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Justice Department: Fighting Discrimination against People Living with HIV

November 26, 2012 • By David Knight, J.D., and Anne E. Langford, J.D., Trial Attorneys, Disability Rights Section, Civil Rights Division, U.S. Department of Justice • no comments

[Editor’s note: As we approach World AIDS Day, we reflect on the fact that many things have happened this year that affect people living with HIV/AIDS and those who care for them, including the release of important new documents and Federal resources. We wanted to call your attention to two recent announcements from the U.S. Department of Justice.]

The U.S. Department of Justice (DOJ) is responsible for enforcing Federal laws and ensuring fair and impartial administration of justice for all Americans. DOJ’s Civil Rights Division works to eradicate discrimination against people with disabilities, including those living with HIV or AIDS, by enforcing the Americans with Disabilities Act (ADA). The ADA prohibits discrimination by employers based on disability, and requires state and local governments and public accommodations, like doctors’ offices, medical clinics, hospitals, and other health care providers, to provide people with HIV equal access to goods, services, facilities, privileges, accommodations, and advantages.

As part of its ongoing ADA outreach efforts, the Department has two recent announcements to share:

Questions & Answers: The ADA and Persons with HIV/AIDS

DOJ recently updated Questions and Answers: The Americans with Disabilities Act and Persons with HIV/AIDS, a 14-page publication explaining the rights of persons with HIV/AIDS and the requirements of the ADA for employers, businesses, and nonprofit agencies that serve the public, and State and local governments to avoid discrimination against persons with HIV/AIDS.

The publication covers such questions as, “Are people living with HIV or AIDS protected by the ADA?” and “What employment practices are covered by the ADA?” It also addresses questions related to public accommodations, including, “Can a public accommodation exclude a person with HIV or AIDS because that person allegedly poses a direct threat to the health and safety of others?” and “Are health care providers required to treat all persons with HIV or AIDS, regardless of whether the treatment being sought is within the provider’s area of expertise?”

The publication is a helpful resource for those who want a better understanding of their rights or obligations under the ADA.

Settlement Agreement with Pennsylvania School Regarding Child with HIV

In September, DOJ and the AIDS Law Project of Pennsylvania Exit Disclaimer reached a settlement with the Milton Hershey School of Hershey, Pa., to remedy alleged violations of the ADA. The agreement resolved allegations that the school violated the ADA by refusing to consider a child for enrollment due to the fact that he has HIV.

Under the settlement agreement, the school is required to pay $700,000 to the child and his mother, adopt and enforce a policy prohibiting discrimination and requiring equal opportunity for students with disabilities, including those with HIV, in the school’s programs and services, and to provide training to staff and administrators on the requirements of the ADA.  The school must also pay a $15,000 civil penalty to the United States.

Both the full text of the settlement agreement and a press release announcing the settlement are available on the Department’s website.

Learn More about the ADA

To learn more about the Department’s activities, please visit its website dedicated to Fighting Discrimination Against People with HIV/AIDS.  For more information about the ADA, you may call DOJ’s toll-free ADA Information Line at 800-514-0301 or 800-514-0383 (TDD), or access the ADA Website at www.ada.gov.

[Editor’s Remarks:  Our readers may also want to be aware of the work of the Office of Civil Rights at the Department of Health and Human Services, described below].

Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990 (ADA) protect individuals with HIV or AIDS from discrimination on the basis of their disability. Section 504 prohibits discrimination by health care and human service agencies that receive federal funds. Title II of the ADA prohibits discrimination by state and local government entities even if they do not receive federal financial assistance. Title II requires that state and local governments provide individuals with disabilities an equal opportunity to participate in a service or receive a benefit from the entities’ activities, programs or services. The Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS) ensures that health care and human service agencies comply with these laws. OCR also enforces the HIPAA Privacy and Security Rules, a set of federal standards to protect the privacy and security of patients’ medical records and other health information maintained by covered entities: health plans; most doctors, hospitals and many other health care providers; and health care clearinghouses. HIPAA also provides patients with important rights such as access to their medical records and significant controls over how their personal health information is used and disclosed. OCR’s website includes helpful information for those who want to learn more about their rights under Section 504, the ADA and HIPAA: http://www.hhs.gov/ocr/civilrights/resources/specialtopics/hiv]

Stories Behind Facing AIDS: Why Do I Face AIDS?

