The LIAAC Blog

News and thoughts from the Long Island Association for AIDS Care

November 7, 2017
by Liaacinc
Comments Off on Hepatitis A Cases Are on the Rise Amongst Men Who Have Sex with Men in New York State.

Hepatitis A Cases Are on the Rise Amongst Men Who Have Sex with Men in New York State.

The New York City Department of Health and Mental Hygiene (NYCDOHMH) reported a significant increase of Hepatitis A infections in men who have sex with men (MSM)[1]. The New York State Department of Health (NYSDOH) also found a similar increase among individuals living outside of the city[2]. Since January 1, 2017, there has been a ten-times increase of reported cases within the MSM population living in New York City, which may be linked to outbreaks in 16 European countries[3].

While Long Island was not specifically mentioned in these alerts, our close proximity to the city and surrounding areas puts us at a high risk. According to the latest data gathered by the NYSDOH, there were 61 cases of Hepatitis A in Nassau and Suffolk Counties from 2013 to 2015, which is higher than any other region outside of NYC.

Hepatitis A is a communicable disease of the liver caused by the Hepatitis A virus (HAV). The virus is usually transmitted when the feces of an infected person gets into the mouth of another person; usually when a person consumes food or water that is contaminated with the feces of an infected person. Even a microscopic amount is enough to cause infection. Transmission can also occur when someone puts their mouth, lips, or tongue on another person’s anus or objects that were near another person’s anus, such as a penis, finger, condom, or sex toy. Once inside the body, the virus attacks the liver and may cause symptoms that can last up to several months, including fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, grey-colored stools, joint pain, and jaundice.

While most people recover completely from Hepatitis A after a couple of months, a few severe cases may be life-threatening. To treat the infection, doctors usually recommend rest and medical monitoring until the infection has passed. Some people may need to be hospitalized.

Fortunately, there is an HAV vaccine that will prevent infection. It is recommended that all gay, bisexual, or other men who have sex with men be vaccinated. Depending on the vaccine, 2 or 3 shots over time may be needed to provide full protection. For those people who are unsure of their vaccination history, the NYSDOH recommends getting one nonetheless; there is no harm in repeating the vaccination. Vaccine costs are covered through the New York State Medicaid program, AIDS Drug Assistance Program, and most private insurances.

If you have had sex, shared drugs, or lived with someone with Hepatitis A within the last two weeks, getting the vaccine or immune globulin can help protect you. The sooner you seek medical attention the better.

For the gay, bisexual, and other men who have sex with men (MSM) that live on Long Island, Long Island Association for AIDS Care, Inc. (LIAAC) has several programs tailored to this population that can make Hepatitis A prevention, diagnosis, and treatment easier:

  • Project Safety Net provide referrals for Hepatitis A (HAV) and Hepatitis B (HBV) testing and vaccinations.
  • YMSM Alternative Prevention and Care  links young men who have sex with men to primary care physicians.
  • Prevention Education  provide educational workshops; offer free and confidential HIV, Hepatitis C (HCV), and STI testing; as well as create campaigns to spread awareness.

All of these programs also provide the MSM population with free and confidential HIV testing, education, and linkage to care, as people living with HIV are disproportionally affected by viral hepatitis. An HIV infection causes viral hepatitis to progress faster and causes more liver damage to occur than among those who do not have HIV.

For more information about Hepatitis A, please visit the sites below. If you have more questions, your doctor or local health care providers are great tools to help you better understand the disease.

Resources:

Long Island Association for AIDS Care, Inc.

Free & Confidential Hotline 877-865-4222

www.liaac.org

New York State Department of Health

Lesbian, Gay, Bisexual and Transgender Health: https://www.health.ny.gov/diseases/aids/consumers/lgbt/

Fact Sheet on Hepatitis A: https://www.health.ny.gov/publications/1859/

Information for Consumers – Hepatitis A: https://www.health.ny.gov/diseases/communicable/hepatitis/hepatitis_a/consumer.htm

Information for Providers – Hepatitis A: https://www.health.ny.gov/diseases/communicable/hepatitis/hepatitis_a/provider.htm

Centers for Disease Control and Prevention (CDC)

Hepatitis Fact Sheet for Gay and Bisexual Men: https://www.cdc.gov/hepatitis/hav/patienteduhav.htm

Hepatitis A Questions and Answers for the Public: https://www.cdc.gov/hepatitis/hav/afaq.htm

Patient Education Resources: https://www.cdc.gov/hepatitis/hav/patienteduhav.htm

Hepatitis A Questions and Answers for Health Professionals: https://www.cdc.gov/hepatitis/hav/havfaq.htm

Other Resource:

Vaccine Information Statements: http://www.immunize.org/vis/vis_hepatitis_a.asp

 


[1] New York City Department of Health and Mental Hygiene. 2017 DOHMH Alert #34: UPDATE: Increase in Cases of Hepatitis Among Men Who Have Sex With Men https://www1.nyc.gov/assets/doh/downloads/pdf/han/alert/alert34-hepatitis-a-among-men.pdf.

