid or Ryan White coverage, nutritional assistance, and
other needs,<sup> </sup>and assisted in achieving viral suppression (and thus
becoming non-infectious sexually). </span></p><p></p></blockquote><p class="MsoNormal" style="margin-bottom: 0in; text-align: center;">
</p><p class="MsoListParagraphCxSpMiddle" style="text-align: left; text-indent: -0.25in;"><o:p></o:p></p>
<p class="MsoListParagraphCxSpMiddle" style="text-align: left;"><span style="font-family: "Times New Roman", "serif"; font-size: 12pt;">We
included some findings from our survey of U.S. state and territorial HIV/AIDS
directors or their designees, which found substantial discrepancies among
jurisdictions in methods, content, and consistency of outreach for partner
services and linkage to care.</span><sup style="font-family: "Times New Roman", "serif";">4 </sup><span style="font-family: "Times New Roman", "serif"; font-size: 12pt;"> </span><span style="font-family: "Times New Roman", "serif"; font-size: 12pt;">As the Williams article noted,</span><sup style="font-family: "Times New Roman", "serif";">1 </sup><span style="font-family: "Times New Roman", "serif"; font-size: 12pt;">partner services activities are currently
required for all CDC-funded health departments, applying the shared guidelines
for HIV, syphilis, gonorrhea, and chlamydia.</span><sup style="font-family: "Times New Roman", "serif";">5</sup><span style="font-family: "Times New Roman", "serif"; font-size: 12pt;"> </span><span style="font-family: "Times New Roman", "serif"; font-size: 12pt;">However, our survey suggested that CDC does
not monitor jurisdictions for details on whether and how this is done. </span><span style="font-family: "Times New Roman", "serif"; font-size: 12pt;"> </span><span style="font-family: "Times New Roman", "serif"; font-size: 12pt;">We have recommended that uniform standards for
public health outreach after newly reported diagnoses be established and written
into CDC grant requirements, with appropriate compliance monitoring.</span><sup style="font-family: "Times New Roman", "serif";">4</sup><span style="font-family: "Times New Roman", "serif"; font-size: 12pt;">
CDC could require that a portion of grant funds be specifically designated for
partner services.</span></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; text-align: left;"><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; line-height: 115%;">State
requirements can supplement federal grant stipulations. In </span><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; line-height: 115%;">New York
State, for example, a law authored by one of our founding officers, the late
Nettie Mayersohn, has required since 1998 that the names of any known sexual or
needle-sharing partners be included as a part of reporting of new HIV diagnoses,
and that local health departments perform contact tracing and partner
notification along with HIV education, which may also be done by physicians.<sup>6.7
</sup> Other states could consider
similar legislation.</span></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; text-align: left;"><span style="font-family: "Times New Roman", "serif"; font-size: 12pt;">The
letter also mentioned some heretofore unpublished findings of our earlier
study</span><span style="font-family: "Times New Roman", "serif"; font-size: 12pt;"> </span><span style="font-family: "Times New Roman", "serif"; font-size: 12pt;">(1993) of partner services by
local public health departments in California. That survey had found that 5%
were not performing any partner services for HIV or other STIs, and 66% were performing
them but not for all four sexually transmitted diseases for which they were
recommended by CDC.</span><sup style="font-family: "Times New Roman", "serif";">5 </sup><span style="font-family: "Times New Roman", "serif"; font-size: 12pt;">Then-current
CDC guidelines on how to conduct partner services were not being followed by
39%, and 27% were not receiving any specific funding for the performance of
partner services.</span></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; text-align: left;"><span style="font-family: "Times New Roman", "serif"; font-size: 12pt;">We
declared that state public health departments have a responsibility to assure
that essential public health programs, including partner services, are available
and adequately maintained in all cities and counties. Partner services are valuable
components of HIV prevention with multiple benefits, and federal and state policy
changes could improve their uniformity, quality, and impact.</span></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><o:p> </o:p></span><b style="text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">REFERENCES</span></b></p><p class="MsoListParagraph" style="margin-left: 0.25in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -0.25in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 0.25in; text-align: left; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman", "serif"; font-size: 12pt; line-height: 115%; text-indent: -0.25in;">Williams
WO, Song W, Huang T, et al. HIV diagnoses through partner services in the
United States in 2019 and opportunities for improvement. Sex Trans Dis 2023;
50:74-78.</span></p><p class="MsoListParagraph" style="margin-left: 0.25in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -0.25in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 0.25in; text-align: left; text-indent: -0.25in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 18.4px; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font-family: "Times New Roman"; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 7pt; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variation-settings: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 18.4px;">National Institutes of Health. Early HIV diagnosis and treatment important for long-term outcomes. October 21, 2022. Available at: </span><a href="https://www.nih.gov/news-events/news-releases/early-hiv-diagnosis-treatment-important-better-long-term-health-outcomes.%20Accessed%20March%2025"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 18.4px;">https://www.nih.gov/news-events/news-releases/early-hiv-diagnosis-treatment-important-better-long-term-health-outcomes. Accessed March 25</span></a><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 18.4px;">, 2023.</span></p><p class="MsoListParagraphCxSpMiddle" style="margin-left: 0.25in; text-align: left; text-indent: -0.25in;"><!--[endif]--></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 0.25in; text-align: left; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">3.<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Centers
for Disease Control and Prevention. Status neutral HIV prevention and care.
Available at </span><a href="https://www.cdc.gov/hiv/effective-interventions/prevent/status-neutral-hiv-prevention-and-care/index.html"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">https://www.cdc.gov/hiv/effective-interventions/prevent/status-neutral-hiv-prevention-and-care/index.html</span></a><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">.
Accessed March 25, 2023. <o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 0.25in; text-align: left; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">4.<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Hattis
RP, Strydom RY, Gaio J, and Stover DC. HIV prevention practices and non-federal
funding among U.S states and non-state regions: a survey of HIV/AIDS directors.
AIDS Education and Prevention 2019; 31:82-94. <o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 0.25in; text-align: left; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">5.<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Centers
for Disease Control and Prevention. </span><span class="markedcontent"><span face=""Arial","sans-serif"">Recommendations for Partner Services
Programs for HIV Infection, Syphilis, Gonorrhea, and Chlamydial Infection. MMWR
2008; 57:1-57. Available at: </span></span><a href="https://www.cdc.gov/mmwr/pdf/rr/rr57e1030.pdf"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">https://www.cdc.gov/mmwr/pdf/rr/rr57e1030.pdf</span></a><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">.
Accessed March 26, 2023. <o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 0.25in; text-align: left; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">6.<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Neidl,
BF. The lesser </span><span class="markedcontent"><span face=""Arial","sans-serif"">of
two evils: New York's new HIV/AIDS partner notification law and why the right
of privacy must yield to public health. St. John’s Law Review 1999 73;1191-1238.
Available at: </span></span><a href="https://scholarship.law.stjohns.edu/cgi/viewcontent.cgi?article=1506&context=lawreview"><span face=""Arial","sans-serif"">ht</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">tps://scholarship.law.stjohns.edu/cgi/viewcontent.cgi?article=1506&context=lawreview</span></a><span class="markedcontent"><span face=""Arial","sans-serif"">.</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">
<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 0.25in; text-align: left; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">7.<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span class="markedcontent"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">New York State Senate, Legislation. Section 2133,
PBH chapter 45, article 21, title 2:</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"> contact tracing of cases of AIDS, HIV, related illness, or
HIV infection. Available at: </span><a href="https://law.justia.com/codes/new-york/2022/pbh/article-21/title-3/2133/"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">https://law.justia.com/codes/new-york/2022/pbh/article-21/title-3/2133/</span></a><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">.
Accessed March 26, 2023.</span></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 0.25in; text-align: left; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">8.<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Centers
for Disease Control and Prevention. Statistics overview, HIV surveillance
report, 2020. Available at: </span><a href="https://www.cdc.gov/hiv/statistics/overview/index.html"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">https://www.cdc.gov/hiv/statistics/overview/index.html</span></a><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">.
Accessed March 26, 2023. <o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="margin-left: 0in; text-align: left;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><o:p> </o:p></span></p>
<p class="MsoListParagraphCxSpLast" style="margin-left: 0in; text-align: left;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><o:p> </o:p></span></p><br /><p></p>Ronald P. Hattis, MD, MPHhttp://www.blogger.com/profile/03917713422765368391noreply@blogger.com0tag:blogger.com,1999:blog-13808410.post-58209606005612775982021-05-25T13:22:00.000-07:002021-05-25T13:22:32.747-07:00 BEYOND AIDS FOUNDATION PUBLIC COMMENT AT CHAC, THE ADVISORY COMMITTEE TO CDC AND HRSA<p>Following are the oral comments presented to CHAC on behalf of the Beyond AIDS Foundation, on April 20, 2021. CHAC is the official advisory committee to the Centers for Disease Control and Prevention (CDC), and the Health Resources and Services Administration (HRSA) concerning HIV, viral hepatitis, and sexually transmitted infections. A longer written document was also submitted.</p><p>_________________________________________________________________________ <br /></p><p>I am Ronald Hattis, Secretary and Past-President of the Beyond AIDS Foundation. This is a
brief synopsis of our written testimony, which I hope committee members will read for the
rationale and details of our recommendations. For over 3 decades we have promoted
improved strategies for HIV prevention and control. Among our leaders are former major
metropolitan STD and HIV directors, health officers, EIS Officers, PACHA members, and HIV
and other I.D. specialists. We hope to renew ongoing direct dialog with both agencies, and
hope for inclusion in future CDC consultations. </p><p> Our recommendations are based in part on findings of our survey of state and territorial
HIV/AIDS Directors, published in 2019 in AIDS Education and Prevention (and provided
to the committee). This revealed marked inconsistencies of policy and practices among
jurisdictions.
Our most important recommendations for CDC and HRSA, include: </p><p></p><ul style="text-align: left;"><li>That more oversight be provided and accountability required by both agencies
regarding adherence to grant conditions. We recommend enhanced routine site visits
for evaluation, education and guidance. <br /></li></ul><ul style="text-align: left;"><li>That CDC recommendations, and grant requirements, specify more standardized public
health outreach to newly diagnosed patients and their providers, particularly for
rapid linkage to care and partner services. 20% of states and territories did not routinely
contact all diagnosed patients and 40% did not try to contact all known providers. </li></ul><p></p><ul style="text-align: left;"><li>That CDC recommend, and include as a grant requirement, the monitoring of MISSED
viral load results, none received in the past year for diagnosed patients, suggesting no
active treatment. </li></ul><p></p><ul style="text-align: left;"><li>That monitoring of genotype results become a CDC recommendation, with results
forwarded to CDC for analysis. Only 38% of jurisdictions even received such results. </li></ul><p></p><ul style="text-align: left;"><li>That all jurisdictions be encouraged to supplement CDC grants with their own money
for HIV prevention. 28% of jurisdictions had no prevention funds other than their CDC
grants.
That there be more joint screening efforts for HIV, STIs, and viral hepatitis, and
more joint health education about their shared prevention measures, and that PrEP
providers urge condom use to prevent other STIs. <br /></li></ul><ul style="text-align: left;"><li>That HRSA grant recipients, be expected to attempt to contact patients to remind them
of upcoming appointments, to follow up on missed appointments, and when possible, 2
to schedule HIV care on the same half day as primary and specialty care. Providers
funded through other sources should be encouraged to act similarly. <br /></li></ul><ul style="text-align: left;"><li>That PrEP costs be covered for uninsured patients, especially seronegative partners
of Ryan White patients. HRSA efforts in this direction are appreciated. <br /></li></ul><ul style="text-align: left;"><li>Finally, that training be made available nationwide to primary care providers on
starting immediate HIV treatment. Presentations that I have used to provide such
training are linked from our written testimony. </li></ul><p>I am honored to have had this opportunity to provide input today. I welcome any
questions, now or after this meeting <br /></p>Ronald P. Hattis, MD, MPHhttp://www.blogger.com/profile/03917713422765368391noreply@blogger.com0tag:blogger.com,1999:blog-13808410.post-32474397893313573522021-03-23T18:04:00.002-07:002021-03-23T18:04:32.671-07:00OUR 2021 INPUT TO FEDS: MORE CAN BE DONE FOR BETTER HIV CONTROL<div class="separator"><p style="text-align: center;"></p><p style="text-align: center;"></p><p style="text-align: center;"></p><p style="text-align: center;"><img alt="Ronald A. Hattis" src="http://www.beyondaids.org/images/leaders/20-21/RonaldHattis.jpg" /></p><p style="text-align: center;">Ronald P. Hattis, MD, MPH, Secretary and Past-President <br /></p><p></p><p>There are mixed effects from communicating virtually (Zoom, Gotomeeting, etc.) and by email, rather than in person, with national and state public health leaders. On the one hand, it has saved us money that we would have needed to spend for travel to Washington, Sacramento, and New York, etc. On the other hand, not meeting in person makes it more difficult to establish the interpersonal connections that can be very helpful to sway thinking and influence public policy. </p></div><p>In the last few months, our Beyond AIDS Foundation (BAF) has remotely submitted input for the 2021-2025 National HIV/AIDS Strategy, which was not incorporated into <a href="https://files.hiv.gov/s3fs-public/HIV-National-Strategic-Plan-2021-2025.pdf">the final plan</a>, but which we are still promoting as activities to optimally implement it. I also provided <a href="http://www.beyondaids.org/pdfs/Written%20testimony%20for%20public%20%20%20%20comment,%20PACHA%20meeting,%20March%208-9,%202021.pdf">public comment on March 9, 2021</a> on behalf or BAF to the Presidential Advisory Council on HIV/AIDS (PACHA), which reintroduced our organization to PACHA (on which two of our Board members had previously served), but did not result in any immediate action. For both of these initiatives, we made reference to the findings and recommendations of our published <a href="http://www.beyondaids.org/articles/201902.html">survey of state and territorial HIV/AIDS Directors</a>, in which we had found much inconsistency and some missed opportunities to enhance the <a href="https://www.hiv.gov/federal-response/policies-issues/hiv-aids-care-continuum">HIV Care Continuum (HCC).<br /></a></p><p></p><p>The HCC refers to the various stages that patients have to move through before the HIV virus can be suppressed to undetectable levels, resulting in almost no sexual transmission. Those stages include screening to diagnose infected persons, linking infected (HIV positive) persons to care, initiating antiviral treatment immediately or as soon as possible, retaining treated patients in care, and suppressing the "viral load." There is dropout at each stage, and a major pubic health objective is to reduce the dropout rates so that the vast majority of patients can reach the ultimate goal of viral suppression, and consequently not passing the virus on to others. The concept is sometimes called "treatment as prevention," something to which I have a strong personal commitment, as <a href="http://www.beyondaids.org/articles/treatment.html">one of the first people to advocate it, back in 1996</a>. It was eventually adopted as a cornerstone of US HIV strategy, but not until 15 years later.<br /></p><p>Beyond AIDS Foundation specifically advocates that state and local public health staff reach out to patients and providers as soon as a new positive HIV test is reported, to urge and help arrange linkage to a source of HIV care, to perform or arrange for partner services (contact tracing and partner notification). and to discuss other relevant concerns. In our survey, we found that most jurisdictions did this, but that some were not doing so routinely. We also advocate that public health departments keep track of a specific reportable HIV test, the viral load, which measures virus in the blood. If test results show high levels of virus that are not dropping, we suggest that providers be contacted to see whether anything can be done to assist. If no viral load tests are reported for a year, there should also be outreach to find out whether the patient has dropped out of care or moved to another jurisdiction, either of which deserves follow-up. Over 40% of jurisdictions had on their own initiative started looking for such "missed viral load results" in diagnosed persons, even though CDC had not required this. We think that this practice should become universal and an expectation of CDC. When medical appointments for HIV patients are missed, providers should be expected to reach out to patients to persuade them to make new appointments, and if are no longer reachable, public health should be notified.<br /></p><p> We also recommend that all states and territories make genotype results, which indicate whether the virus is sensitive or resistant to various medications, reportable to public health. In our survey, in 62% of jurisdictions these were not reportable. We also recommend that genotype results, or aggregate summaries, be forwarded to CDC so that there can be full national surveillance for the emergency of resistant strains. We also found that 28% of states and territories were relying entirely on CDC grants for HIV prevention. CDC money will often be the biggest source of funding for HIV prevention, but is usually not sufficient by itself, and should be supplemented by additional funding raised by states, local jurisdictions, and/or private sources.<br /></p><p>Upcoming is another opportunity for our Foundation to capture the attention of some key federal public health leaders. We plan a brief BAF presentation during the public comment period at the April 20, 2021 meeting of CHAC, an advisory committee to CDC (Centers for Disease Control and Prevention) and HRSA (Health Resources and Services Administration) regarding HIV, STDs, and viral hepatitis programs. This may be our most important interaction with federal personnel, because most of the recommendations of our survey article were for CDC and to a lesser extent HRSA to consider some changes to what is expected in return for their grants.</p><p>Internally, this year we will be updating our Foundation's objectives and declarations, which are over a decade old. We will also be looking for opportunities for involvement "beyond AIDS." As the pandemic diverts staff from control of sexually transmitted infections, rates of some of those infections have risen, and there is a risk that HIV infections may as well. Ongoing prevention and control efforts for all these diseases should not suffer as the pandemic progresses into its second year.<br /></p>Ronald P. Hattis, MD, MPHhttp://www.blogger.com/profile/03917713422765368391noreply@blogger.com0tag:blogger.com,1999:blog-13808410.post-87690174105630730752020-12-12T17:49:00.006-08:002021-05-25T13:08:53.387-07:00A BRIEF HISTORY OF HIV THERAPY, AND NEW DRUGS FOR HIV, 2020-21<!--[if gte mso 9]><xml>
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<p align="center" class="MsoNormal" style="line-height: normal; margin-left: .25in; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> <b>A BRIEF HISTORY OF HIV THERAPY, AND NEW DRUGS FOR
HIV, 2020-21</b></span></p>
<p align="center" class="MsoNormal" style="line-height: normal; margin-left: .25in; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Ronald P. Hattis, MD, MPH</span></p>
<p align="center" class="MsoNormal" style="line-height: normal; margin-left: .25in; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Prepared for Beyond AIDS Foundation as a resource to
providers, updated 5/20/21</span></p>
<p class="MsoNormal" style="line-height: normal; margin-left: .25in; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">In 1987,
AZT (now rarely used), a nucleoside reverse transriptase inhibitor (NRTI) originally
studied as a possible anti-cancer remedy, became the first antiviral drug
approved for AIDS by the FDA. Monotherapy helped temporarily, but typically
resulted in the development of viral resistance. As more NRTIs were developed
and over the next few years, combinations of two of them were found to be more
effective than monotherapy, but still not adequate as a total regimen for
treatment because of some eventual resistance and progression of disease. (Later,
however, some duo combinations were found to be useful for pre-exposure
prophylaxis or PrEP, see below). </span></p>
<p class="MsoNormal" style="line-height: normal; margin-left: .25in; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Starting
in 1996 (when protease inhibitors became available) and until very recently,
the standard of care for “highly effective anti-retroviral therapy” (HAART) for
HIV has been a combination of three drugs in one or more pills. These have
included 2 NRTIs, or in the most highly recommended combinations of recent
years, one NRTI plus the highly effective and chemically similar nucleo<b><u>tide</u></b>
reverse transcriptase inhibitor tenofovir disoproxil, approved in 2001.<span style="mso-spacerun: yes;"> </span>An alternative form of tenofovir, alefenamide
instead of disoproxil, was approved 15 years later and is discussed below. The
term N(t)RTI is now sometimes used to refer jointly to the nucleosides and
nucleotides. Regimens that include N(t)RTIs all utilize either
emtracitabine or the similar (and generically available) lamivudine, as these
are considered to be the least toxic in the group. Those regimens that still
include 2 N(t)RTIs combine one of these with either of those two forms of tenofovir,
or with a less commonly used alternative, abacavir.</span></p>
<p class="MsoNormal" style="line-height: normal; margin-left: .25in; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">The third
drug is selected from a separate class of antivirals. There are now several
antiviral drug classes effective against HIV, but based on effectiveness and
safety, one has become the class of choice to give with 2 N(t)RTIs as a
complete regimen for treating HIV (and especially for starting treatment), This
preferred class is the integrase strand transfer inhibitors, known for short as
integrase inhibitors or INSTIs. Recently developed INSTIs (dolutegravir,
bictegravir, and cabotegravir) have shown great effectiveness and negligible
viral resistance, raising the prospect that they might be effective with only
one other drug for treatment. This has already been approved for dolutegravir
plus one NRTI, lamivudine. Cabotegravir has been approved in a long activing
injection with one other drug, and has been proposed for use alone for PrEP,
see below. This has influenced three of the new developments below. Unfortunately,
INSTI drugs, and particularly dolutegravir and bictegravir, have been
associated with weight gain.</span></p>
<p class="MsoNormal" style="line-height: normal; margin-left: .25in; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Two drugs,
ritonavir and cobicistat, are used solely as "boosters" to raise the
level of another drug. All of the protease inhibitors are now given with a
"booster," as is one of the INSTIs, elvitegravir.</span></p>
<p class="MsoNormal" style="line-height: normal; margin-left: .25in; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">In 2001,
tenofovir disoproxil plus an NRTI, emtracitabine, were approved as the first
drug combination (Truvada) for pre-exposure prophylaxis (PrEP). Unfortunately,
tenofovir disoproxil has some mild toxicity to bone and kidney, which is a
concern in particular when treating persons who are well and not infected.
Fortunately, a pro-drug alternative lacking those bone and kidney side effects,
tenofovir alefenamide, has been developed by the same company, and has been
implemented both for treatment and for PrEP. That is one of the new developments
discussed below. However, a countervailing consideration is that tenofovir
disoproxil actually has some beneficial effects on lipids, which are reversed
by switching to the alefenamide preparation. Also, tenofovir alefenamide has
been associated with more weight gain than the disoproxil. So treatment choices
should be individualized in patients with hyperlipidemia or obesity, and strong
bones and kidneys.</span></p>
<ol start="1" style="margin-top: 0in;" type="A"><li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-list: l1 level1 lfo1; tab-stops: list .5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Dovato (dolutegravir with lamivudine), was approved
4//8/19 as the first 2-drug combination sufficient for a complete
treatment regimen. HHS treatment guidelines suggest that this be an
approved starting regimen, except for patients with pre-treatment HIV RNA
>500,000 copies/mL, <i>or</i> who are known to have active hepatitis B
virus (HBV) coinfection; <i>or </i>who will initiate ART before results of
HIV genotype testing for reverse transcriptase or HBV testing are
available (<a href="https://www.blogger.com/"><span style="color: blue;">https://www.fda.gov/news-events/press-announcements/fda-approves-first-two-drug-complete-regimen-hiv-infected-patients-who-have-never-received</span></a>;
<a href="https://www.blogger.com/"><span style="color: blue;">https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/AdultandAdolescentGL.pdf</span></a>)
</span></li></ol>
<p class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></p>
<ol start="2" style="margin-top: 0in;" type="A"><li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-list: l1 level1 lfo1; tab-stops: list .5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Descovy (tenofovir alefenamide, the pro-drug of
tenofovir not considered to be toxic to bone and kidneys but see above re
lipids and weight gain, plus emtracitabine) was approved in 4/16 as part
of treatment regimens, and 10/19 as the second combination for PrEP, a
safer alternative to Truvada. Unfortunately, it has not been studied or
approved for cis females exposed to sex by males. (<a href="https://www.blogger.com/"><span style="color: blue;">https://www.fda.gov/news-events/press-announcements/fda-approves-second-drug-prevent-hiv-infection-part-ongoing-efforts-end-hiv-epidemic</span></a>)
</span></li></ol>
<ol start="3" type="A"><li class="MsoNormal" style="line-height: normal; mso-list: l2 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Cabotegravir is a new integrase transfer strand
inhibitor, given by injection. When combined with a long-activing
injectable form of rilpivirine (a member of the non-nuclease reverse
transcriptase inhibitors, one of the other drug classes, and previously
approved for daily oral use), it has proven effective. This combination
was approved by FDA as Cabenuva on January 21, 2021, as a complete 2-drug
treatment regimen. It is administered monthly, with the starting
dose 50% higher than subsequent doses. Meanwhile, cabotegravir alone is
being studied and is expected to be approved as the first single-drug and
first injectable PrEP. In a small study with females in sub-Saharan
Africa, it was more effective than Truvada as PrEP. Cabotegravir for this
use was given a "breakthrough therapy designation" by FDA in
November 2020, meaning that the agency will collaborate closely with the
manufacturer in hopes of reaching approval in the near future. (<a href="https://www.blogger.com/"><span style="color: blue;">https://www.who.int/news/item/09-11-2020-trial-results-reveal-that-long-acting-injectable-cabotegravir-as-prep-is-highly-effective-in-preventing-hiv-acquisition-in-women</span></a>;
<a href="https://www.blogger.com/"><span style="color: blue;">https://jamanetwork.com/journals/jama/article-abstract/2771873</span></a>) </span></li></ol>
<p class="MsoNormal" style="line-height: normal; margin-left: 6.2pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">In
addition, two entirely new types of drugs discussed below have recently been
developed for patients with strains of HIV highly resistant to usual
medications.</span></p>
<ol start="4" type="A"><li class="MsoNormal" style="line-height: normal; mso-list: l3 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Trogarzo (ibalizumab-uiyk) is a new type of HIV drug
for adult patients living with HIV who have tried multiple HIV medications
in the past (heavily treatment-experienced) and whose HIV infections
cannot be successfully treated with other currently available therapies
(multidrug resistant HIV, or MDR HIV). It was approved by the FDA on
3/6/18. It must be administered intravenously once every 14 days by a
trained medical professional and used in combination with other
antiretroviral medications. It is the first CD4-directed post-attachment
HIV-1 inhibitor, and binds to CD4+ receptors on host cells, blocking the
HIV virus from infecting the cells. Additional drugs requiring IV infusion
are in the pipeline. (<a href="https://www.blogger.com/"><span style="color: blue;">https://www.fda.gov/news-events/press-announcements/fda-approves-new-hiv-treatment-patients-who-have-limited-treatment-options</span></a>;
<a href="https://www.blogger.com/"><span style="color: blue;">https://www.prnewswire.com/news-releases/theratechnologies-announces-fda-approval-of-breakthrough-therapy-trogarzo-ibalizumab-uiyk-injection-the-first-hiv-1-inhibitor-and-long-acting-monoclonal-antibody-for-multidrug-resistant-hiv-1-300609280.html</span></a>)</span></li></ol>
<ol start="5" type="A"><li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Rukobia (Fostemsavir) is a new fusion/entry inhibitor
for treatment-experienced adults with failing HIV-1 therapy. It was
approved by the FDA on 7/2/20, and is taken orally twice a day. (<a href="https://www.blogger.com/"><span style="color: blue;">https://www.usnews.com/news/health-news/articles/2020-07-07/rukobia-approved-for-patients-with-multidrug-resistant-hiv</span></a>)
</span></li></ol>
<p class="MsoNormal"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">As of 2021, there is a robust pipeline of new drugs
in development, some of which are in clinical trials. Both oral and injectable new
medications will tend to have long half-lives and not require daily dosage.</span></p>
Ronald P. Hattis, MD, MPHhttp://www.blogger.com/profile/03917713422765368391noreply@blogger.com0tag:blogger.com,1999:blog-13808410.post-55635719495634897072019-08-04T17:46:00.000-07:002019-08-04T17:51:25.731-07:00<b style="mso-bidi-font-weight: normal;"><span style="color: black; font-family: "times new roman" , "serif"; font-size: 16.0pt; line-height: 200%;">ABSTRACT AND CONCLUSIONS/RECOMMENDATIONS FROM PUBLISHED BEYOND AIDS SURVEY, FEBRUARY 2019:</span></b><br />
<b style="mso-bidi-font-weight: normal;"><span style="color: black; font-family: "times new roman" , "serif"; font-size: 16.0pt; line-height: 200%;">HIV PREVENTION PRACTICES AND NON-FEDERAL FUNDING AMONG U.S. STATES
AND NON-STATE REGIONS: A Survey of HIV/AIDS Directors </span></b><br />
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 200%;">AUTHORS</span></b></div>
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<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt; line-height: 200%;">Ronald
P. Hattis, MD, MPH; Richel Y. Strydom, MD, MPH; Josileide Gaio, MPH; Deanna C.
Stover, PhD, RN, FNP, CNS, COHN-S</span></div>
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<br /></div>
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<span style="color: black; font-family: "times new roman" , "serif"; font-size: 12.0pt; line-height: 200%;">Published February 2019, AIDS Education and Prevention, Volume 31,
No. 1 </span><a href="https://doi.org/10.1521/aeap.2019.31.1.82">https://doi.org/10.1521/aeap.2019.31.1.82</a></div>
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<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt; line-height: 200%;">Online
abstract and journal information <a href="https://guilfordjournals.com/doi/abs/10.1521/aeap.2019.31.1.82?mobileUi=0">https://guilfordjournals.com/doi/abs/10.1521/aeap.2019.31.1.82?mobileUi=0</a>
<span style="color: black;"></span></span></div>
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<br /></div>
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<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt; line-height: 200%;">Corresponding
author: Ronald P. Hattis, MD, MPH, Beyond AIDS Foundation, 404 New York St.
