Health and the 44th Presidential Administration (Part III). In three nearly back-to-back announcements, President Obama is working prodigiously to fill his leadership roster for health care. Of course, the most newsworthy was his selection of Kansas Governor Kathleen Sebelius as Secretary-designate of the Department of Health and Human Services (HHS). The White House Office of Health Reform, however will be lead by Nancy Ann DeParle who headed up the Center for Medicare & Medicaid Services during the Clinton administration. The administration may deem DeParle, a Beltway-insider, as having a greater amount of political clout to handle what is sure to be high-stakes negotiation within the White House Office of Health Reform. Both women have a depth of experience in health care financing and health insurance, a stakeholder group incidentally with a powerful voice in previous rounds of the health reform debate.

The Office of National AIDS Policy is set to be led by Jeffrey S. Crowley. With a background in public health, Crowley will bring the appropriate knowledge for managing the health of populations and the dynamics of epidemics in leading the effort to set an appropriate national policy. He will also serve as a member of the Domestic Policy Council. The President stated the following:

“In [AIDS and disability policy], we continue to face serious challenges and we must take bold steps to meet them. I look forward to Jeffrey’s leadership on these critical issues.”

Mary Wakefield has been appointed Administrator of the Health Resources and Services Administration (HRSA). President Obama made the following comments regarding her appointment:

“As a nurse, a Ph.D., and a leading rural health care advocate, Mary Wakefield brings expertise that will be instrumental in expanding and improving services for those who are currently uninsured or underserved. Under her leadership we will be able to expand and improve the care provided at the Community Health Centers which serve millions of uninsured Americans and address severe provider shortages across the country.”

For even more insight into this health braintrust, check out what’s on the bookshelf (a widget to the right) featuring books and articles with references and contributions from these political appointees. Several leaders are now in place and not a moment too soon. With the American Recovery and Reinvestment Act of 2009 now signed into law and the more recent unveiling of the budget proposal for 2010, there is plenty of (health care) work to be done.

Sources:

Sebelius at HHS at the White House Blog and Administrator of HRSA Announced and Obama Names Head of AIDS Policy Office and Obama Picks Kansas Governor Sebelius as Health Secretary – washingtonpost.com.

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National Black HIV/AIDS Awareness Day is directed, planned and organized by a working group of national organizations in partnership with the Centers for Disease Control and Prevention (CDC). The goal of this partnership is to to mobilize communities and address specific issues and best practices that are science-based and will influence the course of HIV in Black communities across our country.

According to the CDC, of all racial and ethnic groups in the United States, HIV and AIDS have hit Black Americans the hardest. Latest estimates from their 2006 HIV Incidence (number of new cases) Surveillance System confirms

…that blacks experienced a disproportionate number of HIV infections. Forty-six percent of new HIV infections occurred in blacks, even though blacks comprise only 12% of the US population. The majority (65%) of new infections in blacks occurred in men. Among black men, 63% of new infections occurred through male-to-male sexual contact. Thirty five percent of new infections in blacks occurred in women. Of those, eighty-three percent of the infections occurred through high-risk heterosexual contact. The disparity in new infections was especially pronounced among women, with the incidence rate in black women being almost 15 times higher than that of white women.

Black life is worth saving! Get Educated…

When we look at HIV/AIDS by race and ethnicity, we see that Black Americans have

• More illness. Even though all blacks account for about 13% of the United States population, we account for about half (49%) of the people who contract HIV and are diagnosed with AIDS.
• Shorter survival times. Blacks with AIDS often don’t live as long as people of other races and ethnic groups with AIDS. This is due to the barriers mentioned above.
• More deaths. For Black Americans, HIV/AIDS is a leading cause of death.

For Black men, the most common ways of contracting HIV (in order of frequency) are: having unprotected sex with another man who is HIV+ve, sharing injection drug works (like needles or syringes) with someone who is HIV+ve, and having unprotected sex with a woman who is HIV+ve. On the other hand, for Black women, the most common ways of contracting HIV (in order of frequency) are: having unprotected sex with a man who is HIV+ve and sharing injection drug works (like needles or syringes) with someone who is HIV+ve.

The segment of Blacks in America at highest risk for contracting HIV are those:

• who are unaware of their partner’s risk factors and/or HIV status
• with other STDs (which affect more Blacks than any other racial or ethnic group)
  
• who live in poverty (which is roughly one quarter or 25% of all Blacks)

To reverse these horrific trends, Blacks must overcome the stigma surrounding homosexual sex, HIV/AIDS and other sexually transmitted diseases to speak honestly with their intimate partners about their risk factors.

Get Tested…

Get Involved…

Find an event in your area recognizing National Black HIV/AIDS Awareness Day. Health fairs and related activities are taking place across the country.