[2] Latash J, Dorsinville M, Del Rosso P, et al. Notes from the Field: Increase in Reported Hepatitis A Infections Among Men Who Have Sex with Men — New York City, January–August 2017. MMWR Morb Mortal Wkly Rep 2017;66:999–1000. DOI: http://dx.doi.org/10.15585/mmwr.mm6637a7 .

 

[3] European Centre for Disease Prevention and Control. Rapid risk assessment: hepatitis A outbreak in the EU/EEA mostly affecting men who have sex with men. Third update, June 28, 2017. Solna, Sweden: European Centre for Disease Prevention and Control; 2017. https://ecdc.europa.eu/en/publications- data/rapid-risk-assessment-hepatitis-outbreak-eueea-mostly-affecting-men-who-have-sex .

 

November 6, 2017
by Liaacinc
Comments Off on SAMHSA announces new grant for LIAAC

SAMHSA announces new grant for LIAAC

The Substance Abuse and Mental Health Services Administration (SAMHSA) has awarded grants totaling $166 million over five years through its Targeted Capacity Expansion-HIV (TCE-HIV) Program and its Prevention Navigator Program. Through the two grant programs, SAMHSA expects to fund seventy-nine grants each year up to five years. These grants will be used to prevent HIV among high-risk populations and to treat co-occurring behavioral health disorders and HIV.

“Seventy-nine agencies throughout the United States have been selected to receive grants; LIAAC is privileged to be the only agency on Long Island to receive one.” – Gail Barouh, Executive Transition Officer

More information on the grant from SAMHSA can be found at https://www.hiv.gov/blog/samhsa-awards-166-million-hiv-prevention-and-treatment?utm_source=GovDelivery&utm_medium=Oct25&utm_campaign=SAMHSA

November 3, 2017
by Liaacinc
Comments Off on Keep Talking: Suicide and LGBTQ Youth

Keep Talking: Suicide and LGBTQ Youth

By Sara Guando

There are some words commonly associated with a person’s passing: elderly, sick, disease, “it was his/her time…” Sadly, too many Long Islanders know someone who does not fit these terms.

Would you be surprised to know that suicide is the tenth leading cause of death in the United States? Even more alarming, data shows suicide is on the rise. Since 1999 US suicide rates have increased every year leading to a 15-year high in 2014. On average, 121 Americans die by suicide each day.  This spans across people of all genders, social-economic statuses, and ages. However, there are groups disproportionately affected by suicidal thoughts and actions; veterans, middle-aged men, and LGBTQ population – particularly LGBTQ youth.
Gay, lesbian and bisexual youth are up to five times as likely to have attempted suicide compared to their heterosexual peers. 92% of transgender individuals reported having attempted suicide before the age of 25. LGBTQ are at increased risk for being exposed to bullying, teasing, harassment, and physical assault. Ensuring LGBTQ feel safe emotionally and physically are basic measures friends, family members and the community can take in supporting LGBTQ youth and preventing depression, substance use, and suicidal thoughts or actions. Dr. Gail Barouh states that “the numbers regarding LGBTQ suicide are staggering. We are on the right track with prevention and support but we must continue to make sure LGBTQ youth know they are in a community that loves and accepts them. We also have to educate society as a whole about this issue. These statistics are unacceptable.”

Looking for good news? Prevention is possible. Knowing the warning signs and risk factors are often first steps in helping someone who may not be reaching out for help. More importantly, being open, non-judgemental, and accepting is an essential step whether someone is reaching out or not. Often, we believe that “we all have problems” and minimize the effect certain issues are having on a person because of how we believe we would respond to a similar situation. Remember, that individuals respond to every situation differently, especially when they are younger or have different life experiences. It’s okay to ask for help. Providing a support system, being non-judgemental, and finding resources for help are essential ways which we can all prevent suicide. This September, LIAAC joined the awareness efforts of National Suicide Prevention Month. On September 17th, LIAAC staff participated at Long Island Crisis Center’s “Let’s Walk Let’s Talk” event in Long Beach. This was a community event focused on education, prevention and advocacy for Long Islanders in need. Since 1971 Long Island Crisis Center has provided help to Long Island through their 24/7 free and confidential suicide prevention and crisis intervention hotline.When a disproportionate number of LGBTQ suicide calls were being received by the Crisis Center’s hotline Pride for Youth was established in 1993 to serve Long Island’s lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) youth and their families. Since our beginnings; LIAAC, LICC, and Pride 4 Youth have all expanded their programs and services to fit the needs of Long Islanders. LIAAC staff described “Let’s Walk Let’s Talk” as a unique opportunity to meet and have open conversations with fellow Long Islanders about the realities of suicide and ways to prevent it.

