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 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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District Of Columbia HIV/AIDS Epidemic – Part 3

The Statistics by Age

The District’s HIV/AIDS Update See Part 1 See Part 2 includes 16 tables, 37 figures, 4 maps, and a huge amount of discouraging data.

The United Nations Joint Program on HIV/AIDS (UNAIDS) and the U.S. Centers for Disease Control and Prevention (CDC) define an HIV epidemic as generalized and severe when the overall percentage exceeds 1%. In the District 3% of the population 13 years old and older are living with HIV/AIDS.

Among all residents that are adults and adolescents over the age of 13 (A/A), the age range most impacted is the 40-49 year olds with 7.2% of that age range living with HIV/AIDS. The 50-59 year olds are next with 5.2% and the 30-39 year olds with 3.4%. The District’s 13-19 year olds are the only age group under the 1% threshold; it is 0.1%.

Of the 15,120 A/A living with HIV/AIDS, 37.9% are 40-49 years old, 24.5% are 50-59, and 21.1% are 30-39. The 20-29 year olds and the over 60 group are each 8.1%. The 13-19 year olds are 0.4%.

Unfortunately, even if the District curtails the number of new cases of infection, the number of adults living with HIV/AIDS will remain high for years to come.

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District Of Columbia HIV/AIDS Epidemic – Part 2

The Strategy continued

The District of Columbia’s 2008 HIV/AIDS Update was released in March 2009. See Part 1 It updates the 2007 HIV/AIDS annual report. The District’s Promote-Prevent-Protect (PPP) intervention and prevention strategy had good results. However, District HIV/AIDS statistics remain grim.

At the end of 2007, there were 15,120 residents living with HIV/AIDS. This is 3% of the District’s population 13 years old and older and a 22% increase in the number of adults and adolescents living with HIV/AIDS since the end of 2006.

The District’s publicly funded HIV testing increased 70% from 2007 to 2008; the number of youth tested doubled from 10,000 to 20,000. The District also increased intervention funding so as to reach more residents, distributed 1.5 million free condoms, and doubled the number of needles exchanged to 190,000.

Through its PPP strategy, the District also increased the number of people receiving free HIV medications, decreased the number of babies born with HIV, and increased the number of people receiving early HIV care.

Hopefully, this aggressive and expensive strategy will stop or at least reduce the spread of HIV in the District.

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