November 20, 2012 • By AIDS.gov • no comments
Karen Walker

Karen Walker

Through the Facing AIDS photosharing initiative, you and your community can join the thousands of Americans who are helping reduce stigma and promote HIV testing by putting a face to AIDS for World AIDS Day (December 1) and beyond. Karen Walker, a nurse and a mother, wrote this powerful description of why she is Facing AIDS as part of the AIDS.gov Facing AIDS anti-stigma photo initiative.

Why do I Face AIDS
By Karen Walker

I face AIDS because of my life experiences with two small children who became my foster children in 1984. At that time, my husband and I had three adopted children living in our home, along with two unwed teen mothers and their babies.  We received a frantic phone call asking if we would please take a 4-year-old girl and her 8-year-old brother whose mother had died the day before from AIDS.  The children had not yet been told of their mother’s death, but the foster mother in whose home they living, upon hearing of their mother’s diagnosis, demanded that the state child welfare worker come and get the children immediately. When the worker arrived, the children had been placed outside on the steps with their belongings and had not been allowed back into the house. On the drive to our house, they were told of their mother’s death.  We were only supposed to be an emergency placement for one night as we already had seven children in our house, but it soon became clear that no one else would take them, so we agreed to keep them until the state could find them a permanent home.

They lived with us for 14 months, during which time the first HIV antibody test became available.  I brought the two children to a hospital to be tested and we learned that the little girl was HIV positive, having contracted the disease in utero.

After 14 months, an adoptive home was found for them with a single parent in another part of the state, but their lives were immediately pitched into turmoil. Their pre-adoptive mother had gone to register them for school and a school official had revealed the little girl’s HIV status, breaching confidentiality. An article appeared in a local newspaper that a child with an AIDS-related condition was trying to enroll and all “heck” broke loose. She was never allowed in school that year, and her brother could only attend with a court order and police escort, walking through picketing parents and TV crews, despite the fact that six lab tests showed that he was HIV negative.  For the first week of school, parents pulled their children out of his classes. It was only after the State Commissioner of Education advised those parents that their children would be considered truant, that they agreed to leave their children in school. The boy’s desk was isolated in the classroom, he was not allowed to play with anyone on the playground, and he was told not to use the drinking fountain.

At home, the children had bricks thrown through their windows, they were asked not to attend church, and they endured people running away from them in public places. Life became unbearable for them, and after 6 months, the adoption failed. A social worker came on a Friday to pick up the little girl, and on Sunday, we drove out and picked up the little boy.

Shortly thereafter, we legally adopted the boy. For many years, the state wouldn’t tell us where his sister was.  When they did tell us, we found that she had been moved to another state, and was in a great home with people who were in the process of adopting her. Sadly, she passed away 3 weeks after her 21st birthday from an AIDS-related illness, but at least we were able to be a part of her life again.

THIS IS WHY I FACE AIDS EVERYDAY. The discrimination and stigma are less than they were in the mid-1980s, but they are still very real for many people. I will fight for as long as I can, or until the stigma is gone, and a cure is found.

Thanksgiving and World AIDS Day

November 20, 2012 • By Howard K. Koh, M.D., M.P.H., Assistant Secretary for Health, U.S. Department of Health and Human Services • no comments
Dr. Howard Koh

Dr. Howard Koh

Thanksgiving is a day of gratitude for what matters in our lives. In that spirit, Thanksgiving also marks the lead-up to World AIDS Day (December 1). World AIDS Day prompts us to reflect on how far we’ve come in responding to HIV and to cherish the contributions of so many who are working to create an AIDS-free generation.

