In this issue:
Dramatic drop in HIV among NYC IDUs
Vermont adopts, Kentucky considers unique identifiers
Black - white health gap remains
MCC latest victim of AIDS Fund paperwork
Richman moves on planning "restructuring"
DC clinic funded for lesbian HIV study
HIV+ smokers more likely to have lung problems
Program offers financial aid to Medicare recipients
Official calls for marriage ban in Vietnam
HIV-infected youths continue risky behavior
Researchers have announced that there has been a sharp drop in the rate of new HIV infections among injecting drug users in New York City. During the 1980s, the rate of new infections was 4 percent to 5 percent per year among drug injectors in New York who were not already infected with HIV. This has now fallen to a rate of 1 percent per year.
"This is extremely welcome news," said Dr. Mathilde Krim of the American Foundation for AIDS Research (amfAR), which funded one of the studies, "because a high rate of HIV infection among injection drug users is fuel for the spread of HIV -- not only through needle sharing, but also sexually and perinatally."
"These data clearly show a dramatic reduction in new HIV infections among drug users in the city," said Dr. Don Des Jarlais of Beth Israel Medical Center, the lead author of the report. "This very large HIV epidemic is clearly continuing, but at a markedly diminished pace."
New York City has experienced the largest HIV/AIDS epidemic among injection drug users of any city in the world. There have been over 50,000 cases of AIDS among drug injectors and their sexual partners in the city. These cases account for almost one-tenth of all AIDS cases in the United States and are more cases than have occurred in any single European country.
"These findings speak loudly for strong and comprehensive prevention programs, including needle exchange, and for the expansion of these types of programs," said Krim. "amfAR is proud of its funding and efforts in this area and of its continued support for state-authorized needle exchange programs."
The low rate for new infections was based on a synthesis (a "meta- analysis") of 10 separate studies of new infections among drug injectors conducted from 1992 to 1997. The 10 studies included a total of 4,963 people who were recruited from a wide variety of sites in the city. The individual studies were conducted by Beth Israel Medical Center, New York University School of Medicine, the National Development and Research Institutes, the New York City Health Department, and the New York State Health Department. The report was published in the March 2000 issue of the American Journal of Public Health.
The researchers attributed the low rate of new HIV infections to effective prevention efforts that have been applied for long periods of time. HIV prevention programs for drug users in New York include syringe exchanges, drug abuse treatment, community outreach programs, and HIV counseling and testing services.
"All of the people working in AIDS prevention for drug users in New York City should feel a strong sense of accomplishment for their sustained efforts," said Des Jarlais.
The researchers also cautioned that failure to maintain prevention programs may lead to a rebound in new infections.
"Stopping prevention activities could lead to a new disaster," said Dr. Michael Marmor of the New York University School of Medicine, a senior author of the report. (PR Newswire)
Vermont adopts, Kentucky considers unique identifiers
The Vermont Health Department will soon require doctors to report HIV-positive patients by a coded system. By reporting individuals with HIV and not just those with full-blown AIDS, health officials say they will be able to more accurately track the spread of HIV.
Supporters of the unique identifier system note that in addition to providing information about the HIV epidemic, it will also protect patients' privacy. The new system will take effect on March 24.
Using a unique code consisting of the third letter of the patient's first and last name, the last four digits of their social security number and other details -- such as race, age and county of residence - public health officials hope that the reporting system will help accurately track the spread of the
virus and identify those regions that need prevention programs.
State Epidemiologist Peter Galbraith said, "We need to know where the epidemic is going. It helps us target our preventative funding." He noted that 36 states have implemented HIV reporting systems; Texas and Maryland use unique-identifier HIV tracking systems.
Tim Palmer, executive director of the AIDS service organization Vermont Cares, said, "This allows people who are at risk to feel comfortable getting tested and seeking treatment."
Approximately 165 people in Vermont have AIDS and as many as 250 have HIV, according to the Health Department.
Meanwhile, in Kentucky, a comprehensive set of legislative initiatives aimed at increasing financial support for AIDS prevention efforts, recently introduced in the legislature also called on the state to track those who testing positive for HIV infection by assigning them an identifying code to assist surveillance efforts.
