2017 IN REVIEW: Accomplishments and Unprecedented Challenges

During the eight years of President Obama’s leadership, great progress on HIV and hepatitis C occurred as a result of motivated, compassionate and competent leadership. Obama established a National HIV/AIDS Strategy (NHAS) that focused governments, medical providers and community based organizations on a key set of activities that are significantly increasing the percentage of HIV-positive people who are aware of their status, increasing the number of diagnosed people linked to care and treatment, increasing viral suppression, and reducing new infections. Similarly, Obama established the National Viral Hepatitis Action Plan (NVHAP), which placed much needed emphasis on this huge but under-addressed epidemic, and established important goals for diagnosis, treatment, prevention and reductions in health disparities among people with hepatitis C.

As importantly, of course, President Obama and a Democratic-led Congress achieved the passage of the Affordable Care Act (ACA), which made it possible to meet the goals of the NHAS and NVHAP by extending health care coverage to millions more individuals, particularly those at middle and low incomes. The ACA has been directly responsible for gains in diagnosis and treatment of both HIV and hepatitis C, as well as for making biomedical prevention options such as Pre-Exposure Prophylaxis, or PrEP, available to prevent new infections.

Candidate Donald Trump did not respond to questionnaires regarding his position on HIV or hepatitis C issues, nor were questions about these topics asked in Presidential debates. Upon his election as President, national advocacy groups prepared detailed documents for Trump’s transition team and reached out to key health staffers to discuss the potential that, with strong leadership, both epidemics could be effectively halted during the new administration’s tenure. Crickets. Within the Department of Health and Human Services, however, work to implement the NHAS and NVHAP appears to have continued cautiously, but successfully. To date, the President’s proposals to sharply reduce funding to portions of the Ryan White Program, which provides health care coverage and support services to low-income people with HIV, have yet to be approved by the new Republican-led Congress.

President Trump’s and the Republican Congress’s disdain for the ACA and for health care coverage for low-income people through Medicare and Medicaid, however, are well known. And this week, with the passage of their tax reduction bill, the stage has been set for a massive roll-back not just of the ACA, but of the entire, longstanding social safety net, as well. The bill’s elimination of the individual mandate to have health coverage is expected to reduce the number of insured by 13 million, and the bill includes immediate cuts to Medicare and Medicaid. But it is the $1.5 trillion budget hole this alarming fiscal experiment will produce that sets up the conditions under which Republicans will finally get their wish to gut Social Security, Medicare, Medicaid, the Child Health Insurance Program, financial assistance for low-income people — and many other programs upon which people depend for life’s necessities through no fault of their own.

Project Inform has worked in partnership with dozens of other advocacy groups to create the NHAS, NVHAP and ACA. We have also worked extensively in 2017 to defeat two efforts to repeal the ACA, and in an effort to defeat the draconian tax bill. In 2018, our work will focus heavily on attempting to prevent or mitigate the destruction of programs we view as essential to ending both HIV and hepatitis C. Much of this work will be done at the federal level alongside our advocacy partners. And because a significant portion of our public policy work is focused on our home state, we will work with a sympathetic Governor and State Legislature to rally California’s resources to preserve as much of the social safety net as possible. California is already considering the establishment of an individual mandate to have health insurance in order to stabilize its private health insurance marketplace and limit premium and cost-sharing increases, and we will actively support this move.

Project Inform staff were also engaged in an exhaustive set of activities in 2017 to further our goals of increasing diagnosis, treatment and prevention of HIV and hepatitis C, and we want to share just a very few of our many accomplishments:

  • David Evans continued his research to understand the needs and wishes of people with HIV regarding their possible participation in clinical trials to assess candidates for a cure for HIV. He helped to co-write an extensive report on the search for a cure, which we highly recommend to our readers. And he led a national think tank to consider whether and how to use genetic information gathered on HIV-positive people to link them to care treatment, support them to achieve viral suppression, and prevent new infections.
  • Emalie Huriaux helped launch the first hepatitis C elimination initiative in a U.S. city — End Hep C SF. She advocated for $12.5 million in additional funding for HIV and hepatitis C in California. She co-sponsored AB 186, a bill in California to allow a limited number of jurisdictions to create pilot safe consumption spaces for drug use in order to reduce overdose, reduce transmission of HIV and hepatitis C, reduce improperly discarded syringes and public injection, and increase linkage to drug treatment programs. And she advocated with MediCal to increase the number of people who could receive treatment for hepatitis C.
  • Alan McCord and Emily Mariko-Sanders oversaw the production and national distribution of 707,000 educational pieces about PrEP; and 17,500 educational booklets for people newly diagnosed with HIV.
  • Alan McCord and Charlie Romero helped launch PleasePrEPMe.org, a new online chat service in California that answers questions about PrEP and refers people to providers with whom they can initiate its use. Since April, PleasePrEPMe has helped over 1,000 people make good decisions about whether PrEP fits into their approach to HIV prevention.
  • Alan launched our PrEP Navigation Manual to assist HIV prevention workers who support people wanting to initiate and cover the costs of PrEP.
  • Andrew Reynolds wrote an exhaustive article about current curative treatments for hepatitis C in Positively Aware, as well as an important article about sexual transmission of hepatitis C among HIV-positive gay men and gay men using PrEP. He led a national program to provide continuing medical education to 500 family physicians to engage them in testing patients for hepatitis C. This training is also available online to family practitioners nationally. And he oversaw the production and distribution of booklets for 3,700 people co-infected with HIV and hepatitis C discussing their health care needs, and 1,450 “toolkits” for HIV physicians discussing the importance of screening their patients for hepatitis C.
  • Anne Donnelly helped secure funding in California to establish a PrEP Assistance Program that will pay for medical visits, laboratory services and co-payments for people who cannot otherwise afford them. She worked to stabilize California’s AIDS Drug Assistance Program, which provides HIV medications to low income people, after a disastrous change in program administration. And she led Project Inform’s efforts to oppose repeal of the ACA.
  • Lastly, Dana Van Gorder served on the Steering Committee of Getting to Zero, San Francisco’s effort to become the first city in the United States to achieve zero deaths, zero new infections and zero stigma from HIV. He also served on the Executive Committee of the Public Policy Committee of AIDS United, the leading HIV advocacy agency in Washington, DC.

PIPeNews will report throughout 2018 on additional activities being led by Project Inform. Here are just two that we are particularly excited about, and that signal the expansion of our entry into new areas of work: drug user health, and HIV and aging. In early February, Emalie Huriaux will lead a summit of representatives of Northern California counties to discuss the opioid crisis and its connection to the HIV and hepatitis C epidemics. The goal of this meeting is to encourage program development and public policy that responds fully to this important issue. And David Evans plans to lead a think tank in California to determine what the model state response should be to the medical and psychosocial needs of people aging with HIV.

Please keep reading future issues for more information on Project Inform’s work to end HIV and hepatitis C.