So, let’s take the suggestion of LICC – Talk about it. If you are concerned about a loved one, asking/reaching out is not going to cause them to think about suicide but it may help them feel supported enough to be honest and seek help.

If you, or someone you love, needs help or may be contemplating suicide see information below for where to get help. You are not alone.

National Suicide Prevention Lifeline: 1-800-273-8255

Long Island Crisis Center 24/7 Hotline: 516-679-1111
OR visit longislandcrisiscenter.org to speak to a counselor from any computer, tablet or smart phone.

For more information on risk factors and/or warning signs, visit:

https://afsp.org/about-suicide/risk-factors-and-warning-signs/

For more information on LGBTQ youth and how to support, visit:

http://www.thetrevorproject.org/

https://www.cdc.gov/lgbthealth/youth.htm

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November 1, 2017
by Liaacinc
Comments Off on Countdown to World AIDS Day 2017

Countdown to World AIDS Day 2017

Since 1988, World AIDS Day has been globally observed on December 1st to unite the world in the fight against HIV. It was created to show support for people living with HIV and commemorate those who have died from AIDS-related illnesses. This year’s theme is “Increasing Impact Through Transparency, Accountability, and Partnerships.” Working together with other organizations and the public, we can put an end to HIV/AIDS. Please join us in spreading this message of hope and determination on social media by using the hashtag #WAD2017.

There are an estimated 36.7 million people living with HIV in the world, including an estimated million people in the United States. Closer to home, New York State reported 111,933 HIV and AIDS cases in their HIV/AIDS Annual Surveillance Report For Cases Diagnosed Through December 2015. According to the same report, there were 5,685 individuals living HIV/AIDS in Nassau and Suffolk Counties. Just looking at the numbers, it is easy to see why World AIDS Day is important. HIV/AIDS is not a burden of past generations; the virus continues to affect a significant part of our communities and not just the infected, but their friends and family as well.

LIAAC recognizes that to end the epidemic globally and locally, we must all unite together and compound our efforts in this fight. This is why throughout the month of November, leading up to World AIDS Day, we are launching a social media campaign that will spotlight different organizations that contribute to the battle against HIV/AIDS and the stigma that surrounds it. During the week before World AIDS Day, we will also be honoring our employees on social media, by posting their thoughts about working in the HIV/AIDS field and how they are working hard to end the epidemic.                                               

LIAAC will also be hosting and participating in several World AIDS Day events throughout Long Island during the last week in November to World AIDS Day on December 1st. During those events, we will be providing free HIV education and testing services for those in attendance. For dates and times, visit our events tab on Facebook.

For more information please call our hotline at 1-877-865-4222.

October 27, 2017
by Liaacinc
Comments Off on United We Stand Against Bullying

United We Stand Against Bullying

LIAAC and LINCS employees teamed up to show their support for National Bullying Prevention Month by wearing orange. Gail Barouh, CEO LINCS, said “It was encouraging seeing employees of both LIAAC and LINCS come together to support Unity Day and it’s message against bullying. LINCS is proud to provide several Anti-Bullying initiatives through their BiasHELP program.”



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October 18, 2017
by Liaacinc
Comments Off on LIAAC Receives Five Year Grant Award from SAMHSA

LIAAC Receives Five Year Grant Award from SAMHSA

LIAAC is excited to announce that we have been awarded funding by the Substance Abuse and Mental Health Administration (SAMHSA) for a HIV testing and substance abuse prevention/treatment program, focusing on Men who have Sex with Men (MSM), transgender individuals and returning veterans and their families. This program, Project Safety Net, will include community outreach, HIV/Hepatitis/STI testing, and recovery support services to individuals at high risk for HIV, including those in or seeking substance abuse treatment.

Dr. Gail Barouh congratulated the hard-working staff of LIAAC for securing this funding for our clients, noting that by reducing new HIV infections and connecting individuals with substance abuse and/or mental health treatment Long Island will see an overall improvement in health and community well-being.

