A shift in the federal HIV/AIDS strategy means a dozen large cities, including Washington, D.C., will receive less money this year to help women and children living with the disease. As the government focuses on new epicenters of the disease, we examine the local safety net for people living with HIV/AIDS.

Guests

  • Donald Blanchon Chief Executive Officer, Whitman-Walker Health
  • Lou Chibbaro Jr. Journalist with the Washington Blade

Transcript

  • 13:06:43

    MR. KOJO NNAMDIFrom WAMU 88.5 at American University in Washington welcome to "The Kojo Nnamdi Show," connecting your neighborhood with the world. Later in the broadcast, the complexities of color lines within African-American communities, but first, an update from the front lines of America's fight with HIV/AIDS.

  • 13:07:09

    MR. KOJO NNAMDIWashington, D.C. has long been at the epicenter of the American HIV/AIDS epidemic. Nearly 3 percent of the District's population is diagnosed as living with the disease and this weekend, thousands of people will gather in downtown D.C. for a walk to raise money and awareness to combat that eye-popping infection rate.

  • 13:07:27

    MR. KOJO NNAMDIBut some federal funds for local aid programs in Washington are slated for cutbacks as national strategies to combat the disease take on a new shape. Joining us to explore the next local chapters of the broader struggle against HIV/AIDS is Don Blanchon. He is the chief executive of Whitman-Walker Health in Washington, D.C. Don Blanchon, good to see you again.

  • 13:07:51

    MR. DONALD BLANCHONIt's great to see you always, Kojo.

  • 13:07:52

    NNAMDIAlso in studio with us is Lou Chibbaro. He is a senior news reporter for the Washington Blade. Lou, good to see you again, too.

  • 13:07:59

    MR. LOU CHIBBARO JR.Nice to see you.

  • 13:08:00

    NNAMDIYou can join the conversation at 800-433-8850. Lou, Washington has gotten used to being in the middle of conversations about AIDS in the United States, but recently it was announced that cities with large infection rates, like Washington, D.C., were going to get fewer federal safety net funds as national strategy shifts geographically towards places in the South with high infection rates. What does this shift all about?

  • 13:08:29

    JR.I guess it's an assessment of the overall AIDS epidemic nationwide. The Obama administration, as you know, came up with a national plan that had not been done before, which carefully assessed the situation nationwide and they've determined that some of the shifts are needed in the funds.

  • 13:08:50

    JR.However, they are assuring D.C., and Don Blanchon might know this more than I, that they won't take too much of a hit.

  • 13:08:58

    NNAMDIDon Blanchon?

  • 13:09:00

    BLANCHONSo Kojo, this is one of these things where the pool of funds available for HIV work is relatively flat in this particular program that you're referencing and the money is being spread across multiple communities in an area where now they have the federal level in that state and local level.

  • 13:09:21

    BLANCHONWe just have better epidemiological data about HIV and so this is really a pool of funds being spread across a broader number of communities under the -- with the direct intent of trying to impact the objectives under the national HIV/AIDS strategy.

  • 13:09:38

    NNAMDILou, what conversations have you had with local officials about how shifts in grant funding at the federal level are likely, if at all, to affect local efforts at fighting the disease?

  • 13:09:49

    JR.Oh, the local officials, including Dr. Sol Levine, the acting director of the D.C. Department of Health, say they are. They have been planning for this and they feel that whatever the outcome ultimately is, they are planning to do it in such a way that no individuals would be adversely affected in terms of patients and clients with HIV/AIDS.

  • 13:10:19

    JR.Now, that is not the case, of course, if this other development occurs, which we may be talking about later, about the so-called sequestration of the budget.

  • 13:10:27

    NNAMDIYep, we'll be talking about that also. And if you'd like to join the conversation, you can call us at 800-433-8850. What does the D.C. region's HIV/AIDS epidemic look like from where you live? Is it a public health problem that you think people are now aware of or one that still flies under the conscience, under the radar of many people who live here? 800-433-8850.

  • 13:10:50

    NNAMDIDon, Whitman-Walker Health is organizing its annual walk downtown this weekend where thousands of people are expected to raise money and raise awareness about HIV/AIDS. What does the epidemic in Washington currently look like to you and those that you're working with at Whitman-Walker?

