If you’re HIV-negative but at high risk for possible HIV infection, PrEP (pre-exposure prophylaxis) might be a good option. PrEP means you take a daily dose of Truvada, an anti-HIV drug, to prevent infection if you are exposed to the virus. While taking the drug, you must stay in touch with your doctor for monitoring and support.
But what if you don’t have health insurance? Gilead, the drug’s maker, will provide Truvada to uninsured patients, but those quarterly doctor visits and required monitoring tests can get expensive for someone who doesn’t have insurance.
That’s why the New York State Department of Health, AIDS Institute created a Pre-Exposure Prophylaxis Assistance Program (PrEP-AP). It works a lot like the AIDS Drug Assistance Program. Essentially, PrEP-AP reimburses qualified medical providers for the cost of those visits and tests–which means no financial worries for the uninsured who are at high risk for HIV infection.
If you’ve thought about going on PrEP to prevent HIV infection, but don’t have insurance, PrEP-AP could be a huge help. To find out more, please call 1-800-542-2437. You can also talk to the prevention educators at HVCS for guidance and assistance. Contact the Regional Prevention Initiative.
Here’s the official language from the Department of Health’s announcement:
“The New York State Department of Health, AIDS Institute has created a Pre-Exposure Prophylaxis Assistance Program (PrEP-AP) modeled on and using the HIV Uninsured Care Programs (HUCP), ADAP Plus (primary care) operational systems and infrastructure. PrEP-AP will provide reimbursement for necessary primary care services for eligible individuals being seen by providers who are experienced providing services to HIV- negative high-risk individuals. PrEP clinical guidelines call for the provision of regular HIV testing, counseling, STI/STD testing and treatment and supportive primary care services to assure that individuals receive the monitoring and care they need to continuously adhere to PrEP interventions and medication.
While PrEP medication for the uninsured is covered by the manufacturer (Gilead) patient assistance program, the accompanying monitoring and care services are not. Eligible providers will be reimbursed for a specific set of services including but no t limited to HIV testing, counseling, STI/STD testing and supportive primary ca re services, consistent with clinical guidelines, http://www.hivguidelines.org .
Uninsured individuals will be enrolled in the PrEP-AP program using the enrollment infrastructure and basic eligibility criteria of the ADAP/HIV Uninsured Care Programs. Individuals with no other coverage, or whose coverage is a barrier to care, will be eligible for coverage through the PrEP-AP. Enrolled providers will submit claims for covered services for eligible high-risk HIV- negative individuals receiving PrEP, and the program will reimburse providers . As with the ADAP Plus program, reimbursement will be based on Medicaid primary ca re fee-for-service rates. PrEP medication will be provided to uninsured individuals through the manufacturer patient assistance program (PAP). Providers are responsible for assisting patients with the PAP application to receive Truvada as indicated for PrEP. The HUCP will staff a PrEP hotline to assist participants with the PAP process if problems or barriers are encountered and to refer participants to more comprehensive health care coverage when appropriate.
For information about participating in PrEP-AP, please call 1-800-542-2437.
For general information about PrEP, please call the New York State Department of Health, AIDS Institute, Clinical Education Initiative at – 1-866-637-2342.”
The Generations Project is now enrolling lesbian, gay and bisexual adults who live in or near New York City, Tucson, and the Bay Area into a research interview study. Eligible participants will be asked to meet with researchers and answer questions about how they think about their sexual identities and cope with different sources of stress, like prejudice about gender, race/ethnicity, and sexual orientation.
The interview will take approximately 2 ½ -3 hours. Participants will be compensated $75.00 for their time and participation.
Jennifer Couse, Program Supervisor and William Thompson, Director of Finance
Naomi Kabalkin, RPI Program Supervisor, and Paul Callagy, President of the Board of Directors
Barbara Bennet, Director of Education and Prevention
A sweet (and good-looking) cake
Todd Thomas, volunteer and Saqib Altaf, Director of Client Services
Poughkeepsie staff pose before we cut the cake
Saqib Altaf with Andi Straus, Acting Executive Director
Zelesther Cay, Aretha Thompson (Board Member), Todd Thomas, Andy Bell (Board Member), J. Dewey, and Ross Thompson
Cutting the ribbon
On Thursday, April 16, 2015 HVCS held an official grand opening and open house at our new Poughkeepsie office at 40 Garden Street. Dozens of local business leaders, government officials, and loyal supporters gathered for refreshments, cake and photos at the new space overlooking the city. The Dutchess County Regional Chamber of Commerce conducted the official ribbon cutting ceremony and snapped a few photos. For more pics, check out their Facebook album. Thanks to everyone who stopped by to visit!