Sources: National Black HIV/AIDS Awareness Day website and CDC website

Learn More: from the CDC about HIV/AIDS Crisis among African Americans, Q&A: Men on the Down Low and What You Can Do

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December began with the 20th annual observance of World AIDS Day. Both the NY Times and the Washington Post ran articles discussing the potential benefits of mandatory testing in curbing the incidence (new cases) and prevalence (all existing cases) of the disease. The Washington Post article focused on implementing such a policy in the United States while the New York Times article examined an international perspective. Our Constitution constantly forces us to balance the rights of the individual against the rights of citizens collectively. It endows each of us (even those with disease) with the right to privacy. In addition, principles of bioethics state we also have the right to autonomy. That is, the right to to accept or refuse medical treatment for ourselves. The Post article used bird flu as a disease for comparison. Yet, the fact that, HIV (which causes AIDS) does not have the ability to infect people through casual contact seems to significantly diminish the argument for mandatory testing. Such a mandatory testing policy would violate individual rights to autonomy and privacy of health information. More importantly, well designed health communication campaigns for volunteer testing and aggressive preventive techniques could transform the culture regarding AIDS in America without sacrificing the rights of individuals.

Read the Our Country is Failing the AIDS Test from the Washington Post and A Breathtaking Aspiration for AIDS from the New York Times.

Love Hinson and Donyaeh

On the first Friday of each month, the Health Advocate and enBloom will feature the personal story of an individual’s trials and triumph living with disease or in advocacy for others living with disease. This is an effort, to place you, the patient and health consumer back in the center of what has become an ever increasingly complex and sometimes impossible to navigate health care system.

During a trip to New York City in the spring of 2003, a dear friend and I caught a new and much heralded independent film, a documentary actually at the Film Forum. We were not prepared for the gripping and powerful story that we saw. It was entitled Love & Diane. So our premier post is the life experience of HIV+ teen mom, Love Hinson. A synopsis from the film’s website follows:

Love & Diane tells the epic story of a family over three generations. At its heart lies the highly charged relationship between a mother and daughter, desperate for love and forgiveness but caught in a devastating cycle. For Love, the world changed forever when she and her siblings were torn from their mother, Diane. Separated from her family and thrust into a terrifying world of institutions and foster homes, the memory of that moment is more vivid to her than her present life.

Ten years have passed since that day and Love and her five siblings have been reunited with their mother. But all have been changed by the years of separation. They are almost strangers to each other and Love is tormented by the thought that it was her fault. At 8 years old she was the one who revealed to a teacher that her mother was an drug addict. Now she is 18 and HIV+. And she has just given birth to a son, Donyaeh. For Love & Diane this baby represents everything good and hopeful for the future. But that hope is mixed with fear. Donyaeh has been born with the HIV virus and months must pass before his final status is known. As Diane struggles to make her family whole again and to realize some of her own dreams, Love seems to be drifting further and further away from her child. Diane, torn by her own guilt over her children’s fate when she was an addict, tries to help and to care for her grandson. But when Diane confides her fears for her daughter to a therapist, the police suddenly appear at the door. Donyaeh is taken from Love’s arms and it seems to the family as if history has repeated itself.

Now Love must face the same ordeal her mother had faced years before. She is charged with neglect and must prove to a world of social workers, therapists and prosecutors that she is a fit mother. And Diane must find the courage to turn away from her guilt and grasp a chance to pursue her long-deferred dreams. While the film takes us deep into the life of a single family, it also offers a provocative look at the Byzantine “system” that aims to help but as often frustrates the family’s attempts to improve their situation. The film differs from many documentaries that deal with the problems facing poor communities in that it eschews “talking heads” and interviews with “experts” and aims instead to immerse the viewer in the experiences and thoughts of a family trying to survive and retain autonomy in the face of terrible challenges.

Donyaeh

This film is a presentation of the Independent Television Service (ITVS) with funding provided by the Corporation for Public Broadcasting (CPB). Additional Funding provided by ARTE France. 155 minutes.

Source: Photographs are stills from the film, Love & Diane and synopsis text taken from Women Make Movies website.

AIDS has left a generation of children orphaned on the African continent. Here at home in the US, the incidence of HIV and AIDS is greatest among heterosexual African-American females. This issue is too important not to arm yourself with information and become involved.

There are many ways you can take action in response to HIV/AIDS:
* get tested for HIV

* practice safe methods to prevent HIV
* decide not to engage in high risk behaviors
* talk about HIV prevention with family, friends, and colleagues
* provide support to people living with HIV/AIDS

Learn more: The CDC has developed these fact sheets about HIV/AIDS in the Unite States.  AIDS in the US us.pdf, AIDS in Women women.pdf, AIDS in African Americans hzq2pbj3.pd.