Project Safety Net will provide targeted testing, conscientious outreach and effective intervention including case management and linkage to care. Our Prevention Specialists will focus their diligent efforts on high-risk communities that are disproportionately burdened with the co-occurring epidemics of poverty, substance abuse, mental health disorders, HIV/AIDS and Hepatitis. In collaboration with LIAAC’s Mobile Outreach Coordinator, field-based outreach and intervention will provide essential, supportive services to local communities; ensuring increased engagement with target populations, reducing new HIV infections and improving overall health outcomes. Project Safety Net supports the 2020 National HIV/AIDS Strategy.  Individuals who are identified as HIV-positive will be linked to proper medical care, provided  essential and supportive services, as well as provided with education and techniques to make healthy choices and reduce the spread of HIV.

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August 30, 2017
by Liaacinc
Comments Off on Opioids, Heroin: The Crisis Hits Home

Opioids, Heroin: The Crisis Hits Home

By Sara GuandoThe opioid epidemic has been declared a national emergency. In his remarks President Trump stated “Nobody is safe from this epidemic that threatens young and old, rich and poor, urban and rural communities.  Everybody is threatened.”[i] The statements have recognized a crisis that has been mounting over the years at a sweeping rate. Between 1999 and 2015, deaths from drug overdoses have quadrupled in the United States.

How did we get here?

In the mid-1990s, Oxycontin hit the market and the drug manufacturer, Purdue Pharma, began a large-scale marketing campaign for the drug. This seems typical for any new product but Purdue Pharma’s promotions were anything but typical. Knowing the apprehension of doctors to liberally prescribe opiates, Purdue Pharma marketing campaign included videos that positioned Oxycontin as a safe option for a variety of uses. They claimed that the risk of addiction was under one percent and encouraged both short and long term uses of the drug. As doctors accepted these claims to be true, prescriptions for Oxycontin grew rapidly in the late 1990s – early 2000s. The National Institute on Drug Abuse identified “drastic increases in the number of prescriptions written and dispensed, greater social acceptability for using medications for different purposes, and aggressive marketing by pharmaceutical companies” as key components of the onset of the nation’s ongoing opioid epidemic.[ii] In 2007, Purdue Pharma paid one of the largest pharmaceutical settlements in the amount of $634 million dollars, for its role in the opioid crisis. The company continues to face lawsuits around the country for misleading marketing.
How bad is it, really?

Fueled by a prescription drug addiction, users become more likely to try drugs intravenously and/or turn to heroin, both of which are cheaper options. According to a recent study, 75% of heroin users started by using prescription opioids.[iii]Additionally, because of the prescription opioid crisis, government agencies began cracking down on the prescription methods and practices. Databases were created as doctors and pharmacists suspected of not following guidelines were flagged and investigated. This led to prescription drugs being less available from reckless prescribing of opiates, and less capability for patients to “doctor jump,” meaning users were going to multiple doctors for similar problems and having multiple prescriptions written. However, whatever positive effect this may have had did not sustain, as these crackdowns are typically where the increase in heroin and injection drug use began. With prescription drugs less readily available, users attempted to obtain the drugs illegally, or turned to illicit drugs in their place. And so, America is now in the grips of a two-headed crisis, and this epidemic is not going down without a fight. The answers of how we move forward and combat this issue has proven controversial and time consuming as law makers and physicians seek the best response.

In the meantime…

  • 91 people die every day from opioid overdose.
  • 1 out of 10 new HIV diagnoses involve injection drug use.
  • If current rates continue, 1 in 23 women who inject drugs and 1 in 36 men who inject drugs will be diagnosed with HIV in their lifetime.
  • In the United States, injection drug use is the primary risk factor for transmitting Hepatitis C.

In short, this epidemic affects all areas of social, medical and mental health for users, families, and loved ones, and we need a solution.

I don’t use drugs. Why should I care?
I see it on the news. I hear about it. But, these drug addicts are making a choice. It’s their own fault.

 The issue is closer to home than you may realize. Heroin abuse has increased amongst most demographic groups: male, female, age categories, race/ethnicities, across incomes, and healthcare access. In fact, the highest increases of heroin abuse have been amongst demographics that were previously much less affected by the drug problem. Studies show “heroin use has changed from an inner-city, minority-centered problem to one that has a more widespread geographical distribution, involving primarily white men and women in their late 20s living outside of large urban areas.”[iv]And New York is no exception. From 2013 to 2014 overdose deaths caused by heroin increased over 24%, and have risen still since. Up to 500 people died on Long Island in 2016 from opioid overdoses, a new record high. And just this summer, in June 2017, over a two day period, nearly two dozen people overdosed on opioids.