To get in the spirit of this year’s Hudson Valley AIDS Walk, here’s a quick look back at the fun and festivities of our 2014 Walk. We return to the Walkway on Saturday, May 9th at 10:00 am this year. Check out our AIDS Walk page to register, grab materials, and see what incentives you can earn.
People undergoing treatment for HIV-1 are at increased risk for earlier onset of age-related illnesses such as some cancers, renal and kidney disease, frailty, osteoporosis and neurocognitive disease. But the question arises: is the cause of this the virus that causes AIDS or the treatment?
To answer this question, researchers from the UCLA AIDS Institute and Center for AIDS Research, and the Multi-Center AIDS Cohort Study (MACS) investigated whether the virus induces age-associated epigenetic changes — that is, changes to the DNA that in turn lead to changes in expression of gene levels without changing the inherited genetic code. These changes affect biological processes and can be brought on by environmental factors or by the aging process itself.
In a study published March 25 in the peer-reviewed online journal PLOS ONE, the researchers suggest that HIV itself accelerates these aging related changes by more than 14 years.
“While we were surprised by the number of epigenetic changes that were significantly associated with both aging and HIV-infection, we were most surprised that the data suggests HIV-infection can accelerate aging-related epigenetic changes by 13.7 to 14.7 years,” said Beth Jamieson, professor of medicine in the division of hematology/oncology at the David Geffen School of Medicine at UCLA, director of the UCLA Flow Cytometry Core and one of the study’s senior authors. “This number is in line with both anecdotal and published data suggesting that treated HIV-infected adults can develop the diseases of aging mentioned above, approximately a decade earlier than their uninfected peers.”
The researchers examined samples of white blood cells stored by the UCLA site of the MACS, which has been collecting biological samples as well as clinical, behavioral, and socio-economic data on HIV-infected men and men at risk for infection since 1983. They selected white blood cell samples from both young (20 to 35 years old) and older (36 to 56 years old) adults who at the time had not started antiretroviral therapy (ART). They divided each age group into 12 HIV-infected and 12 age-matched HIV-uninfected samples for a total of 96 samples. The researchers then extracted the DNA from the samples and analyzed the DNA for epigenetic patterns.
They compared epigenetic patterns that are strongly associated with aging to changes that occur during HIV-infection and found significant overlap in the two patterns, Jamieson said. They used those overlapping patterns to estimate the biological age of HIV-infected, untreated adults, and found that at the epigenetic level, the adults appeared to be approximately 14 years older than their chronologic age.
Jamieson noted that the cells they used were taken from men before they began taking ART. Although the findings demonstrate that HIV-infection can accelerate aging related epigenetics, the researchers cannot determine at this point if ART restores those patterns to be more age-appropriate or whether the drugs themselves cause additional changes.
Taken together, however, “these data suggest that HIV-1 infection does accelerate some aspects of aging and that general aging, and HIV-1 related aging, work through at least some common mechanisms,” the authors write. “These results are an important first step for finding potential therapeutic approaches to mitigate the effects of both HIV and aging.
Study co-authors are Tammy M. Rickabaugh, Ruth M. Baxter, Mary Sehl, Janet S. Sinsheimer, Patricia Hultin, Lance Hultin, Austin Quach, Otoniel Martinez-Maza, Steve Horvath, and Eric Vilain, all of UCLA.
This study was supported by NIA Grant 1RO1-AG-030327 awarded to B.D. Jamieson, P.I., NIAID AI-035040 R. Detels and O. Martinez-Maza joint P.I.s, B.D. Jamieson Co-Investigator, and by a UCLA AIDS Institute/CFAR Seed Grant from the National Institutes of Health award AI-028697 given to Dr. Eric Vilain, P.I. Ruth Baxter was supported by a NIH T032 training grant #5T32GM008243-25. Janet Sinsheimer is partially funded by NSF grant DMS-1264153.
AUSTIN, Ind. — Jeanni McCarty, a nurse and native of this threadbare city of 4,200, hurried up and down Main Street in Saturday’s bright sun, handing out stacks of fliers to any business that would take them. They were announcing a hastily planned specialty clinic — FREE, they emphasized in red — that would provide H.I.V. treatment to anyone who needed it.
Quite suddenly, a lot of people around here do. And the number keeps growing.