Originally, the legislation bill would have required that names be reported, but it was amended to use codes instead by state senator Ernesto Scorsone, who said it was a privacy issue. Under the amendment, no master list would be kept of the identifiers and the codes would only be known by the patient and his/her doctor.
"In an era of computers, the notion of privacy and the internet don't work together very well," said Scorsone. "Early treatment is key and any barrier is bad."
Scorsone argued that requiring names would lead to fewer people deciding to get tested and to some avoiding treatment.
The legislation also gives HIV-infected people priority in alcohol and drug intervention programs.
Not having adequate resources and programs like that in the state can mean that more HIV cases develop into AIDS, which is more expensive to treat and more deadly, said Dr. Claire Pomeroy, chief of the Infectious Diseases division at the University of Kentucky. With more education and public awareness, she said, the state would save money in the long run.
Other pending legislation includes a proposal to require AIDS and HIV education in middle and high schools; a bill which would make optional, instead of mandatory, some continuing education required by some health professionals who don't deal with the disease as often as others; and a proposal that would make it legal for pharmacists to sell sterilized needles and syringes. (Boston Globe/Lexington Herald-Leader)
Nearly 50 years and numerous advances in civil rights have not narrowed the gap between the death rate in blacks and that in whites, which was the same in 1995 as it was in 1950, a University of Michigan researcher reports.
While the overall death rate for African Americans has declined, for several causes of death -- including cancer, diabetes, suicide, cirrhosis of the liver and homicide -- it has increased. In addition, black men are nearly six times more likely than white men to die of AIDS.
"The persistence of the racial difference in health and the absence of any reduction in the racial gap in health, I think is quite striking," said study author David R. Williams of the University of Michigan's Institute for Social Research in Ann Arbor.
Although Williams reports that at age 45, white males are likely to have a life expectancy that is nearly 5 years longer than blacks, race may be a misleading difference.
"When we focus only on race and health, we miss the central role of economic status," said Williams in an interview.
After adjusting for their economic status, African Americans are more likely than whites to be unable to meet essential expenses. According to the report, in 1978, the median annual family income for blacks ($25,288) was only 59 cents for every dollar earned by the median white family ($42,695). In 1996, the numbers were nearly identical.
"On average, the white population is 10 times more wealthy than the black population," said Williams. "Those differences persist in every level of income."
While socioeconomic status appears to be the main factor affecting the death rate, there is also research that suggests racism itself can negatively impact health. Williams reports that some studies show that discrimination is adversely related to physical and mental health.
"A large body of evidence indicates that even after adjustment for socioeconomic status, health insurance and clinical status, whites are more likely than blacks to receive a broad range of specific medical procedures," said Williams in the report, published in the current issue of the Annals of the New York Academy of Sciences.
Among other minorities, Hispanics and American Indians have lower levels of heart disease, cancer and stroke, but higher death rates of diabetes and cirrhosis of the liver than whites. The Asian/Pacific Islander population has significantly lower mortality rates than those of whites.
Many Hispanic and Asian people are foreign-born immigrants, and according to the report, evidence suggests that the longer they live in the United States, the more their health deteriorates.
"We need to let communities become aware of this kind of information so that they can take the steps necessary to improve the quality of life and health for the poor population," said Williams. "I think we need additional research attention to the exposure that racism can play in health." (Reuters)
MCC latest victim of AIDS Fund paperwork
The Maternity Care Coalition (MCC), which provides AIDS prevention services to pregnant women and others in Philadelphia, has lost its right to benefit from the annual Philadelphia AIDS Walk because the AIDS Fund, the Walk's sponsor, says it failed to file a form.
MCC is among at least 10 leading AIDS service organizations which has been denied funding from the AIDS Fund this year because of technical problems with their applications. MANNA, which provides over 300,000 meals to homebound people with HIV/AIDS every year, was also denied support from the Walk this year because of a similar problem.
Susan Higginbotham, the director of the AIDS Fund, says that MCC failed to include a copy of a letter which all non-profits receive from the Internal Revenue Service confirming its tax-exempt status. MCC officials have angrily denied that they failed to file the form, and in any case, they say, the organization is one of the most well-known tax-exempt non-profits serving the health needs of women in Philadelphia, a fact they say should have been known to AIDS Fund staffers.
