15-YEAR ANNIVERSARY MEETING CHARTS COURSE ON POLITICAL, SCIENTIFIC ACTION

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.

Beyond AIDS Vice-President, Dr. Monica Sweeney, convened a small group as a hub for Annual Meeting

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.

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 Beyond AIDS Mission and Principles.

 

LEGISLATIVE VICTORIES AND SHORTFALLS, CALIFORNIA AND NEW YORK

 

The Beyond AIDS membership celebrated a legislative success, and expressed disappointment about less successful outcomes. This link will show the legislative report for California, for the 2013 legislative year. 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. 

 

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.

 

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.

 

PUBLIC POLICY INITIATIVES: SAFER SEX IN PORN FILMS

 

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 under Workers Compensation. The industry has been resisting such requirements. 

 

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.

 

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. 

 

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. For a fuller report, check this article, especially the update at the end.

 

AWARDEE SELECTED

 

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.

For descriptions of past awards 2001-2012, see Beyond AIDS Awards.

 

SCIENTIFIC ISSUES

 

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.  

Click on this link to see the 2012 policy statement on a strategy to control the U.S. HIV epidemic.

CALIFORNIA LEGISLATION: WINNING AND LOSING BATTLES FOR HIV PREVENTION

BEYOND AIDS CALIFORNIA LEGISLATIVE REPORT, 2013

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.

SUPPORTED BILL PASSED BY LEGISLATURE AND SIGNED INTO LAW

AB 446 (Mitchell) 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 http://leginfo.ca.gov/pub/13-14/bill/asm/ab_0401-0450/ab_446_bill_20131005_chaptered.htm.

AB 506 (Mitchell) 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 http://leginfo.ca.gov/pub/13-14/bill/asm/ab_0501-0550/ab_506_bill_20130826_chaptered.htm.

SUPPORTED BILL PASSED BY LEGISLATURE BUT VETOED

AB 999 (Bonta) 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 http://leginfo.ca.gov/pub/13-14/bill/asm/ab_0951-1000/ab_999_bill_20130916_enrolled.htm.

SUPPORTED BILLS STUCK IN LEGISLATURE BUT POSSIBLE TO REVIVE IN 2014

AB 640 (Hall) 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 http://leginfo.ca.gov/pub/13-14/bill/asm/ab_0601-0650/ab_640_bill_20130828_amended_sen_v94.htm.

AB 336 (Ammiano) would prohibit the use of seized condoms as evidence in prosecutions for  prostitution. In a deal with county district attorneys, it was weakened to merely require a hearing by the

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 http://leginfo.ca.gov/pub/13-14/bill/asm/ab_0301-0350/ab_336_bill_20130529_amended_asm_v97.htm.

BEYOND AIDS CELEBRATES GAINS AS VICTORY AGAINST HIV WITHIN REACH; PLANS FOR 2013

Beyond AIDS held its Annual Meeting in Redlands, California on November 17, 2012, the first time the organization had held a major event in the "Inland Empire." (See separate report on the associated educational seminar on the morning of the meeting day.) There was considerable excitement because of the organization's progress in the development and promotion of a viable strategy to control the U.S. HIV/AIDS epidemic. If this strategy is vigorously implemented nationwide and promoted by federal health agencies, there is a potential for significant decreases in HIV incidence, something that has not been achieved in the U.S. since the disease was discovered in 1981.

President Ron Hattis reported that the subsidiary Beyond AIDS Foundation had been especially active and successful during 2012. In addition to development of the control strategy, the foundation had sponsored meetings in Washington, D.C. with key federal leaders during the International AIDS Conference, to review Beyond AIDS recommendations for HIV control. The internship/fellowship program had been reactivated, and a fellowship project was underway to survey local California public health agencies on their partner services activities. Consultations had been held with leaders of the California Office of AIDS, and the foundation was conducting continuing medical education programs. The Web site had been updated, and the changes were demonstrated at the meeting by our current Web designer, Heather Rinne.

Beyond AIDS reaffirmed its interest in simplifying current laws in California for HIV testing and partner services/notification. In New York State, preliminary evaluation of a the effects of 2010 legislation to make HIV testing more routine indicate a 13% increase in testing. Beyond AIDS will watch for deficiencies that should be addressed in further legislation.