More than 80 people in Scott County have tested positive for H.I.V. since December, mostly in the last few weeks. They range in age from 20 to 56, and health officials say almost all of them live in Austin, which sits along Interstate 65 about 80 miles south of Indianapolis, surrounded by rural space. The outbreak, the worst in Indiana’s history, stems largely from the intravenous use of the prescription painkiller Opana, which everyone from the police to pastors to the owner of the city’s sole grocery recognizes as a plague on one ragged neighborhood in particular.
Gov. Mike Pence declared a public health emergency in the county on Thursday, and against his political beliefs, he also authorized a short-term needle-exchange program last week in hopes of stopping transmission of the virus through contaminated needles.
Ms. McCarty and her boss, Dr. William Cooke, the city’s only physician, have been at the forefront of a whirlwind response effort. Dr. Cooke’s medical practice, Foundations Family Medicine, will house the new clinic, with infectious disease specialists from Indiana University coming once a week along with mental health counselors and addiction specialists.
The weekly clinic will open on Tuesday, with six of Dr. Cooke’s 15 exam rooms devoted to it. Teams of state workers from Indianapolis will be on hand to sign up uninsured patients for Medicaid, which Governor Pence, a Republican, recently expanded under the Affordable Care Act to cover most low-income adults.
The questions now are how many of the newly infected will show up — and whether the effort, which is being led by the Indiana State Department of Health and involves the federal Centers for Disease Control and Prevention, will keep the number of new cases from spiraling further.
“I really, truly don’t know what to expect,” an exhausted Ms. McCarty said after distributing the fliers. “Even if only a couple come, that’s more than we had before and then maybe they can talk others into it.” Several worried people asked for H.I.V. tests on the spot.
The outbreak here was detected because Indiana requires newly confirmed cases of H.I.V., the virus that causes AIDS, to be reported to state health officials. It is jolting not only because national rates of H.I.V. diagnosis have remained stable or even decreased in recent years, but because the virus is a largely urban problem. Only about 6 percent of new diagnoses in 2013 were in counties with fewer than 50,000 people, according to the C.D.C.
One of the only other rural outbreaks to draw national attention took place in Belle Glade, Fla., where in 1985 researchers found an infection rate higher than New York City’s or San Francisco’s.
There is reason for urgency. The transmission rate has been about 80 percent, Dr. Cooke said, meaning that eight in 10 of those who have acknowledged sharing needles with someone who has the virus have tested positive. That indicates “a very high viral load in the community right now,” he said.
Health officials from nearby Clark County, which handles H.I.V. testing in 11 counties, have been going out since February to test people at their homes, using oral swabs that deliver preliminary results in 20 minutes and asking those who are tested to disclose any needle-sharing and sexual partners.
For the last week, a team from the C.D.C. has been helping with that work; a spokeswoman for the agency said it was not aware of any other jurisdiction’s ever declaring a public health emergency because of an H.I.V. outbreak.
For those who are H.I.V. positive, case managers have been assigned on the spot to help arrange counseling and treatment. But most have not started treatment yet, partly because the closest H.I.V. clinic is in Louisville, Ky., about 35 miles south of here.
“Our first three, we had appointments for them at the Louisville clinic, and to a person, none of them showed up,” said Dr. Kevin Burke, the public health officer who oversees H.I.V. testing in the region. “That may be fatalism. But at the same time, this population doesn’t have reliable transportation.”
Some will not be coming to the clinic for now because they are in the Scott County jail. Sheriff Dan McClain said that 11 of his 120 inmates had tested positive so far, but that they had not started treatment because the cost is so high — upward of $20,000 a year per patient, according to Dr. Burke — and he wants a guarantee of financing first.
“That’s a discussion I’ve had with the governor,” Sheriff McClain said. “Once we get that support, we’ll screen whoever comes through our doors, medicate them, educate them and eventually refer them over to Dr. Cooke.”
For now, only inmates identified as having shared needles or having had sex with someone who has tested positive are being screened, he said.
“Most of them take it no differently from somebody telling them they have a cold,” the sheriff added. “They’re resigned to the addiction.”
That is where the needle exchange may prove crucial to the containment effort, he and others said, although many believe that 30 days — the length of time Governor Pence authorized it for — will not be nearly long enough. The clinic will also help those who are willing get into detoxification and addiction treatment programs, Dr. Cooke said.