MCC was granted tax exempt status by the IRS over 15 years ago.
Since taking the helm at the AIDS Fund last year, Higginbotham has been the target of severe criticism from volunteers and supporters of the AIDS Fund, although she continues to receive strong support from her staff and the group's board of directors.
There have been a growing number of complaints about Higginbotham and the AIDS Fund, by local AIDS advocates, who question why the organization gives higher priority to minor paperwork problems rather than to the need for Fund resources to be allocated to groups that help PWAs. The ire was most extreme with regard to denying MANNA access to Fund support, given the practical help it provides to hundreds of PWAs daily.
"I am appalled at the fact that MANNA was denied funding for a technicality," Jennifer Leary, a Fund volunteer, wrote in a letter to the Philadelphia Gay News. "How many meals could Higginbotham's $7,500 bonus provide to people with HIV/AIDS? Has the board forgotten the AIDS Funds mission statement? Has Susan Higginbotham even bothered to read it?."
Higginbotham also came under attack for accepting a $7500 bonus after the 1999 Walk, on top of her $82,000 annual salary, even though the 1999 event fell $400,000 short of its goal. She has also been embroiled in a controversy in another role as president of the board of Thrift for AIDS, which, according to a recent PGN report, only donates about 5% of its proceeds to AIDS-related charities. And in late February, volunteers at the Fund criticized Higginbotham for what they said was a decision not to inform the public about the possibility that over 600 participants in the group's monthly Gay Bingo event , which attracts many PWAs, had been exposed to chicken pox. Higginbotham denied the charge.
Carol Wolf, another Fund volunteer who wrote to PGN, was also critical of Higginbotham's leadership. "To date, Higginbotham's achievements include decreased success in fund-raising and alienating local agencies. That she has been rewarded for this is unconscionable, that she has taken money and services directly away from the thousands of Philadelphians currently living with AIDS is reprehensible."
The application which the Fund has refused to consider would have expanded HIV education services to Latina women in Philadelphia. The group had asked for $15,000 from the proceeds of the Walk. In recent years, MCC has received almost $75,000 from the AIDS Fund for its HIV-related programs.
The AIDS Fund is the largest private funder of AIDS services in the region, and distributed about $1 million to about 58 recipient agencies in 1999, according to a report in PGN.
Higginbotham said that she supported the decision of a Fund committee to deny any application which did not have all of its paperwork in order.
"The quality of MCC's work itself was not in question," Higginbotham told PGN reporter Tim Cwiek. "But their administrative compliance was in question. ... There is a process, and there is a deadline. They didn't submit everything on time. I'm very disappointed about it, but that's what happened."
Dawn Prall George, director of marketing at MCC, said that the Fund's claim that the group did not submit the tax exemption form is absurd.
"I've been in this business for 15 years, and leaving out [the letter] is a mistake I don't make," she told PGB. Prall said she also provided the Fund with a state form confirming its tax exempt status.
"With this disqualification, we face the challenge of filling that gap in the Latina communities," she said. "We may fill that gap tomorrow, but who knows? The prospective funding pool is very limited."
JoAnne Fisher, MCC's executive director, was equally frustrated by the Fund's action.
"This problem didn't need to occur, because it could have been solved with a telephone call," Fisher said. "The document in question is readily accessible, and we could have provided it to them immediately, if it was missing."
MCC was recently awarded $200,000 for each of the next four years for HIV prevention services targeted to African American women, in a collaboration with the Women's Christian Alliance, Fisher said. But the funding cannot be used for the Latina program because of restrictions on the grant, she said.
"I think it's ironic that, as a result of this grant, we've become an even bigger player in the AIDS arena," Fisher said. "We should be strengthening our relationship with the AIDS FUND. But rather than making us a big player, they are excluding us."
Prall said the coalition's board hasn't decided whether to participate in the upcoming AIDS Walk. Support for this year's effort is expected to drop significantly because so many groups have been denied access to the proceeds.