#7718, Redlands, CA 92373, 909-838-4157, email: <a href="mailto:ronhattis@beyondaids.org">ronhattis@beyondaids.org</a>. </span></div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;"><span style="color: black; font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 200%;">Abstract
and Conclusions provided here, including recommendations for CDC and HRSA:</span></b></div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 200%;">ABSTRACT
</span></b><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt; line-height: 200%;"></span></div>
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<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt; line-height: 200%;">We
surveyed U.S. HIV/AIDS Directors or designees in states and non-state regions,
regarding factors influencing HIV viral suppression: 1) non-federal prevention funding;
2) contacting newly-reported patients and providers, for care linkage and
partner services; 3) follow-up of non-received viral load reports, to identify untreated
patients; and 4) genotype/phenotype surveillance, to monitor drug resistance.
The survey was conducted April-July 2015; 50 (87.7%) participated.<span style="mso-spacerun: yes;"> </span>Of jurisdictions, 80% contacted all newly-reported
patients; 60% contacted all providers. HIV resistance tests were reportable in 38%;
66% contacted providers and/or patients about missed viral loads. Non-federal
funding was significantly associated with annual diagnoses (p=0.0001) and
population (p=0.0002), but not with other factors studied. Many jurisdictions
lacked non-federal funding (28%), or experienced unrestored reductions since
2008 (33%). <span style="mso-spacerun: yes;"> </span>Jurisdictions’ funding and
preventive practices varied greatly<b style="mso-bidi-font-weight: normal;">.<span style="mso-spacerun: yes;"> </span>HIV viral suppression could be enhanced by
restoring (or establishing) non-federal prevention funding, and by more
standardized surveillance/outreach practices. </b></span></div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 200%;">CONCLUSIONS AND
RECOMMENDATIONS</span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 200%;">(ENDORSED BY BOARD OF
DIRECTORS, BEYOND AIDS FOUNDATION)</span></b></div>
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<br /></div>
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<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt; line-height: 200%;">After several
years of economic recovery, restoration of recession funding cutbacks for HIV
prevention was overdue at jurisdictional and local levels. Federal matching of
non-federal funds could incentivize this. <b style="mso-bidi-font-weight: normal;">Restored
(or newly established) non-federal funding could help monitor and facilitate
progression through the HCC, especially if used in part for outreach to
patients and their providers after new diagnoses or if viral load results were
not received for a year, and for collection and forwarding of viral resistance
data to CDC.</b> However, such services, which were not yet specifically funded
routinely by CDC, showed no statistical association with non-federal funding,. </span></div>
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<br /></div>
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<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt; line-height: 200%;">Public health
practices relating to follow-up of newly reported HIV diagnoses and missed
viral load results, and reporting of genotypes and phenotypes, varied widely
among states and NSRs. <b style="mso-bidi-font-weight: normal;">CDC could revise
guidelines to encourage a more uniform system of HIV surveillance and
monitoring, based on HCC stages and goals.</b></span></div>
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<br /></div>
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<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt; line-height: 200%;">Linkage to care
and partner services were already endorsed by CDC, but inconsistently applied. <b style="mso-bidi-font-weight: normal;">They could become a required use of CDC
prevention funding, with specifications regarding the types of outreach
expected.</b> </span></div>
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<br /></div>
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<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt; line-height: 200%;">Public health
tracking of non-received viral load results (an indicator of infected persons
who may not be in treatment), with outreach to providers and patients, may facilitate
two more stages of the HCC: retention in care and antiretroviral treatment.
Despite lack of specific funding by CDC, a majority of jurisdictions already
claimed engagement in this activity.<span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Patient progression through the HCC could
be facilitated by making it a required use for CDC and/or HRSA funding. To make
this a universal surveillance activity, jurisdictions that do not have
mandatory laboratory reporting of all viral loads, regardless of result, would
need to institute such reporting.</b></span></div>
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<br /></div>
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<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt; line-height: 200%;">CDC considered genotype
surveillance optional, did not collect phenotypes, and neither was</span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt; line-height: 200%;">
reportable in most jurisdictions. <b style="mso-bidi-font-weight: normal;">Uniform
reporting, with submission to CDC for nationwide analysis, could produce a more
complete database for monitoring antiretroviral resistance.</b></span></div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt; line-height: 200%;">CDC could require grant
application objectives to address jurisdiction-specific shortfalls in these
areas, and opportunities for improvement.</span></b></div>
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<br /></div>
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<span style="font-family: "times new roman" , "serif"; font-size: 12.0pt; line-height: 200%;">Surveys
like this may prove valuable in increasing awareness among public health
advocates about funding gaps and potentials for expanded surveillance and
outreach within their jurisdictions. Such awareness could stimulate discussions
about policy and any necessary political action.</span></div>
Ronald P. Hattis, MD, MPHhttp://www.blogger.com/profile/03917713422765368391noreply@blogger.com0tag:blogger.com,1999:blog-13808410.post-17411383140764273502019-08-04T16:51:00.002-07:002019-08-04T16:54:31.512-07:00MERGER OF TWO BEYOND AIDS CORPORATIONS PLANNED BY 2020For the first two decades of existence for Beyond AIDS, two separate corporations were maintained: the main Beyond AIDS organization for political work and to maintain the organization, and the Beyond AIDS Foundation for education, research, and other charitable purposes (including our internship/fellowship program and educational Website content). The Foundation was registered with IRS as a 501(c)(3) tax-deductible, charitable corporation, while Beyond AIDS was registered as a tax-exempt but not tax-deductible 501(c)(4) corporation. For all lobbying work, Beyond AIDS funds were utilized.<br />
<br />
At the Annual Meeting of Beyond AIDS in December 2018, the membership present voted to merge the two corporations, with the Foundation becoming the surviving corporation. To accomplish this, a number of documents including Articles of Incorporation of the Foundation are being revised during 2019. The plan is for the merger to become effective at the beginning of 2020.<br />
<br />
A major reason that two corporations were formed in the first place was that originally, we anticipated that a substantial portion of of the income of Beyond AIDS would be needed for political work, which would not be legitimately deductible. That has not proven to be the case. Any work to promote legislation is expected to consume a non-substantial proportion of the income of the Foundation, which should not threaten the tax status of that surviving corporation. The merger will simplify paperwork, corporate expenses, banking, and bill paying.<br />
<br />
Since the Trump-era tax legislation took effect in 2018, having a 501(c)(3) tax-deductible corporation has not been as important as in the past, because charitable contributions by individuals only become deductible when they exceed $24,000 in a year. However, maintaining such a corporation has other benefits, such as making us eligible to receive grants.<br />
<br />
Under the new arrangement, the Beyond AIDS Foundation will have no members, and all authority will be in the hands of the Board of Directors. However, contributors will be known as "supporters," and will be eligible to serve on committees and to attend open Board meetings.<br />
<br />
Anyone with questions is welcome to write to foundation@beyondaids.org.Ronald P. Hattis, MD, MPHhttp://www.blogger.com/profile/03917713422765368391noreply@blogger.com0tag:blogger.com,1999:blog-13808410.post-2639817013581014562018-01-15T16:36:00.000-08:002018-01-15T17:53:46.797-08:00LATE 2017 ACTIVITIES AND PLANS FOR 2018The last two months of 2017 were busy ones for Beyond AIDS and its Foundation.<br />
<br />
The Annual Meetings of Beyond AIDS and of the Foundation Board were held on November 19 in Redlands, CA. The legislative efforts of Beyond AIDS were not particularly effective. A California bill supported by Beyond AIDS (AB 1534), to permit the same physician to serve alternately as a patient's primary care provider and his/her HIV consultant, almost passed, but was stalled at the last minute and will become a two-year bill. Another California bill <a href="http://beyondaids.blogspot.com/2017/06/" target="_blank">(SB 239) strongly opposed by Beyond AIDS</a>, to eliminate all penalties for knowingly exposing others to HIV or other communicable diseases, passed and was signed into law.<br />
<br />
Officers and directors for the Beyond AIDS <a href="http://beyondaids.blogspot.com/2017/12/beyond-aids-leaders-for-2018-2019.html" target="_blank">Board were elected to serve in 2018 and 2019</a>. The Board in turn appointed the Foundation Board. Ron Hattis will continue as President of Beyond AIDS, and Gary Richwald will be the new President of the Foundation.<br />
<br />
In a discussion of projects for 2018, interest was expressed in promoting simultaneous screening for HIV, other STDs, and viral hepatitis. With regard to legislation, Beyond AIDS will continue its efforts to coordinate with the AIDS Healthcare Foundation, and in California, with the California Medical Association and Health Officers Association.<br />
<br />
World AIDS Day, as always, was December 1, and the Beyond AIDS Foundation co-sponsored a 4-hour continuing education program on HIV at Loma Linda University, covering a wide range of topics including legal testing requirements in California, early treatment to benefit both the patient and public health, management of clinical problems in HIV care, pre-exposure prophylaxis (PrEP), and questions presented to a panel of public health and HIV specialists. The slide presentations and videos are available to all <a href="http://www.beyondaids.org/resources.html" target="_blank">on this Beyond AIDS Website</a>. The Foundation is planning to conduct a one-hour Webinar early in 2018, on early HIV treatment and proper use of PrEP. Work is continuing in an effort to publish the findings of a national survey of state and territorial HIV/AIDS directors. The internship/fellowship program also continues.<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9LH7wQW5RBz4hintR8-qYPI72MVfz7OURN1-dLvt54Uc4slTDSQgHEuesByu_IvokVL4qlNRSbu_XYUEMyZK3uH1Tubq2bG-knBqEnK5aXU0T233c2tcV-kY72jjMwVToy9Z6kg/s1600/Cropped+Panel+2%252C+Hattis+makes+point.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="214" data-original-width="640" height="107" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9LH7wQW5RBz4hintR8-qYPI72MVfz7OURN1-dLvt54Uc4slTDSQgHEuesByu_IvokVL4qlNRSbu_XYUEMyZK3uH1Tubq2bG-knBqEnK5aXU0T233c2tcV-kY72jjMwVToy9Z6kg/s320/Cropped+Panel+2%252C+Hattis+makes+point.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="color: #45818e;">Panel discussion 12-1-17 at Loma Linda, L to R Drs. Daniel Pearch, Steven Larson, Ron Hattis, and Prashanth Bhat</span></td></tr>
</tbody></table>
<br />
By vote of the Beyond AIDS Foundation Board, the annual Nettie award for significant contribution to HIV prevention and control was given to Matthew Golden, health officer and HIV director for King County/Seattle Department of Public Health. He won the award for leading the first successful North American campaign to reach the UNAIDS goal of "90-90-90." This means that 90% of infected persons were diagnosed, 90% of them were started on anti-viral medication. and 90% of those reached undetectable viral loads. San Francisco is reportedly close behind in achieving the same.<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjsMArKnqtMovNPTXYIzprfuwHQC9lC0z7VUBtCfMKTx8eFveKTi4gM5irvWshWfFB7OWSCJPlbmPn6hYQW7bcEovhgsWclgN4wz5o2Cjx7toEdKIz_9mnw8jUS7lBi2qZBsjZXzQ/s1600/M+Golden+3+%25280342%2529.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1600" data-original-width="1200" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjsMArKnqtMovNPTXYIzprfuwHQC9lC0z7VUBtCfMKTx8eFveKTi4gM5irvWshWfFB7OWSCJPlbmPn6hYQW7bcEovhgsWclgN4wz5o2Cjx7toEdKIz_9mnw8jUS7lBi2qZBsjZXzQ/s200/M+Golden+3+%25280342%2529.JPG" width="150" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="color: #3d85c6;">The award for Dr. Matthew Golden</span></td></tr>
</tbody></table>
<br />
<br />Ronald P. Hattis, MD, MPHhttp://www.blogger.com/profile/03917713422765368391noreply@blogger.com0tag:blogger.com,1999:blog-13808410.post-13902862575440003802017-12-16T20:19:00.002-08:002019-08-01T21:44:29.047-07:00BEYOND AIDS LEADERS FOR 2018, 2019 <div class="post-header">
</div>
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<b><span style="font-family: "arial" , "sans-serif"; font-size: 16.0pt;"></span></b></div>
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<b><span style="font-family: "arial" , "sans-serif"; font-size: 16.0pt;">In
its biennial election on November 19, 2017, Beyond AIDS selected the
following officers and directors to serve during 2018 and 2019:</span></b><span style="font-family: "arial" , "sans-serif"; font-size: 16.0pt;"><br />
<br />
<b><u>President</u>: Ronald P. Hattis, MD, MPH (California)<br />
<u>Vice-Pres</u>: Jeffrey Klausner, MD, MPH (California)<br />
<u>Secretary</u>: </b></span><span style="font-family: "arial" , "sans-serif"; font-size: 16.0pt;"><b><span style="font-family: "arial" , "sans-serif"; font-size: medium;"><span style="font-family: "arial" , "sans-serif"; font-size: 16.0pt;">Gary A. Richwald (California)</span></span> </b></span></div>
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<span style="font-family: "arial" , "sans-serif"; font-size: 16.0pt;"><b><u>Treasurer</u>: Richel Strydom, MD, MPH (California)<br />
<u>Directors</u>: </b></span><span style="font-family: "arial" , "sans-serif"; font-size: medium;"><b><span style="font-family: "arial" , "sans-serif"; font-size: 16.0pt;"> </span></b></span><span style="font-family: "arial" , "sans-serif"; font-size: medium;"><b><span style="font-family: "arial" , "sans-serif"; font-size: 16.0pt;"></span></b></span><span style="font-family: "arial" , "sans-serif"; font-size: 16.0pt;"><b>Franklyn N. Judson, MD (Colorado)<br />
Elizabeth Kidder, MD, MPH (Washington, DC)</b></span></div>
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<span style="font-family: "arial" , "sans-serif"; font-size: 16.0pt;"><b> </b></span><span style="font-family: "arial" , "sans-serif"; font-size: 16.0pt;"><b><span style="font-family: "arial" , "sans-serif"; font-size: medium;"><span style="font-family: "arial" , "sans-serif"; font-size: 16.0pt;"><span style="font-family: "arial" , "sans-serif"; font-size: 16.0pt;">I. Jean Davis-Hatcher, PhD, PA (California) </span></span></span></b><span style="font-family: "arial" , "sans-serif"; font-size: small;"><span style="font-family: "arial" , "sans-serif"; font-size: 16.0pt;"><span style="font-family: "arial" , "sans-serif"; font-size: 16.0pt;">(from 10/18)</span></span></span><br />
<b> Monica M. Sweeney, MD, MPH (New York)</b></span><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;"> <br />
</span><b><u><span style="font-family: "arial" , "sans-serif"; font-size: 16.0pt;">Past-Pres.</span></u></b><b><span style="font-family: "arial" , "sans-serif"; font-size: 16.0pt;">: Cary Savitch, MD (California)<br />
</span></b><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;"><br style="mso-special-character: line-break;" /> <br style="mso-special-character: line-break;" /> </span></div>
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<b><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">The Advisory Council will consist of:</span></b><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;"><br style="mso-special-character: line-break;" /> <br style="mso-special-character: line-break;" /> </span></div>
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<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Denise Bleak, MSN, PHN (California)<br />
Deanna Stover, PhD, FNP (California) <span style="font-size: x-small;">(from 10/18)</span></span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Josileide Gaio, MPH (California)<br />
Peter Kerndt, MD, MPH (California)</span></div>
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<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Marsha Martin, DSW (Washington, DC)</span></div>
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<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Cesar Reis, MD, fellow (California) <br />
<br />
<b>The subsidiary Beyond AIDS Foundation, a 501(c)3 charitable
corporation, will be governed by the following Board (elected by the
membership of Beyond AIDS):<br />
<br />
<u>President</u>: Gary Richwald, MD, MPH (California)<br />
<u>Vice-Pres.</u>: Monica M. Sweeney, MD, MPH (New York)</b><br />
<b><u>Secretary</u>: Ronald P. Hattis, MD, MPH (California)<br />
<u>Treasurer</u>: Richel Strydom, MD, MPH (California)<br />
<u>Directors</u>: </b><b>Franklyn N. Judson, MD, MPH (Colorado)<br />
<span style="mso-spacerun: yes;"> </span>Elizabeth Kidder, MD, PhD, MPH (Washington, DC)</b><br />
<b> <span style="mso-spacerun: yes;"> </span>Jeffrey Klausner, MD, MPH (California) </b></span></div>
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<b><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;"><span style="mso-spacerun: yes;"> </span>Cary Savitch, MD (California) </span></b><br />
<b><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;"> </span><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;"><span style="text-indent: 63pt;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;"> </span></span></span></span></b><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;"><span style="text-indent: 63pt;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;"><span style="font-size: medium;"><b>I. Jean Davis-Hatcher, PhD, PA</b></span><b> (California)</b></span><b> </b></span></span><span style="font-size: x-small;"><span style="text-indent: 63pt;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">(</span></span><span style="text-indent: 63pt;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">from 10/18)</span></span></span> </span><b><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;"> </span></b><b style="text-indent: 63pt;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;"> </span></span></b></div>
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<b><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;"> </span><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;"> <span style="mso-spacerun: yes;"> </span></span></b><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;"> <br />
<b>The Scientific Committee</b> is assigned by Beyond AIDS <span style="mso-spacerun: yes;"> </span>to work with the Foundation. Members, as of November 2017:</span><br />
<br />
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Franklyn N. Judson, MD, MPH (Colorado) and</span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Monica M. Sweeney, MD, MPH (New York), Co-Chairs</span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">I. Jean Davis-Hatcher, PhD, PA, DC (California)</span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Ronald P. Hattis, MD, MPH (California)</span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Elizabeth Kidder, MD, PhD, MPH (Washington, DC)</span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Peter Kerndt, MD, MPH (Mozambique)</span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Jeffrey Klausner, MD, MPH (California)</span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Gary A. Richwald, MD, MPH (California)</span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Cary Savitch, MD (California)</span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Colin Shepherd, MD (China)</span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Deanna C. Stover, PhD, FNP (California)</span><br />
<br />
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">The memberships of this and other committees are subject to change and available on request.</span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;"> <br style="mso-special-character: line-break;" /> </span></div>
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<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">BRIEF BIOGRAPHIES OF BOARD MEMBERS OF BEYOND AIDS, 2016/2017</span></u></b><br />
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<b><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">RONALD P. HATTIS, MD, MPH, President</span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;"> </span><u><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;"></span></u></b><br />
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<span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Ron Hattis is continuing as President of Beyond AIDS, and Secretary of our subsidiary tax-deductible Foundation.<span style="mso-spacerun: yes;"> </span>When
the organization was founded, he was the first Vice-President, and
later but before his current offices served as Secretary, as well as
President of the Foundation. He has been active in contacts with federal
leaders, and in Beyond AIDS' legislative efforts in California, and has
represented our organization in consultations with the California
Office of AIDS. He developed the original Bylaws for both the membership
organization and the foundation, and has mentored many of our past
interns.<span style="mso-spacerun: yes;"> </span></span></div>
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<span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">He is a physician, board-certified in Public Health/Preventive Medicine, and lives in Redlands, California.<span style="mso-spacerun: yes;"> </span>He
was formerly the Chief of Medical Services at a large state hospital,
where in addition to medical management, he was in charge of HIV testing
and training HIV educators for 20 years, and he treated HIV/AIDS
patients at the infectious disease clinic.<span style="mso-spacerun: yes;"> </span>Since
retiring from that position, he has worked part-time in clinical
medicine, currently including student health and primary care. He has
been an HIV clinician/specialist. <span style="mso-spacerun: yes;"> </span></span></div>
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<span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Dr.
Hattis is an Associate Professor of Preventive Medicine Loma Linda
University School of Medicine, where he has lectured on HIV as a
representative of our Foundation.<span style="mso-spacerun: yes;"> </span>He
spent 23 years with a disaster medical assistance team, serving at the
World Trade Center, Hurricane Katrina, Hurricane Ike, and the Northridge
earthquake.</span></div>
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<span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Other
past positions in reverse order have included teacher of family
medicine, county health officer, country family physician (on Kauai in
Hawaii), and Epidemic Intelligence Service Officer for the Centers for
Disease Control and Prevention (assigned through field services to the
Hawaii Department of Health).<span style="mso-spacerun: yes;"> </span></span></div>
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<span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">His
goals for Beyond AIDS over the next two years include completing research and continuing to develop
proposals for more effective implementation of the National HIV/AIDS
Strategy; and continuing to be involved with legislation in California
and important states, as well as at the federal level. In particular, he
plans to continue to work to promote the HIV care continuum; to utilize
HIV reporting to trigger outreach for referral of patients to
treatment, partner services, and other services to prevent transmission;
and to enhance HIV prevention science.<span style="mso-spacerun: yes;"> </span></span></div>
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<b><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">JEFFREY D. KLAUSNER, MD, MPH, Vice-President</span></b><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"></span></div>
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<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Jeffrey D. Klausner<b> </b>is
a UCLA Professor of Medicine and Public Health. He is a physician,
board certified in Internal Medicine and Infectious Diseases. He served
as a CDC Epidemic Intelligence Service Officer 1995-1997, Deputy Health
Officer and Director of STD Prevention and Control Services, San
Francisco Department of Public Health, 1998-2009, and Branch Chief for
HIV and TB, CDC South Africa, 2009-2011. </span></div>
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<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Dr.
Klausner has been a leader in implementing the public health approach
to HIV prevention and control through policy and programmatic activites
resulting in the streamlining and evaluation of routine HIV testing,
early HIV case detection with HIV RNA screening, linkage-to-care and
contact tracing and partner notification services. In addition Dr.
Klausner through his epidemiologic research, identified the role that
bacterial STDs, the Internet, sex clubs, methamphetamine and Viagra
played in augmenting the risk of HIV tranmission and implemented
successful population-based programs to mitigate those risk factors. In
collaboration with community leaders and organizations, he inititated
sexual health campaigns and peer-led sexual health services for sex
workers and gay men in San Francisco which have been replicated
globally. </span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"></span></div>
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<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Dr.
Klausner has been conducting research in laboratory-based diagnostics
for HIV infection and other STDs since the early 1990s and is considered
an expert in infectious disease detection and management. He has a busy
clinical HIV/AIDS practice in Los Angeles and regularly attends on the
infectious diseases consultation service at UCLA Ronald Reagan
Hospital. Dr. Klausner brings nearly two decades of public health,
clinical and research experience to the Board, much of it specific to
HIV prevention.<b> </b></span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"></span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;"><b><br /></b></span></div>
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<b><span style="background: white; font-family: "arial" , sans-serif; font-size: 12pt;">DEANNA
STOVER, PHD, RN, FNP, CNS, COHN-S, Director</span></b><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"><o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif; font-size: 12pt;"><br />
Deanna Stover is the Chief Executive Officer of the Community Health
Association Inland Southern Region. She began her nursing career in 1979 as a
medic serving in the United States Air Force. She earned her MSN/FNP degree in
1997 and a PhD in Nursing, Health Policy from Loma Linda University in 2011. She
has held leadership positions in both hospital and ambulatory / outpatient
health care environments. <o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif; font-size: 12pt;"><br />
She has actively worked in the medical arena for over 30 years with training
and expertise in community-based health care, health policy, HIV/AIDS health
care, occupational medicine and nursing, and advance practice nursing as a
family nurse practitioner and clinical nurse specialist. She holds a
certificate as an Advanced HIV Nurse Clinician from USC Medical Center, AIDS
education training center (1995) and has provided HIV/AIDS training for
healthcare providers. She is an adjunct professor for the Department of
Nursing at California State University, San Bernardino. <o:p></o:p></span></div>
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<span style="background: white; font-family: "arial" , sans-serif; font-size: 12pt; line-height: 107%;">She has served on
organizational Board of Directors at the state, local, and national levels, including immediate past-president of
the Beyond AIDS Foundation, and Secretary of Beyond AIDS</span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">GARY A. RICHWALD, MD, MPH, Secretar<span style="font-size: small;">y</span></span></b></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Gary Richwald
received his engineering degree from Cornell University, medical degree
from the Mount Sinai School of Medicine in New York City, and Master's
in Public Health (MPH) in health services research/epidemiology from
UCLA. He completed his specialty/subspecialty training in internal
medicine, geriatrics, and preventive medicine at the University of
Michigan and UCLA. He was a Robert Wood Johnson Foundation Scholar at
UCLA/RAND in health policy services research.</span></div>
<br />
<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: 12.0pt; line-height: normal;">From
1981 to 1989, Dr. Richwald was a full-time faculty member at UCLA in
the Schools of Public Health/Medicine, and subsequently served as
Director and Chief Physician, L.A. County Sexually Transmitted Disease
Program (1989-2000). He has been a consultant on STD policy and clinical
care for the AME, American Sexual Health Association (ASHA), and CDC.
He chaired the California STD Control Association for 3 terms, and was a
founding member, National Coalition of STD Directors. He has worked
with GSK, Novartis, Abbott, Merck, 3M Pharmaceuticals, and Focus
Technologies/Quest Diagnostics in the development of STD-related health
care technology. </span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;"> </span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">STRYDOM, MD, MPH, Treasurer</span></b></div>
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<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Richel Strydom, MD, MPH, the current Beyond AIDS, Inc. and Beyond AIDS Foundation Treasurer, <span style="mso-spacerun: yes;"> </span>is presently a third year Loma Linda University (Loma Linda, CA) Preventive Medicine Resident Physician. <span style="mso-spacerun: yes;"> </span>Prior
to beginning her current Preventive Medicine Residency Training, Richel
obtained a Masters degree in Public Health, with a Global Health
Concentration, at the Loma Linda University School of Public Health. <span style="mso-spacerun: yes;"> </span>Prior to her MPH studies, Richel completed a couple of years of Family Medicine Residency Training, in Tallahassee, FL. </span><br />
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<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Dr. Strydom was born and raised in the country of South Africa.<span style="mso-spacerun: yes;"> </span>The
HIV burden of the South African population, as well as the HIV burden
within many African and other countries, including within the U.S.A.,
have contributed to a strong, persistent public health problem. <span style="mso-spacerun: yes;"> </span>In July 2016, shortly following the June 2016 launch of <span style="mso-spacerun: yes;"> </span>the
“Test and Treat” HIV care approach in Lesotho, the first country in
sub-Saharan Africa to formally adopt this strategy recommended by UNAIDS
in 2015, Richel had the privilege of attending a briefing on the new
program while doing a rotation in HIV and Tuberculosis care and
prevention, at Maluti Adventist Hospital, in Lesotho. </span></div>
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<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">While a Family Medicine Resident in training, in Tallahassee, FL, Richel worked as a volunteer </span><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">to provide education and <span style="background: white;">comprehensive support to people who are living with HIV, within an eight-county area of Florida. Earlier, w</span>hile
attending medical school at the American University of the Caribbean
School of Medicine, she worked with students and faculty members to
actively promote knowledge about, and the prevention of, HIV and STIs.