BEYOND AIDS COMMENDS NEW YORK CITY HIV/AIDS PROGRAM AS MODEL FOR COUNTRY

The following statement was released by Beyond AIDS on World AIDS Day, December 1, 2012:

The world’s HIV/AIDS epidemic could soon be controlled, if every community were to adopt the types of programs and policies now in place for New York City. That is the conclusion of Beyond AIDS, a national organization dedicated to reversing that epidemic through sound public health policy. Dr. Monica Sweeney, Assistant Commissioner at the New York City Health Department, gave a presentation about the New York City program at the organization’s annual meeting (and at its expense), in Southern California on November 17.

Dr. Monica Sweeney, Asst. Commissioner of Health, NYC

 “We are very impressed with what New York City is doing,” said Dr. Ronald Hattis of Redlands, California, President of Beyond AIDS. “Every new HIV infection represents a failure to prevent transmission from an existing case,” he continued. “The New York program gets more patients into treatment at an early stage, which suppresses their HIV and makes them much less likely to pass the virus on. If almost all infected persons could be effectively treated before they infect anyone, combined with regular condom use and safer sexual and drug behavior, the epidemic could be brought to an eventual end.”

In late 2011, results from multinational clinical trial with the code name HPTN 052 were announced, which showed that treatment that brought the virus down to an undetectable level in the blood could reduce transmission to sexual partners by 96%. New York City implemented this concept before it had been translated into policy elsewhere.

On December 1, 2011, Mayor Michael Bloomberg and Health Commissioner Thomas Farley released recommendations that healthcare providers offer antiviral drugs to any person living with HIV, regardless of the person’s CD4 count. At that time, the national recommendation was to delay treatment until that count (of a type of white blood cell critical to the immune system) dropped below 500, which could take years. That move, and similar action by San Francisco’s Department of Public Health, helped lead to similar recommendations for the entire nation, almost four months later. There has been little nationwide promotion or implementation of the strategy so far. As a result of New York’s head start, however, already 39% of persons infected in the city have suppressed levels of virus and are unlikely to infected anyone else, compared with 25% nationally.

Other things that impressed Beyond AIDS include the NYC condom availability program, which distributed 36 million male condoms in 2011 at more than 3,900 venues citywide. In addition, New York City distributed 1.3 million female condoms, which are not widely used in most other locations. There is even a NYC condom finder application for mobile phones. The city also has a successful marketing campaign for HIV/AIDS awareness, and a widespread HIV testing program.

“The combination of better control of infection at the source, that is, helping the infected person not to transmit, and also prevention programs including testing and condom availability aimed at entire populations at risk, makes New York City’s program the closest we have found to what we consider the optimal strategy,” said Hattis. “What we want is for every city and state, and every nation, to replicate the sort of things that New York City is doing to control this disease.”

Beyond AIDS’ recommendations on strategy to control the U.S. HIV/AIDS epidemic are published on the organization’s blog. The main Web site, which is integrated with this blog, is www.beyondaids.org.

EDUCATIONAL PROGRAMS ILLUSTRATE STRATEGY FOR BOTH TREATMENT AND CONTROL OF HIV

In November 2012, the Beyond AIDS Foundation conducted continuing medical education programs in Southern California, in conjunction with the annual meeting of the Beyond AIDS membership organization, and in observance of World AIDS Day. These programs both provided state-of-the art updates on HIV treatment, and explained the role that treatment now plays in the foundation's strategy for control of HIV transmission.

A November 17 seminar, conducted at the education pavilion of Redlands Community Hospital, featured Dr. Monica Sweeney, Assistant Commissioner of Health for HIV Prevention and Control, New York City; and Dr. Peter Kerndt, Chief of STD Control for Los Angeles County. Dr. Sweeney presented the model HIV/AIDS treatment and prevention program of the New York City Department of Public Health, including massive condom distribution, widespread HIV testing, and routine linkage of persons who test positive to treatment and partner services. Identification of new infections and onset of treatment are occurring earlier, with prospects for reducing HIV incidence. These are key elements for a comprehensive HIV control and treatment strategy as recommended by the foundation and its sponsoring membership organization, Beyond AIDS.