 There is more danger to drug use than an overdose. The spread of disease, including HIV and Hepatitis is a huge concern. Mental illness, loss of work, and destruction of families are common as addiction takes hold of a person’s life. Treatment options are not as clear, nor as available, as other medical conditions. The societal stigma and criminal nature of illicit drug use can be incredibly damaging to people seeking help. Moreover, the fact that this crisis was created by the companies that we trust our lives and our quality of life with often goes unseen. Because of stigma, isolation, and the threat of having to stop using a drug they have become dependent on, users tend to live in the dark. Maybe not in dark, deserted alleys that TV suggests, but in the shadows of everyday life. They are our neighbors, friends, family members, who keep part of themselves as hidden as they can. So, we should all care. No one is a good, law-abiding person one day and then wakes up the next and decide to inject themselves with heroin.  It’s easy to blame a drug addict for “getting themselves addicted” but in reality; it’s more complicated than that.

How many degrees of separation are you from this crisis? Chances are, on Long Island, you aren’t far from it.

Next time, we will dive into the options. What can we do? How do we combat this epidemic and protect our loved ones? How do we get people the help they need, and stop the spread of HIV and Hepatitis? Join LIAAC for Part 3 of our blog series on the Opioid Crisis.

 

References

i. The White House. Remarks by President Trump Before a Briefing on the Opioid Crisis. (8 August 2017) https://www.whitehouse.gov/the-press-office/2017/08/08/remarks-president-trump-briefing-opioid-crisis

ii.  Office of the New York State Comptroller, Thomas P DiNapoli. Prescription Opioid Abuse and Heroin Addiction in New York State. 2016 June. Retrieved from http://www.osc.state.ny.us/press/releases/June16/heroin_and_opioids.pdf

iii. Seelye, Katharine Q. The Numbers Behind America’s Heroin Epidemic. (30 Oct 2015) Retrieved from https://www.nytimes.com/interactive/2015/10/30/us/31heroin-deaths.html

iv. Cicero, Thomas, Ellis, Matthew, & Surratt, Hilary. The Changing Face of Heroin Use in the United States: A Retrospective Analysis of the Past 50 Years. 2014 July. Retrieved from JAMA Psychiatry. http://jamanetwork.com/journals/jamapsychiatry/fullarticle/1874575

More References

Center for Disease Control. Drug Overdose Death Data.(December 2016) https://www.cdc.gov/drugoverdose/data/statedeaths.html

“Purdue Pharma OxyContin Commercial” (22 Sep 2016) https://www.youtube.com/watch?v=Er78Dj5hyeI

“Purdue in $634 million settlement over Oxycontin” (20 July 2007) http://money.cnn.com/2007/07/20/news/companies/purdue/index.htm

Center for Disease Control. Understanding the Epidemic. (December 2016) https://www.cdc.gov/drugoverdose/epidemic/index.html

Center for Disease Control. HIV and Injection Drug Use. (March 2017) https://www.cdc.gov/hiv/risk/idu.html

Campbell, Cecily, Canary, Lauren, Smith, Nicole, Teshale, Eyasu, Ryerson, Blythe, & Ward, John. State HCV Incidence and Policies Related to HCV Preventive and Treatment Services for Persons Who Inject Drugs — United States, 2015–2016. (12 May 2017) https://www.cdc.gov/mmwr/volumes/66/wr/mm6618a2.htm

Morales, Mark. “Nearly 500 People Died on LI from Opioid Overdoses in 2016” Mark Morales (9 April 9 2017) http://www.newsday.com/long-island/nearly-500-people-died-on-li-from-opioid-overdoses-in-2016-1.13387679

Brooks, Khristopher. “Police: 22 opioid ODs, 1 fatality in 48 hours cause for concern” (30 June 2017) http://www.newsday.com/long-island/suffolk/police-22-opioid-overdoses-1-fatality-in-48-hours-a-cause-for-concern-1.13705833

August 14, 2017
by Liaacinc
Comments Off on The Affordable Health Care Act and Its impact on HIV/AIDS Affected Long Island

The Affordable Health Care Act and Its impact on HIV/AIDS Affected Long Island

By Kristina Robles

No matter what side of the national health care debate that you are on, there is no denying that the Affordable Health Care Act (ACA), or as it is nicknamed Obamacare, made significant changes to the treatment and prevention of HIV/AIDS. Seven years after it was signed into law, the new Trump Administration seeks to repeal and replace ACA, which has many people worried about how this would affect those benefits gained through the act.

On March 23, 2010, the ACA was signed into law, changing how millions of Americans received health care coverage. One significant change, particularly to those living with HIV/AIDS and the people who are at high-risk of contracting the virus, was the expansion of Medicaid. The federally funded health care program provides coverage to low-income or disabled individuals and is the leading payer of HIV care in the country.