  • 13:11:04

    BLANCHONSo the epidemic is, unfortunately, in too many communities and, unfortunately, it's across the entire city. We still, with respect to new infections every year, the city shows somewhere between 825 and 850 new infections a year. More than half of them are attributed to men having sex with men, many of whom are men of color.

  • 13:11:28

    BLANCHONI can tell you that from some of the historic numbers we saw four or five years ago where there were more than 1,100 new infections a year, what we've seen is some great progress, particularly around the needle exchange program, which has really cut back on the number of infections there.

  • 13:11:43

    BLANCHONBut I would remind people, 800 to 850 new infections a year is more than two a day and our number is really with what we know about care, prevention and linkage to services. We really should be targeting zero, both in terms of new infections and in terms of AIDS-related deaths, and I think we need to change the conversation away from what's the baseline to absolutely moving the baseline to zero new infections and zero deaths.

  • 13:12:10

    NNAMDIIt wasn't long ago that groups like DC Appleseed were giving the District failing grades on report cards about their efforts. The Appleseed report card issued this summer, however, marked a lot of progress particularly in the amount of data being collected about the epidemic in D.C. What do you think accounts for recent progress in the District?

  • 13:12:30

    BLANCHONSo concerted leadership at the political level, quite frankly, Mayor Fenty and Mayor Gray both have made commitments to having the best real-time data that we can have about who is infected and who is at risk. And as you well know, when you have data like that and you have information, you can act upon it.

  • 13:12:48

    BLANCHONAnd so all of the prevention strategies and the care strategies and how you fund new initiatives and which groups may be at risk, we talked more in the last 18 months about people over the age of 50 in the District being at risk. That was a group that, quite frankly, wasn't even in the conversation five years ago.

  • 13:13:03

    BLANCHONAnd so I think it's having that robust data allows you actually to act and then hopefully prevent new infections.

  • 13:13:09

    NNAMDIWe're talking about how HIV/AIDS in the District and how it's likely to -- how its funding is likely to be affected. Affected funding to fight the disease is likely to be affected. Donald Blanchon is the chief executive officer of Whitman-Walker Health in Washington, D.C. He joins us in studio along with Lou Chibbaro, senior news reporter for the Washington Blade.

  • 13:13:30

    NNAMDIWe're taking your calls at 800-433-8850. Gentlemen, don your headphones, please, because we're going to be talking with Melanie in Chantilly, Va. Melanie, you are on the air. Go ahead, please.

  • 13:13:44

    MELANIEHi Kojo. I am from South Africa and I'm so happy to be on your show. I'm a first-time caller. I just would like to make the comment that the United States gives aid to so many countries around the world and especially in terms of money to fight AIDS and help with HIV treatment.

  • 13:14:03

    MELANIEThey've giving billions to Africa and I really think that in so doing they're appearing so generous, but what effect does that generosity have if charity is not beginning at home? And I think it's really sad that the local Americans have to run, you know, helter-skelter looking for money to help themselves and I really think the American government should have a look at their AIDS policy.

  • 13:14:30

    NNAMDIMelanie, I'm glad you raised that point because Lou Chibbaro mentioned earlier sequestration and whether we would talk about that. Lou, the Blade ran a piece recently about what might happen to HIV/AIDS funding at the federal level if Congress fails to pass a deficit reduction deal in automatic spending cuts known as sequestration goes into effect. What are we looking at here?

  • 13:14:50

    JR.Well, right off the bat, all funds that are not considered entitlement, which would be considered all of the AIDS funding, the federal AIDS funding and the millions and millions of dollars that would be an across-the-board 8.5 percent cut and that would impact all of the local jurisdictions, the states and the cities, including D.C.

  • 13:15:16

    JR.I'm told by some people at the local level, that they're hopeful that the way the cuts will work would be up to the individual federal agencies, assuming this happens. It would be up to the individual federal agencies to allocate the funds and they're hoping that some of the most pressing needs like HIV prevention and the AIDS drug assistance program, which provides lifesaving drugs to people who don't have private insurance or who are under-insured, really it literally saves lives, that they would try to skimp and scrape other programs to preserve those as much as they could.

  • 13:15:56

    JR.I'm also hearing some hope from people that heard the president last night say in the debate that there shall not be. This shall not happen. I don't think everybody is so assured as he, but that made some people a little hopeful that an agreement would be reached.