To understand how this could happen in Austin, or perhaps any small, poor, insular American town, is to take a drive with Donald Spicer, the city’s longtime police chief, through a neighborhood known as the North End. There, people in their 20s wandered the streets one afternoon last week, alone or in small groups, often averting their eyes as the police cruiser passed. “No trespassing” signs were posted in most yards, and many were strewn with ragtag furniture and trash. As many as two-thirds of the modest homes are rented out, Chief Spicer said, and they are often neglected to the point of crumbling.
“We have houses I like to refer to as shooting galleries, where they all lay around and get high all day,” he said.
Addicts have long crushed narcotic pills and combined them with liquid to inject directly into their veins. And while the makers of Opana reformulated it in 2012 to make it harder to abuse, many addicts still manage to do so.
Tammy Breeding, 41, who lives in the neighborhood, put a handwritten sign on her lawn that says, “No loitering or prostituting is allowed in front of these premises.” She said that she had taken several hundred pictures “of all this stuff going on” since moving back to Austin last summer, and that she had gotten a license to carry a handgun because she feared for her young children.
“I do nothing but call into the tip line,” she said.
Chief Spicer said his force of seven had made about 60 arrests this year, almost all of them drug-related. I-65, which runs from Mobile, Ala., to Gary, Ind., is a conduit for illegally trafficked prescription drugs that make their way here, he said. People also travel to Louisville for drugs, he said. Chief Spicer and Sheriff McClain said that local doctors had been their partners in trying to solve the problem and had not been lax prescribers, but that people with valid prescriptions sometimes sold Opana for at least $30 a pill.
The jobs situation, though bleak, could be worse. Austin is home to a canning plant, a Pepsi plant and an auto-parts plant. It is close enough to Louisville, a relatively thriving city of 600,000, for people to commute. But unemployment remains high, perhaps partly because of addiction problems that go back a generation, Chief Spicer said.
In retrospect, an outbreak of H.I.V. was inevitable, Dr. Cooke said. The county has seen a torrent of hepatitis C cases in recent years, he said, and a number of overdoses and cases of endocarditis, an infection of the lining of the heart that can be caused by injecting drugs with dirty needles.
“We had all the ingredients in place for this,” he said on Saturday morning, after finishing an overnight shift in the hospital emergency room in Scottsburg, about five miles away. “I suspect a lot of rural America does.”
As the response effort begins, the organizers are also looking to quell fear in the community. An elderly patient told a physician assistant at Dr. Cooke’s practice that she feared catching H.I.V. from pushing a shopping cart. Ms. McCarty said the practice had received several threats after announcing its plans to house an H.I.V. clinic. Anxiety over the outbreak even affected the Easter egg hunt at a local park: A group of volunteers scoured it for needles on Saturday before hiding the candy-filled eggs.
Money remains a question mark — the governor has not said how much will be attached to the 30-day public health emergency, or to continuing treatment for those affected.
“My biggest fear with this is they come in like a hurricane, and then after 30 days, they leave us high and dry,” Chief Spicer said. “Don’t leave us. Stay with us until we get past this thing.”
Get ready for the Hudson Valley AIDS Walk, HVCS’ biggest fundraiser of the year! Join us on the Walkway Over the Hudson on Saturday, May 9, 2015 from 10:00 am to 1:00 pm with lots of free snacks, coffee, vendors, music and fun for all ages. This is the only fundraising walk that benefits local people living with HIV/AIDS and we need your help to end AIDS in our lifetime. Together, we can make it happen!
Special thanks to care manager Frankee Ryan, long-time volunteer Patrick Decker and Solaris 3 Productions for making this happen!
Thanks to our wonderful supporters and customers of Gunk Haus, Drag Brunch 2015 has officially sold out! There will be limited seating in the bar area during the show. Please call Gunk Haus that morning for availability: (845) 883-0866. You may also email us to go on a waiting list–just in case we receive any cancellations.
If you’re like us (and so many of our supporters) you love when local food combines with local charity…that’s why Empty Bowls at Rondout Valley High School is such a great event! Now in its 12th year, Empty Bowls unites hard-working art students, local restaurants, food pantries and Ulster County residents who want to do good. On Friday, April 17th, hundreds of generous guests gather at Rondout Valley for an all-you-can-eat soup and ice cream buffet. For a $15 donation, choose from a one-of-a-kind handmade bowl and get your fill–or opt for a $5 paper bowl. You get to take home your beautiful bowl when you’re done! All proceeds benefit local food pantries including HVCS. We recommend getting there early, since the handmade bowls go quickly. Check out all the details on the event page or go to www.emptybowls.webs.com.