State-level advocacy efforts are crucial to create lasting change. Often efforts that are started at local and state levels inform national trends and structural changes at the federal level (think about the history of same-sex marriage, health care reform, and syringe exchange in the United States). Because of California’s status as the most populous state in the country, and its history of health policy innovation and leadership, it is a bellwether state. Engaging in HIV and viral hepatitis advocacy in California is a crucial part of Project Inform’s efforts to end these epidemics in the United States and beyond. For 2017, Project Inform’s California policy agenda focuses on:
Advocating for state general fund investments in HIV and hepatitis C. As the managing member of the California Hepatitis Alliance, a coalition of over 100 organizations working to eliminate hepatitis B and hepatitis C in California, and as a member of the California HIV Alliance, a coalition of California-based HIV advocacy organizations, Project Inform has been pounding the pavement in Sacramento with these partners to secure funding that would:
- restore stability in the AIDS Drug Assistance (ADAP) and Office of AIDS-Health Insurance Premium Payment (OA-HIPP) programs, which are key affordability and coverage programs that help low incoming people living with HIV access lifesaving medications and purchase comprehensive health coverage;
- increase provider reimbursement rates in the AIDS Waiver Program, which provides comprehensive case management and in-home services to eligible Medi-Cal recipients living with HIV/AIDS as an alternative to nursing facility care or hospitalization;
- support HIV and hepatitis C testing and linkage to care services in drug treatment programs, syringe exchange programs, and other programs that serve people who use drugs; and
- modify the PrEP Assistance Program trailer bill language to ensure access to financial assistance for both insured and uninsured individuals seeking HIV PrEP.
On May 23, the Assembly and Senate released their budget plans, which include the ADAP stability proposal, the HIV Waiver (the Senate version includes $4 million and the Assembly version includes $2 million, so we are working to understand that discrepancy, which will have to be negotiated in Conference Committee), and the modification to the PrEP Assistance Program trailer bill language. We are hopeful the Governor will maintain all of these items in the final budget. Unfortunately, the HIV and hepatitis C testing and linkage to care proposal was not in either the Senate or Assembly plan, so we will reintroduce this proposal next year.
Working toward passage of AB 186 (Eggman), which creates a pilot program that would allow a limited number of California jurisdictions to permit and operate supervised consumption services (SCS) and would provide legal protections for programs and participants. SCS provide sterile injection equipment, information about reducing the harms of drugs, health care, treatment referrals, and access to medical staff. Some offer counseling, hygienic amenities, and other services. They are also successful in reducing public disorder associated with illicit drug use, including improper syringe disposal and public drug use. SCS have been researched and evaluated for years. The evidence is conclusive that they reduce HIV and hepatitis transmission risks, prevent overdose deaths, reduce public injections, reduce discarded syringes, and increase the number of people who enter drug treatment. Project Inform is a proud co-sponsor of this bill, along with the California Association of Alcohol and Drug Program Executives (CAADPE), California Society of Addiction Medicine (CSAM), Drug Policy Alliance, Harm Reduction Coalition, and Tarzana Treatment Centers. The bill has passed the Assembly Health Committee by a vote of 9-4 and the Assembly Public Safety Committee by a vote of 4-3. Similar bills have been introduced in other states, including one in California last year, but none have ever won a vote. AB 186 now goes to the Assembly Floor for a vote.
Continuing our efforts to ensure people at risk for and living with HIV, hepatitis C, and other chronic conditions have appropriate access to preventive and health care services, particularly through Medi-Cal (the state’s Medicaid program) and Covered California (the state’s health insurance exchange marketplace). For example, in 2017 we are continuing our advocacy to ensure that all people living with hepatitis C who are covered through Medi-Cal have access to hepatitis C treatment and that Covered California plans provide affordable access to HIV and hepatitis C medications.
Tracking relevant state legislation and supporting or opposing bills as necessary. For example, Project Inform is a strong supporter of SB 239 (Wiener), which addresses several current state criminal laws that specifically target people living with HIV, and eliminates this form of HIV exceptionalism by incorporating the current scientific understanding of HIV, addressing exposure to HIV in the same manner as exposure to other serious communicable diseases, and eliminating extra punishment for people living with HIV who engage in consensual sexual activity. Project Inform is also a strong supporter of SB 180 (Mitchell), the Repeal Ineffective Sentencing Enhancement (RISE) Act, which would amend the criminal code that doubles or triples the sentence for a nonviolent drug offense if a person has been previously convicted of a similar offense. We know that the emphasis on incarceration rather than public health strategies contributed to the worst epidemic of fatal opioid overdose in our country’s history, and high rates of HIV and viral hepatitis among people who use drugs.
Efforts to address HIV, hepatitis C, and related health issues like overdose, through stakeholder education and networking, and working with programs “on the ground” to help us develop our advocacy agenda for the future. For example, we are planning a summit for counties in the rural northern part of the state to discuss the opioid crisis and these syndemics (overlapping and related epidemics). We are also planning a meeting for all syringe exchange programs in the state to share strategies for integrating viral hepatitis services, such as hepatitis B vaccination, hepatitis B and C testing, hepatitis C linkage to care, and hepatitis C treatment, into their programs. Meetings like these help us understand the barriers programs and individuals face and what advocacy efforts are needed to help address and remove those barriers. In addition, we hope to sponsor a legislative hearing about infectious diseases in the state prison system to educate legislators about the impact of hepatitis C, HIV, and other conditions on people who are incarcerated and their families and recommend solutions.
As the saying goes, “As California goes, so goes the nation.” Let’s hope the next year brings positive changes at the state level that help lead the country down a path toward ending HIV and hepatitis C!