  • 13:16:13

    NNAMDIDon, to what degree is the work that you can do at Whitman-Walker being shaped by policies crafted at the national level by the current administration, more specifically, what's at stake for the work that Whitman-Walker does on the HIV/AIDS front when it comes to The Affordable Care Act?

  • 13:16:30

    BLANCHONThat's a great question, Kojo. It's actually -- we're in probably one of the biggest changes around HIV care in the 30 years of the epidemic and it's really the intersection of The Affordable Care Act, which means over time more people living with HIV are going to be covered either through Medicaid or through the health insurance exchanges here in the District or in other communities.

  • 13:16:56

    BLANCHONAnd this means organizations like us have to learn to how to behave in an insurance, health insurance, third-party world, which is a little bit different than what we've been doing for a long time in HIV care which has largely been funded by federal and local grants and private fundraising.

  • 13:17:13

    BLANCHONAnd you know, if you know the start of the epidemic, it was private fundraising first from the communities that were most impacted and that kind of volunteerism and that community support is really critical. But we absolutely now are being shaped by health care reform, the national HIV/AIDS strategy and quite frankly, the local epidemic and that's what we need to be responsive to.

  • 13:17:35

    NNAMDILou, you've been reporting for the Blade for more than 30 years. There's even a repository of your work housed at the library at George Washington University. In all that time, what changes have you noticed within the community in this town about how people see this disease? Earlier this summer, we spoke with activists who told us how significant it is that people no longer see it as a death sentence.

  • 13:17:58

    JR.That's right. That is the biggest change and certainly to the relief of so many that the technical advancements, the scientific advancements in the 1990s made it change the situation so that HIV and AIDS is a treatable, chronic illness rather than literally a death sentence.

  • 13:18:18

    JR.There still are some exceptions. The health experts tell me that there's some people, the drugs don't work as well as they could for, or do for most other people, but for the majority, overwhelming majority it's a treatable now chronic disease but.

  • 13:18:36

    NNAMDIThe other side of that coin?

  • 13:18:37

    JR.Well, the other side is that the infection rate is continuing about -- they can't seem to get the infection rate lower than the ceiling or the floor, I guess, where it is now and that's the most vexing part of the problem. And these cuts, of course, would add to that problem because HIV prevention programs would be slashed.

  • 13:18:56

    NNAMDIAnd the fact that it is not seen by many people as a disease that would cause them to die, it is my understanding people have to be warned not to indulge in careless behavior because of the perception that it's not a death sentence.

  • 13:19:10

    JR.That's right. And, Kojo, one other major change I've seen, that really has been marked, is the idea that HIV testing is very important. In the early years of the epidemic, AIDS activists were skeptical because they knew the stigma that was attached to HIV/AIDS and there was a reluctance to promote testing.

  • 13:19:33

    JR.That has changed now. People are assured that it would not lead to discrimination. But still many people don't get tested and as Don probably could attest, the huge amount of infections come from people who do not know they are infected. And the most important thing is to determine as many as possible.

  • 13:19:55

    NNAMDIDon, our earlier caller mentioned South Africa where drugs, of course, and in a lot of the Third World are a lot less expensive now. But there have been reports recently about how trade talks might affect the access that poor patients have to generic drugs. What are the issues at work here and how international trade talks might likely affect the price of drugs taken by AIDS patients?

  • 13:20:19

    BLANCHONYeah, you know, I'm one of these people who professes not to be an expert in areas that I know absolutely nothing about. So let me share with you as a human being. I think there's a basic tenant (sp?) of humanity around this which is we have an intervention in health, namely these medications which are lifesaving. And that I think the pure -- our kind of faith in humanity and what we are as a country would lend us to look at those trade negotiations in a way that we would not want to make the price of the drugs so much higher that it's actually going to present the barrier.

  • 13:20:53

    BLANCHONAnd what you're seeing in a lot of the countries in Sub-Saharan Africa is actually (sounds like) have made movement and they've really done a great job. They're keeping a generation of people alive who ten years ago the threat to AIDS to wipe out some of the countries was very real. It wasn't a hypothetical model. It was significant. So I think the practical side of this will be, I hope, that our trade officials tread lightly in this area because people's lives are at stake.

  • 13:21:19

    NNAMDIWhat are your hopes for the walk this weekend? What are you aiming to do on Saturday morning?