Prior to that, while attending North Carolina State University, she
worked with the Alliance of AIDS Services – Carolinas (AASC) as a
volunteer “care partner” for a young woman living with HIV. </span></div>
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<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Richel feels compelled to work to improve HIV care and prevention policies and practices. <span style="mso-spacerun: yes;"></span>Serving with Beyond AIDS furthers that aim.</span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">FRANKLYN N. JUDSON, MD, MPH, Director<span style="mso-spacerun: yes;"> </span></span></b><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"></span></div>
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<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Frank
Judson received his BA from Wesleyan University in 1964, his MD from
the University of Pennsylvania in 1968, and his house staff training
from the University of Wisconsin Hospitals (internal medicine) and the
University of Colorado (infectious diseases).<span style="mso-spacerun: yes;"> </span>He
was an Epidemic Intelligence Service officer with the Centers for
Disease Control assigned to the Colorado Department of Public Health<span style="mso-spacerun: yes;"> </span>(1970-72), and Scientific Liaison, Global Program on AIDS, Geneva (1990 -91).<span style="mso-spacerun: yes;"> </span>He is board-certified in internal medicine, infectious diseases and preventive medicine.<span style="mso-spacerun: yes;"> </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"></span></div>
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<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">For
over 41 years, his research interests have concentrated on the
epidemiology and control of sexually transmitted infections including
hepatitis B and HIV.<span style="mso-spacerun: yes;"> </span>His public
health policy interests have run the gamut from childhood and
adolescent vaccine programs, to urban air pollution, bioterrorism
preparedness, and tobacco, tuberculosis, influenza, and HIV prevention
and control.<span style="mso-spacerun: yes;"> </span>He has authored or co-authored more than 270 scientific publications.<span style="mso-spacerun: yes;"> </span></span></div>
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<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Dr.
Judson has served as President of the American STD Association (ASTDA),
President of the International Society for STD Research (ISSTDR),
President of the International Union Against the Sexually Transmitted
Infections (IUSTI), Chairman of the Board of the American Social Health
Association (ASHA), Chief of Infectious Diseases for the Denver Health
Medical Center (1983-2002), and Director of the Denver Public Health
Department (1986-2004). He has been a member of the Presidential
Advisory Council on HIV/AIDS (PACHA), the CDC/HHS Advisory Committee on
Immunization Practices (ACIP), the Board of Regents of the American
College of Preventive Medicine, and the Colorado State Board of Health.
Currently, he is a member of the Colorado Governor’s Expert Emergency
Epidemic Response Committee (GEEERC) and Professor, Department of
Medicine (Infectious Diseases) and the Colorado School of Public Health,
University of Colorado, Denver. </span></div>
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</span><b style="mso-bidi-font-weight: normal;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">ELIZABETH (BETSY) KIDDER, MD, PhD, MPH, Director</span></b></div>
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<span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Elizabeth (Betsy) Kidder, MD, PhD, MPH received her<b> </b>Master's
in Public Health, Medical Degree, and PhD in Public Policy and Health
Policy from the George Washington University. She completed her residency in Internal Medicine and Primary Care
program at the George Washington University Hospital. Her career and
research interests focus on access to quality health care by underserved
communities, improving access to addiction treatment, and implementing
innovative and patient-centered cancer screening options. Her
dissertation research investigated self-administered HPV testing as a
cervical cancer screening option for underscreened women.</span></div>
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<span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Betsy
joined Beyond AIDS in 2001 as an intern, and has served as a Board
member since 2003. She received her Master's in Public Health in 2004
and her Medical Degree in 2011, both from the George Washington
University. She also completed a doctorate there in health policy.<br />
<br />
As a public health professional, she has worked in Rome, Italy with the
United Nations on the development team for the "Initiative to End Child
Hunger" - a collaboration between the World Bank, the United Nations
Children's Fund, and the World Food Program. Previous to that, she
worked with the Global Health Council in Washington, DC on issues
related to HIV/AIDS and child health, as a part of a national PBS media
and outreach campaign in global health. She has also worked at the
Department of Defense's HIV/AIDS Prevention Program as well as the
Futures Group, where she assisted with the research and writing of a
"What Works" program guide for developing country policymakers on
evidence-based practices in HIV/AIDS/STI prevention. </span></div>
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<span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Her
interest in issues related to HIV was initially sparked by the case of
Nushawn Williams, a young man who knowingly spread HIV in her small
hometown community and high school. After that incident, she traveled to
South Africa, where she studied the epidemic in the Eastern Cape,
taught an HIV/AIDS education class, and volunteered in a pediatric HIV
clinic, all of which deepened her commitment to staying involved with
HIV advocacy through her career.</span></div>
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<span style="font-size: x-small;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">MONICA SWEENEY, MD, MPH, Director</span></b></span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"> </span><br />
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<span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Monica Sweeney is Vice Dean for Global Engagement and Chair, Dept. Health Policy and Management,</span> <span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">School of Public Health, State University of New York (SUNY) Downstate Medical Center.<span style="mso-spacerun: yes;"> </span>Additionally, she is the chair of the SUNY Downstate Medical Center's Association of Council Members and College Trustees. </span></div>
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<span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Before
that, she was the Assistant Commissioner of Health for New York City.
Previously, for six years, she was in charge of the NYC Bureau of
HIV/AIDS Prevention and Control. Her responsibilities there included
oversight of programs and budgets for prevention; care and treatment
(Ryan White); Housing<span style="font-family: "arial" , "sans-serif";"> </span>Opportunities for People With AIDS (HOPWA); and the epidemiology/Field Services Unit. </span></div>
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<span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Previously,
she was the medical director and vice president for medical affairs in a
Federally Qualified Health Center in Bedford Stuyvesant, Brooklyn NY.<span style="mso-spacerun: yes;"> </span>The
community served was medically and economically deprived and HIV/AIDS
was one of many challenges she addressed daily during her 17 years in
Bedford Stuyvesant.<span style="mso-spacerun: yes;"> </span>During her
tenure there, in addition to direct patient care, she became involved in
policy and advocacy and had the opportunity to work with Assemblywoman
Nettie Mayersohn to get her historic legislation (the Baby AIDS Bill,
and Named-based Reporting) passed -- over almost insurmountable
opposition.</span></div>
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<span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Dr. Sweeney is a board-certified internist and geriatrician with a masters degree in public health.<span style="mso-spacerun: yes;"> </span>She
has always combined individual and public health in her practice, by
working with the Medical Society for the State of New York (MSSNY), the
National Association of Community Health Centers (NACHC), and the
American College of Physicians (ACP) and by serving on the President’s
Advisory Council on HIV/AIDS (PACHA).<span style="mso-spacerun: yes;"> </span>Prior
to election to the position of Vice-President, she was a Director on
the Beyond AIDS Board, and before that she served on the Advisory
Council. Her goals as Vice-President include working diligently to
broaden the reach of the only AIDS organization that has always used
sound public health policy to fight the epidemic.</span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"></span></div>
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</span><b style="mso-bidi-font-weight: normal;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">CARY SAVITCH, MD, Immediate Past-President</span></b></div>
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<span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Cary
Savitch was one of the Founding Members of Beyond AIDS, organized its
founding meetings, and was elected its first President. He has served on
the Board of Directors since the founding of the organization.<span style="mso-spacerun: yes;"> </span>He
recruited many of the early members of the organization by speaking to
friends, colleagues, and patients about the need for HIV reform, writing
a book about the subject, and giving talks on HIV, especially in
Ventura County and the surrounding area where the founding meetings were
held.<span style="mso-spacerun: yes;"> </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"></span></div>
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<span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">He
is an infectious disease physician, and has taken care of AIDS patients
for the past 33 years (starting even before the disease had a name). </span><br />
<br />
<span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">In
1997, he published a book, “The Nutcracker is Already Dancing,” which
highlighted the lack of application to HIV of sound public health
practices that had been successfully utilized for diseases such as
syphilis and tuberculosis. He believes strongly that the mission of
Beyond AIDS, to stop the transmission of HIV, is the direction we must
take in order to save lives in this epidemic.</span></div>
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<span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">He
expresses pride in the time he has already spent with Beyond AIDS,
which he believes is the only organization willing to stand up and
support the necessary public health policies needed to contain HIV. His
goals are to continue these efforts in every and any capacity needed,
and to encourage others to join our battle for HIV/AIDS prevention. </span></div>
Ronald P. Hattis, MD, MPHhttp://www.blogger.com/profile/03917713422765368391noreply@blogger.com0tag:blogger.com,1999:blog-13808410.post-81182130312613496262017-06-07T23:20:00.004-07:002017-11-20T18:59:37.035-08:00BEYOND AIDS POSITION, HIV EXPOSURE PENALTIES; CA SB 239 The following letter to California Governor Jerry Brown outlines the Beyond AIDS position on this controversial issue. Against the opposition of Beyond AIDS, the bill was signed into law.<br />
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September 15, 2017</div>
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<br /></div>
<div class="MsoNormal">
Hon. Governor Edmund “Jerry” G. Brown</div>
<div class="MsoNormal">
Office of the Governor, Suite 1173, California State Capitol<span style="font-size: 10.0pt;"> </span></div>
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Sacramento, CA 95814</div>
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Fax: 916-558-3160 (5 pages)</div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;">RE: REQUEST VETO OF
SB 239 (WIENER); COSTS AND RISKS TO STATE</b></div>
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<br /></div>
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Dear Governor Brown:</div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;">Beyond AIDS, an
organization dedicated to reversing the course of the HIV epidemic through
sound public health policy, urges that you veto SB 239 (Wiener). This bill will
endanger public health and safety and risk excessive costs to the state. </b>The
AIDS groups in support, who like the repeal of penalties that only apply to
HIV-infected individuals, have paid no heed to the public health implications
and how they would endanger the state’s population. Beyond AIDS is unique among
AIDS-related organizations in that it prioritizes public health.</div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;">SPONSORS REFUSED TO
COMPROMISE WITH CONCERNED PUBLIC HEALTH OPPONENTS; BILL REPEALS ALL PENALTIES
FOR WILLFUL EXPOSURE TO ANY COMMUNICABLE DISEASE</b></div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;">On Wednesday, August
16, a conference call was held with the sponsors of SB 239 and some of the
opponents, including the California Academy of Preventive Medicine. Our
organizations approached this meeting with a very reasonable compromise
proposal, making many concessions, including agreeing to the repeal of all
current felony penalties and of all current penalties specific to HIV. The sole
thing we held out for, in the interests of protecting the public against not
only HIV but also many other communicable diseases affecting public health, was
to <u>retain an existing misdemeanor penalty in the Health and Safety Code
(Section 120290) for willful exposure to a communicable disease. SB 239
abolishes this, along with all lthe other penalties</u>, in effect throwing out
the baby with the bathwater. We offered to soften the wording of that section
to make it more specific and scientific, exempting cases in which the exposed
person was informed and consented, or where precautions against transmission
were taken Alternatively, other wording was offered to accomplish essentially
the same thing. <u>The sponsors would not compromise even to change a single
word, leaving no choice other than to oppose the bill. </u></b></div>
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<b style="mso-bidi-font-weight: normal;"><u><span style="text-decoration: none;"><br /></span></u></b></div>
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<b style="mso-bidi-font-weight: normal;">HSC 120029 applies to
any communicable disease, not just HIV. It is necessary to retain this in state
law, to maintain clout to control the future spread of Ebola virus, deadly new
strains of influenza, SARS, and future emerging contagious diseases. </b></div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;">FINANCIAL COSTS TO
THE STATE AND COUNTIES</b></div>
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<br /></div>
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The wording in SB 239 substituting for existing law fails to
provide a disincentive to irresponsible, willful or negligent behavior that
endangers unknowingly exposed persons to any communicable disease. <b style="mso-bidi-font-weight: normal;">As a result, it subjects the state to significant
financial liability. </b></div>
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<br /></div>
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Let us take HIV not as the sole infection, but as an
example. The bill removes all deterrents to reckless and unsafe behavior
exposing others to HIV.<span style="mso-spacerun: yes;"> </span>Some additional
cases of HIV infection are bound to result, and each one carries an estimated
lifetime cost for persons who become HIV infected at age 35 is $326,500 (60%
for antiretroviral medications, 15% for other medications, 25% non-drug costs).
For individuals who remain uninfected but at high risk for infection, the
discounted lifetime cost estimate is $96,700. (Reference: <span class="cit"><a href="https://www.blogger.com/null">Med
Care. 2015 Apr; 53(4): 293–301<span style="color: black;">, full text readable
online at</span> https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4359630/.) </a>For
younger patients, the costs are greater because they live longer with the
virus; for untreated patients who develop AIDS and require hospitalization, the
cost can be millions. </span></div>
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<br /></div>
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<span class="cit">For each patient on regular Medi-Cal, 50% of
this cost will be borne by the state. For expanded Medi-Cal, state costs are
currently less, but will greatly increase if any Republican health reform
legislation is passed. </span>In addition to direct state costs, the county
hospitals will be taxed with huge expenses for HIV treatment of uninsured
patients.</div>
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<br /></div>
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The state is also fully responsible for 100% of treatment
costs for incarcerated persons in state prisons and in state hospitals, who are
particularly likely to willfully expose others to HIV or another communicable
disease, unless there is a deterrent penalty such as an extension of
incarceration.</div>
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<br /></div>
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<span class="cit">In addition, public health data show that
each person infected by a person not deterred by the weakened law will, on
average, spread the infection to others. The current transmission rate is
5%/year, with an average life expectancy of over 20 years, so the epidemic will
tend to get worse and worse as a result of this bill. (Reference: <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2848261/">Public Health Rep</a>.
2010 May-Jun; 125(3): 372–376, full text readable online at <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2848261/">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2848261/</a>)
Of course, each new case will incur the same treatment costs as above,
multiplying the expense to the state and the danger to the public.</span></div>
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<br /></div>
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<span class="cit"><b style="mso-bidi-font-weight: normal;">Additional
potential state costs may result from this bill. It eliminates the requirement
for HIV testing and education of two extremely high-risk groups, drug users in
diversion programs, and persons convicted of prostitution. These programs are
effective, and their elimination can be predicted to result in more new cases
of HIV, as well as more transmission by those who are already infected but may
not know it. </b>We recommended retention of these programs, but the sponsors
refused to do so.</span></div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;">THE FALLACY OF “HIV
CRIMINALIZATION” AND STIGMA</b></div>
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<br /></div>
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In recent years, a virtual ideology has arisen in the name
of “decriminalization of HIV.” We believe that this way of thinking is
dangerously erroneous, and regret that it seems to have persuaded a number of
well-intentioned organizations to support this bill as well as periodic
initiatives in other states. </div>
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Thus, shooting blindly into a crowd is illegal, but this
does not “criminalize” gun ownership or serve as a disincentive to it.
Similarly, dangerous acts in a vehicle such as driving a car into a crowd of
pedestrians, or negligently running someone over, are illegal, but that does
not “criminalize” or serve as a disincentive to driving, car ownership, or
obtaining a driver’s license. A similar analogy is that driving under the
influence of alcohol is illegal, but that does not “criminalize or serve as a
disincentive to drinking.</div>
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<br /></div>
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Similarly, behaving in a dangerous manner that exposes
others to a significant risk of communicable diseases, including but not
limited to HIV infection, should be illegal, and does not “criminalize” those
diseases (including HIV) or serve as a disincentive to being tested. The same
organizations now supporting SB 239 once fought against our campaign for
reporting of HIV infections to public health. They claimed that this would
reduce HIV testing, but in fact, testing increased after this, and today’s
National HIV/AIDS Strategy relies on testing, reporting, and outreach to those
testing positive to link them to treatment.</div>
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<br /></div>
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Another invalid argument against penalties for dangerous
behavior exposing others to HIV is that they somehow add to the stigma of HIV,
or of minorities that have higher HIV prevalence rates. The opposite is more
likely and logical, i.e., people with HIV, gay men, etc. should be less subject
to stigma as a source of danger, if it can be noted that they are unlikely to
endanger others since there would be penalties for that. </div>
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<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">THERE IS NO VALID
SCIENTIFIC EVIDENCE TO SUPPORT THE SPONSORS’ CLAIMS</b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The sponsors claim that having criminal penalties for
egregious behavior that threatens to spread HIV and other communicable diseases
does not reduce the incidence of those diseases. However, there is no evidence
for that claim. The most recent article cited by the sponsors is by Sweeney et
al. in the journal AIDS in June of this year. (<a href="http://journals.lww.com/aidsonline/Citation/2017/06190/Association_of_HIV_diagnosis_rates_and_laws.15.aspx">http://journals.lww.com/aidsonline/Citation/2017/06190/Association_of_HIV_diagnosis_rates_and_laws.15.aspx</a>).
It found that states that 30 states that have laws criminalizing HIV exposure
do not have lower HIV diagnosis rates. However, we would expect that the states
with higher rates would have been more prone to adopting such laws, and that
states with high rates would do more testing and therefore find more cases. So
the fact that these states do not have higher rates could in fact be cited as
evidence of effectiveness, not ineffectiveness. Most other articles in the
literature on this subject are just emotional and ideological essays, or
scattered anecdotal examples of miscarriages of justice in places like
Zimbabwe.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">THE SPONSORS CONCEDE
THAT SOME EXPOSURE SHOULD BE CRIMINAL BEHAVIOR, BUT ARBITRARILY EXCLUDE
WILLFUL/RECKLESS EXPOSURE</b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The current bill does create a misdemeanor penalty for <b style="mso-bidi-font-weight: normal;">intentional and successful</b> transmission
of an infectious or communicable disease, but legal experience has shown that
proof of intent is almost impossible, and such statutes can rarely be used. The
bill also creates a misdemeanor penalty for <b style="mso-bidi-font-weight: normal;">intentional exposure</b> without requiring actual transmission, but the
penalty of only 90 days is so mild for such an egregious offense as to be
inadequate. The proposed amendments include increasing this penalty to six
months, which was in the original wording of the bill. This is still a
significant reduction from the current law, which makes intentional and
successful exposure a felony when applied to HIV. Also, if our amendments were
accepted (either alternative), there would be no remaining criminal penalties
specifically relating to transmission of HIV, although ironically, criminal and
civil penalties would remain for informing someone that a person has HIV
without the consent of the infected person. This demonstrates that the
supporting organizations want to evade all accountability for irresponsible
behavior, and not to totally de-exceptionalize the disease.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
SB 239 also creates a new offense entitled “reckless
exposure to an infectious or communicable disease,” but it only applies for 4-8
days, and only if a health officer happens to know of a specific individual who
poses a specific risk. SB 239 also does not specify a penalty for this offense,
so as a misdemeanor it could be up to a year in county jail, 4 times more
severe a penalty than for the more egregious offense of intentional exposure.
Ironically, in the case of HIV, it is illegal for anyone (even a physician) to
actually notify a health officer of a risky exposure situation without the
infected person’s written authorization (see Health and Safety Code Section
121015), so this provision would almost be moot for that disease.</div>
<div class="MsoListParagraph">
<br /></div>
<div class="MsoNormal">
Imagine if the only penalty for other life-threating endangerments
were to apply only if law enforcement were able to predict the perpetrator and
the offense, and to have issued an order in advance not to commit the offense.
That is not how the criminal justice system works; we rarely can predict a
crime in advance, and we prosecute after the fact. The California penal code is
unlike that of many other states in lacking a crime of reckless endangerment
(reference: California Penal Code), so the offense of reckless exposure to an
infectious or communicable disease can be most useful if it applies to actions
that fulfill three of the five conditions for intentional, successful infection
of another person, as provided in an alternative we proposed with our proposed
amendments:</div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l1 level1 lfo1; text-indent: -.25in;">
<span style="mso-list: Ignore;">a)<span style="font: 7.0pt "Times New Roman";">
</span></span>The defendant knows of the infection (A above);</div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l1 level1 lfo1; text-indent: -.25in;">
<span style="mso-list: Ignore;">b)<span style="font: 7.0pt "Times New Roman";">
</span></span>The defendant engages in the reckless behavior causing
exposure (C above); and</div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l1 level1 lfo1; text-indent: -.25in;">
<span style="mso-list: Ignore;">c)<span style="font: 7.0pt "Times New Roman";">
</span></span>The person exposed did not know of the infection (E
above). </div>
<div class="MsoNormal">
Violation of a health officer instruction would be an
alternative criterion for this crime. The proposed amendments, Alternative 2,
sets a maximum of 90 days of jail time, which would be appropriately less than
for intentional exposure. All of the other wording in the section providing for
protection of the defendant’s rights would be retained.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">EXAMPLES OF WHY A
CRIMINAL PENALTY FOR WILLFUL/RECKLESS EXPOSURE OF OTHERS TO COMMUNICABLE
DISEASES IS NECESSARY FOR THE PROTECTION OF PUBLIC HEALTH</b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Public health ultimately relies on police powers, including
the power to punish, isolate, or quarantine, to protect the public from serious
communicable disease threats. (<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2569983/">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2569983/</a>)
A significant portion of all transmission of communicable diseases is caused by
behavior that exposes others without notifying them and without any precautions
against transmission, and also without specific intent to infect an individual.
Even a single person engaged in such behavior can cause an outbreak. It is this
irresponsible type of behavior which cannot be deterred by threat of punishment
in the current SB 239.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
A man infected with multi-drug-resistant TB traveled through
the U.S. and Canada and flew on commercial flights to get married, and was only
isolated upon his return by a CDC order followed by the imposition of Georgia
state law (<a href="https://en.wikipedia.org/wiki/2007_tuberculosis_scare">https://en.wikipedia.org/wiki/2007_tuberculosis_scare</a>.)
Without such provisions in state laws, or the threat of incarceration, it can
be impossible to control the spread of dangerous organisms. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Control of the SARS epidemic would not have been successful
without involuntary isolation and the threat of punishment for violating it.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
One young man with HIV in New York infected 13 girls at the
school, several of whom became pregnant and had HIV-infected babies. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
A patient at Patton State Hospital with some psychopathy
traits wanted to infect as many men with HIV as she could, by seducing them and
by exposing them to her blood, her rationale being that “some guy” had infected
her. Had she gone to court, her behavior could have been proven, but she could
have easily denied intent to infect any specific individual.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">ARGUMENTS FOR
PUNISHMENT FROM CRIMINAL JUSTICE THEORY </b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Penalties against endangering the lives and health of others
are universal and considered necessary among all societies on earth, and they
are directed at dangerous behavioral abuses rather than at a state of being. </div>
<div class="MsoNormal">
<a href="http://law.jrank.org/pages/9576/Punishment-THEORIES-PUNISHMENT.html">http://law.jrank.org/pages/9576/Punishment-THEORIES-PUNISHMENT.html</a>
</div>
<div class="MsoListParagraph">
<br /></div>
<div class="MsoListParagraph" style="margin-left: 0in;">
Criminal justice theory
justifies punishment on several bases:</div>
<div class="MsoListParagraph" style="mso-list: l0 level1 lfo2; text-indent: -.25in;">
<span style="mso-list: Ignore;">a<span style="font: 7.0pt "Times New Roman";">
</span></span>Utilitarian: deter future crime by the defendant;
includes rehabilitation</div>
<div class="MsoListParagraph" style="mso-list: l0 level1 lfo2; text-indent: -.25in;">
<span style="mso-list: Ignore;">b <span style="font: 7.0pt "Times New Roman";">
</span></span>Retributive: includes keeping the offender off the
streets to temporarily avoid re-offence</div>
<div class="MsoListParagraph" style="mso-list: l0 level1 lfo2; text-indent: -.25in;">
<span style="mso-list: Ignore;">c <span style="font: 7.0pt "Times New Roman";">
</span></span>Denunciation: make the public aware of the penalty, to
deter future crime by others</div>
<div class="MsoListParagraph">
<br /></div>
<div class="MsoListParagraph" style="margin-left: 0in;">
All of these rationales are
appropriate in the case of willful/reckless exposure to a communicable disease.</div>
<div class="MsoListParagraph" style="margin-left: 0in;">
<br /></div>
<div class="MsoListParagraph" style="margin-left: 0in;">
<b style="mso-bidi-font-weight: normal;">CONCLUSIONS:</b></div>
<div class="MsoListParagraph" style="margin-left: 0in;">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">Please veto SB 239
for all of the above reasons.</b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="text-indent: 4.0in;">
Sincerely,</div>
<div class="MsoNormal" style="text-indent: 4.0in;">
<img border="0" height="50" src="file:///C:\Users\R\AppData\Local\Temp\msohtmlclip1\01\clip_image002.jpg" width="266" /></div>
<div class="MsoNormal" style="text-indent: 4.0in;">
Ronald P. Hattis, MD, MPH</div>
<div class="MsoNormal" style="text-indent: 4.0in;">
President, Beyond AIDS</div>
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<![endif]-->Ronald P. Hattis, MD, MPHhttp://www.blogger.com/profile/03917713422765368391noreply@blogger.com0tag:blogger.com,1999:blog-13808410.post-18917214283333084232016-12-10T13:56:00.000-08:002016-12-10T13:56:16.140-08:00ANNUAL MEETING HIGHLIGHTS, NOVEMBER 13, 2016The Annual Meeting of Beyond AIDS, and an open Board meeting of the Beyond AIDS Foundation, were held on Sunday, November 13. The central meeting place was in Redlands, California, supplemented by conference call participants from across the country.<br />
<br />
Two of the topics discussed at the Annual Meeting, <a href="http://beyondaids.blogspot.com/2016/12/beyond-aids-legislative-activities.html" target="_blank">legislative activities in California this year</a>, and <a href="http://beyondaids.blogspot.com/2016/12/impressions-from-21st-international.html" target="_blank">reports from the International AIDS Conference in Durban, South Africa</a>, have already been reported in separate articles. <br />
<br />
A special feature at the meeting was a report from Richel Strydom, the current Treasurer, about her recent work in the small African country of Lesotho (pronounced "lesutu"), which is entirely surrounded by South Africa.<br />
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<![endif]-->Dr. Strydom, a native of South Africa, is also a Loma Linda Preventive Medicine resident. She did a residency
rotation at the Maluti Adventist hospital in July 2016. She expressed appreciation to Loma Linda University
and to the hospital for the opportunity. The HIV prevalence rate for ages 15-49 in Lesotho is estimated at 23.4%, second
highest in the world, with higher rates in females under age 40. Partly as a
result, there is a high rate of cervical cancer.
