ADAPs, Latinos, and HIV/AIDS Infrastructure

1. ADAPs, Latinos, and HIV/AIDS Infrastructure ADAP Advocacy Association 6th Annual Conference AIDS Drugs Assistance Programs: Renewing the Commitment June 7th, 2013 John Hellman Director of Advocacy Latino Commission on AIDS

2. Latino Commission on AIDS Founded in 1990 to fight HIV/AIDS in at-risk communities nationwide Shaped by national AIDS advocate Dennis deLeon from 1994 to 2009 Local , Regional and National Services in more than 40 States, Puerto Rico & the Virgin Islands. Long demonstrated history of building national, regional and local coalitions Five core areas: Hispanic Behavioral Research Center HIV Prevention & Health Promotion Capacity Building Assistance (CHANGE approach) HIV Testing and Access to Care Health Policy & Community Mobilization Picture by: bleacher + everard

3. “Of all of our national holidays, Independence Day is the one most intimately rooted in our common history and shared experience. Yet this year it arrives against a background of polarization, separation, and confrontation in the states and Washington alike. With municipal politics as the occasional exception, the pattern of solidifying agreement within the parties—and widening disagreement between them—is dominating our decisions at every level.”

4. Goals • Understand the vital role ADAPs will continue to play for HIV positive Latinos • Consider our HIV/AIDS infrastructure through a Latino-centric lens • Brainstorm strategies to address the post-ACA and post-CIR (?) landscape for Latino HIV care

5. Structure • HIV/AIDS Trends • HIV/AIDS and Latinos • Foreign born vs. U.S. born • Geographic concentration • Post-2014 ACA Landscape • The impact of (not) implementation • Possible Impact of CIR • Discussion

6. HIV/AIDS Trends

7. HIV Infections in the US

8. Treatment Cascade Gardner, et al., 2011

9. Awareness of Serostatus Among People with HIV: Estimates of Transmission Accounting for: ~46% of New Infections ~75% Aware of Infection ~54% of New Infections ~25% Unaware of Infection PWHA: 1,039,000-1,185,000 New Sexual Infections Each Year: ~32,000 Source: R. Russell. Guidance to Integrating Affordable Care Act, National HIV/AIDS Strategy and Ryan White. Ryan White 2012 Grantee Meeting;AIDS 2006, 20:1447-50.

10. HIV/AIDS, ADAPs, and Latinos

16. Post-2014 ACA Landscape

17. Insurance and Care for PWHA 17 Source: R. Russell. Guidance to Integrating Affordable Care Act, National HIV/AIDS Strategy and Ryan White. Ryan White 2012 Grantee Meeting.

18. The Henry J. Kaiser Family Foundation, (2012). How the ACA changes pathways to insurance coverage for people with HIV. Retrieved from website: http://healthreform.kff.org/notes-on-health-insurance-and-reform/2012/september/how-the-aca-changes-pathways-to-insurance-coverage-for-people-with-hiv.aspx?CFID=567585223&CFTOKEN=74185225&jsessionid=6030aa207ae092ba6d8019601b655963616b

19. 19 The Henry J. Kaiser Family Foundation, (2012). How the ACA changes pathways to insurance coverage for people with HIV. Retrieved from website: http://healthreform.kff.org/notes-on-health-insurance-and-reform/2012/september/how-the-aca-changes-pathways-to-insurance-coverage-for-people-with-hiv.aspx?CFID=567585223&CFTOKEN=74185225&jsessionid=6030aa207ae092ba6d8019601b655963616b

20. Medicaid Expansion and Ryan White Source: hivhealthreform.org • Ryan White becoming payer of last resort • Relief to an increasingly underfunded Ryan White Program • New investments in community-based care • Transitioning clients to Medicaid • Today, 70% of Ryan White clients have insurance and rely on RW to supplement limits in coverage • Health insurance alone does not cover cost of HIV care or services needed to keep PWHA in treatment • Role of Ryan White likely to continue

21. Post Implementation of the ACA: Remaining Uninsured Undocumented immigrants Legal immigrants within 5 year ban Individuals exempt from the mandate who choose to not be insured (e.g., because coverage not affordable) Individuals subject to the mandate who do not enroll (and are therefore subject to the penalty) Individuals who are eligible for Medicaid but do not enroll Source: R. Russell. Guidance to Integrating Affordable Care Act, National HIV/AIDS Strategy and Ryan White. Ryan White 2012 Grantee Meeting.

25. Possible Impact of Comprehensive Immigration Reform

26. S. 774 The Border Security, Economic Opportunity, and Immigration Modernization Act of 2013 • Passed the Senate • Low-income people granted RPI status would have to wait, at a minimum, 13 to 15 years to become eligible for federal means-tested public benefit programs • RPIs will have a minimum 10-year wait before they will be able to buy affordable health insurance under the ACA

27. CIR in the House of Representatives • Bipartisan talks failed – one of the issues re: health care access • Speaker John Boehner will not consider Senate bill • Republican/House bill will likely have more restrictions, may not have pathway to citizenship

28. Discussion • How are these policy issues impacting work in your state? • In an endlessly polarized political environment, how can we strategize? • How can we centralize HIV positive Latinos in our overall HIV/AIDS strategy?

29. Thank you! Phone: 646-375-4415 Email: jhellman@latinoaids.org