"Here's an organization that's given us $73,500 in the last four years," she said. "One would think that this type of technical issue [IRS letter] is moot. They should give us the benefit of the doubt. We have a history with them ... It's embarrassing."
Higginbotham has so far refused to release the names of the 10 other agencies excluded from the AIDS Fund competition.
Richman moves on planning "restructuring"
Philadelphia director of social services Estelle Richman announced this week that she will move ahead on implementing a plan, adopted by a community panel several weeks ago, that seeks to restructure the HIV planning process for Philadelphia and the region after her suspension of the Philadelphia HIV Commission late last year.
Richman's plan calls for a stronger emphasis on data and needs assessments in determining priorities for Ryan White CARE Act Title I funds awarded to the Philadelphia metropolitan area, which includes southeastern Pennsylvania and southern New Jersey, and AIDS prevention funds awarded by the U.S. Centers for Disease Control (CDC) and state and local governments.
The new plan shifts responsibility for overseeing the planning process from the city's AIDS Activities Coordinating Office (AACO) to the new office of the Director of Social Services, which she was appointed to head by Mayor John Street in January.
Richman had earlier said that conflict that arose between AACO, which distributes federal AIDS funds according to priorities established by two federally-mandated planning councils, and the members of the planning councils necessitated the new structure. Each major funding source has a planning group comprised of consumers and professionals which set priorities for the use of the funds.
Richman has appointed David Fair, the founding director of AACO and former executive director of We The People Living with AIDS/HIV of the Delaware Valley, to facilitate the process. In a letter to planning council members, Richman said that Fair will develop guidelines for how the new planning process will work, develop a planning and needs assessment agenda with members of the planning council, and staff a nominating process to attract additional members to the planning councils to assure that they meet federal representational mandates and bring the required expertise to the process.
"Our goal is a planning process that is based on real needs assessments, data analysis and mature, and constructive debate over priorities for federal funding provided for our region by a group of consumers, providers and others that is fully representative of the communities most impacted by the HIV epidemic," Richman said.
The Lesbian Services Program of Washington, DC's Whitman-Walker Clinic has begun recruiting women with HIV to take part in a study funded by the federal Centers for Disease Control and Prevention to determine whether there are any cases of female-to-female sexual transmission of the virus.
Another goal of the study, which will involve 200 participants from Washington, D.C., New York, and San Francisco, is to identify which sexual practices between women might facilitate the transmission of HIV. In addition, the researchers would like to learn more about prevention strategies used by HIV-positive women who have sex with women.
"One of the most important parts of the study is giving a voice to a group of women we have not heard from yet," said Kathleen Ethier, a behavioral scientist in the CDC's Division of STD Prevention who is coordinating the study. "I think that's essential."
Ethier wrote the grant for the $264,721 study, which is scheduled to be completed in September. She also served as its principal investigator while she was an associate research scientist in Yale University's epidemiology and public health department.
Data is being collected from women with HIV infection at three U.S. sites: Whitman-Walker Clinic in Washington, D.C., Montefiore Medical Center in New York City, and the Center for AIDS Prevention Studies at the University of California at San Francisco.
Ellen Kahn, director of Whitman-Walker's Lesbian Services Program, said her division plans to recruit and interview up to 75 women for the study.
"Currently, we're trying to educate people who work with patients with HIV about the study so they can inform clients they see about this opportunity," Kahn said.
Whitman-Walker Clinic is scheduled to begin interviewing study participants in January.
Researchers at Montefiore Medical Center in New York City plan to recruit 50 study participants who acknowledge that they have a current or past sexual history with another woman.
"We want them to bring in a female sex partner we can interview as well," said Dr. Ellie Schoenbaum, director of the medical center's AIDS Research Program, which also is part of the Albert Einstein College of Medicine's Department of Epidemiology and Social Medicine.
"The goal is to assess whether there are any female sexual partners whose only risk for HIV is that they had sex with another woman," she said. Some study participants will be asked to provide blood samples, Schoenbaum said, and CDC officials plan to analyze the samples to determine whether one HIV-positive woman possibly infected her current or past partner with HIV. If the analyses indicate they have the same strain of the virus, this could indicate, as some Lesbian and women's health advocates believe, that women can sexually transmit HIV to other women.