<br />
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The Health Ministry adopted a “test and treat strategy” to
take effect the month she was there, and she attended the introductory
training. HIV meds will be offered immediately after a positive test result. This strategy, already implemented in the U.S., was endorsed by UN AIDS in 2015, but Lesotho is the
first country in sub-Saharan Africa to implement such guidelines. Assistance has been assured from the Elisabeth Glaser Pediatric AIDS Foundation,
and from the U.S. government President's Emergency Plan for AIDS Relief (PEPFAR) fund. <div class="MsoNormal" style="margin: 0in 0in 0.65pt 76.5pt; text-align: left;">
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Richel discussed a plan for cervical cancer testing – every
5 years for sexually active women. However, Pap testing and high risk HPV
screening are not yet routinely available there. She gave presentations at the
hospital and at the school of nursing, on the importance on cervical cancer
screenings, using a more primitive technique, visual inspection during a pelvic
examination with acetic acid application to the cervix to identify abnormal
tissue. Women with positive findings currently need to be referred by the
hospital elsewhere for biopsy and treatment. She also assisted in HIV and TB
care, prevention, and community education.<br />
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At the Foundation Board meeting (which followed the Annual Meeting), Dr. Strydom was presented with a certificate for having recently completed a 2-year part-time fellowship with the Beyond AIDS Foundation. Her research study, a survey of state and regional AIDS Directors, is still ongoing. <br />
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Also still pending completion is an earlier survey of local jurisdictions in California concerning their practices for HIV partner services.<br />
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The Foundation recognized Michael Weinstein, President and founder of the AIDS Healthcare Foundation, for its annual Nettie Award, citing his courageous and innovative advocacy for HIV prevention and treatment. The award is to be presented in Los Angeles in December.<br />
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Cesar Reis was accepted as a new fellow, and Camila Araujo as a new intern. Their first duties will involve helping to complete research studies. They have also expressed interest in helping to organize an educational webinar under guidance from Beyond AIDS Vice-President Jeffrey Klausner. Further <a href="http://www.beyondaids.org/internships.html" target="_blank">information and the application form for the Beyond AIDS Foundation's internship and fellowship program</a> is available on the Beyond AIDS web site.<br />
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<br />Ronald P. Hattis, MD, MPHhttp://www.blogger.com/profile/03917713422765368391noreply@blogger.com0tag:blogger.com,1999:blog-13808410.post-28982594983232252802016-12-10T10:17:00.000-08:002016-12-10T10:28:11.509-08:00BEYOND AIDS 2016 LEGISLATIVE ACTIVITIES, CALIFORNIABeyond AIDS legislative activities for 2016 have focused on California. We supported a new bill that passed and was signed. In addition, we supported a voter initiative that failed, and continued follow-up on a bill that had passed recently but had not been implemented.<br />
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<b>AB 2439 (Nazarian) will establish a pilot program to study HIV testing in hospital emergency departments. </b>This passed, was signed into law, and will take effect January 2017. The bill was sponsored by the AIDS Healthcare Foundation and supported by Beyond AIDS. It was watered down from originally requiring all ERs to offer HIV testing. In its final version, it established a study at up to 4 hospitals to determine effectiveness. <br />
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<b>Proposition 60, a statewide voter initiative also sponsored by AIDS Health Care Foundation, would have required condoms for adult film industry, and testing at employer expense. </b>Beyond AIDS was named in TV ads and listed as a supporting organization in the voter booklet sent to millions of Californians. Beyond AIDS activists Gary Richwald and Jeff Klausner were both named in the booklet as spokespersons. It failed to pass at the November 8 election, 53 – 47% against with another million votes to be counted. <br />
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OSHA CA (Cal-OSHA)’s interpretation of the bloodborne pathogen standard issued years ago for healthcare institutions is that it also requires condom use for workers and employees that are exposed. The industry (producers, but with support from some actors) has fought this for years, initially stating that the actors were independent contractors and not employees, however they were found to be employees in a court case. Their fear is that if condoms are portrayed, fewer films will be sold. <br />
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Those involved in the industry, as well as the HIV/AIDS community, are also sensitive to anything involving the government telling anyone how to have sex. However, this argument fails to distinguish bedroom from "industrial" sex. From a public health perspective, we were disappointed that organized medicine (CMA) opposed the initiative out of concern for excessive litigation, because it would have allowed citizens to sue the companies. The power to sue was added to the wording because no one seems to want to enforce rules requiring condoms or involving this industry. Los Angeles voters approved a proposition similar to this one a few years ago, but there has been no enforcement; and Cal-OSHA only acts on complaints.<br />
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Beyond AIDS has been in favor of condom requirements for the adult film industry for years, and has been working on this issue for a long time. Several years ago, Denise Bleak and Ron Hattis attended CAL OSHA hearings, but no regulation was ever issued. Peter Kerndt was also an early champion. CAL OSHA has been dragging its feet, but now is talking about once more holding hearings. This issue is important not only to protect workers, but to set a standard for safe sex, since millions of people watch porn and are tempted to emulate what they see. Monica said that this may be a national issue, not just a California thing.<br />
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The number of actors in the industry over time is actually fairly large, with considerable turnover, and each performer may have thousands of exposures. There is potential transmission to the general community. <br />
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<b>Follow-up of AB 466 of 2013, HIV Test Offering in California Primary Care Clinics <br />
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This bill passed in 2013, and has been in effect since January 2014. This law requires HIV testing to be offered if doing blood tests for something else, and if there is no recent test result on record. However, there was virtually no effort to inform the clinics or providers affected, and many still do not know about or follow it. Beyond AIDS has reached out to the California Primary Care Association and received a recent encouraging message from Dr. Mike Witte, Chief Medical Officer. The issue has also been raised at the California Public Health Medical Leadership Forum, of which Ron Hattis is Secretary. <br />
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For 2017, Beyond AIDS will look for opportunities to support any legislation and regulations in California, other states, and federally, that could enhance the control and prevention of HIV/AIDS.<br />
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Ronald P. Hattis, MD, MPHhttp://www.blogger.com/profile/03917713422765368391noreply@blogger.com0tag:blogger.com,1999:blog-13808410.post-49851518815962186952016-12-08T12:59:00.000-08:002016-12-08T14:43:27.104-08:00IMPRESSIONS FROM DURBAN, SOUTH AFRICA: 21ST INTERNATIONAL CONFERENCE ON AIDS, JULY 18-22, 2016Deanna Stover, Beyond AIDS Foundation President, and Marsha Martin, Advisory Council member, represented Beyond AIDS at this conference in South Africa. They discussed their impressions at the Beyond AIDS Annual Meeting, November 13, 2016.<br />
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Marsha Martin reported that the conference had been in Durban before, in 2000. This was an opportunity to come back and see how things have moved along after 16 years. There were about 20,000 attendees, and the mood was optimistic and people were feeling good. Treatment is available, much more is being done. Science is being used on the ground. At the earlier International AIDS Conference in Durban, this was not the sentiment. <br />
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Marsha coordinated a satellite conference call/meeting with a new organization she is working with – a global network of black people working on HIV, including UN AIDS, leadership of the conference, and a network of professionals from organizations working in Africa and with African Americans. National and local people need to be involved, not from the outside but from the inside, and including vertical leadership. The resources exist to impact the epidemic, so the challenge is to harness them and improve outcomes. <br />
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The message behind key populations – gay males, injection drug users, sex workers, and transgender persons – was evident. These “key populations” have been emphasized in the latest funding, including the recent announcement of a $100 million U.S. government’s PEPFAR (Presidential Emergency Fund for AIDS Relief) grant, at a high level UN meeting in June. This can be understood, because these groups have been ignored by some governments. However, there was some tension between these groups and those working with women and girls, who now account for 62% to 71% of new cases in various countries. Two years ago, the Dreams Initiative, funded by PEPFAR, the Gates Foundation, and other NGOs, had emphasized young women and girls in east and southern Africa, and is ongoing. Most transmission in Africa, unlike in the U.S. and some other developed countries, is among heterosexuals.<br />
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Martin said that there was a consensus that after 15 years of PEPFAR, the time has come for national “ownership” of the epidemic, with local governments and national NGOs taking more responsibility. Collaborations and partnerships need to be established. <br />
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Deanna Stover addressed maternal child transmission rates, which have decreased in South Africa, through the use of community health workers – from the “community.” Six countries reported that they now had no or almost no perinatal transmission. Deanna attended discussions on PrEp (pre-exposure prophylaxis) for discordant partners, and treatment as prevention. Funders spoke about the future of funding and the need to have outcome metrics moving forward. Overall, she said it gave a profound overview of the epidemic, and of the challenges for the future.<br />
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Ron Hattis, who did not attend, mentioned that if the prevalence rate could be gradually be reduced, particularly through successful “test and treat” programs, the current high levels of funding could eventually be reduced; if not, they will be needed indefinitely.<br />
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Jeff Klausner also did not attend, but mentioned that there was a sobering presentation in Durban regarding the “real world” effectiveness of “test and treat” in KwaZulu-Natal (the South African province in which Durban is located), funded by French ANRS group. The outcome was that fewer than 1/3 were virally suppressed in one year, and incidence did not decrease, compared with a control group. This was a well-done trial and speaks to the limitations of “test and treat” and the need for additional strategies such as newborn circumcision and PrEP. The weaknesses of the effort appeared to be in keeping the positive patients on treatment.<br />
Ronald P. Hattis, MD, MPHhttp://www.blogger.com/profile/03917713422765368391noreply@blogger.com0tag:blogger.com,1999:blog-13808410.post-55954702107235955522016-11-30T22:50:00.002-08:002017-12-16T20:57:13.825-08:00BEYOND AIDS LEADERS FOR 2016, 2017<!--[if !mso]> <style>
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" 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UnhideWhenUsed="false" QFormat="true" Name="Normal"/> <w:LsdException Locked="false" Priority="9" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="heading 1"/> <w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 2"/> <w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 3"/> <w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 4"/> <w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 5"/> <w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 6"/> <w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 7"/> <w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 8"/> <w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 9"/> <w:LsdException Locked="false" Priority="39" Name="toc 1"/> <w:LsdException Locked="false" Priority="39" Name="toc 2"/> <w:LsdException Locked="false" Priority="39" Name="toc 3"/> <w:LsdException Locked="false" Priority="39" Name="toc 4"/> <w:LsdException Locked="false" Priority="39" Name="toc 5"/> <w:LsdException Locked="false" Priority="39" Name="toc 6"/> <w:LsdException Locked="false" Priority="39" Name="toc 7"/> <w:LsdException Locked="false" Priority="39" Name="toc 8"/> <w:LsdException Locked="false" Priority="39" Name="toc 9"/> <w:LsdException Locked="false" Priority="35" QFormat="true" Name="caption"/> <w:LsdException Locked="false" Priority="10" SemiHidden="false"
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<b><span style="font-family: "arial" , "sans-serif"; font-size: 16.0pt;"></span></b></div>
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<b><span style="font-family: "arial" , "sans-serif"; font-size: 16.0pt;">In its biennial election on November 15, 2015, Beyond AIDS selected the following officers and directors to serve during 2016 and 2017:</span></b><span style="font-family: "arial" , "sans-serif"; font-size: 16.0pt;"><br />
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<b><u>President</u>: Ronald P. Hattis, MD, MPH (California)<br />
<u>Vice-Pres</u>: Jeffrey Klausner, MD, MPH (California)<br />
<u>Secretary</u>: Deanna C. Stover, PhD, FNP (California)<br />
<u>Treasurer</u>: Richel Strydom, MD, MPH (California)<br />
<u>Directors</u>: Adriana Andaluz, MPH (New York), </b></span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 16.0pt;"><b> </b><b> </b></span><span style="font-family: "arial" , "sans-serif"; font-size: large;"><b><span style="font-family: "arial" , "sans-serif"; font-size: 16.0pt;">replaced by Gary A. Richwald (California), </span></b></span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: large;"><b><span style="font-family: "arial" , "sans-serif"; font-size: 16.0pt;"> 11/19/17</span> </b></span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 16.0pt;"><b> Franklyn N. Judson, MD (Colorado)<br />
Elizabeth Kidder, MD, MPH (Washington, DC)</b><br />
<b> Monica M. Sweeney, MD, MPH (New York)</b></span><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;"> <br />
</span><b><u><span style="font-family: "arial" , "sans-serif"; font-size: 16.0pt;">Past-Pres.</span></u></b><b><span style="font-family: "arial" , "sans-serif"; font-size: 16.0pt;">: Cary Savitch, MD (California)<br />
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<b><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">The Advisory Council will consist of:</span></b><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;"><br style="mso-special-character: line-break;" /> <br style="mso-special-character: line-break;" /> </span></div>
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<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Denise Bleak, MSN, PHN (California)<br />
I. Jean Davis, PA, DC (California)</span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Josileide Gaio, MPH (California)<br />
Peter Kerndt, MD, MPH (California)</span></div>
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<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Marsha Martin, DSW (Washington, DC)</span></div>
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<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Cesar Reis, MD, fellow (California)<br />
Gary A. Richwald, MD, MPH (California, moved to Board 11/19/17) <br />
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<b>The subsidiary Beyond AIDS Foundation, a 501(c)3 charitable corporation, will be governed by the following Board (elected by the membership of Beyond AIDS):<br />
<br />
<u>President</u>: Deanna C. Stover, PhD, FNP (California)<br />
<u>Vice-Pres.</u>: Monica M. Sweeney, MD, MPH (New York)</b><br />
<b><u>Secretary</u>: Ronald P. Hattis, MD, MPH (California)<br />
<u>Treasurer</u>: Richel Strydom, MD, MPH (California)<br />
<u>Directors</u>: </b><b>Franklyn N. Judson, MD, MPH (Colorado)<br />
<span style="mso-spacerun: yes;"> </span>Elizabeth Kidder, MD, PhD, MPH (Washington, DC)</b><br />
<b> <span style="mso-spacerun: yes;"> </span>Jeffrey Klausner, MD, MPH (California) </b></span></div>
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<b><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;"><span style="mso-spacerun: yes;"> </span>Cary Savitch, MD (California)<br />
<span style="mso-spacerun: yes;"> </span></span></b><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;"> <br />
The Scientific Committee is assigned by Beyond AIDS <span style="mso-spacerun: yes;"> </span>to work with the Foundation. Members, as of April 2017:</span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Franklyn N. Judson, MD, MPH (Colorado) and</span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Monica M. Sweeney, MD, MPH (New York), Co-Chairs</span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">I. Jean Davis-Hatcher, PhD, PA, DC (California)</span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Ronald P. Hattis, MD, MPH (California)</span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Elizabeth Kidder, MD, PhD, MPH (Washington, DC)</span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Peter Kerndt, MD, MPH (Mozambique)</span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Jeffrey Klausner, MD, MPH (California)</span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Gary A. Richwald, MD, MPH (California)</span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Cary Savitch, MD (California)</span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Colin Shepherd, MD (China)</span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Deanna C. Stover, PhD, FNP (California)</span><br />
<br />
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">The memberships of this and other committees are subject to change and available on request.</span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;"> <br style="mso-special-character: line-break;" /> </span></div>
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<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">BRIEF BIOGRAPHIES OF BOARD MEMBERS OF BEYOND AIDS, 2016/2017</span></u></b><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTFBSCZgcGrJMd7zzieNGTrMDoZQqHs7_665O-f-Q0xu671phav-tJWvc0KVgigRlz-kini_EbIPoAcnFH-wvJXrWFxNV_KR5UJkuUo0n6gJerrd78fESrE17gb-ewJK9k9GVfUg/s1600/Hattis+2013.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="195" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTFBSCZgcGrJMd7zzieNGTrMDoZQqHs7_665O-f-Q0xu671phav-tJWvc0KVgigRlz-kini_EbIPoAcnFH-wvJXrWFxNV_KR5UJkuUo0n6gJerrd78fESrE17gb-ewJK9k9GVfUg/s200/Hattis+2013.jpg" width="200" /></a></div>
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">RONALD P. HATTIS, MD, MPH, President</span></b><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"></span></div>
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<span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Ron Hattis is continuing as President of Beyond AIDS, and Secretary of our subsidiary tax-deductible Foundation.<span style="mso-spacerun: yes;"> </span>When the organization was founded, he was the first Vice-President, and later but before his current offices served as Secretary, as well as President of the Foundation. He has been active in contacts with federal leaders, and in Beyond AIDS' legislative efforts in California, and has represented our organization in consultations with the California Office of AIDS. He developed the original Bylaws for both the membership organization and the foundation, and has mentored many of our past interns.<span style="mso-spacerun: yes;"> </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"></span></div>
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<span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">He is a physician, board-certified in Public Health/Preventive Medicine, and lives in Redlands, California.<span style="mso-spacerun: yes;"> </span>He was formerly the Chief of Medical Services at a large state hospital, where in addition to medical management, he was in charge of HIV testing and training HIV educators for 20 years, and he treated HIV/AIDS patients at the infectious disease clinic.<span style="mso-spacerun: yes;"> </span>Since retiring from that position, he has worked part-time in clinical medicine, currently including student health and primary care. He has been an HIV clinician/specialist. <span style="mso-spacerun: yes;"> </span></span></div>
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<span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Dr. Hattis is an Associate Professor of Preventive Medicine Loma Linda University School of Medicine, where he has lectured on HIV as a representative of our Foundation.<span style="mso-spacerun: yes;"> </span>He spent 23 years with a disaster medical assistance team, serving at the World Trade Center, Hurricane Katrina, Hurricane Ike, and the Northridge earthquake.</span></div>
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<span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Other past positions in reverse order have included teacher of family medicine, county health officer, country family physician (on Kauai in Hawaii), and Epidemic Intelligence Service Officer for the Centers for Disease Control and Prevention (assigned through field services to the Hawaii Department of Health).<span style="mso-spacerun: yes;"> </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"></span></div>
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<span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">His goals for Beyond AIDS over the next two years include developing proposals for more effective implementation of the National HIV/AIDS Strategy; and continuing to be involved with legislation in California and important states, as well as at the federal level. In particular, he plans to continue to work to promote the HIV care continuum; to utilize HIV reporting to trigger outreach for referral of patients to treatment, partner services, and other services to prevent transmission; and to enhance HIV prevention science.<span style="mso-spacerun: yes;"> </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"></span></div>
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<b><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">JEFFREY D. KLAUSNER, MD, MPH, Vice-President</span></b><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"></span></div>
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<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Jeffrey D. Klausner<b> </b>is a UCLA Professor of Medicine and Public Health. He is a physician, board certified in Internal Medicine and Infectious Diseases. He served as a CDC Epidemic Intelligence Service Officer 1995-1997, Deputy Health Officer and Director of STD Prevention and Control Services, San Francisco Department of Public Health, 1998-2009, and Branch Chief for HIV and TB, CDC South Africa, 2009-2011. </span></div>
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<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Dr. Klausner has been a leader in implementing the public health approach to HIV prevention and control through policy and programmatic activites resulting in the streamlining and evaluation of routine HIV testing, early HIV case detection with HIV RNA screening, linkage-to-care and contact tracing and partner notification services. In addition Dr. Klausner through his epidemiologic research, identified the role that bacterial STDs, the Internet, sex clubs, methamphetamine and Viagra played in augmenting the risk of HIV tranmission and implemented successful population-based programs to mitigate those risk factors. In collaboration with community leaders and organizations, he inititated sexual health campaigns and peer-led sexual health services for sex workers and gay men in San Francisco which have been replicated globally. </span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"></span></div>
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<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Dr. Klausner has been conducting research in laboratory-based diagnostics for HIV infection and other STDs since the early 1990s and is considered an expert in infectious disease detection and management. He has a busy clinical HIV/AIDS practice in Los Angeles and regularly attends on the infectious diseases consultation service at UCLA Ronald Reagan Hospital. Dr. Klausner brings nearly two decades of public health, clinical and research experience to the Board, much of it specific to HIV prevention.<b> </b></span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"></span></div>
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<b><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">DEANNA STOVER, PHD, RN-BC, FNP-BC, CNS, COHN-S, Secretary </span></b><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"></span></div>
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<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Deanna Stover is the Executive Director, Community Based (Outreach) Programs and Services, at Redlands Community Hospital, with responsibility for the provision of healthcare to the community with a focus on low-income and underserved populations. She began her nursing career in 1979 while serving in the United States Air Force in Europe, and she earned her PhD in Nursing, Health Policy from Loma Linda University in 2011. She holds board-certification as a family practice nurse practitioner, medical-surgical nurse, and occupational health nurse specialist.</span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"></span></div>
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<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Prior positions include Director, Medical Services, City of Los Angeles, and Chief of Clinical Operations, Center for Employee Health and Wellness, County of San Bernardino. She has actively worked in the medical arena for over 30 years with training and expertise in community-based healthcare, health policy, HIV/AIDS health care, occupational medicine, and advance practice nursing as a family nurse practitioner and clinical nurse specialist. </span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"></span></div>
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<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">She holds a certificate as an Advanced HIV Nurse Clinician from USC Medical Center, AIDS education training center (1995) and has provided HIV/AIDS training for healthcare providers. </span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"></span></div>
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<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">She has served on organizational boards at the state and local level and is a current board member for a local non-profit community service organization, Building A Generation, located in Redlands California, in addition to being the current Secretary, Beyond Aids, Inc, and the President of the organization’s Foundation.</span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"></span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">RICHEL STRYDOM, MD, MPH, Treasurer</span></b></div>
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<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Dr. Strydom was born and raised in the country of South Africa.<span style="mso-spacerun: yes;"> </span>The HIV burden of the South African population, as well as the HIV burden within many African and other countries, including within the U.S.A., have contributed to a strong, persistent public health problem. <span style="mso-spacerun: yes;"> </span>In July 2016, shortly following the June 2016 launch of <span style="mso-spacerun: yes;"> </span>the “Test and Treat” HIV care approach in Lesotho, the first country in sub-Saharan Africa to formally adopt this strategy recommended by UNAIDS in 2015, Richel had the privilege of attending a briefing on the new program while doing a rotation in HIV and Tuberculosis care and prevention, at Maluti Adventist Hospital, in Lesotho. </span></div>
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<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">While a Family Medicine Resident in training, in Tallahassee, FL, Richel worked as a volunteer </span><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">to provide education and <span style="background: white;">comprehensive support to people who are living with HIV, within an eight-county area of Florida. Earlier, w</span>hile attending medical school at the American University of the Caribbean School of Medicine, she worked with students and faculty members to actively promote knowledge about, and the prevention of, HIV and STIs. Prior to that, while attending North Carolina State University, she worked with the Alliance of AIDS Services – Carolinas (AASC) as a volunteer “care partner” for a young woman living with HIV. </span></div>
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<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Richel feels compelled to work to improve HIV care and prevention policies and practices. <span style="mso-spacerun: yes;"></span>Serving with Beyond AIDS furthers that aim.</span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">ADRIANA ANDALUZ, MPH, Director (until 11/19/17)<span style="mso-spacerun: yes;"> </span></span></b></div>
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<span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;"></span><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Adriana Andaluz originally hails from Los Angeles, CA, where she studied Microbiology along with a minor in Spanish Literature at the University of California, Los Angeles. She began her path in public health as an undergrad while working with Dr. Helen Rodriguez-Trias at the Pacific Institute for Women’s Health, an incubator for programs designed to further women’s health in the US, Africa, Latin America, the Middle East, and Asia. </span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"></span></div>