Today, I want to honor all those who are making a difference in the course of the HIV/AIDS epidemic. That group includes: people living with HIV and their partners, friends, and families; service providers; medical professionals and scientists; advocates and policy makers; and our colleagues from across the U.S. Government — including Federal staff at HHS, HUD, Justice, Labor, and VA — and so many others.

In 10 days, World AIDS Day will once again offer an opportunity to make a difference. The observance inspires us to redouble efforts for education, for supporting HIV testing, and for linking people to sustained care.

I hope you will join all of us in observing World AIDS Day! You can get more information about activities and events for the day at AIDS.gov.

Great American Smokeout: An Opportunity for Smokers Living with HIV to Improve their Health

November 14, 2012 • By Ronald Valdiserri, M.D., M.P.H., Deputy Assistant Secretary for Health, Infectious Diseases, and Director, Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services • no comments
Ronald Valdiserri

Dr. Ronald Valdiserri

Across the country, many people are preparing to take an important step to improve their health tomorrow (11/15/2012); they are planning to quit smoking. Why tomorrow? It’s the 37th Great American Smokeout Exit Disclaimer. Organized annually by the American Cancer Society Exit Disclaimer, the observance encourages smokers to use the date to make a plan to quit, or to plan in advance and quit smoking that day. By doing so, smokers—including those living with HIV—will be taking an important step towards a healthier life – one that can lead to reducing cancer and other health risks.

Smoking and People Living with HIV

In the HRSA Guide for HIV/AIDS Clinical Care it is stated that smoking prevalence among people living with HIV/AIDS (PLWH) is estimated to be two to three times greater than in the general population, with estimates ranging from 50% to 70%. This higher smoking prevalence persists despite more than two decades of research that has concluded that smoking is a widespread problem and a major modifiable risk factor for disease and death in PWLH. That research has demonstrated that smokers with HIV/AIDS are more likely than PLWH who do not smoke to:

  • Be at higher risk of a variety of tobacco-related conditions such as lung cancer, head and neck cancers, cervical and anal cancers, oral candidiasis, and oral hairy leukoplakia;
  • Be more likely to develop bacterial pneumonia, Pneumocystis jiroveci pneumonia, other pulmonary conditions, and cardiovascular disease;
  • Have a decreased immunologic and virologic response to antiretroviral therapy;
  • Be non-adherent to treatment;
  • Report lower quality of life than do nonsmoking persons with HIV/AIDS; and
  • Have a greater chance of being diagnosed with an AIDS-defining condition or dying.
    (HRSA Guide for HIV/AIDS Clinical Care and Harris, 2010)

In a study of over 5,000 persons with HIV from over 30 countries, Dr. Alan Lifson and colleagues concluded that “current smoking represented a significant risk factor for both all-cause mortality and several serious clinical disease outcomes, such as cardiovascular disease, non-AIDS cancers, and bacterial pneumonia. Significant reductions in morbidity and mortality among HIV-infected patients achieved by advances in HIV therapy may be undercut by increases in adverse clinical outcomes attributable to smoking.”

In other words, quitting smoking may be one of the most important steps toward better health that a person living with HIV can take. If you are a smoker and would like to quit, our colleagues at smokefree.gov recommend that you START by taking these five important steps:

S = Set a quit date (even if it’s not tomorrow, use the Great American Smokeout as motivation to set the date that you’ll quit)
T = Tell family, friends, and coworkers that you plan to quit.
A = Anticipate and plan for the challenges you’ll face while quitting.
R = Remove cigarettes and other tobacco products from your home, car, and work.
T = Talk to your doctor about getting help to quit.

Health Care Providers

That last tip underscores the important role that health care providers can play in encouraging and supporting people living with HIV to quit smoking. The Lifson study also concluded that encouraging smoking cessation should become a high priority for clinicians and other HIV service providers to promote health and reduce morbidity and mortality in their patients. Similarly, in its chapter on Smoking Cessation in the Guide for HIV/AIDS Clinical Care (2011), the Health Resources and Services Administration’s HIV/AIDS Bureau observes, “Although many care providers may feel that they can do little to affect the smoking behaviors of patients, evidence suggests that brief interventions by physicians are quite effective. Studies indicate that smoking cessation interventions as brief as 3 minutes in duration, when delivered by a physician, have a positive impact on abstinence rates of current smokers. Furthermore, studies have found that more than half of current HIV-infected smokers have expressed interest in, or have thought about, smoking cessation.”