The act expanded eligibility to those with incomes at or below 133% of the Federal Poverty Line ($14,400 for an individual and $29,3000 for a family of 4), including single childless adults who were usually denied Medicaid unless they were diagnosed with AIDS. Now single HIV-positive individuals can get the care and treatment they need before the virus progresses to the more serious and life-threatening stage of AIDS. This new expansion is particularly important for many gay, bisexual, and other men who have sex with men (MSM). These populations are the most affected by the HIV epidemic. An epidemic that still has a significant impact on our Long Island community.

There is a false assumption that Long Island, being so close to New York City, is just as affluent as the big city to our West. While the Island is home to some of the countries richest neighborhoods, the reality is that the vast majority of Long Islanders are low to middle class. Unfortunately, due to the high cost of living and limited job opportunities, many Long Islanders live well below the Federal Poverty Line. As stated in a recent Newsday article, the Long Island Association found that just over 185,400 residents fall beneath the threshold, and when adjusted for the region’s high cost of living, they determined that another 56,000 people would be considered impoverished (Newsday, 2017).

More than 300,000 people on Long Island do not know how they will get their next meal (Newsday, 2017). Tragically, many people who are food-insecure[i] and HIV-positive have to decide between food and their life-saving HIV medications. Constant adherence to daily ART (antiretroviral therapy) medications is not only important for the infected person’s health but also to the HIV Epidemic as a whole, as people with undetectable viral loads do not transmit the virus to others. When people have to decide between food and their HIV/AIDS medicines, the fight to end the epidemic becomes more difficult. A very important concern since Long Island is considered to have the highest numbers of HIV cases of any suburban area in the nation. According to the latest New York State HIV/AIDS Annual Surveillance Report (2017), there are 5,685 people living with HIV and AIDS on Long Island, with the white MSM population being the most affected[ii]. These numbers do not include the many more cases that go unreported.

Thanks to the expansions in Medicaid coverage, more people have access to care and prevention services that they would not have been able to afford otherwise. In 2010, the average annual patient cost in the United States was $19,912, with the average person paying $9,360 yearly for ART, the cost of which grows as the infection progresses (Carter, 2010). It is important to note that this estimate does not include any mental health or substance abuse services needed by many HIV-positive patients. The ACA requires Medicaid and other insurers to cover Essential Health Benefits, including mental health and substance use services.

Medicare (a federally funded health coverage for seniors) is another significant payer of HIV care. The ACA is closing the coverage gap, or “donut hole”, during which enrollees of Medicare Part D Prescription Drug Benefit must pay in full for all medical services, drugs, and devices they need. It also makes AIDS Drugs Assistance Programs (ADAP) benefits count toward out of pocket limits, moving people through the gap faster and allowing them to resume coverage. It has been shown that Medicare patients who reach the gap are 57 percent more likely than those with continual coverage to stop taking critical heart medication (Rovner, 2012). It can be easily assumed that important ART and PrEP drugs are also sacrificed.

Beyond the federally funded health care programs, ACA allowed more people to obtain coverage, whether privately or through employers. No longer can an insurer deny coverage to children living with HIV/AIDS or any one with a pre-existing condition, nor can they refuse coverage because of a mistake on an application. Gone are the lifetime caps on insurance benefits that were easily surpassed if one is living with a chronic illness. HIV is a life-long illness, that if acquired at birth or a young age, can easily exceed those lifetime caps, leaving patients with a great financial burden.

For those who are not eligible for Medicaid/Medicare or are not insured under an employer, the act has set up online marketplaces and exchanges where people can shop for the best coverage for them and their families. To help people afford coverage, tax subsidies are available for those with low to middle-class income. The ACA also ensures that people who purchase their own coverage will get similar benefits to a typical employer plan, making sure that not only do they have coverage but access to quality care.

To ensure equal care, the ACA has increased funding for health centers and organizations in underserved areas, with great emphasis on preventative care. Coverage must include HIV screening for people ages 15-65 without additional costs such as co-payments or deductibles.

For all its positive changes for HIV/AIDS care (of which the benefits described above is only a portion), the ACA is not without its problems and criticism. For some, the act was overly regulating, and for others, it was not strict enough. But whether one is conservative, liberal, or somewhere in between there were a few issues that could be agreed on.

The new regulations had caused insurers to react with raising the costs for premiums, deductibles, and copayments. Other insurers have opted to leave the marketplaces and exchanges, which led to higher prices due to the lack of competition. And if an individual is not part of the 80 percent of Americans who are eligible for subsidies, nor does he or she receive insurance through his or her employer, the weight of higher costs could be overwhelming (Abelson & Sanger-Katz, 2016). This could lead to people opting out of coverage altogether or circumvent the open-enrollment rules, making the system less stable (Kodjak, 2016).