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2V0zp9bK7r7dH35BBsZ6c/wCB3/mOU/qlk4WR1HFybCMfqGVblY1eWTttr9al+zOoDttDqqXfq9dT/wDSKsFRH8Qjspbj5T/tl0Nbe6nPynk2D1WNIxel0O/NwqHt/Sf9trtPq9mOy/qtVc7eLL2udZZa0MNr2HY/JoYz2/ZNrfSr9ta4fMb6VdPTaRZj0WuNdrLRre0bmG4ud9GvOsY+1tn+Deuj6B1nqPVMXK6W4bsbFxmnC2tAuYK/0VtDy32W1MYP+MemHUWOy6IqQB3JdP6uMZZdk5LQfSZ7G7vznFFznE7y6DbuFT7Il5c76GPjj+r/ADjvoIn1UpDOnvI0Y9+9niR5qr1PoB6jlV35N1lpra9teNU70garP51mRYPzXfvt96EG2Nni+rde6Y7Kfh4h3vqMOcwlwMchrm+3d/UWt9U8izJvi6osrguosfAc5o+k17PpN937yNf0Dqb3FmEMPp1BAZ+rVAvIH5u5353/AAi0un9P6f0StrbXmzIzHBrS/wB11rx3Y383Yn0OgSBKtUeT0eu2rKayx5ssadzuGhx+i5n9RcHl4nUaMp2JdkV4z2gBttktbPc16bdy9YDQ1jt5AawS5x4E/vO/ecsjrAZhg5WRiV5nRg0eplNh9lDiY/TUn6eN/wAIxH5TpraSARX8vteW6HhdStsppp6pVlWVvmp2xz3s/fa23/uO76NtL11XWMTIooo6w0Mffh1OoyKwS2k1Ez637+6j/pomF1TAFe3FNbWOAANTQ3T+yrGd6lnTsv0SLw+kuZWdPcz3bXfynKPISTf5K4KiQ+euFnUaeqVdDzX5OFkNrt6rZeG1WFlG59VFGLLnuo/0dlP6X99XOg4rHdPpxchgoy7C5+Mw6u9Ij9DVb/wn57WKpmZNFb6sek11vkPysqpkWifd6Ff9VypX5T7SKcUua19kutB3Wvdzu3/mud/JUgkdABo58vUREOln1ZVPTvTpDW5Ln7G22uDQ0N/nN276SA7JtxMezptAJ+1U1vyrLIfkerP6K2u76OPRu93/AAipvyTkiupzDbQ1vpsfadxDCd9+w/6X8zereZ6bn4edeWXOh2yilsWNoH80zM/e9Jo20oGro7Jxjfa3/9PK6dn1ZXVntOK1uG7ErxKMFxD5NH801+n6XOf9PGsVb6x4Dbc01kxXh2CnIsIiyXjfV9oYz9HXdu9n6P6CD0zPd0b6wdOyiPRfj2NGQy5vuazI/QX5DmH6F9bXf9bXT3fUnqeR1TNxMa3HDcWG22WvO+xmRutrybWs+jd9Ot2//rSrEEEEXskix/dahwLcyjpPpXsfkZ2Ldl5j7nH0tlB9PGFDz7vtH0v0f83+eidBbfRkY78W1luRdtsx6KHQ52NZpksy3H6GTQ73fZkzWYB9fA6sHZDsDELumCv+bx3VksrryRV/Obr9no22fo/9IgdGyKcDNb1DLtpr2Od691gJe21rN1wo2f4X3elV++mgigNrKom5w8a1L6Hivw/UyMTFeHWYjg3JYBEFwltjUwrG99tjtoOgHwVbomM1jreqCqyhvWmsssxrhF1dtY0bZ+76jPf6aj1jIdWAxp+nxHceCafTJuA6kA34tHq/Vq8WouqgEGGQO65v6udSzr/rLZ1Sxn2htFFlNVbjG0uj9Iz9391P1a51u2uk77QDtaO0f6Qfm7UbpNtXRm1YTKv2h1nK91OFWeSdfVyLPo0UN/lJ4kuNAV37tzqHXrXYvoZlDsNg1eKj6kH8xrv31mhvWs/pWTVQXUdPewstaP526efb+ZW5R6pX9a8+yy97aq7a2b/s+PENrHtcXWO+k9jlDC6B1/7DdmZPUK+luqg1syHgBwI3suNp+h+6lR3tJMQNZD83I6dk24rxQTDqtG+Y42rsPq91I2ZBxbNa72vEHv7T+d+YuGxs63qr2Ouq9Jz5a61gj1Hj/CV/ym/4RdV0HHNHUsYPMw17iex2tPuKGQVod1CQkLBeaDjbiuuyKQzOaLGyBtYGTFVjv37N/wD0EI9VxHZtfUa2/Zr8VlJxQGgVW5NZ/T2Xf6Oh7VXwrnWX3NveHV32vdZuPtP0w1mnuYx/76rtos+zNe7awEmtrrDLBB1d/KYxilEehc8CiS7jLWZ97ntxWsyci4vfj1nbTX6xjHxsaz9/IsUnYmVlbjXT6n2a5lFjqXfRdP8ARrnfn4+/2WW/4NU/U6c3LpxOgfafdZSMS28a3Zs7GZDq/wDA1+79XqVvHo6pj9Vuw8S/ZlOyTg2OBBDsiwivJe5n0f596ZKJBJjXhxbJqFdfo//UpddwbsupuZkPw6h1LZTkXUkybz78LquZj7N/TftbWenfV9D1v55b/U7eo4tbfrTk1fZqX4NeJm9OtcG3Z9pFjfT9m70X0O/S0XVfrFlG/wDwaq5DG9doGZiPZZ1ltDa84Y+0DqNBaG5FbarNn6zg7fY//tr/AAXpZtWay76qX/V/qhLcvEtNnS8i8ua2nIrO5vSrHv8A01WQyn1NnrfzlVvp/mKsKIom9P8AnMm/1/JDlYz8bPr9d1bc6nFrOUWEsFN2SfZ0y4EltrPR2P8A0n+FWdmNHp5D6doGAWtsa8fpm2A7m7A7+d943rayb6hnY3UMm2zDyGilnX72179rtp+w5FTHB/q+13pb9izsqjY+zGM5NdTwKmsG57KnvO11Tm/pMzLyt2+yr/AJsSaGm3RYQARXT7Hp+mfWjDquf6Nd9brwzKzs64+qy1zWCk/a6vpYFPtaynJq/QLa+sFYsxq76/cIbcwjwdrIK856ZQKfrP8AZM62/ANTvdfa3feXkNsx2Z2KNzLMO3/uMvR+nFmV0c1k73473Nsa3gb/AHbWD82v/RsQlEiIG9M2CXQvGfWvDbQT1GhxYbdjciNNzJG7/NV7pHQ3dKzH9Q6Jlvq+0Mabm3AWtLfpb3k+7b7la6ngtysWzBt1D27WOHlqFb6fVYzFqrZ/g2hm390j8z+q5GEtGciwNLcrqGb1jGczHotF4ax4utdW0OdvO8M/61/gljVUPuyCc2mvNfcNj7895eWs520Ut9jNv5i6TOw3ibbH+n6rvogzp47vzf6izK+k4ht3fbZcDO0wjf0XRIA+UfYg6thRXjDHbuGM8QQAPb4CFYvvZhYWflmQKcYsa7mH3foJ/sbt6PlEMrAkOLDJ8I/lLP6pbm10fY8Q01ZPpnNttyiAxwHsrxsLd9PN/wC670zUkBbOdAn7HlqmYg2VOGxtVew2OmHEa7g36Xp3f+Bo+RdiVCt1gHqsZLWBu6J+j67fo1/2E+f07qHT8vGxMmg05ORSLMbDB9S4usJ2ty/9BbZ9J9Tv5tMaaxl2Nc9j/Rhl4B9rrY/SVbvz/Td7d7VOQWkQNCO9IMrFuwshtRtD7oa/9C6XDd7qnAj6F2v0v8Gi+nb6v2cWRex2117Hx738Tf8A4S51n85Yk+muA+is+sHn9CwQG0x73b3fvO/mlKvDrfY9zHGynGr/AE1TdLGG0bam7Xe2yz/SWNQ4rGq4dQH/1b131axcrIx8DpuTZZ1BjAzqGXdWaGOre7Zl347drdmZR/2kx6/5j99X/rJ0Pp9jMq7HyPVyaMFledVaA6zIDCPsGVfb7NuTW5llf2jZ6j2exWuodWxK8vBFpbWen1OyMxlzpbiVlmyl2bd7nuvdbtrxsdv6e1651zvUxaH5ebZg5Odf9sz6r2Td1Giot+z14DWH9Bj7d7MbCtZ6v+G/r0YznLThEY6mXEPVL93hj+iu7Ug+q/TL+oHBzcqyurAzX24jm5Fh9TK2hz6LcRke9mJkV/o962/qe6qnqnVc/LvwvQxWhlj8dhYxtrNzcjJr9X+ada32ZLf9KgdEweqZfX6L7cG2jouLLujBzBFfqNcX3P8AdvrdW7/S/wA8uf6rmDLz83FwvTy8DOzPtOBj0EOuyM2v9DZZYxv83RZfvus3bK/Q/SKSIOhArr9FxPpN+QbGPbk/WTrg6n0bCqx+se6wgkit2PcfSZmZvqfn1M+gyr3/AMheg43TcfpGFj4OP7mAGXH6Vlh91lr/AOUo/VX6vt6J07bdtf1HKi7qGQ3860j+bY7/AEGP/NUM/c/4xWuvYGTm9OsbhOFedT+mw3nj1me5jLP+Cu/mbf8Ag3qb2/SQdSVkDRF93B6ljNJOwy0nTxH9VZrcyzGd+kaT4vbqT/KRGdWZ1DFblurdQ5rjTkNHOPe325GLkM+k1zbP5v8A4NUci67XbteydHNPKr1XgW5bDql5ymHZZp+6VlsxvTaxrn6sO6WiSVaNxeDDSNYgjuoFzwRsbLjokmy3um4zsnJZZe2cfHIs9EHVx/Mr3/nLI6t9Wc0DI6h0y6zrGHZabdjavUyqcg6MpysNxb7H/wA19so/Sfn+muh6XAaY1bWHOAJ1c8D2sB/lLA6F1rJFf22mx1eVTY5lzeLK/dpj2NP85R/XT4HU6WFmSHEN6LgOyDigsrIZm3bx1DR/2qp4c6u3GtsyPe3j3uYoY9DXGupjqxVS76QM7h9Jgr/efuXa9X6Fh/W7Duy+m0VY31lDm2XEuc1uSxjfTsqql/p0vf7PzP8Ajf8ATLk7eidf6OWZGR0fJxw32scGeszXX3ur3bVLw6elrS7bEJTiZNuSaKGuvvu3WikHb7GjfZf6jtrGV1fn71C00vwxfZYfRpc1lce19mW/3fT/AMJTi0+6z8xS6X1Z9ZyrMh9dv2up+NbXb7Hmtx/Temx+331LddjYmPijAultTqRRRDRvDbR7ntd/prd36RqgkeEi0EiMRI6yOlP/1p5d/T8CwXWUOzOgOI6h1jGrPrXsy3bRjYvV7t/6fFZZ+loqs+m/+e9T/Ca31cxqD1TAyc7ZfnZuPba7qAMtutc7Y7C/0lObg4Ttnp/6P/inqiS9nWvXxrsrFuZSyrLeK24ftbLmb8Wz9D/N/wAxdlfnrTrqzc/LyLvqzm491+PYBnYXUqCK6sg+5mdX9nY39f2N2erU70HqpjAkRf6G66gCSD4eTo77MTHw+h5l29maMyjbaXfabKmNe+puLZ9F1rK3Nb+m+msD6hfUzPxM7G65mUt6b6NT6q8QgG6xrxsbZkn/AAHt/M/nV3LKhT+sZTwbnhpP5zGPDdr/ALNu/SbXuT+pkEtDGbGuPusfz/Zr+l/nKzHHrZ+g8FspdGwTHzTjXVAcN10EaAEESjt0ACeQtB1eJ+unRs3Bvt+snRAfXNf+VcMCW5FLP+1LG/R+1Yrf8+r/AMG5enPxc+sWVfo3vbuaazoR/JavXLWgtB0BaZDj2XnP1v8Aqd+z7Lus9HZ+pn9L1DCZp6R5ObiN/wBHp+sUf61x5cfEOIfMN2xhy0eCW36Jcpnrjl8gckjhFFbjG9/waFWqseWtIg7gC0jUFrtWvZ+8xyn6x1EwBpKrNrhP2Oo21ra21gaEjQf99XI9TN/TerOz6RuMkXM7WsP0mv8A5Tf311GI2LK/VBAe0+kSe/8AKVDq2CLCBEgzI8ClA1K1GNim/wBBeH2NtxyTqLKnN0InXn91i9F6fmOvra24g3Aaub9B/wDKrcvK/qvXbRijeSa7HuawH90H81y9D6PZlVsrZc4em90NYBOnA2H83b+ereOPpamb5vwb3Ueg9F6o0t6jg0ZM/nWMaXD+rb/OM/suWDZ/i46IwNrwnWU4xcPXxXvdZW+s+25rXvd9opsdX9C2u72InQvrD1N/U+pdNzmDLpwb3V1ZlQAf6fP6bHH856P80+2j/ttdILKTQbQ8elG/1AdIGu5KUQRqLYiO4f/X6Or6k/bRV+08rIvod7803nbkZDv+49llbv0PS2fSZi/TXUY2NRi49WJhVNpx6WhrGtHtaG6BrW/nI8bvpceH96fgIRiI7BTBtbGOLtXPPLnalSJEa/eoWtseBsMeIQAS07bAYP8ArongX1WElOyDPEnQnzHiptOqpYdpGZk4zj9EMtZP7rhtd/0mq4PpE/JIijSB0K7pjx8kC7Lx6SyrIsrqdkv9KhlhA9R0F3pifpO2td7UW++nHpffe9tVNTS6yx5hrWj6Rc4rzHr/AFY/WDqTcp7XMwKAWdPqcCHGf5zOf+fU++P0H5/o/wDGIBeI2d3oOpfUOvHJt6K+uip24uwrifT3OO6Ma3V2Pu/0X82ucz+kZWPvZdQ7GvrAID9a4P0h61e5n9RGxbQ39Hkh11TtCHPcQB5arS/TYrB6NzzjH6Jcd4H7ocH7lFLFEmxoWxDLKG/ri5lIPptFjtzYEOGuo8HKxa0OALhq7Se8easxi2u3Pq9Kx3+Gp0j/AI2g+3ag3UWUureXB9bzFV7B7THjP83d/wAG5QnFKO40vdsRywnoDR7Fh07HaekYlzRBbbY2Rxz2W5R1V2B0y+2mp+TkUN/R0sG4jdocg/8ABV/4ZZvSay7oGJ522u+A3KzivsryWW1kguOjh2HBH9Ryu44+iPjEfk0shucv7zh4uRZ0+6qxj99rSXutaYLnOO614/rSui6Z1zPuqy7mtFXpMfa5xbDLQG7vXr/NZlUvH6Rn0L2Kk7pOOcw7QPTJmI4B+lsXT/ZKW4npbfaWent7bSIn+smVQUS//9D1IuDdTwovtYCGkiSJAPcKvk37RodOCPisl9+7IdZuDfTbO5zoDahp6bG/nP3J4h1KziLuNf4ajmVKWPEFY1XUjW8se7dGoPaPBWBmB8O7t7fFHhBUmuoGPmV5hdFIrdVdPZv02E/2ln9Q+uHTMYFmKx+deBoysbW/2rn+1qvMzoaW2CRxrrPxQrMTouZ9OprXnWW+0pafpapDxfU83qfWrA7PeHUVu3VYVYLaGuH0X3bvflWM/N3/AKFU/TcSWuMuHI7rtcj6tMe0/Z7t47B3P+cFlZP1dyK3bjyPxTSL2XAhxa6XD6Oo7BXMTJdQSzaHMd9Op2rT4q3VgPYYcDI7FH+yVPG17Y/lDlNpcJNb0az76P5oiXbtSw/6L+U1GrY0Ney1nqUXDbdVP0h+ZZP5uRT/AINHbgurEtG4DX5DxRmU7zNejXD2TyB+8/8AlJ4FhaTRsK6R0p1fTacW1/rPpDgy1ugexxkOI/Ns/NerQwfs59RzSG8AzBae3s/OUsOv0H7HWOa3IOoZq4uA/nHu/wAHV/waC/KsyHmzVrRLKGHkNHt9Qj996PFwjhA8FfMSSfEs6KTdeGxo07pHf96VqaGzcdGRA+SFg0DHo32aH+PipUstJstJgAHTsT2KYUv/2QA4QklNBCEAAAAAAFUAAAABAQAAAA8AQQBkAG8AYgBlACAAUABoAG8AdABvAHMAaABvAHAAAAATAEEAZABvAGIAZQAgAFAAaABvAHQAbwBzAGgAbwBwACAAQwBTADYAAAABADhCSU0EBgAAAAAABwAEAQEAAQEA/+ENfWh0dHA6Ly9ucy5hZG9iZS5jb20veGFwLzEuMC8APD94cGFja2V0IGJlZ2luPSLvu78iIGlkPSJXNU0wTXBDZWhpSHpyZVN6TlRjemtjOWQiPz4gPHg6eG1wbWV0YSB4bWxuczp4PSJhZG9iZTpuczptZXRhLyIgeDp4bXB0az0iQWRvYmUgWE1QIENvcmUgNS4zLWMwMTEgNjYuMTQ1NjYxLCAyMDEyLzAyLzA2LTE0OjU2OjI3ICAgICAgICAiPiA8cmRmOlJERiB4bWxuczpyZGY9Imh0dHA6Ly93d3cudzMub3JnLzE5OTkvMDIvMjItcmRmLXN5bnRheC1ucyMiPiA8cmRmOkRlc2NyaXB0aW9uIHJkZjphYm91dD0iIiB4bWxuczp4bXBNTT0iaHR0cDovL25zLmFkb2JlLmNvbS94YXAvMS4wL21tLyIgeG1sbnM6c3RFdnQ9Imh0dHA6Ly9ucy5hZG9iZS5jb20veGFwLzEuMC9zVHlwZS9SZXNvdXJjZUV2ZW50IyIgeG1sbnM6ZGM9Imh0dHA6Ly9wdXJsLm9yZy9kYy9lbGVtZW50cy8xLjEvIiB4bWxuczpwaG90b3Nob3A9Imh0dHA6Ly9ucy5hZG9iZS5jb20vcGhvdG9zaG9wLzEuMC8iIHhtbG5zOnhtcD0iaHR0cDovL25zLmFkb2JlLmNvbS94YXAvMS4wLyIgeG1wTU06RG9jdW1lbnRJRD0iMzA0NUJCODE5MTA4RUJCNjhCOTA1MUIzMTJBMTA2NUQiIHhtcE1NOkluc3RhbmNlSUQ9InhtcC5paWQ6MUIwM0ZEMEQ5MUI3RTYxMTg3MDBDOUMyODVFRTZEOUMiIHhtcE1NOk9yaWdpbmFsRG9jdW1lbnRJRD0iMzA0NUJCODE5MTA4RUJCNjhCOTA1MUIzMTJBMTA2NUQiIGRjOmZvcm1hdD0iaW1hZ2UvanBlZyIgcGhvdG9zaG9wOkNvbG9yTW9kZT0iMyIgeG1wOkNyZWF0ZURhdGU9IjIwMTYtMTEtMjdUMTE6NTk6MDctMDg6MDAiIHhtcDpNb2RpZnlEYXRlPSIyMDE2LTExLTMwVDIyOjQwOjMxLTA4OjAwIiB4bXA6TWV0YWRhdGFEYXRlPSIyMDE2LTExLTMwVDIyOjQwOjMxLTA4OjAwIj4gPHhtcE1NOkhpc3Rvcnk+IDxyZGY6U2VxPiA8cmRmOmxpIHN0RXZ0OmFjdGlvbj0ic2F2ZWQiIHN0RXZ0Omluc3RhbmNlSUQ9InhtcC5paWQ6MUEwM0ZEMEQ5MUI3RTYxMTg3MDBDOUMyODVFRTZEOUMiIHN0RXZ0OndoZW49IjIwMTYtMTEtMzBUMjI6NDA6MzEtMDg6MDAiIHN0RXZ0OnNvZnR3YXJlQWdlbnQ9IkFkb2JlIFBob3Rvc2hvcCBDUzYgKFdpbmRvd3MpIiBzdEV2dDpjaGFuZ2VkPSIvIi8+IDxyZGY6bGkgc3RFdnQ6YWN0aW9uPSJzYXZlZCIgc3RFdnQ6aW5zdGFuY2VJRD0ieG1wLmlpZDoxQjAzRkQwRDkxQjdFNjExODcwMEM5QzI4NUVFNkQ5QyIgc3RFdnQ6d2hlbj0iMjAxNi0xMS0zMFQyMjo0MDozMS0wODowMCIgc3RFdnQ6c29mdHdhcmVBZ2VudD0iQWRvYmUgUGhvdG9zaG9wIENTNiAoV2luZG93cykiIHN0RXZ0OmNoYW5nZWQ9Ii8iLz4gPC9yZGY6U2VxPiA8L3htcE1NOkhpc3Rvcnk+IDwvcmRmOkRlc2NyaXB0aW9uPiA8L3JkZjpSREY+IDwveDp4bXBtZXRhPiAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICAgICA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" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Largely inspired by Dr. Rodriguez-Trias’ dedication to health policy and increasing access to care, Ms. Andaluz’s first post-collegiate job was in the Public Affairs department at Planned Parenthood Los Angeles. During her tenure, she was able to work on many politically charged state and federal campaigns, including California’s historic Reproductive Privacy Act.</span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"></span></div>
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<span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Ms. Andaluz later moved to New York to pursue a master in public health and work at the New York City Department of Health, where she has been since 2007. She currently serves as the Director of External Affairs for the Bureau of HIV/AIDS Prevention and Control where she oversees the development of priority policy initiatives, is responsible for the Bureau’s interactions with the Mayor’s Office, other inter- and intra-governmental agencies and key-stakeholders including the agency’s press office, and also oversees the Bureau’s social marketing and social media activities. </span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"></span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">FRANKLYN N. JUDSON, MD, MPH, Director<span style="mso-spacerun: yes;"> </span></span></b><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiaTFtnRgDBkDQwUbvnq_IdQDPkFd-7M6seOGCMMWgnZnJio4-m8_QGdlPPi6aDHfyXz5PcreAhnfd8PCbSNzjBf-62_8_MvW3JczPgq8_kbizZSTQNdVz3KcW3MVgRX5K_fH24mw/s1600/Judson+2005.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiaTFtnRgDBkDQwUbvnq_IdQDPkFd-7M6seOGCMMWgnZnJio4-m8_QGdlPPi6aDHfyXz5PcreAhnfd8PCbSNzjBf-62_8_MvW3JczPgq8_kbizZSTQNdVz3KcW3MVgRX5K_fH24mw/s200/Judson+2005.jpg" width="193" /></a></div>
<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Frank Judson received his BA from Wesleyan University in 1964, his MD from the University of Pennsylvania in 1968, and his house staff training from the University of Wisconsin Hospitals (internal medicine) and the University of Colorado (infectious diseases).<span style="mso-spacerun: yes;"> </span>He was an Epidemic Intelligence Service officer with the Centers for Disease Control assigned to the Colorado Department of Public Health<span style="mso-spacerun: yes;"> </span>(1970-72), and Scientific Liaison, Global Program on AIDS, Geneva (1990 -91).<span style="mso-spacerun: yes;"> </span>He is board-certified in internal medicine, infectious diseases and preventive medicine.<span style="mso-spacerun: yes;"> </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"></span></div>
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<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">For over 41 years, his research interests have concentrated on the epidemiology and control of sexually transmitted infections including hepatitis B and HIV.<span style="mso-spacerun: yes;"> </span>His public health policy interests have run the gamut from childhood and adolescent vaccine programs, to urban air pollution, bioterrorism preparedness, and tobacco, tuberculosis, influenza, and HIV prevention and control.<span style="mso-spacerun: yes;"> </span>He has authored or co-authored more than 270 scientific publications.<span style="mso-spacerun: yes;"> </span></span></div>
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<span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Dr. Judson has served as President of the American STD Association (ASTDA), President of the International Society for STD Research (ISSTDR), President of the International Union Against the Sexually Transmitted Infections (IUSTI), Chairman of the Board of the American Social Health Association (ASHA), Chief of Infectious Diseases for the Denver Health Medical Center (1983-2002), and Director of the Denver Public Health Department (1986-2004). He has been a member of the Presidential Advisory Council on HIV/AIDS (PACHA), the CDC/HHS Advisory Committee on Immunization Practices (ACIP), the Board of Regents of the American College of Preventive Medicine, and the Colorado State Board of Health. Currently, he is a member of the Colorado Governor’s Expert Emergency Epidemic Response Committee (GEEERC) and Professor, Department of Medicine (Infectious Diseases) and the Colorado School of Public Health, University of Colorado, Denver. </span></div>
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</span><b style="mso-bidi-font-weight: normal;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">ELIZABETH (BETSY) KIDDER, MD, PhD, MPH, Director</span></b></div>
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<b style="mso-bidi-font-weight: normal;"></b><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Elizabeth (Betsy) Kidder, MD, PhD, MPH received her<b> </b>Master's in Public Health, Medical Degree, and PhD in Public Policy and Health Policy from the George Washington University. She is currently in the last year of her residency in the Internal Medicine and Primary Care program at the George Washington University Hospital. Her career and research interests focus on access to quality health care by underserved communities, improving access to addiction treatment, and implementing innovative and patient-centered cancer screening options. Her dissertation research investigated self-administered HPV testing as a cervical cancer screening option for underscreened women.</span><span style="color: black; mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: Calibri;"></span></div>
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<span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Betsy joined Beyond AIDS in 2001 as an intern, and has served as a Board member since 2003. She received her Master's in Public Health in 2004 and her Medical Degree in 2011, both from the George Washington University. She also completed a doctorate there in health policy.<br />
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As a public health professional, she has worked in Rome, Italy with the United Nations on the development team for the "Initiative to End Child Hunger" - a collaboration between the World Bank, the United Nations Children's Fund, and the World Food Program. Previous to that, she worked with the Global Health Council in Washington, DC on issues related to HIV/AIDS and child health, as a part of a national PBS media and outreach campaign in global health. She has also worked at the Department of Defense's HIV/AIDS Prevention Program as well as the Futures Group, where she assisted with the research and writing of a "What Works" program guide for developing country policymakers on evidence-based practices in HIV/AIDS/STI prevention. </span><span style="color: black; font-family: "times new roman" , "serif"; font-size: 12.0pt;"></span></div>
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<span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Her interest in issues related to HIV was initially sparked by the case of Nushawn Williams, a young man who knowingly spread HIV in her small hometown community and high school. After that incident, she traveled to South Africa, where she studied the epidemic in the Eastern Cape, taught an HIV/AIDS education class, and volunteered in a pediatric HIV clinic, all of which deepened her commitment to staying involved with HIV advocacy through her career.</span><br />
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<span style="font-size: small;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">GARY A. RICHWALD, MD, MPH, Director (from 11/19/17)</span></b></span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Gary Richwald received his engineering degree from Cornell University, medical degree from the Mount Sinai School of Medicine in New York City, and Master's in Public Health (MPH) in health services research/epidemiology from UCLA. He completed his specialty/subspecialty training in internal medicine, geriatrics, and preventive medicine at the University of Michigan and UCLA. He was a Robert Wood Johnson Foundation Scholar at UCLA/RAND in health policy services research.</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: 12.0pt; line-height: normal;">From 1981 to 1989, Dr. Richwald was a full-time faculty member at UCLA in the Schools of Public Health/Medicine, and subsequently served as Director and Chief Physician, L.A. County Sexually Transmitted Disease Program (1989-2000). He has been a consultant on STD policy and clinical care for the AME, American Sexual Health Association (ASHA), and CDC. He chaired the California STD Control Association for 3 terms, and was a founding member, National Coalition of STD Directors. He has worked with GSK, Novartis, Abbott, Merck, 3M Pharmaceuticals, and Focus Technologies/Quest Diagnostics in the development of STD-related health care technology. </span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;"> </span></b><br />
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<span style="font-size: small;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">MONICA SWEENEY, MD, MPH, Director</span></b></span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"> </span><br />
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<span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Monica Sweeney is Vice Dean for Global Engagement and Chair, Dept. Health Policy and Management,</span> <span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">School of Public Health, State University of New York (SUNY) Downstate Medical Center.<span style="mso-spacerun: yes;"> </span>Additionally, she is the chair of the SUNY Downstate Medical Center's Association of Council Members and College Trustees. </span></div>
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<span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Before that, she was the Assistant Commissioner of Health for New York City. Previously, for six years, she was in charge of the NYC Bureau of HIV/AIDS Prevention and Control. Her responsibilities there included oversight of programs and budgets for prevention; care and treatment (Ryan White); Housing<span style="font-family: "arial" , "sans-serif";"> </span>Opportunities for People With AIDS (HOPWA); and the epidemiology/Field Services Unit. </span></div>
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" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Previously, she was the medical director and vice president for medical affairs in a Federally Qualified Health Center in Bedford Stuyvesant, Brooklyn NY.<span style="mso-spacerun: yes;"> </span>The community served was medically and economically deprived and HIV/AIDS was one of many challenges she addressed daily during her 17 years in Bedford Stuyvesant.<span style="mso-spacerun: yes;"> </span>During her tenure there, in addition to direct patient care, she became involved in policy and advocacy and had the opportunity to work with Assemblywoman Nettie Mayersohn to get her historic legislation (the Baby AIDS Bill, and Named-based Reporting) passed -- over almost insurmountable opposition.</span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"></span></div>
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<span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Dr. Sweeney is a board-certified internist and geriatrician with a masters degree in public health.<span style="mso-spacerun: yes;"> </span>She has always combined individual and public health in her practice, by working with the Medical Society for the State of New York (MSSNY), the National Association of Community Health Centers (NACHC), and the American College of Physicians (ACP) and by serving on the President’s Advisory Council on HIV/AIDS (PACHA).<span style="mso-spacerun: yes;"> </span>Prior to election to the position of Vice-President, she was a Director on the Beyond AIDS Board, and before that she served on the Advisory Council. Her goals as Vice-President include working diligently to broaden the reach of the only AIDS organization that has always used sound public health policy to fight the epidemic.</span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"></span></div>
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</span><b style="mso-bidi-font-weight: normal;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">CARY SAVITCH, MD, Immediate Past-President </span></b><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"></span></div>
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<span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Cary Savitch was one of the Founding Members of Beyond AIDS, organized its founding meetings, and was elected its first President. He has served on the Board of Directors since the founding of the organization.<span style="mso-spacerun: yes;"> </span>He recruited many of the early members of the organization by speaking to friends, colleagues, and patients about the need for HIV reform, writing a book about the subject, and giving talks on HIV, especially in Ventura County and the surrounding area where the founding meetings were held.<span style="mso-spacerun: yes;"> </span></span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"></span></div>
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<span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">He is an infectious disease physician, and has taken care of AIDS patients for the past 33 years (starting even before the disease had a name). In 1997, he published a book, “The Nutcracker is Already Dancing,” which highlighted the lack of application to HIV of sound public health practices that had been successfully utilized for diseases such as syphilis and tuberculosis. He believes strongly that the mission of Beyond AIDS, to stop the transmission of HIV, is the direction we must take in order to save lives in this epidemic.</span><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt;"></span></div>
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<span style="color: black; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">He expresses pride in the time he has already spent with Beyond AIDS, which he believes is the only organization willing to stand up and support the necessary public health policies needed to contain HIV. His goals are to continue these efforts in every and any capacity needed, and to encourage others to join our battle for HIV/AIDS prevention. </span></div>
Ronald P. Hattis, MD, MPHhttp://www.blogger.com/profile/03917713422765368391noreply@blogger.com0tag:blogger.com,1999:blog-13808410.post-79325047193163517982015-10-29T17:37:00.000-07:002015-11-26T21:01:13.659-08:00BEYOND AIDS 2015 LEGISLATIVE ACTIVITIES, AND THE CONTROVERSIAL ISSUE OF "DECRIMINALIZATION"<div>
The following positions were adopted during 2015 by the Beyond AIDS Board of Directors.</div>
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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.</div>
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<b>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.<o:p></o:p></b></div>
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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.</div>
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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.</div>
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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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. </div>
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Ronald P. Hattis, MD, MPHhttp://www.blogger.com/profile/03917713422765368391noreply@blogger.com0tag:blogger.com,1999:blog-13808410.post-59898180852834636372015-10-29T14:28:00.002-07:002015-11-29T14:27:05.854-08:00BEYOND AIDS CONDUCTS CONTINUING EDUCATION CONFERENCE ON HIV, AND ANNUAL MEETINGS, LOMA LINDA UNIVERSITY, NOVEMBER 15, 2015<div align="center" class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 0in; margin-right: -15.3pt; margin-top: 0in; text-align: center; text-indent: -13.5pt;">
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<b><span style="color: #002060; font-family: "times new roman" , "serif"; font-size: 19.0pt; line-height: 115%;"> </span><span style="color: #002060; font-family: "times new roman" , "serif"; font-size: large; line-height: 115%;">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: </span></b><span style="line-height: 29.1333px; text-align: center; text-indent: -13.5pt;"><span style="color: #002060; font-family: "times new roman" , serif; font-size: large;"><b><a href="http://www.beyondaids.org/resources.html" target="_blank">http://www.beyondaids.org/resources.html</a></b></span></span></div>
<b><span style="color: #002060; font-family: "times new roman" , "serif"; font-size: 19.0pt; line-height: 115%;"><br /></span></b>
<b><span style="color: #002060; font-family: "times new roman" , "serif"; font-size: 19.0pt; line-height: 115%;">ADVANCES IN PREVENTION AND TREATMENT OF HIV<o:p></o:p></span></b></div>
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<a href="https://www.blogger.com/blogger.g?blogID=13808410" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=13808410" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><br /></div>
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<b><span style="color: #002060; font-family: "times new roman" , "serif";">A FREE continuing education
program, </span></b><span style="color: #002060; font-family: "times new roman" , "serif";">supported by Beyond AIDS Foundation and a grant from Gilead
Corp.<o:p></o:p></span></div>
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<span style="color: #002060; font-family: "times new roman" , "serif"; font-size: 10.5pt; line-height: 115%;">Co-sponsored by the LLU Departments of
Preventive and Family Medicine <o:p></o:p></span></div>
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<span style="color: #002060; font-family: "times new roman" , "serif"; font-size: 10.0pt; line-height: 115%;">Loma Linda University
School of Medicine and Staff Development designate this Activity for 3.5 hrs.,
various credits<b>*</b></span><b><span style="color: #002060; font-family: "times new roman" , "serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-style: italic;"> </span></b><span style="color: #002060; font-family: "times new roman" , "serif"; font-size: 10.5pt; line-height: 115%;"><o:p></o:p></span></div>
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<b><span style="color: #002060; font-family: "times new roman" , "serif"; font-size: 12.0pt; line-height: 115%;">WHEN:</span></b><span style="font-family: "times new roman" , "serif";"> </span><b><span style="font-family: "times new roman" , "serif"; font-size: 12.5pt; line-height: 115%;">Sunday, November 15, 2015, 8:00a.m.
to 12:30 p.m.</span></b><b><span style="font-family: "times new roman" , "serif";">
</span></b><span style="font-family: "times new roman" , "serif"; font-size: 10.0pt; line-height: 115%;">(Beyond AIDS business meetings to follow</span><b><span style="font-family: "times new roman" , "serif"; font-size: 10.5pt; line-height: 115%;">**</span></b><span style="font-family: "times new roman" , "serif"; font-size: 10.0pt; line-height: 115%;">)<b><o:p></o:p></b></span></div>
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<b><span style="color: #002060; font-family: "times new roman" , "serif"; font-size: 12.0pt; line-height: 115%;">WHERE:</span></b><span style="font-family: "times new roman" , "serif";"> Loma
Linda University, Cutler Amphitheater, attached to Evans Hall/Center for Health
Promotion, <o:p></o:p></span></div>
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<b><span style="font-family: "times new roman" , "serif";">24785 Stewart St., Loma Linda, CA
92350; SW corner of Anderson and Stewart (see map)<o:p></o:p></span></b></div>
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<u><span style="font-family: "times new roman" , "serif";">Directions</span></u><span style="font-family: "times new roman" , "serif";">: I-10 to Anderson, S. to
Stewart. Enter from south side of
building (away from Stewart St.). <o:p></o:p></span></div>
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<b><span style="color: #002060; font-family: "times new roman" , "serif"; font-size: 12.0pt; line-height: 115%;">PARKING</span></b><span style="color: #002060; font-family: "times new roman" , "serif"; font-size: 12.0pt; line-height: 115%;">:</span><span style="color: #002060; font-family: "times new roman" , "serif";"> </span><span style="font-family: "times new roman" , "serif";">Lot
U, Stewart and Anderson, NE, kitty-corner from amphitheater. No charge, no
permit needed, 8-5.<o:p></o:p></span></div>
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<b><span style="color: #002060; font-family: "times new roman" , "serif"; font-size: 12.0pt; line-height: 115%;">REGISTRATION:</span></b><b><span style="font-family: "times new roman" , "serif"; font-size: 12.0pt; line-height: 115%;"> </span></b><b><u><span style="font-family: "times new roman" , "serif";">No charge
(except for food</span></u></b><span style="font-family: "times new roman" , "serif";">
(tea and continental breakfast at cost of <b>$5,
payable on site). <u>Advance reservation is required for slides/food</u> (deadline
11/10/15). </b>D<span style="color: #002060;">onations
to Beyond AIDS Foundation (tax-deductible),</span> &/or Beyond AIDS membership
($50, $25 student/resident) welcomed. <o:p></o:p></span></div>
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<b><span style="font-family: "times new roman" , "serif";">*For CEU, NCHEC, dietetic, APA,
etc. (but not physician CME), register at: <a href="https://ce.llu.edu/">https://CE.llu.edu</a>.