  • 13:21:23

    BLANCHONSo, you know, this is as much as a friend raiser as it is a fund raiser. I tell people that all the time. We want as much support out there from our extended Whitman-Walker family but really from the entire metropolitan area. This is a big deal in the District and it's a big deal in the suburban communities. And I think Lou hit it on the head. When it was first and foremost in people's, not just minds but eyes, when you physically saw people and interacted with people and you knew they were ill, you saw it. It was palpable. You could feel it being next to them. We don't have that anymore.

  • 13:21:57

    BLANCHONAnd so what's happened is this level, you know, baseline HIV 2, 3 percent in our community is kind of like, oh well yeah, it's here and we have to do some things every year and we've got to do prevention and what have you. We actually need to up our game and that includes Whitman-Walker. We've talked about this. It's not enough to have 850 people newly infected every year. We've got to do it differently.

  • 13:22:18

    BLANCHONWe've got some great tools. We know more about prevention. We know that treatment can work as prevention. And we also know with health care reform we've got a great opportunity to test people who get basic medical care but who never ask or are never offered an HIV test during that medical visit, which is just unconscionable.

  • 13:22:38

    NNAMDIWe got an email from Donna who says, "Will someone address the need for coverage of contraception in the Affordable Health Care Bill that is crucial in the fight against AIDS?" Care to address that, Don?

  • 13:22:50

    BLANCHONSo from my perspective, particularly with what we do at Whitman-Walker Health, we would absolutely say that this needs to be a part of whatever the health insurance exchange's benefit package looks like, that you'd want to have this for men and women who are sexually active for a whole host of reasons. Not just as an HIV prevention measure but for STDs and other issues. And so from our perspective we regularly advocate for, you know, a progressive health benefits package that covers these types of services.

  • 13:23:20

    NNAMDIWe're in the middle of election season. Do either of you see a quality of difference between the two presidential candidates when it comes to policies that would affect the treatment of people with HIV/AIDS and research for a cure to it, starting with you, Lou.

  • 13:23:36

    MR. LOU CHIBARROWell, I think the majority of activists and even bipartisan activists -- there are gay Republicans -- but from the LGBT community they feel that the Obama Administration provided a number of advancements that they had not seen under the prior administration. A lot of it has bipartisan support in congress but for example the Obama Administration's plan or strategy documents did seem to change what some critics told me in the past was a sort of one-size-fits-all in terms of HIV prevention programs.

  • 13:24:17

    MR. LOU CHIBARRONow they are tailoring them specifically to all communities and all cultures, particularly the gay male community, the so called men who have sex with men, which represent the highest number of cases. And the idea again of the goal was to try to get this infection rate down. They see more improvements there. They're fearful that a Romney Administration might turn the clock back. He professes to be strongly in favor of, you know, all the HIV measures that are needed, and it remains to be seen.

  • 13:24:49

    NNAMDIDon Blanchon.

  • 13:24:51

    BLANCHONYou know, as a voter I've been trying to figure out just exactly what either candidate would bring to the table on this. I think with the president it's much easier because of the National HIV/AIDS Strategy we have a pretty good handle. But the -- Governor Romney really hasn't offered a lot on this issue so it's kind of difficult to assess that. And I think the place that I go to regularly around this is if we wait for the federal government to respond to such a local issue like HIV, we're actually looking to the wrong place.

  • 13:25:24

    BLANCHONThe right place is right in front of us. It's in our own community. We've got real-time data. We know which individuals are getting infected and we have tools now that we didn't have 20 plus years ago. And so I absolutely want the federal government to be a partner. I want them to be a funder. I want them to be a supporter of everything we're doing here in the district. But I think sometimes my colleagues, we get a little bit too much into, let's let the federal government act and then we'll figure out what to do. Well, meantime we have people who are getting infected every day. We have a really good idea on how to do that here.

  • 13:25:55

    NNAMDIDon Blanchon, he is the chief executive officer of Whitman-Walker Health in Washington, D.C. Don, thank you very much for joining us.

  • 13:26:02

    BLANCHONIt's a pleasure.

  • 13:26:03

    NNAMDILou Chibarro is senior news reporter for the Washington Blade. Lou, thank you for joining us.

  • 13:26:08

    CHIBARROYou're very welcome.

  • 13:26:08

    NNAMDIWe're going to take a short break. When we come back the complexities of color lines within African American communities. We'll be talking with writer Marita Golden. I'm Kojo Nnamdi.

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