Montefiore Medical Center officials already have begun recruiting women to take part in the study. Schoenbaum said HIV-positive women are being recruited from existing studies as well as from local health clinics where providers might know of other possible participants.
She predicted that it would be difficult to determine whether a woman in the study contracted HIV from another woman.
"My sense is that this will be like looking for a needle in a haystack," Schoenbaum said, "because there's now ample evidence that many Gay women who have HIV have a higher risk [for being infected with the virus] than even the average heterosexual intravenous drug user."
This is because Gay women with HIV frequently have a history of having sex with men for money as well as having been in abusive relationships, she said. "Women with a very high risk [for contracting HIV] tend to have gone through abuse and violent episodes," Schoenbaum said. "Even in studies we've done in which women didn't contract HIV because of drug use, their past history with men is such that one has to wonder if that is where the HIV came from. So I think it's going to be hard" to find evidence of female-to-female HIV transmission. In metropolitan Washington, Kahn said Whitman-Walker officials plan to recruit 50 women with HIV to take part in the study. An additional 25 women from Baltimore might be included in the study as well but Kahn said Clinic officials have not made a final decision about this.
"We hope to include participants from Baltimore and we're exploring that possibility," she said. "But we don't have a site in that city where we could conduct phlebotomies, it's not convenient for participants there to travel to D.C., and we don't have enough funds to help with travel expenses."
Kahn said, however, Clinic officials are negotiating with several Baltimore-based organizations that might be able to help coordinate this effort so women from that city could take part in the study.
Another concern she mentioned is making sure that a broad sample of HIV-positive women who might not necessarily identify as Gay is recruited to take part in the study.
"We want to find women who are HIV-positive who have or have had sexual relationships with women in the past," she explained. "They might have a Lesbian identity, be bisexual, or identify as heterosexual women who have had sexual intimacy with women at some point.
"A challenge is to reach beyond the Lesbian- and bisexual-visible women," she added. "We want to be careful not to exclude anyone, because not everyone identifies as Lesbian."
The study should help researchers and advocates for Lesbian health learn more about the differences between women's sexual behavior and how they identify their sexual orientation, Kahn said. Because the study is behaviorally based, she said Lesbian health advocates and researchers should be able to learn more about sexual behaviors among women that could put them at risk for contracting other sexually transmitted infections.
To protect study participants' confidentiality, each woman who takes part in the study will be identified by a numerical code instead of by her name, CDC officials said. In Washington, they will be asked to take part in one 90-minute interview and be paid $25 for that participation.
Based on the women's responses during the interviews, Ethier said, some, but not all, study participants will be asked to provide blood samples. Researchers at the CDC in Atlanta plan to analyze the samples to determine whether HIV-positive women who have been sexually involved with each other are infected with the same strain of the virus. This would provide more conclusive proof that woman-to-woman HIV transmission is possible.
Although the risk of HIV transmission between women is likely very small, some researchers and Lesbian health advocates contend that cases of female-to-female transmission of HIV have, most likely, been underreported. This is because the CDC's method of tracking how HIV is transmitted has not included a category for female-to-female transmission.
Kitty Warren, a CDC spokesperson, said that, on the CDC's standard HIV surveillance report, federal officials list a hierarchy of the most efficient ways HIV is transmitted. The categories include: men who have sex with men, injection drug use, men who have sex with men and inject drugs, heterosexual contact, blood transfusion, hemophiliac, and mother-to-infant transmission. There also are categories for no risk, unknown risk, and unreported risk.
For women who have HIV but do not report one of the previously mentioned risk factors, Warren said, health officials would conduct a follow-up interview to determine how they might have been infected.
Some Lesbian health authorities have said the CDC should implement a procedure that would more easily identify possible cases of female-to-female HIV transmission.
Dr. Robert Janssen, acting director of the CDC's HIV/AIDS Prevention division, said special studies conducted by the CDC on risk factors for HIV transmission among women who have sex with women indicate that most are infected from "traditional modes." Such modes would include having sexual intercourse with a man, he said, or by injecting illicit drugs.