</span></b><span style="font-family: "times new roman" , "serif";">Search for course
by calendar date, find November 15, add to “shopping cart”; open account if
none.<b><o:p></o:p></b></span></div>
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<b><span style="font-family: "times new roman" , "serif";">Physicians, others not using
above registration method, and <u>for all to reserve food and/or afternoon
meeting</u>, send email to: <a href="mailto:foundation@beyondaids.org">foundation@beyondaids.org</a></span></b><span style="font-family: "times new roman" , "serif";">. Include in message<b>:</b> </span><span style="font-family: "times new roman" , "serif"; font-size: 10.0pt; line-height: 115%;">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.)<o:p></o:p></span></div>
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<b><span style="color: #002060; font-family: "times new roman" , serif; font-size: 12pt; line-height: 18.4px;">SCHEDULE:<o:p></o:p></span></b></div>
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<i><span style="color: #002060; font-family: "times new roman" , serif; font-size: 10pt; line-height: 15.3333px;">8:00 a.m. Registration and Continental breakfast (reserve as above)<o:p></o:p></span></i></div>
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<i><span style="color: #002060; font-family: "times new roman" , serif; font-size: 10pt; line-height: 15.3333px;">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<o:p></o:p></span></i></div>
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<i><span style="color: #002060; font-family: "times new roman" , serif; font-size: 10pt; line-height: 15.3333px;">PART 1: HIV PREVENTION STRATEGY AND TESTING<o:p></o:p></span></i></div>
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<i><span style="color: #002060; font-family: "times new roman" , serif; font-size: 10pt; line-height: 15.3333px;">8:45 a.m. The 2015 update to National HIV/AIDS Strategy and the HIV Care Continuum: Ronald Hattis, MD, MPH (LLU)<o:p></o:p></span></i></div>
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<i><span style="color: #002060; font-family: "times new roman" , serif; font-size: 10pt; line-height: 15.3333px;">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): <o:p></o:p></span></i></div>
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<i><span style="color: #002060; font-family: "times new roman" , serif; font-size: 10pt; line-height: 15.3333px;">9:30 a.m. Use of social media to promote HIV self-testing: Jeffrey Klausner, MD, MPH (UCLA)<o:p></o:p></span></i></div>
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<i><span style="color: #002060; font-family: "times new roman" , serif; font-size: 10pt; line-height: 15.3333px;">9:55 a.m. HIV testing and the law in California; and tools to aid compliance: Ronald Hattis, MD, MPH (LLU)<o:p></o:p></span></i></div>
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<i><span style="color: #002060; font-family: "times new roman" , serif; font-size: 10pt; line-height: 15.3333px;">10:15 a.m. BREAK<o:p></o:p></span></i></div>
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<i><span style="color: #002060; font-family: "times new roman" , serif; font-size: 10pt; line-height: 15.3333px;">PART 2: HIV TREATMENT AND PROPHYLAXIS<o:p></o:p></span></i></div>
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<i><span style="color: #002060; font-family: "times new roman" , serif; font-size: 10pt; line-height: 15.3333px;">10:30 a.m. HIV treatment, the "Restaurant Menu" approach: Ronald Hattis, MD, MPH (LLU)<o:p></o:p></span></i></div>
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<i><span style="color: #002060; font-family: "times new roman" , serif; font-size: 10pt; line-height: 15.3333px;">10:50 a.m. Pre-exposure prophylaxis (PrEP) in high-burden jurisdictions: Jeffrey Klausner, MD, MPH (UCLA)<o:p></o:p></span></i></div>
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<i><span style="color: #002060; font-family: "times new roman" , serif; font-size: 10pt; line-height: 15.3333px;">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<o:p></o:p></span></i></div>
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<i><span style="color: #002060; font-family: "times new roman" , serif; font-size: 10pt; line-height: 15.3333px;">11:40 a.m. Hepatitis C, HIV, and Public Policy: Monica Sweeney, MD, MPH (SUNY Downstate)<o:p></o:p></span></i></div>
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<i><span style="color: #002060; font-family: "times new roman" , serif; font-size: 10pt; line-height: 15.3333px;">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<o:p></o:p></span></i></div>
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<i><span style="color: #002060; font-family: "times new roman" , serif; font-size: 10pt; line-height: 15.3333px;">12:30 p.m. ADJOURN<o:p></o:p></span></i></div>
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<b><span style="color: #002060; font-family: "times new roman" , serif;">**1:00-3:00 p.m. Beyond AIDS Annual Meeting for members, Suite 204, Evans Building </span></b><span style="color: #002060; font-family: "times new roman" , serif; font-size: 10pt; line-height: 15.3333px;">(attached)</span><b><span style="color: #002060; font-family: "times new roman" , serif;">; lunch $12.50</span></b><span style="color: #002060; font-family: "times new roman" , serif; font-size: 4pt; line-height: 6.13333px;"><o:p></o:p></span></div>
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<b>Target<span style="letter-spacing: -.3pt;"> </span>Audience</b><span style="font-family: "palatino linotype" , "serif"; mso-bidi-font-family: "Palatino Linotype"; mso-fareast-font-family: "Palatino Linotype";"><o:p></o:p></span></div>
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<span style="font-family: "palatino linotype" , serif; position: relative; top: -0.5pt;">Ph<span style="letter-spacing: -.05pt;">y</span><span style="letter-spacing: .05pt;">s</span>ician<span style="letter-spacing: -.05pt;">s</span>,<span style="letter-spacing: -.25pt;"> </span>P<span style="letter-spacing: -.05pt;">u</span>blic Health<span style="letter-spacing: -.05pt;"> </span>Pr<span style="letter-spacing: -.05pt;">o</span>fess<span style="letter-spacing: -.05pt;">i</span>onal<span style="letter-spacing: -.05pt;">s</span>,<span style="letter-spacing: 1.75pt;"> </span>N<span style="letter-spacing: -.05pt;">u</span>rses,<span style="letter-spacing: -.2pt;"> </span>A<span style="letter-spacing: -.05pt;">l</span>li<span style="letter-spacing: -.05pt;">e</span>d </span><span style="font-family: "palatino linotype" , serif;">Health Prof</span><span style="letter-spacing: -.05pt;">e</span><span style="letter-spacing: .05pt;">s</span><span style="font-family: "palatino linotype" , serif;">s</span><span style="letter-spacing: -.05pt;">i</span><span style="font-family: "palatino linotype" , serif;">onals</span><br />
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<span style="font-family: "times new roman" , serif; font-size: 8pt; line-height: 12.2667px;">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). </span></div>
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<b><span style="color: #65659a; font-family: "palatino linotype" , "serif"; mso-bidi-font-family: "Palatino Linotype"; mso-fareast-font-family: "Palatino Linotype";">* Continuing<span style="letter-spacing: -.6pt;"> </span>Education<span style="letter-spacing: -.5pt;">
</span>Credits:</span></b><span style="font-family: "palatino linotype" , "serif"; mso-bidi-font-family: "Palatino Linotype"; mso-fareast-font-family: "Palatino Linotype";"><o:p></o:p></span></div>
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<span style="font-family: "palatino linotype" , serif; position: relative; top: -0.5pt;">Up<span style="letter-spacing: .05pt;">o</span>n<span style="letter-spacing: -.2pt;"> </span>s<span style="letter-spacing: .05pt;">u</span>ccess<span style="letter-spacing: .05pt;">f</span>ul<span style="letter-spacing: -.3pt;"> </span>completion,<span style="letter-spacing: -.4pt;"> </span><span style="letter-spacing: .05pt;">t</span><span style="letter-spacing: -.05pt;">h</span>e<span style="letter-spacing: -.05pt;"> </span>par<span style="letter-spacing: -.05pt;">t</span>icipant<span style="letter-spacing: -.45pt;">
</span>will<span style="letter-spacing: -.15pt;"> </span><span style="letter-spacing: .1pt;">b</span>e<span style="letter-spacing: -.1pt;"> </span>awarded<span style="letter-spacing: -.35pt;"> </span><span style="letter-spacing: .05pt;">3</span>.5</span><span style="font-family: "palatino linotype" , serif;"><o:p></o:p></span></div>
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<span style="font-family: "palatino linotype" , serif;">contact<span style="letter-spacing: -.25pt;"> </span>hou<span style="letter-spacing: .1pt;">r</span>s<span style="letter-spacing: -.25pt;"> </span>of<span style="letter-spacing: .05pt;"> </span>c<span style="letter-spacing: .05pt;">o</span>nti<span style="letter-spacing: .05pt;">n</span>uing<span style="letter-spacing: -.35pt;"> </span><span style="letter-spacing: .05pt;">educa</span>t<span style="letter-spacing: .05pt;">io</span>n<span style="letter-spacing: -.45pt;"> </span>credit.<o:p></o:p></span></div>
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<div style="margin: 0px;">
<b style="background-color: white;"><span style="line-height: 13.8px;">CME </span></b><span style="background-color: white; line-height: 13.8px;">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 <b>maximum of 3.5 <i>AMA PRA Category 1 Credits <sup>TM</sup></i>. </b>Physicians should claim only the credit commensurate with the extent of their participation in the activity.</span></div>
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<ul>
<a href="https://www.blogger.com/blogger.g?blogID=13808410" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=13808410" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a>
<li>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</li>
<li>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.</li>
<li>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.</li>
<li>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)</li>
<li>This course meets the qualifications for 3.5 continuing education credits by the American Nursing Credentialing Center (ANCC).</li>
<li>Respiratory Care Practitioners reciprocate with Provider #00239.</li>
<li>Behavioral Health Professionals reciprocate with APA.</li>
</ul>
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<a href="https://www.blogger.com/blogger.g?blogID=13808410" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=13808410" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><span style="font-family: "arial unicode ms" , sans-serif; font-size: x-small;">DISCLOSURE</span><span style="font-family: "arial unicode ms" , sans-serif; font-size: x-small;"> </span><span style="font-family: "arial unicode ms" , sans-serif;"><span style="font-size: x-small;">S<span style="letter-spacing: -.05pt;">T</span>ATEMENT: <span style="font-family: "arial unicode ms" , sans-serif;">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.</span></span></span></div>
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Ronald P. Hattis, MD, MPHhttp://www.blogger.com/profile/03917713422765368391noreply@blogger.com0tag:blogger.com,1999:blog-13808410.post-22793212534180818372015-01-13T16:40:00.000-08:002015-01-13T18:46:32.121-08:00ANNUAL MEETINGS APPROVE HIV STRATEGY, PRESENTED TO GOVERNMENT LEADERSAnnual 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.<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh8GgDgeu3CDU2MX4IiJbHATmEHmKF0gHu9pFfDSSruKLKoPmLDHtkZhm0DXjwwTz3tMFLfZ__wwJVv-Odpkor9dK8oGhyXAdmU9AcJ-eEz48F0V0L1V4JLaHE1ohHCwG-xSWrLEA/s1600/BA+Mtg+10-19-14,+Sherry,+Andeluz,+Hattis,+Judson,+Martin.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh8GgDgeu3CDU2MX4IiJbHATmEHmKF0gHu9pFfDSSruKLKoPmLDHtkZhm0DXjwwTz3tMFLfZ__wwJVv-Odpkor9dK8oGhyXAdmU9AcJ-eEz48F0V0L1V4JLaHE1ohHCwG-xSWrLEA/s1600/BA+Mtg+10-19-14,+Sherry,+Andeluz,+Hattis,+Judson,+Martin.jpg" height="215" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="color: blue;">James Sherry, Adriana Andaluz, Ron Hattis, Frank Judson, and Marsha Martin (L to R) at Beyond AIDS meeting</span></td><td class="tr-caption" style="text-align: center;"><br /></td></tr>
</tbody></table>
LEGISLATION<br />
<br />
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 <a href="http://beyondaids.org/legislative.html" target="_blank">report on recent legislation</a>. 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.<br />
<br />
RESEARCH<br />
<br />
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.<br />
<br />
AWARDS<br />
<br />
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 <a href="http://beyondaids.org/awardslist.html#2014" target="_blank">Dr. Bernard Branson</a>, 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.<br />
<br />
The Board also approved <a href="http://beyondaids.org/awardslist.html#2014" target="_blank">plaques for California Assembly Member Rob Bonta, and his Legislative Director, Amy Alley</a>, in recognition of their dedicated work and persistence in passing Beyond AIDS-supported legislation to provide condoms in prisons. <br />
<br />
HIV PREVENTION STRATEGY AND POLICY<br />
<br />
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 <a href="http://beyondaids.org/pdfs/NHASupdateBeyondAIDShattis-leith29Oct2014.pdf" target="_blank">plan is posted on the Beyond AIDS Web site</a>, along with a <a href="http://beyondaids.org/pdfs/COMPARISONSCHARTUPDATED24SEPT2014.pdf" target="_blank">comparison with the 2010 NHAS and the 2013 Presidential Initiative</a> 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.<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNaLMwjcIdD3o5iPNQP-2NtxM9NAUSDrwlyYd5HtAEn0LJ00fDCKNy3TCi2DKoPVYohKttuaUcx4Axa4p9TLRZ-q32zcyufl1fg39y8Slm9dklgkyU-58gY4jy2xzFSAH0JH3VBA/s1600/Judson,+Valdiserri,+Hattis+10-20-14.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNaLMwjcIdD3o5iPNQP-2NtxM9NAUSDrwlyYd5HtAEn0LJ00fDCKNy3TCi2DKoPVYohKttuaUcx4Axa4p9TLRZ-q32zcyufl1fg39y8Slm9dklgkyU-58gY4jy2xzFSAH0JH3VBA/s1600/Judson,+Valdiserri,+Hattis+10-20-14.jpg" height="296" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="color: blue;">Drs. Frank Judson, Ron Valdiserri, and Ron Hattis </span><br />
<span style="color: blue;">at HHS headquarters, Washington, DC</span></td></tr>
</tbody></table>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwnuNTAcYXbrEE35ALVny892dHwINBRrRmQUc9pNFyjCpJFBCzWgpqJZ_0gjHjDVzFwXS7azBJ6beYkeXU_vOSTSFEhxWZtRewx1-eWwiDyOPW0RwDyig2E9C6EW892y4Ql5OOqA/s1600/Valdiserri,+Harrison,+Hattis,+States+at+HHS+10-20-14.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwnuNTAcYXbrEE35ALVny892dHwINBRrRmQUc9pNFyjCpJFBCzWgpqJZ_0gjHjDVzFwXS7azBJ6beYkeXU_vOSTSFEhxWZtRewx1-eWwiDyOPW0RwDyig2E9C6EW892y4Ql5OOqA/s1600/Valdiserri,+Harrison,+Hattis,+States+at+HHS+10-20-14.jpg" height="285" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="color: blue; font-size: x-small;">Ron Valdiserri, Timothy Harrison from HHS (L), </span><br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container"><tbody>
<tr><td class="tr-caption" style="text-align: center;"><span style="color: blue;"> <span style="font-size: x-small;">Ron Hattis, Leith States from Beyond AIDS (R)</span></span></td></tr>
</tbody></table>
</td><td class="tr-caption" style="text-align: center;"></td><td class="tr-caption" style="text-align: center;"></td><td class="tr-caption" style="text-align: center;"></td><td class="tr-caption" style="text-align: center;"></td><td class="tr-caption" style="text-align: center;"><br /></td><td class="tr-caption" style="text-align: center;"></td></tr>
</tbody></table>
<br />
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.Ronald P. Hattis, MD, MPHhttp://www.blogger.com/profile/03917713422765368391noreply@blogger.com0tag:blogger.com,1999:blog-13808410.post-50980913678239567622014-09-30T21:01:00.000-07:002018-01-15T14:56:06.559-08:00BEYOND AIDS TO MEET IN WASHINGTON, DC, PRESENT STRATEGY IDEAS TO FEDERAL POLICY LEADERS<div align="left">
<span style="font-size: small;">The 2014 Annual Meetings
of Beyond AIDS and of the Beyond AIDS Foundation will be held on <strong>Sunday,
October 19.</strong> The physical hub of the meeting will be at the Club
Quarters Hotel at 839 17th St. NW, Washington, DC 20006, and we welcome members
who cannot attend that in person to phone in<strong> for conference
call</strong> <strong>participation.</strong> <strong>The time will be 4:00-7:00
p.m. Eastern, 1:00-4:00 p.m. Pacific.</strong> The meeting is open to all members. Nonmembers will need to be specially invited, so please first write to info@beyondaids.org to express interest and check on available space.</span></div>
<div align="left">
</div>
<div align="left">
Complete information,
including "handouts" and the phone number and code to use when calling in, will
be sent to those who RSVP about their interest. Write to info@beyondaids.org. </div>
<div align="left">
</div>
<div align="left">
<div align="left">
This has been an active year for Beyond
AIDS, and we look forward to telling you all about it. Three California bills
that we have supported passed both houses of the legislature, have been signed by the Governor. The Foundation has continued its research and
fellowship programs. </div>
<div align="left">
</div>
<div align="left">
Our Scientific Committee is putting the finishing touches
on important recommendations for changes in the National HIV/AIDS Strategy,
which will be presented to the Foundation Board at our meeting. The following
morning, a Beyond AIDS leadership delegation has an appointment with key
HIV/AIDS policy leaders of the U.S. Department of Health and Human Services to
present these recommendations. Thus, we intend to make maximum use of our
presence in Washington to influence policy. If Beyond AIDS recommendations are
adopted, the U.S. can finally drive down the U.S. epidemic; if not, there may
be no end in sight to this scourge.</div>
</div>
Ronald P. Hattis, MD, MPHhttp://www.blogger.com/profile/03917713422765368391noreply@blogger.com0tag:blogger.com,1999:blog-13808410.post-34985465556182464862014-05-15T22:30:00.000-07:002015-01-13T18:41:24.970-08:002014 CALIFORNIA LEGISLATION SUPPORTED BY BEYOND AIDS<!--[if gte mso 9]><xml>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Beyond
AIDS supported four California bills in the 2014 legislature.</span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Assembly Bill 966 (Bonta): </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">This
is a simplification of 2013’s AB 999, to assure that condoms are eventually
provided in California’s prisons. Governor Brown vetoed that bill, and former
Governor Schwarzenegger vetoed two similar bills during his term. After
Schwarzenegger’s second veto, he established a pilot program at one prison that
proved to be very successful. Brown’s staff claims that his veto was because he
already has the authority to do this, just as Schwarzenegger did at the one
prison. So rather than presume to establish new authority for this on the part
of the Administration, the new bill merely requires a plan to provide condoms
to all the prisons within five years.</span><br />
<br />
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Outcome: Bill was passed by Legislature and signed into law by Gov. Brown. <a href="http://leginfo.ca.gov/pub/13-14/bill/asm/ab_0951-1000/ab_966_bill_20140926_chaptered.pdf" target="_blank">Click here</a> for the final text of the bill.</span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Assembly
Bill 1576 (Hall)</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">: This was another attempt to require
adult film actors to use condoms, and for producers to use other infection
control precautions. Last year's California bills AB 640 and the subsequent AB
332, both on condoms and other infection control measures for the adult film
industry, failed to pass. The same author, Assembly Member Hall, with the same
sponsor, the AIDS Healthcare Foundation, have introduced this bill as a new,
simpler version. The bill<b> </b><span style="mso-bidi-font-weight: bold;">requires
both condoms and STD testing every 2 weeks for performers, without specifying
what tests will be done for which diseases.</span> It also makes note of the
fact that current law already requires an exposure control plan for any work
situation in which there may be exposure to blood or other potentially
infectious materials, and that this bill makes specific requirements for
such plans for adult film employers. Cal-OSHA has failed to act in over 3 and a half
years, and its draft regulations don't include testing.</span><br />
<br />
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Outcome: Bill did not pass. </span></div>
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<br /></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">AB
1898 (Brown): </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">This</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"> </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">will add to the HIV co-infections that
would be reportable and could be discussed among local and state public health
officials and with the patient's healthcare provider. Current law (Section
121025 of the Health and Safety Code) permits this only apply for tuberculosis
and a few unspecified STDs (syphilis, gonorrhea, and chlamydia). This bill adds
hepatitis B and C, and meningococcal infections, occurring in patients who also
have HIV. The bill is sponsored by the Health Officers Association of
California.</span><br />
<br />
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Outcome: Bill was passed by Legislature and signed into law by Gov. Brown. </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><a href="http://leginfo.ca.gov/pub/13-14/bill/asm/ab_1851-1900/ab_1898_bill_20140925_chaptered.pdf" target="_blank">Click here</a> for the final text of the bill.</span><br />
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span>
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><b>AB 336 (Ammiano): </b>This 2013 bill will make it more difficult for prosecutors to use the possession of condoms as evidence in prostitution cases. It did not make progress due to objections from prosecutors when it was worded more strongly that year, and was revived in 2014 with compromise wording. Naturally, public health advocates want to encourage sex workers to use condoms, but if possession increases their chances of jail time, that has a chilling effect on prevention efforts. The bill requires a hearing in judge's chambers on the issue of use of this evidence before it can be presented openly in court.</span><br />
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><b> </b></span><br />
<br />
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Outcome: Bill was passed by Legislature and signed into law by Gov. Brown. </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><a href="http://leginfo.ca.gov/pub/13-14/bill/asm/ab_0301-0350/ab_336_bill_20140918_chaptered.pdf" target="_blank">Click here</a> for the final text of the bill.</span></div>
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<br /></div>
Ronald P. Hattis, MD, MPHhttp://www.blogger.com/profile/03917713422765368391noreply@blogger.com0tag:blogger.com,1999:blog-13808410.post-29870071085081674272013-12-22T01:29:00.001-08:002018-01-15T14:54:41.394-08:00WHITE HOUSE HIV/AIDS DIRECTOR MEETS WITH BEYOND AIDS DELEGATION, BEFORE LEAVING POSITION<br />
<b><u>Update</u>: President Donald J. Trump did not fill the position of White House Director of National HIV/AIDS Policy in 2017, in effect allowing that office to die. Adding insult to injury, at the end of December, the Presidential Advisory Council on HIV/AIDS (on which two current Beyond AIDS Board members have served in the past) was <a href="https://www.washingtonpost.com/news/to-your-health/wp/2017/12/29/trump-administration-fires-all-members-of-hivaids-advisory-council/?utm_term=.4665d907b3d2" target="_blank">disbanded by firing all of its members</a>. Clearly, Trump does not consider HIV/AIDS to be an issue worthy of presidential attention, as did every other President since 1995.</b><br />
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On December 13, 2013, Dr. Grant Colfax, White House Director of National HIV/AIDS Policy (ONAP, a part of the Domestic Planning Council), met with a 7-member Beyond AIDS delegation. The discussion took place at UCLA, immediately after Dr. Colfax delivered a lecture there on "National HIV/AIDS Strategy and the HIV Care Continuum Initiative. Dr. Colfax was the third ONAP Director to have met with Beyond AIDS, over the course of two Presidential Administrations. UCLA Professor Jeffrey Klausner, who was a former colleague of Colfax when they both worked at the San Francisco Department of Public Health, arranged the session. <br />
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<tr><td class="tr-caption" style="text-align: center;"><span style="color: blue;">ONAP Director Colfax lecturing at UCLA</span></td></tr>
</tbody></table>
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The delegation members provided an introduction to the past accomplishments and future goals of Beyond AIDS, as well as individual introductions. Beyond AIDS expressed support for the President's HIV Care Continuum Initiative, which Dr. Colfax had developed for President Obama and which was issued in July 2013. The delegation also offered to help keep public discussion on national HIV/AIDS strategy focused on the HIV Continuum of Care.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhOA7SbaNGX33aRdhLoinf5vPjAfXCDvh4L6LSnBTcIBtAldndxk9nL95PNhrRXa1liO2066jMKoa4E92yYv61tryBc9elN882GlCfLqgJPSswajof11fzX18vXNkbWLinGQ1pejg/s1600/Colfax+and+Hattis.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhOA7SbaNGX33aRdhLoinf5vPjAfXCDvh4L6LSnBTcIBtAldndxk9nL95PNhrRXa1liO2066jMKoa4E92yYv61tryBc9elN882GlCfLqgJPSswajof11fzX18vXNkbWLinGQ1pejg/s200/Colfax+and+Hattis.jpg" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="color: blue;"> Hattis presents papers to Colfax</span></td></tr>
</tbody></table>
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Dr. Colfax reiterated some of the epidemiological points he had expressed in his lecture, including the 9
current goals of the Initiative, noting that the key risk groups continue to be similar to ten
years ago: young gay males, blacks, Latinos, and transgender females. The discussion included the recent focus on interrupting transmission, as can be achieved through effective treatment that suppresses the virus. Ron Hattis presented a collection of Beyond AIDS policy drafts and PowerPoint presentation files for Colfax's review.<br />
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Jean Davis described the gaps in training of providers and other leaders, left by reduced funding of AIDS Education Training Centers. Gary Richwald brought up linkages of treatment and prevention. <br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-h4RGvf_5CPQYlncxbbZ6krcArbkkuFqXzS0Avy8XQnyFxXLAjcDL7-LebQKqN6aNXSUj8miBsZWe5Me7tASPq8J8_ctQirwVVHhQCodMUFWuLJYyjbra-qFoVhZICghopVGmrg/s1600/Colfax+w+Flanary,+Davis,+Thompson,+Richwald.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-h4RGvf_5CPQYlncxbbZ6krcArbkkuFqXzS0Avy8XQnyFxXLAjcDL7-LebQKqN6aNXSUj8miBsZWe5Me7tASPq8J8_ctQirwVVHhQCodMUFWuLJYyjbra-qFoVhZICghopVGmrg/s320/Colfax+w+Flanary,+Davis,+Thompson,+Richwald.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="color: blue;">(Clockwise around table, from front) Jean Davis, Peggy Flanary, </span><br />
<span style="color: blue;">Grant Colfax, Gary Richwald, Dennis Thompson</span></td></tr>
</tbody></table>
Dr. Klausner commented on a proposed recommendation that gay males be tested every 6 rather than 12
months. Klausner suggested that the frequency of testing should depend on their
number of partners. Hattis suggested that all infected persons and their immediate
partners could be considered as top risk groups deserving focused attention for
interruption of transmission.<br />
<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmAUu1aZmfE7k1C7wOFDNTmm1yM9pSKlOhq8nfUguyPyGbflrv0u7Hvl_ipRV9Ab_4AOUBnpoSn5e_gq-Aw53YGMDaIi2zwG6cIubFVqxYh3_vNCzyuL02aK5PnNg4hupLHw3oPg/s1600/Colfax+Makes+Point+at+BA+Mtg.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="151" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmAUu1aZmfE7k1C7wOFDNTmm1yM9pSKlOhq8nfUguyPyGbflrv0u7Hvl_ipRV9Ab_4AOUBnpoSn5e_gq-Aw53YGMDaIi2zwG6cIubFVqxYh3_vNCzyuL02aK5PnNg4hupLHw3oPg/s320/Colfax+Makes+Point+at+BA+Mtg.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="color: blue;">Grant Colfax, center, makes a point to delegation members (clockwise around table, from </span><br />
<span style="color: blue;">front) Jeffrey Klausner, Peggy Flanary, Gary Richwald, Dennis Thompson, and Leith States</span></td></tr>
</tbody></table>
Ron Hattis explained that Beyond AIDS hoped to contribute ideas during 2014, for the 2015 update of the National HIV/AIDS Strategy, and suggested that it could be organized around the HIV Care Continuum. Leith States, a new Fellow of Beyond AIDS' Foundation, who was part of the delegation, offered to assist with that project. Beyond AIDS was hoping to establish an ongoing communication with ONAP so as to have input during the planning process. However, Dr. Colfax indicated that work had not yet been started on a revision to the strategy.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEilgWBcQwywxZeVVaScSfRF142DYa9I2qKCx8P6_kuUp7vgF4QvAtvlDxzrqvv6pdXHnPKOPPauKzbsPsRPNheuzTHjQxCEqvIe-yd6bp7mFiA37Pj9L766YgPwO4i5mmZ70gjC0Q/s1600/Colfax+Pose+w+full+BA+deleg.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="161" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEilgWBcQwywxZeVVaScSfRF142DYa9I2qKCx8P6_kuUp7vgF4QvAtvlDxzrqvv6pdXHnPKOPPauKzbsPsRPNheuzTHjQxCEqvIe-yd6bp7mFiA37Pj9L766YgPwO4i5mmZ70gjC0Q/s320/Colfax+Pose+w+full+BA+deleg.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="color: blue;">Delegation with ONAP Director: (left to right) Jeffrey Klausner, Jean Davis, Ron Hattis, </span><br />
<span style="color: blue;">Grant Colfax, Dennis Thompson, Gary Richwald, Leith States, and Peggy Flanary</span></td></tr>
</tbody></table>
Only six days after the meeting, a White House official let it be known that Dr. Colfax would be leaving his position at ONAP on January 13, 2014. Unfortunately, this means that the personal relationships established in the Beyond AIDS meeting will not result in the establishment of an ongoing liaison with White House planning, and further contacts will need to be made with the next Director of ONAP.Ronald P. Hattis, MD, MPHhttp://www.blogger.com/profile/03917713422765368391noreply@blogger.com0tag:blogger.com,1999:blog-13808410.post-45451272755002452782013-12-21T18:13:00.002-08:002015-12-05T18:30:26.749-08:00MEDICARE COVERS HIV TESTING...BUT ONLY IF YOU USE THE RIGHT CODE (Z11.4 for ICD10, FORMERLY V73.89 for ICD9)! AND OTHER INSURANCE MAY USE DIFFERENT CODES...(Updated 10/28/15 for ICD-10; original article 12/21/13))<br />