Dr. Sweeney demonstrates poster used to promote NYC testing

Dr. Kerndt reported on a recent multi-county syphilis outbreak in Southern California, associated with lack of condom use by the adult film industry.  This association was relevant in view of the approval earlier in November by L.A. County voters of a ballot proposal to require condom use by that industry. He also reviewed the diagnosis and treatment of syphilis, including new laboratory testing technology, and the association between syphilis and HIV infection.

Dr. Kerndt explains advances in testing methods for syphilis

Two other presentations at the seminar were provided by Dr. Ron Hattis, Beyond AIDS President. Dr. Hattis reviewed the most recent national guidelines for treatment of HIV/AIDS, which for the first time recommend offering treatment to all infected persons regardless of their CD4 counts. He reviewed the evidence that effective treatment, which suppresses "viral load" (the amount of HIV virus in blood) to undetectable levels, can reduce HIV transmission by up to 96%, a concept commonly referred to as "treatment as prevention." This is a cornerstone in the recommended strategy of Beyond AIDS for controlling the HIV epidemic (see http://www.beyondaids.blogspot.com/2012/07/normal-0-false-false-false-en-us-x-none.html). However, this strategy can only be effective if infections are detected and effective treatment is instituted much earlier than has been traditional, i.e.,  before transmission occurs. Dr. Hattis also provided information and a model checklist to help providers comply with California's unique legal requirements for testing without written consent, and similar information and a checklist for performing or referring partner services.

On November 30, 2012, Hattis was the featured speaker at Loma Linda University in advance of World AIDS Day. He reviewed the history of World AIDS Day, and delivered another update on the treatment and prevention of HIV/AIDS, again explaining how early onset of treatment and following the Beyond AIDS model could reduce national HIV/AIDS incidence by at least 60%.

Dr. Hattis presenting World AIDS Day lecture at Loma Linda University

Implementation of the 2012 guidelines from the U.S. Health and Human Services Panel on Antiretroviral Treatment for Adults and Adolescents (posted on the NIH Website), and from the International Antiretroviral Society-U.S., both of which recommend treatment of all infected persons, has lagged as this aspect of the new guidelines has not been actively promoted to providers and patients. The Beyond AIDS Foundation seeks to stimulate further education for both, to hasten implementation of earlier treatment which can benefit both patients and public health.

BEYOND AIDS ANNOUNCES CONTINUING EDUCATION AND ANNUAL MEETINGS, REDLANDS, CA, SAT. 11/17/12

Update on Treatment and Prevention of HIV and Syphilis

A Continuing Education Seminar Co-Sponsored by the

Beyond AIDS Foundation and the Infectious Disease Association of California

When:               Saturday, November 17, 2012

Where:             Redlands Community Hospital, Weisser Education Pavilion

  350 Terracina Blvd., Redlands, CA 92373

Schedule:

8:00-8:50 a.m.:       Registration, Coffee

8:50-9:00 a.m.:       Welcome and Introduction

                                  Deanna Stover, PhD, RN, FNP-BC, CNS, Pres., Beyond AIDS Foundation;

                                  Executive Director, Community Programs, Redlands Community Hosp.

9:00-9:45 a.m.:       What’s New in 2012 Guidelines for Antiretroviral Treatment of Adults/Adolescents with HIV          

                                  Ronald Hattis, MD, MPH

9:45-10:30 a.m.:    From Routine Testing to Viral Load Suppression: New York City HIV Interventions

                                  Monica Sweeney, MD, MPH

10:30-11:00 a.m.:  Break; pharmaceutical displays*

11:00-11:45 a.m.:   HIV Testing & Partner Notification Requirements in California: Keeping it Simple and Legal

                                  Ronald Hattis, MD, MPH; demonstration with I. Jean Davis, PA, DC, PhD and Trista Baker, LVN

11:45-12:30 p.m.:  Syphilis Update: Lessons Learned from an Outbreak Associated with the Adult Film Industry       

                                  Peter Kerndt, MD, MPH

12:30-1:30 p.m.:    Lunch (included with registration; pharmaceutical displays will be open)

1:30-3:30 p.m.:       Annual Meetings of Beyond AIDS and Beyond AIDS Foundation, including report on International AIDS Conference and discussion of strategy  for controlling U.S. HIV epidemic, incl. “treatment as prevention.”

