Straight Platform Politics

Health Care Reform And Veterans – Part 2

Recent health care reform proposals have caused the public to evaluate the health care systems currently operated by the U.S. government, namely the Veterans Health Administration (VHA) and the Indian Health Service. Recent investigations have revealed serious problems within the VHA system.

Earlier this year, the VHA was dealing with the scandal that unsanitary equipment used in procedures infected about 53 patients with either HIV or hepatitis B or C. See Part 1 Then, in June, it was reported that 92 veterans were given wrong radiation doses in a common procedure to treat prostate cancer. These veterans were treated at the VHA facility in Philadelphia.

These problems have caused people to question whether or not the VHA is showing signs of an institutional breakdown. There apparently has been little genuine oversight provided by the VHA and investigations into grave problems produced little improvement. Sadly, the Philadelphia tragedy was allowed to continue for six years.

Funding, of course, is always a problem for anything that is run by the government. Many people cite lack of proper funding as the reason for the decrease in quality health care in the VHA. However, the same thing can be said of the Indian Health Service, Medicare, Medicaid, etc.

And we want the government to run our whole health care system because…….?

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Health Care Reform And Veterans – Part 1

Recent health care reform proposals have caused the public to evaluate the health care systems currently operated by the U.S. government, namely the Veterans Health Administration (VHA) and the Indian Health Service. The quality of these government-run systems is not encouraging.

Some people continue to refer to past studies that found the VHA to be better than Medicare, managed-care systems, and the highest rated non-VHA hospitals. Phillip Longman, in his article “The Best Care Anywhere,” (Washington Monthly Jan/Feb 2005) observed: “Outside experts agree that the VHA has become an industry leader in its safety and quality measures.”

But that was then.

Earlier this year, more than 10,000 former VHA patients were notified that they could have been exposed to HIV or hepatitis B or C through unsafe endoscopic procedures. These procedures involved substandard, unclean practices; some of these procedures were done as long ago as 2003. Three different states were involved – Florida, Tennessee, and Georgia. Unfortunately, 53 patients have tested positive so far.

U.S. Rep. Harry Mitchell, chair of the House Veterans’ Affairs Subcommittee on Oversight and Investigations, had this to say in a June press release: “Most infuriating is the irony that these veterans were undergoing routine medical evaluations to prevent illness, but ultimately, they may be in more danger now than before the procedures. [T]here is no question that shoddy standards – systemic across the VA – put veterans at risk and dealt a blow to their trust in the VA.”

And a blow to our trust in the ability of government to provide descent health care to many more people than just veterans.  See Health Care Reform And The Bridge

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District Of Columbia HIV/AIDS Epidemic – Part 11

Behavioral Surveillance: Findings continued

The District’s HIV/AIDS Behavioral Surveillance (HBS) Summary Report 2008 also looked at the risk behavior of concurrency – having more than one sexual partner. The HBS Report found that having more than one sexual partner was common, even for people with primary or stable relationships.

The vast majority of participants (74.2%) reported that their most recent partner was a main partner. But 57.9% also reported that they had 2 or more sexual partners in the last 12 months and 45.9% believed their last sex partner definitely or probably had sex with someone else during the past 12 months of the relationship.  See Part 7

This means that condom use is vital even in main relationships. The Report states, “Concurrency has been shown in many studies in the United States and abroad to be a key factor in the emergence of heterosexual HIV epidemics.”

The District’s intervention and prevention strategies must include the routine offering of HIV testing to all who present themselves for health care. This is especially true for Black females since they are at great risk of being infected even if they do not manifest common risk factors.

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District Of Columbia HIV/AIDS Epidemic – Part 9

Behavioral Surveillance: Participants

The District’s HIV/AIDS Behavioral Surveillance (HBS) Summary Report 2008 was released in March. This HBS concentrated on heterosexuals at risk of HIV infection (HBS-HET).

The targeted population for this HBS-HET was males and females 18 years and over who had sexual intercourse with a member of the opposite sex in the past 12 months and had some connection to a geographical high risk area (HRA). The HRAs were those with the highest poverty rates and the highest AIDS rates. There were 4 such HRAs: one was located in Ward 7, one was in Ward 8, one was located on the border between Wards 5 and 6, and one included parts of Wards 1, 2, 5, and 6. See Part 4

Participants filled out a survey and were offered free anonymous rapid HIV tests. The participants were given risk reduction materials, free condoms, and service referrals as needed. Participants also received monetary rewards for participating.