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We thought we had it all solved four years ago. On December 8, 2009, Medicare announced that it would start covering the cost of annual HIV screening for all beneficiaries regardless of age, diagnosis, or risk indication, at no cost to the patient. <a href="http://beyondaids.blogspot.com/2010/08/medicare-finally-covers-hiv-screening.html" target="_blank">(Click here to read the story behind the approval, including the testimony from Beyond AIDS to the Center for Medicare and Medicaid Services, or CMS.)</a> One might assume that if a test is free and does not require a special diagnosis or risk as an indication, coverage should be approved regardless of what codes are entered for billing. But one would be wrong! That's not how government, healthcare, or insurance work.<br />
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Beyond AIDS had originally become involved in 2009 when a member on Medicare was billed $77 by a lab because HIV testing was not a covered benefit. Four years after Medicare agreed to cover HIV screening, the same thing happened, only this time the lab bill was $169! Knowing that the test was supposed to be covered, our member appealed and asked for an explanation. It turned out that the doctor had used the "wrong" ICD diagnostic code.<br />
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When the physician was told of the correct code (which we're revealing to you here), the billing was revised. However, the lab initially neglected to pass on the corrected code to Medicare, and instead began sending the patient threatening letters from its collection agency. Eventually, the charge for the test was cancelled, but the lack of transparency on the part of CMS, combined with high charges and negligence by the lab, had meanwhile resulted in a lot of avoidable stress. <br />
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<span style="font-size: large;">The good news is that for right now, providers can use the information in this posting and enter ICD-10 code <b>Z11.4</b></span><b><span style="font-size: large;">,</span> </b><span style="font-size: large;">to assure coverage of a routine EIA screening test on a Medicare patient.</span><br />
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ICD-10 code <b>Z11.4 is an encounter for HIV screening,</b> which the provider should enter on the lab requisition, and may also bill if there is no other diagnosis for the visit (this was formerly V73.89 under ICD-9). If there is special high risk, the additional code Z72.89 should be added. Medicare's requirement for codes for patients not complaining of a specific risk factor for HIV is not publicized, and is very difficult for physicians to locate with Web searches. This makes the promise of coverage for screening of all beneficiaries almost meaningless for practical purposes.<br />
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There are other codes that providers will generally not need to include in billing. The HCPCS code G0432 (infectious agent antibody detection by EIA technique) identifies an ELISA (EIA) combined HIV-1 and 2. If it is a rapid test, the code is G0435 (infectious agent antibody detection by rapid antibody test). According to <a href="https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/Downloads/MPS-QuickReferenceChart-1TextOnly.pdf" target="_blank">CMS publication ICN 006559, October 2015</a>, appropriate HCPCS codes for an HIV screening test depend on technique used.<br />
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Since the start of the Affordable Care Act ("Obamacare") at the beginning of 2014, all
medical insurance coverages affected by the law (not just Medicare) are required to
cover HIV screening at no cost to patients. That requirement is based on a strong (Class A) <a href="http://www.uspreventiveservicestaskforce.org/uspstf/uspshivi.htm" target="_blank">recommendation
for routine and universal HIV screening of all persons ages 15 to 65,
by the U.S. Preventive Services Task Force (USPSTF), in April 2013</a>. In addition to HIV testing, <a href="http://www.hhs.gov/healthcare/facts/factsheets/2010/07/preventive-services-list.html#CoveredPreventiveServicesforAdults" target="_blank">a number of other preventive services, including tests, immunizations, and treatments, will be covered </a>by all qualified insurance plans under the law, <a href="http://www.hhs.gov/healthcare/facts/factsheets/2011/08/womensprevention08012011a.html" target="_blank">especially for women</a>. Hopefully, each insurance plan will agree to use the same codes as Medicare for the free screening. If an insurance plan were to select its own obscure
code for the coverage of HIV screening and for each of the other preventive tests, that would present a barrier to preventive screening.<br />
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Additional issues are raised by this experience. Our member was required to obtain the HIV test by a healthcare employer. The legality of such a requirement will not be dealt with here, but is problematic. The lab charge for a simple HIV antibody screening when insurance apparently does not apply was already exorbitant in 2009, and increased by 119% in just 4 years. So it's a good thing that the country is moving toward free, routine HIV screening. But the billing code requirements that are currently used in the U.S. are not going to make that a simple matter.<br />
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The take-home pearl here is that Medicare providers should use ICD-10 code Z11.4, and Medicare patients who want an HIV test should pass that information on to providers to avoid getting big bills from labs. But that's just for Medicare, and it might even change in the future. This is only the tip of the iceberg, because different codes may be used by a myriad of insurance plans, and for other newly covered tests and procedures as well as HIV testing. Medical organizations and insurance plans should determine and publicize the ICD-10 codes that must be used for billing each of the newly covered preventive services under the Affordable Care Act. The Beyond AIDS Foundation will continue to follow this issue.Ronald P. Hattis, MD, MPHhttp://www.blogger.com/profile/03917713422765368391noreply@blogger.com0tag:blogger.com,1999:blog-13808410.post-2427833176787004352013-12-09T18:26:00.000-08:002013-12-09T18:26:22.286-08:00ELEMENTS FOR A NATIONAL STRATEGY ON REDUCING NEW HIV INFECTIONS<!--[if gte mso 9]><xml>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"></span></b></div>
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<i style="mso-bidi-font-style: normal;"><span style="font-family: "Times New Roman","serif";">(Prepared with input from
individual members of HIV Policy Working Group, HIV/AIDS Section, American
Public Health Association, but not adopted as an APHA document; carried forward by the Beyond AIDS Foundation)</span></i></div>
<div align="center" class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; text-align: center;">
<i style="mso-bidi-font-style: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Non-highlighted
text was approved in concept as a basis for further policy development, at the
Annual Meeting of Beyond AIDS, 11/9/13. Additions in <b style="mso-bidi-font-weight: normal;">bold text</b> and deletions in <s>strikethrough</s> have been proposed as update,
12/2/13. This draft is a work in progress, and should not be considered as final policy of Beyond AIDS.</span></i></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">For
prevention of HIV infections, Beyond AIDS supports periodic updates to the 2010
National HIV/AIDS Strategy through progress reports, to integrate the concepts
described in the President’s 2013 <b style="mso-bidi-font-weight: normal;">HIV </b>Care
Continuum Initiative. The next overall revision of the National AIDS Strategy <b style="mso-bidi-font-weight: normal;">(expected in 2015)</b> should emphasize a
central role for the care continuum, with the goals of achieving treatment as
prevention as well as benefiting the health of persons living with HIV. This
continuum, with public health enhancements as included in the outline below,
should be promoted and supported with adequate public funding, and with a high
emphasis on the rights, confidentiality, voluntary cooperation, and dignity of
persons with HIV:</span></div>
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-list: l0 level1 lfo1;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Universal, routine, opt-out screening should be
provided to adolescents and adults, as recommended by the Centers for
Disease Control and Prevention (CDC), and by the U.S. Preventive Services
Task Force (USPSTF). Screening methods and confirmation algorithms used should
be selected from the latest recommended by CDC or by the National
Institutes of Health (NIH).</span></li>
<li class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-list: l0 level1 lfo1;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Risk assessment and effective prevention
messages should be offered to all persons testing negative who can be
accessed for such services, with availability of counseling, referrals,
and repeat screening based on risk. Nucleic acid or antigen screening at
the initial visit should be considered for those with very recent
suspected exposure (such as partners of persons with detectable viral
loads or persons who have very recently engaged in high risk sex), if
these may detect early infections that have not yet produced antibodies.</span></li>
<li class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-list: l0 level1 lfo1;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><span style="mso-spacerun: yes;"> </span>Prompt
and routine initial outreach services, consistently and adequately funded
in all local jurisdictions nationwide, should be provided for all
individuals confirmed as testing positive:</span></li>
</ul>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-list: l2 level1 lfo2; text-indent: -.25in;">
<span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Linkage to care by healthcare providers
who are knowledgeable about HIV management and prevention</span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-list: l2 level1 lfo2; text-indent: -.25in;">
<span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Initial partner services by disease intervention
or other public health specialists, or by properly trained healthcare personnel
as permitted by law, to identify the most likely source partner and the most
recently exposed partners, including confidential notification, counseling, and
opt-out testing of possibly exposed individuals</span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in;">
<br /></div>
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-list: l0 level1 lfo1;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Maintenance of continuous HIV care, including
integrated prevention measures, should be optimized by competent providers
and support resources, including the following services:</span></li>
</ul>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-list: l3 level1 lfo3; text-indent: -.25in;">
<span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Prompt offering and initiation of
antiretroviral treatment, and assurance of continuous treatment availability,
based on current guidelines and best practices</span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-list: l3 level1 lfo3; text-indent: -.25in;">
<span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Proven strategies for maintaining tight
adherence to antiretroviral regimens</span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-list: l3 level1 lfo3; text-indent: -.25in;">
<s><span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span></s><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Active community outreach to
patients missing appointments, and closely tracked referrals to new sources of
care for those who require a change in provider </span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-list: l3 level1 lfo3; text-indent: -.25in;">
<span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Referrals to specialists, support
groups, ADAP, case management cross-trained in prevention, substance abuse
treatment, mental health services, housing, prevention with positives, and
other programs (historically funded by the Ryan White CARE Act) as appropriate</span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-list: l3 level1 lfo3; text-indent: -.25in;">
<s><span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span></s><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Prevention messages fully incorporated
into ongoing care and treatment, and provided with the best evidence-based
approaches <s>including:</s></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-list: l1 level1 lfo4; text-indent: -.25in;">
<span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Routine assessment and brief counseling
during clinical visits, regarding sexual and drug-related behavior, with
referrals as appropriate</span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-list: l1 level1 lfo4; text-indent: -.25in;">
<span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Monitoring of treatment adherence, with
simplification or adjustment of regimens as needed</span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-list: l1 level1 lfo4; text-indent: -.25in;">
<span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Monitoring of viral load suppression,
with resistance testing and adaptation of treatment when indicated, with the
aim of achieving undetectable viral loads or lowest viral levels possible, to prevent
transmission as well as the development of viral resistance</span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-list: l1 level1 lfo4; text-indent: -.25in;">
<span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Use of surveillance data by public
health departments to monitor adherence, retention, and viral suppression with
follow-up that maintains strict confidentiality</span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-list: l1 level1 lfo4; text-indent: -.25in;">
<span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Ongoing assessment about new partners,
and referral (as above) or performance of follow-up partner services, including
confidential notification, counseling, and opt-out testing for contacts</span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-list: l1 level1 lfo4; text-indent: -.25in;">
<span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Other Prevention with Positives
components, including accessible, available, and acceptable condom
distribution; screening and treatment of other STDs, hepatitis B and C, and
tuberculosis; prevention of mother-to-child transmission; reproductive health
care; and referral to other services as needs arise during care </span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in;">
<br /></div>
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-list: l0 level1 lfo1;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Prophylactic use of antiretroviral medications
by uninfected persons should <b style="mso-bidi-font-weight: normal;">gradually
</b>become less necessary with implementation of the above strategy. <span style="mso-spacerun: yes;"> </span><s>and should be for <b style="mso-bidi-font-weight: normal;">clear and limited</b></s> <b style="mso-bidi-font-weight: normal;">Its
</b>indications <b style="mso-bidi-font-weight: normal;">should be </b><s>approved</s>
<b style="mso-bidi-font-weight: normal;">prioritized</b> by CDC.<span style="mso-spacerun: yes;"> </span>Pre-exposure prophylaxis should not be <b style="mso-bidi-font-weight: normal;">advocated as a </b>substitute for
condoms.<span style="mso-spacerun: yes;"> </span>The efficacy of
intra-exposure prophylaxis <b style="mso-bidi-font-weight: normal;">with
various regimens</b> for sero-negative partners <b style="mso-bidi-font-weight: normal;">of persons known to be infected and on treatment, e.g., if viral
load is still detectable on treatment, or when </b>condoms are <b style="mso-bidi-font-weight: normal;">refused or </b>deferred to attempt
pregnancy, should be <b style="mso-bidi-font-weight: normal;">intensively </b>studied.</span></li>
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<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Beyond
AIDS also supports population-based efforts<s> </s><b style="mso-bidi-font-weight: normal;">to reduce risk-prone behaviors within high-risk communities. Such
efforts include raising awareness </b>of the issues surrounding HIV/AIDS, reducing
stigma related to testing and treatment, mobilizing communities to take <b style="mso-bidi-font-weight: normal;">preventive </b>action<b style="mso-bidi-font-weight: normal;">s</b>, making condom distribution a structural intervention, and changing
community norms about condom use.<span style="mso-spacerun: yes;"> </span>These
efforts also should <b style="mso-bidi-font-weight: normal;">incorporate</b> <b style="mso-bidi-font-weight: normal;">prevention of </b>other similarly-transmitted
STDs and bloodborne pathogens (including hepatitis B and C), especially
emphasizing the avoidance of unsafe sexual and drug/needle-related behavior. <b style="mso-bidi-font-weight: normal;">Education and screening should be utilized
as an important means of detecting infected persons to initiate the HIV
continuum of care.</b></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">For injection drug users, clean
needles/syringes should be made available, including through pharmacies and
private sector initiatives; but prevention of infections depends on keeping
them clean and ultimately unused. Public health and other publicly funded
efforts should emphasize disinfection and non-sharing of “works”; screening for
HIV, hepatitis C, and hepatitis B; drug abuse prevention and treatment; education
and counseling including group support; referrals as needed to health care,
nutrition, and housing; and rehabilitation.</span></b></div>
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<br /></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">In
the 2010 National HIV/AIDS Strategy, the three prevention steps <b style="mso-bidi-font-weight: normal;">were</b> all targeted at populations
(intensifying HIV prevention efforts in the communities where HIV is most
heavily concentrated; expanding targeted efforts with evidence-based
approaches, and educating all Americans about HIV and how to prevent it). While
such efforts tend to be less efficient for prevention of HIV than the care
continuum, which stops HIV transmission at the source, they remain valuable in
preventing infection of persons unaware that they have HIV-infected partners,
and in reducing transmission of other sexually transmitted diseases. Funding
should be distributed to achieve the most cost-effective <b style="mso-bidi-font-weight: normal;">combinations and </b>balance<b style="mso-bidi-font-weight: normal;">s</b>
<b style="mso-bidi-font-weight: normal;">among</b> such population-based
strategies, <b style="mso-bidi-font-weight: normal;">and between them </b>and the
<b style="mso-bidi-font-weight: normal;">HIV </b>care continuum.</span></div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Population-based</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">
programs should be culturally appropriate, and should include sexual health
education across the lifespan. They should include efforts to change community
norms relating to risk behaviors, which have proven to have high potential
effectiveness, <b style="mso-bidi-font-weight: normal;">such as</b> the A-B-C
programs in Uganda and some other locations, and <b style="mso-bidi-font-weight: normal;"><s>with</s></b> community-level interventions in the US. All should utilize
intensive outreach efforts and the use of social network referral programs and
should emphasize screening, in order to initiate the care continuum as outlined
above; including combined or coordinated screening for HIV and other similarly
transmitted diseases. </span></div>
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<br /></div>
Ronald P. Hattis, MD, MPHhttp://www.blogger.com/profile/03917713422765368391noreply@blogger.com1tag:blogger.com,1999:blog-13808410.post-57640091594157492942013-11-09T17:27:00.000-08:002014-10-16T18:46:00.802-07:00BEYOND AIDS SELECTS LEADERS FOR 2014, 2015<h3 class="post-title entry-title" itemprop="name">
</h3>
<div class="post-header">
</div>
<span style="font-size: large;"><b>In its biennial election on November 9, 2013, Beyond AIDS has selected the following officers to serve during 2014 and 2015:</b></span><br />
<br />
<b><span style="font-size: large;"><u>President</u>: Ronald P. Hattis, MD, MPH (California)<br />
<u>Vice-Pres</u>: Monica M. Sweeney, MD, MPH (New York)<br />
<u>Secretary</u>: Deanna C. Stover, PhD, FNP (California)<br />
<u>Treasurer</u>: Dennis Thompson, MD (California)<br /><u>Past-Pres.</u>: Cary Savitch, MD (California)<br />
<u>Directors</u>: Adriana Andaluz, MPH (New York)*</span></b><br />
<b><span style="font-size: large;"> Franklyn N. Judson, MD (Colorado)<br />
Elizabeth Kidder, MD, MPH (Washington, DC)</span></b><br />
<b><span style="font-size: large;"> Yvonne W. Pover, RDH (Virginia)</span></b> Passed away 4/14, replaced 9/14 by <b><span style="font-size: large;">Je</span><span style="font-size: large;">ffrey D. Klausner, MD, MPH (California)</span></b><br />
<br />
<br />
<b>The Advisory Council will consist of:</b><br />
Denise Bleak, MSN, PHN (California)<br />
I. Jean Davis, PA, DC (California)<br />
Paul Galatowitsch, PhD* (New York) <br />
Peter Kerndt, MD, MPH (California)<br />
Jeffrey D. Klausner, MD, MPH* (California) Moved to Board 9/14<br />
Evette Oszyk, BA (Florida)<br />
Gary A. Richwald, MD, MPH (California) <br />
<br />
<br />
<b>The subsidiary Beyond AIDS Foundation, a 501(c)3 charitable corporation,
will be governed by the following Board (appointed by the Board of
Beyond AIDS):<br />
<br />
<u>President</u>: Deanna C. Stover, PhD, FNP (California)<br />
<u>Vice-Pres.</u>: Cary Savitch, MD (California)<br />
<u>Secretary</u>: Ronald P. Hattis, MD, MPH (California)<br />
<u>Treasurer</u>: Dennis P. Thompson, MD (California)<br />
<u>Directors</u>: Adriana Andaluz, MPH* (New York)</b><br />
<b> Franklyn N. Judson, MD (Colorado)<br />
Elizabeth Kidder, MD, MPH (Washington, DC)</b><br />
<b> Jeffrey Klausner, MD, MPH (California) </b>replacing Yvonne W. Pover, RDH <b> </b><br />
<b> Monica M. Sweeney, MD, MPH (New York)</b><br />
<br />
The Foundation's Scientific Committee is co-chaired by Drs. Franklyn Judson and Monica Sweeney.<br />
<br />
*new appointments<br />
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<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">BRIEF BIOGRAPHIES OF BOARD
MEMBERS OF BEYOND AIDS, 2014/2015</span></u></b></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">RONALD P. HATTIS, MD,
MPH, President</span></b></div>
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<span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt;">Ron Hattis has served as President of Beyond AIDS for the past six
years.<span style="mso-spacerun: yes;"> </span>When the organization was
founded, he was the first Vice-President, and later served as Secretary, as
well as President of our subsidiary tax-deductible Foundation. He has been
active in contacts with federal leaders, and in Beyond AIDS' legislative
efforts in California, and has represented our organization in consultations
with the California Office of AIDS. He developed the original Bylaws for both
the membership organization and the foundation, and has mentored many of our
past interns.<span style="mso-spacerun: yes;"> </span></span>
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<span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt;">He is a physician, certified as a practicing HIV/AIDS specialist (AAHIVMS) and board-certified in Public Health/Preventive Medicine,
living in Redlands, California. <span style="mso-spacerun: yes;"> </span>He was
formerly the chief physician at a large state hospital, where he was in charge
of HIV testing and training HIV educators for 20 years, and he treated HIV/AIDS
patients at the infectious disease clinic. <span style="mso-spacerun: yes;"> </span>Since retiring from that position, he has worked
part-time in clinical medicine including HIV care, and is on the clinical
faculty of Loma Linda University School of Medicine, where he has lectured on
HIV as a representative of our Foundation.<span style="mso-spacerun: yes;">
</span>He is also active with a disaster medical assistance team, and helped
out at the World Trade Center, Hurricane Katrina, Hurricane Ike, and the
Northridge earthquake.</span></div>
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<span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt;">Other past positions in reverse order have included teacher of
family medicine, county health officer, country family physician (on Kauai in
Hawaii), and Epidemic Intelligence Service Officer for the Centers for Disease
Control and Prevention (assigned through field services to the Hawaii
Department of Health).<span style="mso-spacerun: yes;"> </span></span></div>
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<span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt;">His goals for Beyond AIDS over the next two years include developing
proposals for the 2015 update of the National HIV/AIDS Strategy; and continuing
to be involved with legislation in California and important states, as well as
at the federal level. In particular, he plans to continue to work to promote
the HIV care continuum; to utilize HIV reporting to trigger outreach for referral
of patients to treatment, partner services, and other services to prevent
transmission; and to enhance HIV prevention science.<span style="mso-spacerun: yes;"> </span></span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;"></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">MONICA SWEENEY, MD,
MPH, Vice-President</span></b></div>
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<span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt;">Monica
Sweeney recently retired from her position as the Assistant Commissioner of
Health for New York City after over 6 years in charge of the Bureau of HIV/AIDS
Prevention and Control. Her
responsibilities there included oversight of programs and budgets for
prevention; care and treatment (Ryan White); Housing Opportunities for People
With AIDS (HOPWA); and the epidemiology/Field Services Unit. <span style="mso-spacerun: yes;"> </span>She immediately took a position at the Mailman
School of Public Health, Columbia University also accepted a position with a
Foundation Board. Additionally, she is
now the chair of the SUNY Downstate Medical Center's Association of Council
Members and College Trustees.</span></div>
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<span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt;">Prior to her
present position, she was the medical director and vice president for medical
affairs in a Federally Qualified Health Center in Bedford Stuyvesant, Brooklyn
NY. <span style="mso-spacerun: yes;"> </span>The community served was medically and
economically deprived and HIV/AIDS was one of many challenges she addressed
daily during her 17 years in Bedford Stuyvesant. <span style="mso-spacerun: yes;"> </span>During her tenure there, in addition to direct
patient care, she became involved in policy and advocacy and had the
opportunity to work with Assemblywoman Nettie Mayersohn to get her historic
legislation (the Baby AIDS Bill, and Named-based Reporting) passed -- over
almost insurmountable opposition.</span></div>
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<span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt;">Dr.
Sweeney is a board-certified internist and geriatrician with a masters degree
in public health. <span style="mso-spacerun: yes;"> </span>She has always
combined individual and public health in her practice, by working with the
Medical Society for the State of New York (MSSNY), the National Association of
Community Health Centers (NACHC), and the American College of Physicians (ACP)
and by serving on the President’s Advisory Council on HIV/AIDS (PACHA). <span style="mso-spacerun: yes;"> </span>Prior to election to the position of
Vice-President, she was a Director on the Beyond AIDS Board, and before that she
served on the Advisory Council. Her goals as Vice-President include working
diligently to broaden the reach of the only AIDS organization that has always used
sound public health policy to fight the epidemic.</span></div>
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<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">DEANNA
STOVER, PHD, RN-BC, FNP-BC, CNS, COHN-S, Secretary </span></b></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Deanna
Stover is the Executive Director, Community Based (Outreach) Programs and
Services, at Redlands Community Hospital, with responsibility for the provision
of healthcare to the community with a focus on low-income and underserved
populations. She began her nursing career in 1979 while serving in the United
States Air Force in Europe, and she earned her PhD in Nursing, Health Policy from
Loma Linda University in 2011. She holds board-certification as a family
practice nurse practitioner, medical-surgical nurse, and occupational health
nurse specialist.</span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Prior
positions include Director, Medical Services, City of Los Angeles, and Chief of
Clinical Operations, Center for Employee Health and Wellness, County of San
Bernardino. She has actively worked in the medical arena for over 30 years with
training and expertise in community-based healthcare, health policy, HIV/AIDS
health care, occupational medicine, and advance practice nursing as a family
nurse practitioner and clinical nurse specialist. </span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">She
holds a certificate as an Advanced HIV Nurse Clinician from USC Medical Center,
AIDS education training center (1995) and has provided HIV/AIDS training for
healthcare providers. </span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">She
has served on organizational boards at the state and local level and is a
current board member for a local non-profit community service organization,
Building A Generation, located in Redlands California, in addition to being the
current Secretary, Beyond Aids, Inc, and the President of the organization’s Foundation.</span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt;">DENNIS P.