Time will tell if President Trump and his team will be able to repeal ACA. What is clear is that whatever the future of health coverage is, those affected by HIV/AIDS cannot be neglected. The HIV/AIDS epidemic has come a long way since its start in the 1980s, but we still have a long way to go before we end it. Equal access to quality health care and prevention services are key to doing so.

 

 

References

Abelson, Reed and Sanger-Katz, Margot (2016 October 25) A Quick guide to Rising obamacare Rates. The New York Times. Retrieved from https://www.nytimes.com/2016/10/26/upshot/rising-obamacare-rates-what-you-need-to-know.html

 

Carter, Michael (2010 September 27) HIV Treatment Is Costly, Especially For The Sickest Patients. NAMaidsmap. Retrieved from http://www.aidsmap.com/aboutus/Who-we-are/page/1276062/

 

The Editorial Board (2017 April 2) Push LI Poverty Out Of The Shadows. Newsday. Retrieved from http://www.newsday.com/opinion/editorial/growing-poverty-on-long-island-1.13345480

 

Kodjak, Alison (2016 November 1) Shopping For Obamacare Opens to Mixed Reviews From Consumers. NPR. Retrieved from http://www.npr.org/sections/health-shots/2016/11/01/500183737/insurance-open-enrollment-opens-to-mixed-reviews-from-consumers

 

Rovner, Julie (2012 April 17) Seniors In Medicare ‘Doughnut Hole’ More Likely To Stop Heart Drugs. NPR. Retrieved from http://www.npr.org/sections/health-shots/2012/04/17/150823790/seniors-in-medicare-doughnut-hole-more-likely-to-stop-heart-drugs

 

[i] For Long Islanders that are food-insecure and HIV-positive LIAAC’s Nutrition Health Education program may be able to help provide assistance with obtaining food. Please visit liaac.com or call 1-877-865-4222 for more information.

 

[ii] While Non-Hispanic whites (1,822 reported cases) are the most affected by HIV/AIDS on Long Island, they are closely followed by Non-Hispanic Blacks (1,683 reported cases), and Hispanics (1,593 reported cases).

July 31, 2017
by Liaacinc
Comments Off on Witnessing a Crisis: A Review of HBO Documentary “Warning: This Drug May Kill You”

Witnessing a Crisis: A Review of HBO Documentary “Warning: This Drug May Kill You”

By Sara Guando

As children we would defend ourselves with the old saying “stick and stones…” As adults we know that, yes, sticks and stones might break your bones but words can also hurt you. In this day and age, we also know that words are not always dependable. People are relying on mainstream news less than ever and that can be very dangerous. So, what can we rely on? What can we trust? Well, what about images? We don’t always talk about the effect of things we see, but images can be incredibly powerful. Images make us react – they can make us laugh, bring us to tears, or allow us to witness something about the world that we have never seen, or know nothing about. When we see something, it becomes more than just words on a page. So, let’s talk images.

We all have preconceived ideas about certain things. If I said “describe the best thing about summer” you may picture your favorite beach, your backyard pool, your family and friends at a barbeque. If I said “what’s the best thing about the morning?” you may think of a steaming cup of coffee in your favorite mug. But, if I said “tell me what a heroin user looks like” what would you picture? How does it make you feel? Can your idea of “a drug addict” ever be changed?The HBO Documentary “Warning: This Drug May Kill You” is series of images that can open up people’s eyes to the opioid epidemic that is often hidden and not fully understood. From the beginning, the documentary is an unflinching look at opioid use. It begins with a series of cell phone videos of people in the midst of an overdose. Facts about opioid use in America as it currently stands are shown on screen. The combination of these two images are concerning and provide no sugar coating to the crisis. The cell phone videos are then layered with audio from pharmaceutical marketing videos from the 90s. The marketing campaign, from Purdue Pharma (maker of OxyContin) promoted more generous use of opioids to treat pain and downsized the risk of addiction. The words spoken are in clear contrast with the images on screen. The drugs are being called safer and less addictive “than previously believed,” meanwhile, on screen, people on opioids are seen doubled over on sidewalks and buses, unable to keep their eyes open. As the pharmaceutical campaign is stating “less than one percent of patients taking opioids become addicted” cell phone videos of opioid overdoses appear, and the images of people doing CPR, yelling, and slapping those overdosing become overwhelming. Then, another fact: “deaths from prescription opioids have quadrupled since 1999.”