The majority of participants: was over 30 years old (61.4%), was black (92.3%), had never been married (61.6%), had a high school degree or less (85.7%), had an annual household income of less than $9,999 (60%), and, if insured, was insured through Medicaid or Medicare (91.8%).

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District Of Columbia HIV/AIDS Epidemic – Part 8

Behavioral Surveillance: Background

The District of Columbia HIV/AIDS Epidemiology Update 2008 was released in March of this year. The District’s HIV/AIDS Behavioral Surveillance (HBS) Summary Report 2008 was also released in March. This behavioral surveillance studied what people are doing and what risks they are taking before they are infected. Understanding risk behaviors is an important step in reducing the problem of the HIV disease in the District.

This HBS concentrated on heterosexuals at risk of HIV infection (HBS-HET). It was a partnership between DC’s Department of Health and George Washington University’s School of Public Health and Health Services. Unfortunately, the Report reinforced the Update’s bleak statistics and disheartening conclusions. (See previous posts on the HIV/AIDS epidemic in DC.)

The District has the highest HIV/AIDS case rate in the United States and this rate is considered to be of epidemic proportion. Unfortunately, heterosexual contact leads new transmissions: about 37% of newly reported infections are through heterosexual contact. The data imply that a generalized epidemic among heterosexuals at high risk for HIV may be emerging in the District.

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District Of Columbia HIV/AIDS Epidemic – Part 6

The Statistics by Race

The District of Columbia’s HIV/AIDS 2008 Update was released in March and includes many staggering facts and conclusions on the District’s current epidemic.

The Update reports the District’s total population by race as being 52.9% Black, 34.2% White, 8.0% Hispanic, and 4.9% other. These are adults and adolescents over the age of 13 (A/A). The percentages of A/A living with HIV/AIDS by race are: 4.3% Black, 1.9% Hispanic, 1.5% other, and 1.4% White.

There are 15,120 A/A living with HIV/AIDS. The percentages of this group by race are: 76.3% Black, 16.0% White, 5.2% Hispanic, and 2.5% other. Blacks comprise a little over half of the total A/A population of the District, but comprise ¾ of the A/A population living with HIV/AIDS.

The mode of transmission of HIV differs by race. Men-having-sex-with-men (MSM) is the greatest mode for white males: 82.4%. The greatest modes for black males are: 42.1% MSM, 20.0% heterosexual contact, and 19.7% injection drug user (IDU). Greatest modes for Hispanic males are: 59.3% MSM and 19.7% heterosexual contact.

Heterosexual contact is the greatest mode for females: Hispanic 70.1%, Black 58.1%, and 51.1% White.

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District Of Columbia HIV/AIDS Epidemic – Part 5

The Statistics by Gender

The District of Columbia HIV/AIDS Epidemiology Update 2008 verifies that the District is in the midst of a “modern HIV/AIDS epidemic.” See Part 1

The Update reports that the District’s total population of adults and adolescents over the age of 13 (A/A) is 506,722. There are 15,120 A/A living with HIV/AIDS, which is 3% of the total A/A population. See Part 3

The gender percentages of the total A/A population are 46.6% male and 53.4% female. However, even though there are fewer males, they have an HIV/AIDS infection rate almost 3 times higher than females: 4.6% to 1.6%.

The male-to-female comparison within the 15,120 population is startling: 71.7% male to 28.3% female. This reflects Update results showing that men-having-sex-with-men is the leading mode of disease transmission. This includes not only homosexuals but also non-homosexual men engaging in risky sexual behavior.

Unfortunately, data also show that heterosexual contact as a mode of disease transmission is increasing. This puts the female population of the District at great risk. Sadly, many of them may already be infected and not even know it.

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District Of Columbia HIV/AIDS Epidemic – Part 4

The Statistics by Neighborhood

The District’s HIV/AIDS Update See Part 1 also sorted the data by neighborhood wards. Among all residents of the District that are adults and adolescents over the age of 13 (A/A), the rates of those living with HIV/AIDS show that the epidemic is widespread.

UNAIDS and CDC define an HIV epidemic as generalized and severe when the overall percentage exceeds 1%. See Part 3 There are eight District wards and seven have rates ranging from 1.7-2.8%.

Ward 3 has the lowest number of HIV/AIDS cases (267) and the lowest rate of infection (0.3%) and the least number of publicly funded HIV/AIDS service providers (2).

There are two noteworthy observations about the District made in the 2008 Update. One is that persons engaging in any type of unprotected sex are at risk for becoming infected. The other is that, in recent years, trends in new AIDS cases and trends in new HIV (not AIDS) cases suggest that heterosexual contact is slowly emerging as the leading mode of transmission.

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