THOMPSON, MD, Treasurer</span></b></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Dennis
Thompson recently retired as a plastic surgeon in solo practice in Santa
Monica, California.<span style="mso-spacerun: yes;"> </span>For approximately
the last 13 years, he has been an active participant in Beyond AIDS.<span style="mso-spacerun: yes;"> </span>He has also been active in Physicians for HIV
Control, and was elected its President In<span style="mso-spacerun: yes;">
</span>October 2007. He has promoted the positions on HIV/AIDS of both
organizations as a frequent delegate to the California Medical Association
House of Delegates.<span style="mso-spacerun: yes;"> </span></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">In
the past, he served as President of the Los Angeles Society of Plastic
Surgeons, California Society of Plastic Surgeons, UCLA Plastic Surgery Society,
and International Society of Clinical Plastic Surgeons.<span style="mso-spacerun: yes;"> </span>Other organizational affiliations include
membership in the Los Angeles County Medical Association, California Medical
Association, American Medical Association (Life Member), American Society for
Aesthetic Plastic Surgery, and the American Society of Plastic Surgeons. In
addition, Dr. Thompson is a Clinical Professor of Plastic Surgery at UCLA.<span style="mso-spacerun: yes;"> </span>His goals in his new role of Treasurer, and as
a continued member of the Board of Directors. include lending his
organizational experience, and his medical and academic background, to help
advance the goals of Beyond AIDS. </span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt;">ADRIANA
ANDALUZ, MPH, Director (New Addition to the Board)<span style="mso-spacerun: yes;"> </span></span></b></div>
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<span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt;">Adriana Andaluz originally hails from Los Angeles, CA, where she
studied Microbiology along with a minor in Spanish Literature at the University
of California, Los Angeles. She began her path in public health as an undergrad
while working with Dr. Helen Rodriguez-Trias at the Pacific Institute for
Women’s Health, an incubator for programs designed to further women’s health in
the US, Africa, Latin America, the Middle East, and Asia. </span></div>
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<span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt;">Largely inspired by Dr. Rodriguez-Trias’ dedication to health
policy and increasing access to care, Ms. Andaluz’s first post-collegiate job
was in the Public Affairs department at Planned Parenthood Los Angeles. During
her tenure, she was able to work on many politically charged state and federal
campaigns, including California’s historic Reproductive Privacy Act.</span></div>
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<span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt;">Ms. Andaluz later moved to New York to pursue a master in public
health and work at the New York City Department of Health, where she has been
since 2007. She currently serves as the Director of External Affairs for the
Bureau of HIV/AIDS Prevention and Control where she oversees the development of
priority policy initiatives, is responsible for the Bureau’s interactions with
the Mayor’s Office, other inter- and intra-governmental agencies and
key-stakeholders including the agency’s press office, and also oversees the
Bureau’s social marketing and social media activities. </span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt;">FRANKLYN
N. JUDSON, MD, MPH, Director<span style="mso-spacerun: yes;"> </span></span></b></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Frank
Judson received his BA from Wesleyan University in 1964, his MD from the
University of Pennsylvania in 1968, and his house staff training from the
University of Wisconsin Hospitals (internal medicine) and the University of
Colorado (infectious diseases).<span style="mso-spacerun: yes;"> </span>He was
an Epidemic Intelligence Service officer with the Centers for Disease Control
assigned to the Colorado Department of Public Health<span style="mso-spacerun: yes;"> </span>(1970-72), and Scientific Liaison, Global
Program on AIDS, Geneva (1990 -91).<span style="mso-spacerun: yes;"> </span>He
is board-certified in internal medicine, infectious diseases and preventive
medicine.<span style="mso-spacerun: yes;"> </span></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">For
over 41 years, his research interests have concentrated on the epidemiology and
control of sexually transmitted infections including hepatitis B and HIV.<span style="mso-spacerun: yes;"> </span>His public health policy interests have run
the gamut from childhood and adolescent vaccine programs, to urban air
pollution, bioterrorism preparedness, and tobacco, tuberculosis, influenza, and
HIV prevention and control.<span style="mso-spacerun: yes;"> </span>He has
authored or co-authored more than 270 scientific publications.<span style="mso-spacerun: yes;"> </span></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt;">Dr.
Judson has served as President of the American STD Association (ASTDA),
President of the International Society for STD Research (ISSTDR), President of
the International Union Against the Sexually Transmitted Infections (IUSTI),
Chairman of the Board of the American Social Health Association (ASHA), Chief
of Infectious Diseases for the Denver Health Medical Center (1983-2002), and Director
of the Denver Public Health Department (1986-2004). He has been a member of the
Presidential Advisory Council on HIV/AIDS (PACHA), the CDC/HHS Advisory
Committee on Immunization Practices (ACIP), the Board of Regents of the
American College of Preventive Medicine, and the Colorado State Board of Health.
Currently, he is a member of the Colorado Governor’s Expert Emergency Epidemic
Response Committee (GEEERC) and Professor, Department of Medicine (Infectious
Diseases) and the Colorado School of Public Health, University of Colorado,
Denver. </span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt;">ELIZABETH
(BETSY) KIDDER, MD, MPH, Director</span></b><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgG-lGv0jAwkRybH6qsZX7XMM6W1eGkLUzbqfvspwgiEPaRZBg8PdlaH8GJ2T7I3QwmYdu-dhzY0GpZhIBQpH3nAQSXRmkAK50u1Oblz07IJZw_rz3oJYhKaCsK7owohSgGL4OftA/s1600/Kidder+2013%29.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgG-lGv0jAwkRybH6qsZX7XMM6W1eGkLUzbqfvspwgiEPaRZBg8PdlaH8GJ2T7I3QwmYdu-dhzY0GpZhIBQpH3nAQSXRmkAK50u1Oblz07IJZw_rz3oJYhKaCsK7owohSgGL4OftA/s200/Kidder+2013%29.jpg" height="200" width="168" /></a><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Elizabeth (Betsy) Kidder
is a medical doctor with a background in public health. Her career focus is on
access to quality health care by underserved communities and populations, with
a particular interest in innovation in preventive health care services and
policy change processes that improve access to such services.<br />
<br />
Betsy joined Beyond AIDS in 2001 as an intern, and has served as a Board member
since 2003. She received her Master's in Public Health in 2004 and her Medical
Degree in 2011, both from the George Washington University. She is currently
finishing her doctoral dissertation in health policy, and will begin medical
residency in 2014.<br />
<br />
As a public health professional, she has worked in Rome, Italy with the United
Nations on the development team for the "Initiative to End Child
Hunger" - a collaboration between the World Bank, the United Nations
Children's Fund, and the World Food Program. Previous to that, she worked with
the Global Health Council in Washington, DC on issues related to HIV/AIDS and
child health, as a part of a national PBS media and outreach campaign in global
health. She has also worked at the Department of Defense's HIV/AIDS Prevention
Program as well as the Futures Group, where she assisted with the research and
writing of a "What Works" program guide for developing country
policymakers on evidence-based practices in HIV/AIDS/STI prevention. </span></div>
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<span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><br />
Her interest in issues related to HIV was initially sparked by the case of
Nushawn Williams, a young man who knowingly spread HIV in her small hometown
community and high school. After that incident, she traveled to South Africa,
where she studied the epidemic in the Eastern Cape, taught an HIV/AIDS
education class, and volunteered in a pediatric HIV clinic, all of which
deepened her commitment to staying involved with HIV advocacy through her
career.</span></div>
<br />
<br />
<span style="font-size: large;"><b><span style="font-family: Arial, Helvetica, sans-serif;">JEFFREY D. KLAUSNER, MD, MPH (appointed 9/14)</span></b></span><br />
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</span></b><span style="font-family: Arial, Helvetica, sans-serif;"></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: 12pt; line-height: 115%;">Jeffrey D. Klausner<b> </b>is a UCLA
Professor of Medicine and Public Health. He served as a CDC Epidemic
Intelligence Service Officer 1995-1997, Deputy Health Officer and Director of
STD Prevention and Control Services, San Francisco Department of Public Health,
1998-2009, and Branch Chief for HIV and TB, CDC South Africa, 2009-2011. </span></span><br />
</div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span>
<br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: 12pt; line-height: 115%;">Dr. Klausner has been a leader in implementing the
public health approach to HIV prevention and control through policy and
programmatic activites resulting in the streamlining and evaluation of routine
HIV testing, early HIV case detection with HIV RNA screening, linkage-to-care
and contact tracing and partner notification services. In addition Dr.
Klausner through his epidemiologic research, identified the role that bacterial
STDs, the Internet, sex clubs, methamphetamine and Viagra played in augmenting
the risk of HIV tranmission and implemented successful population-based
programs to mitigate those risk factors. In collaboration with community
leaders and organizations, he inititated sexual health campaigns and peer-led
sexual health services for sex workers and gay men in San Francisco which have
been replicated globally. </span><span style="font-size: 12pt; line-height: 115%;"></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span>
<br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span>
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: 12pt; line-height: 115%;">Dr. Klausner has been conducting research in
laboratory-based diagnostics for HIV infection and other STDs since the early
1990s and is considered an expert in infectious disease detection and
management. He is currently board certified in Internal Medicine and
Infectious Diseases. He has a busy clinical HIV/AIDS practice in Los
Angeles and regularly attends on the infectious diseases consultation service
at UCLA Ronald Reagan Hospital. Dr. Klausner brings nearly two decades
of public health, clinical and research experience to the Board, much of it
specific to HIV prevention.</span><b><span style="font-family: Arial, Helvetica, sans-serif;">
</span></b></span></div>
<span style="font-family: Arial, Helvetica, sans-serif;">
</span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">
</span></span>
<br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><span style="color: black;"> </span></span></span></div>
</div>
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<b style="mso-bidi-font-weight: normal;"><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt;">YVONNE
POVER, RDH, Director (until passing 4/14)</span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /></span></b></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFTtv0S47SvDvE98l4UFj5TYKuB0J3WdluAYs_g3__TtneRtu8A_XSGwqhv-vHfZSQdoC2ZjM6VMPP147wgC9GvGGFMRFkXOWjli6D8lKAuIyTrdFDs4sFVwiGB3Uc6i4rZLUbBQ/s1600/Pover+2010.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFTtv0S47SvDvE98l4UFj5TYKuB0J3WdluAYs_g3__TtneRtu8A_XSGwqhv-vHfZSQdoC2ZjM6VMPP147wgC9GvGGFMRFkXOWjli6D8lKAuIyTrdFDs4sFVwiGB3Uc6i4rZLUbBQ/s200/Pover+2010.jpg" height="200" width="175" /></a></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt;"></span></b></div>
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<span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt;">Yvonne Pover is one of the original founders of Beyond AIDS, and served
as the Treasurer for the organization’s first 15 years. The East Coast
headquarters of Beyond AIDS is housed rent-free in her office. She worked with
the attorneys to incorporate both Beyond AIDS Inc. and Beyond AIDS Foundation. She
designed and formerly produced the organization’s awards and certificates, and previously
issued the newsletter and maintained our donor database. She has provided
advice and guidance on our web site. As she lives close to the Capitol in
suburban Virginia, she has represented Beyond AIDS at Congressional hearings on
the Hill. <span style="mso-spacerun: yes;"> </span>She has been involved in our
strategy, public relations, and fundraising from the beginning.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt;">Before she became a designer and art director, she spent years as
a registered dental hygienist, a profession she subsequently continued to
practice part-time. In that profession, she became acquainted with HIV/AIDS
issues “up close and personal -- at a blood level,” as she says. Since 1981,.she has
seen the havoc this disease has wrought, and began wondering early on why we
did not deal with the virus in the same way we dealt with some other
STD's--with sound public health policy. She is a graduate of Marquette
University (dental hygiene), Institut Minerva in Zürich (German languages), and
NVCC (Ad Design) in Virginia, and is fluent in German, Swiss-German, and
Spanish.</span></div>
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<br /></div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;"><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt;">CARY
SAVITCH, MD, Immediate Past-President </span></b></div>
<div class="MsoNormal">
<span style="color: black; font-size: 12.0pt;"><br /></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivdOz4fNoNvEFjc42wTcoFlpJLdThEA3WSWZv14kbUOrbQSkt23OTZsuaCcZ1K8F2u77Xi4BHjYAa0X65t0g7cTBOaarbJ0NeYf3iI3rNprrONXIPxl6TJ_qU46Rw4vgZn7fOceQ/s1600/Savitch+2012.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivdOz4fNoNvEFjc42wTcoFlpJLdThEA3WSWZv14kbUOrbQSkt23OTZsuaCcZ1K8F2u77Xi4BHjYAa0X65t0g7cTBOaarbJ0NeYf3iI3rNprrONXIPxl6TJ_qU46Rw4vgZn7fOceQ/s200/Savitch+2012.jpg" height="200" width="166" /></a></div>
<div class="MsoNormal">
<span style="color: black; font-size: 12.0pt;"></span></div>
<div class="MsoNormal">
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt;">Cary Savitch was one of the Founding Members of Beyond AIDS,
organized its founding meetings, and was elected its first President. He has
served on the Board of Directors since the founding of the organization.<span style="mso-spacerun: yes;"> </span>He recruited many of the early members of the
organization by speaking to friends, colleagues, and patients about the need
for HIV reform, writing a book about the subject, and giving talks on HIV,
especially in Ventura County and the surrounding area where the founding
meetings were held.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt;">He is an infectious disease physician, and has taken care of AIDS
patients for the past 33 years (starting even before the disease had a name). In
1997, he published a book, “The Nutcracker is Already Dancing,” which
highlighted the lack of application to HIV of sound public health practices
that had been successfully utilized for diseases such as syphilis and tuberculosis.
He believes strongly that the mission of Beyond AIDS, to stop the transmission
of HIV, is the direction we must take in order to save lives in this epidemic.</span></div>
<div class="MsoNormal">
<br /></div>
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<span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt;">He expresses pride in the time he has already spent with Beyond
AIDS, which he believes is the only organization willing to stand up and
support the necessary public health policies needed to contain HIV. His goals
are to continue these efforts in every and any capacity needed, and to
encourage others to join our battle for HIV/AIDS prevention. </span><br />
<br />
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt;"><br /> </span></div>
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Ronald P. Hattis, MD, MPHhttp://www.blogger.com/profile/03917713422765368391noreply@blogger.com0tag:blogger.com,1999:blog-13808410.post-49113566116501596472013-11-07T17:16:00.001-08:002013-11-13T22:01:03.153-08:0015-YEAR ANNIVERSARY MEETING CHARTS COURSE ON POLITICAL, SCIENTIFIC ACTION<br />
The 2013 Annual
Meeting of Beyond AIDS recognizing 15 years of the organization's
existence, was held by nationwide conference call, November 9,
2013. There was a small hub of members who met in person in Brooklyn, NY, hosted by Vice-President Monica Sweeney, while others phoned in from around the country. <br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUk_D-MRg5ls5HS31w-TNXDwcgCsrXIp4htcqIpGstUukrppldxcVDT2XVbPr1N3h2uHBuumytIWFOmc8-4RLwQCCAxdg5O0VGV0ijEiCo__P8VV1AtrXB5f4dU6v7K745nNVJ2Q/s1600/Monica+Sweeney+7-25-12+DCb.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUk_D-MRg5ls5HS31w-TNXDwcgCsrXIp4htcqIpGstUukrppldxcVDT2XVbPr1N3h2uHBuumytIWFOmc8-4RLwQCCAxdg5O0VGV0ijEiCo__P8VV1AtrXB5f4dU6v7K745nNVJ2Q/s320/Monica+Sweeney+7-25-12+DCb.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="color: blue;">Beyond AIDS Vice-President, Dr. Monica Sweeney, convened a small group as a hub for Annual Meeting</span></td></tr>
</tbody></table>
Later the same day, in conjunction with this gathering, the
Boards of Directors of Beyond AIDS and its charitable subsidiary Beyond
AIDS Foundation also conducted meetings. Each gathering charted
courses of action for 2014 to achieve further advance in HIV control and
prevention. <br />
<br />
<h3 style="font-weight: normal;">
<span style="font-size: small;">The organization's ultimate mission remains the reversal
of the course of the HIV epidemic, through sound public health policy.
For the complete listing of the organizations's
goals, objectives, and principles, see <a href="http://beyondaids.org/mission.html">Beyond AIDS Mission and Principles</a></span>.</h3>
<h3 style="font-weight: normal;">
</h3>
<h3 style="font-weight: normal;">
<b><span style="font-size: small;">LEGISLATIVE VICTORIES AND SHORTFALLS, CALIFORNIA AND NEW YORK</span></b></h3>
<h3 style="font-weight: normal;">
<b><span style="font-size: small;"> </span></b></h3>
<h3 style="font-weight: normal;">
<span style="font-size: small;"> The Beyond AIDS membership celebrated a legislative success, and expressed disappointment about less successful outcomes.<a href="http://www.beyondaids.blogspot.com/2013_10_01_archive.html" target="_blank"> This link</a><a href="http://www.beyondaids.blogspot.com/2013_10_01_archive.html" target="_blank"> will show the legislative report for California, for the 2013 legislative year</a>.</span> <span style="font-size: small;">One
key bill (AB 446, also discussed below) on HIV testing passed and was
signed into law, another bill (AB 999) to allow condoms in prisons
passed but was vetoed. Still other bills supported by Beyond AIDS failed
to progress and may get another chance in 2014. </span></h3>
<h3 style="font-weight: normal;">
<span style="font-size: small;"> </span></h3>
<h3 style="font-weight: normal;">
<span style="font-size: small;">The organization discussed the legislative
situation in New York State. New York's recent bill A11487 was intended to allow HIV testing
without written consent. It was a partial victory in a multi-year effort
by Beyond AIDS' Nettie Mayersohn, who at that time was a member of the
state Assembly, to promote routine HIV testing. Unfortunately, this bill
in the end did not enable opt-out routine testing, and only eliminated
the requirement for written consent in the case of rapid testing, where
the result can be available within an hour of specimen collection.
Clinics or phlebotomy stations drawing a blood specimen to be sent out
for later testing, and laboratories not offering rapid testing, must
still use a written consent form. Beyond AIDS will consider further legislation to permit routine oral opt-out consent for testing in that state.</span></h3>
<h3 style="font-weight: normal;">
<span style="font-size: small;"> </span></h3>
<h3 style="font-weight: normal;">
<span style="font-size: small;">One positive provision in the New York bill is that
health care providers must offer an HIV test at least once, to every
patient ages 13-64 who might be at risk of acquiring the disease. New
York was the first state to enact such a provision, but California' AB
446, strongly supported by Beyond AIDS, will take effect in 2014 with a
similar provision. AB 446 will require universal offering of HIV testing
to adolescents and adults by primary care providers, if other blood
tests are also planned.</span></h3>
<h3 style="font-weight: normal;">
<span style="font-size: small;"> </span></h3>
<h3 style="font-weight: normal;">
<span style="font-size: small;"><b>PUBLIC POLICY INITIATIVES: SAFER SEX IN PORN FILMS</b></span></h3>
<h3 style="font-weight: normal;">
<span style="font-size: small;"><b> </b></span></h3>
<h3 style="font-weight: normal;">
<span style="font-size: small;">The Beyond AIDS Foundation has taken an active role since
2010 in advising the California Occupational Safety and Health
Administration (Cal/OSHA) on regulations to protect worker safety in the
adult film industry. After three years, no regulations have yet been issued, however a new draft proposal has been posted.
Beyond AIDS has advocated for mandatory condom use, expanded screening
for sexually transmitted and bloodborne infections, and coverage of
treatment for such infections<b> </b>under Workers Compensation. The
industry has been resisting such requirements. </span></h3>
<h3 style="font-weight: normal;">
<span style="font-size: small;"> </span></h3>
<h3 style="font-weight: normal;">
<span style="font-size: small;">In November 2012, Los Angeles County passed an ordinance with 57% voter support, to require condoms and infection control measures for this industry in that county. A recent court decision, however, will limit the ability of the county to enforce the ordinance.</span></h3>
<h3 style="font-weight: normal;">
<span style="font-size: small;"> </span></h3>
<h3 style="font-weight: normal;">
<span style="font-size: small;">During the 2013 legislative year, one of the bills supported by Beyond AIDS (AB 332, later converted to AB 640) aimed at extending condom and infection control requirements for the industry statewide. Unfortunately, this was one of the bills that did not progress, but it is still alive for 2014 consideration. </span></h3>
<h3 style="font-weight: normal;">
<span style="font-size: small;"> </span></h3>
<h3 style="font-weight: normal;">
<span style="font-size: small;">The membership meeting,
as well as the Foundation Board, received reports on these
developments and will continue participation and efforts in this area. While members noted that few HIV cases actually occur among porn film actors, another reason to pursue a requirement for condoms is that adult films set a model for what constitutes exciting sex. If millions of viewers view attractive people engaging in safer sex, this could have positive fallout. <a href="http://beyondaids.blogspot.com/2011/09/sex-and-safety-beyond-aids-weighs-in-on.html" target="_blank">For a fuller report, check this article, especially the update at the end.</a></span></h3>
<h3 style="font-weight: normal;">
<span style="font-size: small;"> </span></h3>
<h3 style="font-weight: normal;">
<span style="font-size: small;"><b>AWARDEE SELECTED</b></span></h3>
<h3 style="font-weight: normal;">
<span style="font-size: small;"><b> </b><br /><b> </b></span></h3>
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. This year's award recipient has not been publicly announced, but will be a medical epidemiologist from New York City.<br />
<span class="Apple-style-span" style="border-collapse: separate; color: black; font-family: 'Times New Roman'; font-size: small; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; orphans: 2; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px;"><span class="Apple-style-span" style="font-size: x-small;"></span></span><br />
<h3 style="font-weight: normal;">
</h3>
<h3 style="font-weight: normal;">
</h3>
<h3 style="font-weight: normal;">
<span style="font-size: small;">For descriptions of past awards 2001-2012, see</span> <span style="font-size: small;"><a href="http://beyondaids.org/awardslist.html">Beyond AIDS Awards</a>.</span></h3>
<h3 style="font-weight: normal;">
<span style="font-size: small;"> </span></h3>
<h3 style="font-weight: normal;">
<span style="font-size: small;"><b>SCIENTIFIC ISSUES</b></span></h3>
<h3 style="font-weight: normal;">
<span style="font-size: small;"><b> </b></span></h3>
<h3 style="font-weight: normal;">
<span style="font-size: small;">The Beyond AIDS Foundation Board approved in concept draft policy statement on preventing new HIV infections, and adopted as a project the preparation of recommendations for the 2015 update to the National HIV/AIDS Strategy. The Beyond AIDS Scientific Committee serves the
Foundation and will be consulted.</span> </h3>
<h3 style="font-weight: normal;">
<a href="http://www.beyondaids.blogspot.com/2012/07/normal-0-false-false-false-en-us-x-none.html" target="_blank"><span style="font-size: small;">Click on this link to see the 2012 policy statement on a strategy to control the U.S. HIV epidemic.</span></a></h3>
<h3 style="font-weight: normal;">
</h3>
Ronald P. Hattis, MD, MPHhttp://www.blogger.com/profile/03917713422765368391noreply@blogger.com0tag:blogger.com,1999:blog-13808410.post-64303412073112187052013-10-31T15:22:00.002-07:002013-10-31T15:22:46.516-07:00CALIFORNIA LEGISLATION: WINNING AND LOSING BATTLES FOR HIV PREVENTION<!--[if gte mso 9]><xml>
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<b style="mso-bidi-font-weight: normal;"><span style="font-size: 14.0pt;">BEYOND AIDS CALIFORNIA LEGISLATIVE
REPORT, 2013</span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-size: 8.0pt;"></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">Beyond AIDS had an active legislative season in Sacramento in 2013. Following is a summary of victory, loss, and a few campaigns that will be continued in 2014.</b></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><br /></b></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">SUPPORTED BILL PASSED
BY LEGISLATURE AND SIGNED INTO LAW</b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">AB 446 (Mitchell) </b>will
require all primary care providers to offer an HIV test to all adolescents and
adults who have not had one in the last year, if blood is to be drawn for other
purposes. It also facilitates posting HIV results confidentially for Web
access, and permits oral consent for HIV testing in most non-clinical settings.
The bill adds a requirement for post-test counseling, and the first version of
the bill would have eliminated pre-test counseling, but this had to be changed
due to ACLU opposition. The bill was sponsored by the AIDS Healthcare
Foundation (AHF), but usually only two speakers in favor were permitted by each
legislative committee, and at every hearing, Beyond AIDS testified alongside
the AHF lobbyist and provided the only testimony from a physician (Ron Hattis).
We also sent letters to legislators, met with committee analysts, and wrote to
the Governor to urge signature. For final text of bill as chaptered into law,
see <a href="http://leginfo.ca.gov/pub/13-14/bill/asm/ab_0401-0450/ab_446_bill_20131005_chaptered.htm">http://leginfo.ca.gov/pub/13-14/bill/asm/ab_0401-0450/ab_446_bill_20131005_chaptered.htm</a>.
</div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;">AB 506 (Mitchell) </b>permits
social workers to consent to an HIV test of an infant under age one who has
been taken as a temporary dependent of a court, often due to drug abuse, child
abuse, or neglect by the mother. Beyond AIDS supported it in principle, but
tried in vain to get the language changed, so that the authorization would not need
to be in writing. Written consent seemed inconsistent with our push to
eliminate the need for written consent in other circumstances, including in AB
446 by the same author. The bill was sponsored by Los Angeles County, whose
lobbyist was not receptive to changes and Assembly Member Mitchell was not
willing to make changes without the sponsor’s agreement. In order to avoid
antagonizing Ms. Mitchell (so as to permit continued close partnership on AB
446), the above point was not raised in open testimony. For final text of the
bill as chaptered into law, see <a href="http://leginfo.ca.gov/pub/13-14/bill/asm/ab_0501-0550/ab_506_bill_20130826_chaptered.htm">http://leginfo.ca.gov/pub/13-14/bill/asm/ab_0501-0550/ab_506_bill_20130826_chaptered.htm</a>.</div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;">SUPPORTED BILL PASSED
BY LEGISLATURE BUT VETOED</b></div>
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<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">AB 999 (Bonta)</b>
would have made condoms available in state prisons. The condoms and dispensers
would have been donated. It passed but was vetoed by Gov. Brown. Two similar
bills in recent years had also passed but been vetoed by Gov. Schwarzenegger,
and Beyond AIDS made a big effort for the first of those. Beyond AIDS also
testified at some of the hearings, met with legislative and committee staff,
and wrote letters, including an unsuccessful request to the Governor to sign
the bill. One of the problems in getting gubernatorial support for such a
measure is that sodomy in prison (i.e., what the condoms would be used for) is
still a felony, which can add a year of additional prison sentence. It may be
necessary to remove that crime from the penal code. For text of bill as sent to
Governor, see <a href="http://leginfo.ca.gov/pub/13-14/bill/asm/ab_0951-1000/ab_999_bill_20130916_enrolled.htm">http://leginfo.ca.gov/pub/13-14/bill/asm/ab_0951-1000/ab_999_bill_20130916_enrolled.htm</a>.</div>
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<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;">SUPPORTED BILLS STUCK
IN LEGISLATURE BUT POSSIBLE TO REVIVE IN 2014</b></div>
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<b style="mso-bidi-font-weight: normal;">AB 640 (Hall)</b>
would require infection control practices, presumably including condoms, for
the adult film industry. So far, Los Angeles and Ventura Counties have local
ordinances on this issue, but a judge has thrown out the L.A. ordinance. Even
if this wins on appeal, there is concern is that the industry may simply move
to other counties. The original bill, AB 332, was held in suspense in Assembly
Appropriations. AB 640, a bill requiring a license to sell tobacco products,
which had passed the Assembly, was amended in the Senate to replace AB 332, and
is being held by Senate Rules Committee for a decision on whether this is
acceptable. If AB 640 passes Senate in 2014, it will need to return to
Assembly, which never saw it in its current form. Beyond AIDS supported this
bill with letters and visits to legislative staff, and has also been involved
in a slow-moving state regulatory process on this issue by attending hearings
of Cal-OSHA on the subject since 2010, and by supporting the 2012 L.A.
initiative. For text of bill, see <a href="http://leginfo.ca.gov/pub/13-14/bill/asm/ab_0601-0650/ab_640_bill_20130828_amended_sen_v94.htm">http://leginfo.ca.gov/pub/13-14/bill/asm/ab_0601-0650/ab_640_bill_20130828_amended_sen_v94.htm</a>.
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<b style="mso-bidi-font-weight: normal;">AB 336 (Ammiano) </b>would
prohibit the use of seized condoms as evidence in prosecutions for<span style="mso-spacerun: yes;"> </span>prostitution. In a deal with county district
attorneys, it was weakened to merely require a hearing by the </div>
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judge in chambers on the admissibility of such evidence. Beyond
AIDS supported it with letters and met with legislative and committee staff.
The bill passed the Assembly in that weakened form and was referred to Senate
Public Safety Committee, but the author became unhappy with the compromise and
cancelled the hearing, hoping that the original form might be restored in 2014
if more support can be enlisted. For text of bill in present form, see <a href="http://leginfo.ca.gov/pub/13-14/bill/asm/ab_0301-0350/ab_336_bill_20130529_amended_asm_v97.htm">http://leginfo.ca.gov/pub/13-14/bill/asm/ab_0301-0350/ab_336_bill_20130529_amended_asm_v97.htm</a>.
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Ronald P. Hattis, MD, MPHhttp://www.blogger.com/profile/03917713422765368391noreply@blogger.com0