To get ready to support PLWH who are prompted by the Smokeout or even a New Year’s Resolution to make the decision to quit smoking, HIV care providers may wish to review the Smoking Cessation chapter since it contains information on behavioral and pharmacologic interventions that may be useful in supporting patients seeking to quit.

Resources to Help You Quit Smoking

As you consider taking the health enhancing step of quitting smoking—or if you are supporting someone else in doing so, the following are some resources that may be helpful:

  • CDC’s Office on Smoking and Health offers a wealth of information and tools including fact sheets, e-cards to encourage friends and loved ones who have chosen to quit smoking, FAQs, and other resources.
  • Smokefree.gov provides free, accurate, evidence-based information and professional assistance to help support the immediate and long-term needs of people trying to quit smoking. Among their services is SmokefreeTXT, a mobile service designed for young adults providing 24/7 encouragement, advice, and tips to help smokers stop smoking for good. A Spanish language version of the site is available at http://espanol.smokefree.gov/.
  • It’s Time to Live: HIV and Smoking Exit Disclaimer is a 12-page brochure, developed by the New York State Department of Health, that shows how HIV and smoking work together to harm your body. It explains how your health gets better as soon as you quit smoking and gives you advice on how to quit.

 

Honoring Veterans Day

November 11, 2012 • By AIDS.gov • no comments

Today is Veterans Day and AIDS.gov salutes both America’s veterans for their service and the work of the U.S. Department of Veterans Affairs (VA). The VA is the nation’s single largest provider of HIV care and an important partner in implementing the National HIV/AIDS Strategy. Read more about the VA’s HIV/AIDS program on their website and in these blog posts.

 

Using Your Mobile Phone to Find Health Information: New Data

November 8, 2012 • By Miguel Gomez, Director, AIDS.gov, and Senior Communications Advisor, Office of HIV/AIDS Policy, U.S. Department of Health and Human Services • no comments

Pew Internet & American Life Project released new data Exit Disclaimer today on using mobile phones to access health information.

  • “One in three cell phone owners (31%) have used their phone to look for health information. In a comparable, national survey conducted two years ago, 17% of cell phone owners had used their phones to look for health advice.”
  • “Smartphone owners lead this activity: 52% gather health information on their phones, compared with 6% of non-smartphone owners. Cell phone owners who are Latino, African American, between the ages of 18-49, or hold a college degree are also more likely to gather health information this way.”

Have you asked your clients and stakeholders if they want to access your HIV related information from their phones?

With the release of the Digital Government Strategy,  we must ask ourselves “…how are we using technology to make a real difference in people’s lives.” – President Barack Obama“

We encourage you to learn more about the Digital Strategy and explore the Pew data. They are both tools to help the HIV community provide important HIV-related  information and improve people’s lives.

Working to Address HIV/AIDS in Native American Communities

November 7, 2012 • By Ronald Valdiserri, M.D., M.P.H., Deputy Assistant Secretary for Health, Infectious Diseases, and Director, Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services • no comments
Ronald Valdiserri

Dr. Ronald Valdiserri

In her statement last week on the observance of National Native American Heritage Month, Secretary of Health and Human Services Kathleen Sebelius reiterated the Department’s commitment to ensuring the health and well being of all Americans. She highlighted examples of how the Department is working to reduce the health disparities that have burdened American Indians and Alaska Natives.