"In the studies we've done to date, female-to-female transmission is very rare," Janssen said, noting that this is why the CDC has not taken steps to change its methods for documenting such cases.
In a CDC report titled, "Epidemiology of Reported Cases of AIDS in Lesbians, United States 1980-89," Dr. Susan Chu noted that two instances of female-to-female transmission of HIV infection had been reported, though not confirmed.
But Kahn at Whitman-Walker said HIV transmission among women has been "grossly understudied."
"There have been some documented cases of woman-to-woman transmission but they haven't been thoroughly convincing to people in the research world because they weren't looking at other risk factors."
Ethier noted that, when information about HIV was first disseminated, it focused, primarily, on Gay men, then people who inject illicit drugs, and those infected with HIV through heterosexual contact.
"The risk was so much larger [for these groups] that people didn't focus on the risk for HIV-positive women or women with sexually transmitted diseases," she said.
In the past few years, however, researchers have seemed more interested in tracking HIV cases among women, she said. Two recent factors led to this. In 1995, the CDC convened a meeting for researchers, health care providers, and Lesbian health activists to discuss HIV issues related to Lesbians. The meeting brought together people who had been pushing for more research on Lesbian health and, Ethier said, this provided the impetus for the current study.
In addition, data reported in 1995 from the HIV-Epidemiologic Research Study (HERS) indicated that 18 percent of HIV-positive women reported same-sex contact. But, again, CDC officials have said that HIV-positive women who reported same-sex contact also tend to report engaging in heterosexual contact or injecting illicit drugs.
Nevertheless, Ethier said the number of HIV-positive women who reported same-sex contact was much higher than expected. The HERS study involved identifying females with HIV as well as collecting information about sexual behavior for women who were HIV-positive and HIV-negative.
"This is really something that needs attention and that hasn't always been an easy process, but the CDC has been really receptive to this study," Ethier said. "We hope what we get out of it shows the importance of looking further into this issue."
Renee Culver will be coordinating Whitman-Walker Clinic's participation in the study about woman-to-woman transmission of HIV. For information about enrolling in the study, contact Culver at (202) 939-7896.
Smokers with HIV are significantly more likely to develop the lung condition emphysema than HIV-negative smokers. Emphysema is a condition in which lung tissue is destroyed, possibly by immune system reactions, and researchers from Ohio State University in the United States have discovered that the development of emphysema is vastly accelerated in HIV-positive people.
Researchers recruited 114 HIV-positive patients and 44 HIV-negative individuals matched for age, sex and smoking history. They found that 15% of HIV-positive patients had emphysema, compared with 2% of the HIV-negative group, and in people who had smoked for 12 years or more, the difference was even more striking. 37% of the long-term HIV-positive smokers had evidence of emphysema, whilst none of the long-term HIV-negative smokers had signs of emphysema. The average age of the HIV-positive patients was 34, indicating very early onset of smoking-related emphysema.
HIV-positive smokers were also found to have much higher levels of cytotoxic lymphocytes (CD8+ cells) in their lung tissue, and the researchers suggest that some of the damage may have been caused by these immune cells. This study was conducted between 1994 and 1997, before the widespread use of protease inhibitor therapy amongst these patients, and HAART is known to reduce levels of CD8+ cells. But if this form of immune activation is not responsible for accelerated emphysema, the researchers warn that the condition could become a more common problem as people with HIV live longer. (aidsmap.com)
Program offers financial aid to Medicare recipients
by Thomas McCormack
Little-known programs can mean an extra $45.50 monthly in Social Security checks and extra medical benefits for disabled and elderly persons who are on Medicare but are not also on SSI or Medicaid already, according to a statement released by AEGIS.
Those with Social Security and other income under $960 monthly will see the Medicare Part B premium ($45.50 in 2000), which is currently deducted, restored to their checks once the Specified Low Income Medicare Beneficiary (SLIMB) and Qualified Individual (I) QI (I) programs begin paying it for them.
Those with Social Security and other income under $716 per month will not only get the premium paid for them and have the $45.50 restored to their Social Security checks - the Qualified Medicare Beneficiary (QMB) program will also pay the hospital admission deductible ($776 in 2000), the $100 annual doctor bill deductible and the 20% of doctr and outpatient bills that Medicare doesn't cover.