                                  Seminar participants invited to attend but handouts only available if intent included in RSVP (see below).

Accreditation:

Physicians: The Infectious Disease Association of California (IDAC) is accredited by IMQ/CMA to provide CME to physicians, and designates this educational activity for a maximum of 3.0 AMA PRA Category 1 Credits^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.  This credit may also be applied to HIV Specialist certification.

CEUs (3 units) for nurses and others will be available through Redlands Community Hospital.

                        

Map and directions: http://www.mapquest.com/maps?address=350%20Terracina%20Blvd&city=Redlands&state=CA&zipcode=92373

From 10 Freeway, take Alabama exit; south on Alabama. At end of road turn right on Barton, and soon after turn left onto Terracina Blvd.  Pass Olive, then take 1st entrance into hospital grounds on right. Weisser Education Pavilion is a separate building to right of main hospital. Enter building from the right (north) side. Parking available in hospital lots at no charge.

Registration:   

Course registration fees (checks) will be collected at check-in.

Physicians, nurse practitioners, physician assistants, and doctorate-level professionals: $60      

Nurses and all others: $30                      

Special discounts:          Members of Beyond AIDS: No charge*                 

                                                Members of IDAC: $10             Redlands Community Hospital Employees: $10

RSVP required:  

To reserve seating, food, handouts, e-mail foundation@beyondaids.org or leave phone message at 888-239-2437.  Include in your message name, phone number, e-mail address, and whether also attending afternoon B.A. meeting.

*Membership:  

Attendees may join Beyond AIDS at registration check-in and have course registration fee waived.

Information on the organization and membership available at www.beyondaids.org.   Dues: Regular $50, couples $75, students $25.

BEHIND THE SCENES: VOLUNTEERS ARE KEY TO AIDS CONFERENCE SUCCESS

Hayes distributing conference bags and programs

Frank E. Hayes is not a youngster or college student. He has an important full-time job at the Washington State Health Department, as the Coordinator for Health Education and Risk Reduction for HIV and Hepatitis. In his spare time, he also serves as a member of the Advisory Council of Beyond AIDS.  But when he heard at the beginning of April 2012 that volunteers were being sought to work at the upcoming International AIDS Conference in July in the other Washington (DC), for no pay and no travel reimbursement, he rushed to sign up. So many other people did too, mostly from the U.S. but also from other countries, that volunteer registration was closed after only two weeks.

Hayes checking badges for security

1500 volunteers were initially sought, and about 1000 actually served throughout the conference. The received yellow T-shirts, but transportation and housing were at their own expense.

Volunteers filled many essential roles, including helping to plan the conference and to coordinate activities, assisting with registration, greeting visiting delegates and assuring security by verifying proper credentials. They also acted as guides, staffed various offices and activities, and assisted in a display area known as the Global Village. Only occasionally were they free to attend actual conference sessions. However, they bonded socially, and many new friendships developed.

Volunteers cheer for photo near end of conference

Judging from discussions with Hayes and other volunteers during the conference, morale and esprit de corps was excellent. Many gathered on the last day for a group photo, at which they were heard to whoop and cheer.

These volunteers were the unsung heroes who made the conference run smoothly. They were a key to its success, and indirectly, to the spirit of global unity that was evident during the conference.

For a more complete report on the XIX International AIDS Conference from the perspective of Beyond AIDS' President, see next posting.

SAD POSTSCRIPT: The following message was received from Justin Hahn, a colleague of Frank Hayes at the Washington State Health Department, on July 25, 2013, when we inquired about his welfare, since we had not heard from him in some months:

"I am so sorry to say that Frank Hayes passed away on February 18, 2013.  Frank was diagnosed with a malignant brain tumor shortly after returning home from the International AIDS Conference last year. Frank was enjoyed and loved by his friends and co-workers. His laugh could be heard across a large room. Some of us at the office spent considerable time with Frank in the hospital and later in the care facility where he made his transition. I personally got to know Frank so much better during this time and I feel so lucky for it. Frank was a loving and generous man."