Throughout the documentary compelling stories are paired with powerful facts about the epidemic. The film predominantly follows the life of a young woman named Stephany, and her struggles with heroin – an addiction that, for her, began with being prescribed opioids for kidney stones at the age of 16. Stephany describes the progressive take-over of her addiction. She illustrates how she and her sister, Ashley, went from faking pain for prescriptions, to getting pills from friends, and then from snorting pills, to snorting heroin, to injecting the drugs. Stephany goes on to tell about the loss of her sister to a heroin overdose and the impact that has had on her life. We learn that 80% of heroin users start with prescription drugs.Perhaps more than the facts, a powerful feature of this documentary is that Stephany is the only heroin or prescription drug user that we meet throughout the film. None of the others are alive to tell their story. The rest of the stories we hear are from the loved ones of people that ultimately died of opioid overdoses. We hear about how loved they were, and how ordinary their lives were when they began. When clean, Wynn Doyle was a wonderful mother with a passion for a happy life and for her children. We learn that she quickly became reliant on prescription pills after her third C-section. Wynn tried to prevail. She went to rehab at least eleven times trying to conquer her addiction. Her children would search her home regularly for drugs, but through purposeful self-harm and “doctor jumping” Wynn continued to feed her addiction until her death. Through his parents, we meet Brendan Cole, the oldest brother of three boys, who died of a drug overdose in his parents’ home, within 24 hours of returning from rehab. Brendan’s struggles began at a young age, after a cyst removal. How could he or his family have known that a prescription to ease the pain of that procedure would ultimately take his life?

In a way, Stephany becomes more purposeful in understanding the “normalcy” of someone who becomes addicted to opioids, and then heroin. Not only is she telling her story first-hand but when we first see Stephany she’s clean. She is young, coherent, well-dressed. The viewer is sympathetic, if not relatable, to her emotions regarding her struggles, and the loss of her sister. However, when we return to Stephany’s story later, we see the addiction more than the girl. Stephany has relapsed and the viewer responds to this with steadfast emotion – anger, frustration, sadness. We watch as her daughter describes what steps she would take if she sees her mother overdosing. Stephany is unkempt, and distant, no longer communicating her feelings or telling her story. And this image is what many people see when asked “tell me what a heroin user looks like.” Many most likely no longer see someone who is relatable, who is “normal,” who you may love or who is in many ways just like you – a mother, a daughter, a brother, an only child, someone who was at a simple doctor’s visit one day, or had surgery, or had a baby. Yet it is in these small acts that so many people’s lives have changed forever.

The facts throughout this film are strong, but the images are what dominate in the viewer’s mind. However, for all of this unwavering, unforgiving effort to show the opioid crisis throughout the country, there are big pieces of the puzzle missing. In this man-made epidemic there are risks beyond addiction. The spread of HIV and hepatitis has been affected greatly by heroin and injection drugs. How did we get here? What can we do? The documentary is missing a lot of this vital and potentially life-saving information.

Join us on Part Two of this opioid blog series, where we will pick up the parts of this discussion that fell short, and how the epidemic is hitting home here on Long Island.

July 21, 2017
by Liaacinc
Comments Off on Fifth Annual African American Hepatitis C Action Day

Fifth Annual African American Hepatitis C Action Day

July 25, 2017 marks the Fifth Annual National African American Hepatitis C Action Day (NAAHCAD), lead by the National Black Leadership Commission on AIDS, Inc. (NBLCA) and the Coalition on Positive Health Empowerment (COPE). It is a day dedicated to promoting Hepatitis C prevention, testing, treatment, and Linkage to Care in our African American communities, and other at-risk people that are disproportionately affected by the virus.

According to the New York State Department of Health’s (NYSDOH) latest publication on the reported cases of communicable diseases, there were 1,400 reported cases of people living with Hepatitis C in Nassau and Suffolk County in 2015. And with the current opioid epidemic, and the increasing use of injection drugs, the numbers may rise further. In July 2017, the NYSDOH reported that over 5,300 Long Islanders have been admitted to an OASAS-certified chemical dependence treatment program, with the majority of clients living in Suffolk County.

Hepatitis C has been called the Silent Epidemic because many people who are infected with the Hepatitis C virus (HCV) do not show apparent symptoms for decades. It is most recognized in the chronic stages when liver damage has occurred.

HCV infections could range in severity from a mild illness lasting a few weeks (acute infection), or a lifelong illness (chronic infection) that attacks the liver, resulting in liver problems, including cirrhosis or liver cancer. The virus is spread when infected blood enters the body of someone who is not infected.

There are several ways one could become infected, but sharing injection drug needles; being born to an infected mother, and blood transfusions and organ transplants before 1992 are the most common ways it is transmitted.

LIAAC will be participating in NAAHCAD by spreading Hepatitis C awareness and encouraging testing on our social media outlets. LIAAC provides free and confidential Hepatitis C testing as well as education and Linkage to Care services. For more information, or to schedule a Hepatitis C test, call our hotline at 1-877-865-4222.