Both SLIMB/QI (I) and QMB are run by state Medicaid programs through local welfare offices - not Social Security offices - even though they involve federal Medicare benefits. To be eligible for both SLIMB/QI (I) and QMB, one can have assets up to $4,000, an automobile and a lived-in home of any value. An additional $1,500 in savings is permitted if it's kept separately from other money and the applicant plans to use it for burial.
Applications are taken at local welfare offices - not at Social Security branches. Those applying should bring birth certificates, bank account and other asset records, deeds, mortgages, auto registrations and driver's license or other proof of identity and residency. Most importantly, applicants need to show their Medicare cards and the latest letter from Social Security stating what their benefit total is. (Call 800-722-1213 for a copy.)
In computing eligibility, it's the total Social Security amount that counts against the $947 and $707 income levels. The checks only show the net amount - after the $45.50 has been deducted. So, in computing total income, one must add the $45.50 Medicare Part B deduction back onto the net check amount.
Applying for SLIMB or QMB at the welfare office now can bring a $45.50 increase in total income for those who qualify - and coverage of Medicare deductibles and co-payments as well for those who get the more generous QMB coverage. But again, those who are already on SSI or Medicaid too don't need to apply for these programs because (whether they know it or not) the state is already paying their Medicare premiums.
Social Security Disability Insurance (SSDI) beneficiaries can keep their Medicare even if they return to work - and they should do so, even if they secure employer health coverage. (When you have a serious illness, two health insurances in force beat only one, and, besides, Medicare covers some things private coverage doesn't, and it won't lapse (like the employer plan will) if you are laid off or become too sick to work again.)
Medicare coverage is available - for a lifetime, even after returning to work - as long as one continues to have the condition which originally qualified one for SSDI.
For those who are working, QMB and SLIMB/QI(I) disregard $65 and half the rest of gross earnings per month, and out-of-pocket medical expenses you pay yourself, before comparing your net, countable income to their eligibility levels. This means that someone who has given up SSDI to resume work can have gross monthly earnings of $1,965-- or more, depending on paid medical expenses--and still get SLIMB/QI(I) to pay his $45.50 premium. And to get QMB to pay the premium and also deductibles and co-payments, one can have total monthly wages of $1,477 or more.
And, after 45 months back at work, Medicare Part A starts charging a premium too (in 2000, either $166 or $301 monthly, depending on how long you paid FICA payroll taxes before you became disabled). But those with gross monthly earnings under $2,869 or more can have the welfare office's Qualified Disabled Working Individual (QDWI) program pay their Part A premiums.
Medicare, QMB or SLIMB/QI (I) won't help with prescription drugs or care outside the Medicare benefit package. Medicaid does so - for those who are eligible. Those applying for QMB or SLIMB/QI (I) at welfare offices in Alaska, California, Connecticut, the District of Columbia, Florida, Hawaii, Maine, Massachusetts, Michigan, Mississippi, Nebraska, New Jersey, North Carolina, North Dakota, Pennsylvania, Rhode Island, South Carolina, Utah and Vermont should remember that Medicaid levels there are as high as - or almost as high as - the QMB levels. So it would pay to ask for "full" Medicaid as well while applying for QMB or SLIMB/QI (I).
Those who can't qualify for Medicaid might be eligible for their state's AIDS Drug Assistance (ADAP) program, which has much higher income limits. Call (800) 432-AIDS to find out how to contact the state's ADAP programs.
(Thomas McCormack wrote the AIDS Benefits Handbook (Yale University Press), handled eligibility policy for SSDI, SSI, Medicare and Medicaid at the Department of Health and Human Services and did public benefits advocacy with several AIDS and disability organizations. He writes frequently on entitlements advocacy and now consults for the Tittle II Community AIDS National network (T2CANN). Email him at
People with HIV carriers should be barred from marrying to stop the spread of AIDS, an official conference on marriage laws in Vietnam has been told.