American Indian and Alaska Native Heritage MonthEven though the numbers of HIV and AIDS diagnoses among American Indians and Alaska Natives represent less than 1% of the total cases, when population size is taken into account, rates are higher than those reported for whites. According to the most recent HIV surveillance report from the Centers for Disease Control and Prevention (CDC), the estimated rate of annual diagnoses of HIV infection from 2007 through 2010 remained stable nationally, but the rate among American Indians/Alaska Natives increased during that period. In 2010, the rate of HIV diagnoses in the American Indian/Alaska Native population was 9.7 per 100,000 persons. This rate is greater than the rates reported for the white and Asian and Pacific Islander populations. In addition, while the rate of annual AIDS diagnoses decreased nationally during 2007-2010, the rate of AIDS diagnoses among American Indians/Alaska Natives increased. In 2010, the rate of AIDS diagnoses was 7.2 per 100,000 persons in the American Indian/Alaska Native population. (Additional information is available in the CDC fact sheet “HIV/AIDS among American Indians and Alaska Natives” and in the CDC’s HIV Surveillance Report, 2010.)

As we observe National Native American Heritage Month, we salute our federal and community partners working to address these HIV/AIDS trends in the American Indian and Alaska Native populations. Some highlights include:

  • With nearly $4 million awarded from the Secretary’s Minority AIDS Initiative Fund in fiscal year 2012, the Indian Health Service (IHS) is working across its programs to promote and increase HIV testing and expand the capacity of IHS health centers to diagnose and treat HIV/AIDS, including individuals co-infected with viral hepatitis. Other activities are focused on re-engaging Native persons living with HIV in HIV care as well as enhancing the continuity and quality of care to people living with HIV/AIDS who have co-occurring substance abuse service needs.
  • The HIV/AIDS Bureau (HAB) of the Health Services and Resources Administration (HRSA) is implementing a special HIV care training initiative for health care providers serving American Indian or Alaska Native populations through the existing national network of AIDS Education and Training Centers. This training activity is also supported by the Secretary’s Minority AIDS Initiative Fund.
  • Several community health centers serving Native American populations are engaged in intensive HIV/AIDS care and treatment capacity building efforts through the HRSA-funded National Center for HIV Care in Minority Communities Exit Disclaimer (NCHCMC). The NCHCMC is working with federally supported community health centers serving communities of color to reduce HIV related health disparities by expanding HIV care and treatment capacity at the community level and facilitating linkages to care. Among the Native American-serving sites participating are the Southern Indian Health Council Exit Disclaimer and the Sacramento Native American Health Center Exit Disclaimer in California, the Kyle Health Center in South Dakota, and South Dakota Urban Indian Health Exit Disclaimer.

Those of us working to address the HIV/AIDS epidemic in the U.S. join the Secretary and our partners in Native communities across the country in celebrating National Native American Heritage Month and bolstering our commitment to ensuring that all American Indian and Alaska Native people have a healthier future, free of HIV/AIDS and other preventable diseases.

Video: Facing AIDS Photo App for World AIDS Day

November 6, 2012 • By Aisha Moore, Communications Director, AIDS.gov • 2 comments

Since launching the Facing AIDS mobile app in July, we have taken it on the road to AIDS 2012, the U.S. Conference on AIDS, and the American Public Health Association Annual Meeting. The AIDS.gov team has showed hundreds of people how easy it is to Snap. Write. Share. a personalized message/photo with a mobile device. If you haven’t run into AIDS.gov at a conference, we have a created a video that explains the Facing AIDS photo-sharing initiative and how to use the app.

Download the app onto your iPhone/iPad by searching “Facing AIDS” in the iTunes store. With World AIDS Day quickly approaching on December 1, you can get involved by spreading the word about Facing AIDS and using the app at home and in your community. Here’s how:

  1. Share the video in a blog post, tweet, or Facebook post
  2. Show the video at your event
  3. Embed the video onto your website.
  4. Snap. Write. Share. Facing AIDS photos!

To get ideas and see signs already submitted to the Facing AIDS photo initiative with the new mobile app, visit the Facing AIDS gallery. We hope that you can help us make our 5th year of Facing AIDS our best year.

Join us in Facing AIDS!

AIDS 2012 Lessons Continue to Resonate Across U.S.