Yesterday's Tuoi Tre newspaper said the submission was made by a senior Ho Chi Minh City police official. "The marriage law's objective is to protect our nation and race, therefore we must forbid those with HIV from marrying to stop the disease from spreading," the official told the conference.
HIV specialists said the proposal showed the extent of discrimination suffered by Vietnamese with the virus.
Churchmen and welfare workers dismissed the suggestion as a violation of human rights."I understand that those wanting to forbid [HIV carriers] from marriage are trying to protect the whole community and we don't recommend such marriages," Ho Chi Minh City Women's Union chairwoman Nguyen Thi Lap Quoc said."But those suffering the disease are still human beings and they still have rights."HIV testing before marriage is mandatory in neighboring Cambodia but is not yet compulsory in Vietnam.
The sometimes heavy-handed response of authorities to the growing HIV epidemic has come under fire, most recently with a decision last year banning people with HIV from working in certain occupations.
The head of UNAIDS in Vietnam, Dr Laurent Zessler, said that without widespread understanding and acceptance of the disease the problem would be driven underground, with potentially catastrophic results."Compulsory testing is absolutely counterproductive and obviously some sectors of Vietnamese society need more education," he said. But he said Vietnam had only just begun to acknowledge its HIV problem and policy remained where Thailand was about 15 years ago. More than 15,000 people have been identified as HIV positive since the first case was identified in Ho Chi Minh City in the early 1990s. But the real rate of infection is widely believed to be much higher. Two-thirds of infections have been attributed to intravenous drug use and recent figures revealed nearly 20 per cent of prostitutes in the Mekong Delta carried the virus. According to health authorities, most of those infections were contracted in Cambodia, where 50 per cent of prostitutes are HIV positive and where as many as 30,000 Vietnamese women work in the sex industry.
HIV-infected male and female youths are twice as likely as adults to practice unsafe sex or to share needles following diagnosis, according to Seattle researchers.
The results of the study of HIV-positive patients show that, despite prevalent messages warning people about the dangers of sharing needles for illicit drugs and having unprotected sex, young people tend to believe the precautions do not apply to them.
"Many people assume HIV-positive youths have more knowledge about the risks than they do," the study's lead author Dr. Catherine Diamond, an epidemiologist at the University of Washington (UW), told Reuters Health.
"When healthcare providers see an HIV-positive youth, they tend to focus on treatment and not on prevention. We may need to more carefully target public health messages to certain subgroups of people," she said.
The study, published in the January issue of the American Journal of Public Health, compared risky behaviors of 139 young HIV patients with those of 2,880 adult patients. Half of the youths were younger than 20 when diagnosed with HIV and half were older, but under 22. Among the adults in the study, the median age was 32 when diagnosed with HIV, meaning half were older than that and half were younger than 34 but older than 22.
Diamond, who is now at the University of California at Irvine, and her UW colleague, Dr. Susan Buskin, reviewed the medical records of the study participants in Seattle and its surrounding King County area for the period between 1990 and 1998.
Evidence of risky behavior included documented incidences of unprotected sex, needle sharing without disinfecting, contracting sexually transmitted disease, exchanging sex for money, and pregnancy within 6 months after a positive HIV test.
Among the HIV-positive young women, 66% exhibited evidence of risky behavior as compared to 46% of adult women. When pregnancy was excluded, the ratios dropped to 46% and 34% for the youths versus adults. Among the HIV-positive males, 28% engaged in risky behavior compared to 16% of adult males.
While the study was not designed to explain why the young women appeared to engage in more risky behaviors, the researchers theorize that more frequent screening for sexually transmitted disease and the inclusion of pregnancy might have skewed the number of documented incidences of such behavior.
The investigators note that their findings represented only information obtained from people under medical care, which may represent an underestimate of the extent of risky behavior among all HIV-infected people.
They add that because most of the study period predated the advent of the protease inhibitors, which have successfully checked the advance of the disease in many people, further study of risky behavior among HIV-infected people is more urgent than ever.
"Most of the public health messages are aimed at prevention among non-infected people," Diamond said. "The risky behaviors of HIV-positive people are not being adequately addressed. It is important to continue to try to intervene with prevention measures among HIV-infected people because of the potential for infecting others." (Reuters)