November 2, 2012 • By AIDS.gov • no comments

Dr. Koh at AIDS 2012 PlenaryThe AIDS 2012 conference organizers recently reminded us that many resources from the conference are now available online at the AIDS 2012 website Exit Disclaimer. Whether you were able to in person in Washington, D.C. or not, you will find a wealth of information at your fingertips, including information from many of the sessions Exit Disclaimer such as slides, links to abstracts, rapporteur reports, and even webcasts of the plenary sessions and several others. (To access these features, click on “More info” at the bottom of the session entry in the online Programme-at-a-Glance.)

We’d also like to remind readers interested in learning more about significant developments at the conference or who wish to refer back to or share some of that information that all of the AIDS.gov blog posts and videos Exit Disclaimer from AIDS 2012 also are available. Our “Conversations from AIDS 2012” video series includes interviews conducted by both Dr. Howard Koh and Dr. Ron Valdiserri with federal leaders including NIH’s Dr. Tony Fauci who spoke about scientific advances Exit Disclaimer that have lead to discussion of the end of AIDS, NIH’s Dr. Gina Brown on women’s HIV research Exit Disclaimer, CDC’s Dr. Kevin Fenton on the HIV treatment cascade Exit Disclaimer, and the White House’s Dr. Grant Colfax who spoke about the National HIV/AIDS Strategy progress report Exit Disclaimer. Dr. Koh and Dr. Valdiserri also interviewed a number of non-federal partners, getting perspectives on information being shared at the conference from NASTAD’s Terrance Moore, AIDS Alabama’s Kathie Hiers, and Tiffany West of the DC Department of Health, among others.

Others colleagues have written blog posts and news stories on the conference, such as What I Learned at AIDS 2012 Exit Disclaimer by David Ernesto Munar, CEO of AIDS Foundation Chicago, and the series of AIDS 2012 Updates from the San Francisco AIDS Foundation’s Beta blog Exit Disclaimer. The Kaiser Family Foundation also released a video “look back” Exit Disclaimer at the conference, featuring perspectives on the key lessons of the conference from an expert panel.

The Black AIDS Institute Exit Disclaimer is also conducting a series of post-conference AIDS 2012 Updates Exit Disclaimer in communities across the country so that people who were unable to attend the conference are able to hear the groundbreaking information shared there.

We hope these resources are helpful in informing your work in your community and encourage you to refer back to them often and share them with others who might find them useful.

Commentary Discusses “On-the-Ground” Details Necessary to Achieve an AIDS-Free Generation

November 1, 2012 • By Miguel Gomez, Director, AIDS.gov, and Senior Communications Advisor, Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services • no comments

World AIDS Day (December 1) is fast approaching and plans are underway both here at AIDS.gov and throughout the HIV/AIDS community to mark this important international health observance, which serves as a key opportunity to raise awareness and renew and invigorate our commitment to ending AIDS.

In anticipation of World AIDS Day, Dr. Ronald Valdiserri, Deputy Assistant Secretary for Health, Infectious Diseases, and Director, Office of HIV/AIDS Policy, U.S. Department of Health and Human Services, authored a commentary in the November/December 2012 issue of Public Health Reports Exit Disclaimer providing insights into the challenges of achieving an AIDS-free generation.

In the commentary, Achieving an AIDS-Free Generation: It’s the Details the Matter Exit Disclaimer, Dr. Valdiserri maintains that while new scientific breakthroughs are key to curbing the epidemic, we also must attend to the critical “on-the-ground” details of their implementation. He proposes five principles for such implementation efforts: addressing the social determinants that fuel the epidemic, engaging communities in finding solutions to HIV/AIDS, encouraging leaders in all sectors to view the fight against HIV/AIDS as “their” fight, engineering the systems and infrastructure necessary to implement new research findings into practice, and adapting to changes in the epidemic.

As you prepare your World AIDS Day activities, I strongly encourage you to read Dr. Valdiserri’s article and use it an opportunity for discussion: what are you doing integrate evidence-based interventions into your policies and practices, and how are you attending to the day-to-day details of implementing the advances in prevention and clinical science? Use the comments box below to tell us how you and your community are adapting to new scientific advances in the ever-evolving epidemic.

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