Policy Updates: Hill Happenings and Administration Activities
*Editor’s note: There will be no weekly newsletter on the week of August 8 and 22.
Fiscal Year 2023 Appropriations
On July 28, Senate Democrats released their slate of Fiscal Year 2023 (FY2023) spending bills, bypassing committee markups and issuing party-line Chairman’s marks due to the ongoing lack of a bipartisan budget resolution. The Senate’s progress on the FY2023 spending bills comes after the House of Representatives approved a 6-bill spending minibus on July 20 that did not include the Labor, Health and Human Services, Education, and Related Agencies (LHHS) subcommittee spending bill, which was approved by the House Appropriations Committee on June 30 and awaits a full House floor vote.
Senate Democrats proposed significant increases to health programs in the FY2023 LHHS package, including a $116.5 million total increase to the CDC National Center for HIV, Hepatitis, STD, and TB Prevention. The upper chamber also included the following key increases:
- Division of HIV Prevention: $1.048 billion (+61 million)
- EHE - $250 million (+$55 million)
- School Health - $42.1 million (+$6 million)
- Division of Viral Hepatitis: $54.5 million ($13.5 million)
- Opioid and Related Infectious Diseases: $43 million (+$25 million)
- Division of HIV Prevention: $1.048 billion (+61 million)
- Health Resources and Services Administration (HRSA)
- Ryan White Program: $2.63 billion (+$135.5 million)
- Part C: $206 million (+$0.5 million)
- EHE - $260 million (+$135 million)
- Community Health Centers: $5.9 billion (+$170 million)
- Ryan White Program: $2.63 billion (+$135.5 million)
- Minority AIDS Initiative
- Minority HIV/AIDS Fund: $60 million (+$3.1 million)
- SAMHSA Minority AIDS: $118.1 million (+2.1 million)
- Housing and Urban Development (HUD) (via the Transportation, Housing, and Urban Development Bill)
- Housing Opportunities for People with AIDS (HOPWA): $468 million (+$18 million)
Notably, Senate Democrats proposed to remove restrictions on the use of federal dollars to purchase syringes and safer consumption equipment. However, Democrats will have to secure Republican support to pass the final FY2023 spending package.
With both the House and Senate Democratic spending proposals in place, Congress is expected to pivot to the reconciliation process to pass the Inflation Reduction Act before issuing a continuing resolution in September and resuming the appropriations process after the November elections. NASTAD will continue to monitor the appropriations process and advocate for the highest funding level on behalf of HIV and hepatitis programs.
NASTAD Calls on Congress to Robustly Fund Monkeypox Response
On July 19, NASTAD joined a coalition of 32 organizations and called on top appropriators to ensure that the nation’s public health system has sufficient resources to mount a robust response to the escalating Monkeypox outbreak. The infectious disease and public health advocates request a minimum of $100 million in the FY2023 LHHS bill to fund clinical services, such as testing, treatment, and vaccine distribution, and partner services, education, and community outreach. The coalition highlights the urgent need to address the monkeypox outbreak while maintaining strong funding for HIV, viral hepatitis, and STD programs that continue to face increasing rates of disease burden while managing chronic workforce limitations.
CDC Observes World Hepatitis Day
On July 28, the CDC observed World Hepatitis Day, a day to raise awareness about the global burden of viral hepatitis, which impacts more than 354 million people worldwide. This year, CDC emphasized its vision to achieve a world without viral hepatitis and recommitted the nation to reducing disparities, preventing new viral hepatitis infections, and improving the lives of those with viral hepatitis. Click here to read a Dear Colleague Letter from the CDC National Center for HIV, Viral Hepatitis, STD, and TB Prevention and Division of Viral Hepatitis leadership highlighting the agency’s work on viral hepatitis and commenting on the importance of World Hepatitis Day.
HHS Issues New Proposal to Strengthen ACA Nondiscrimination Protections
On July 25, the Department of Health and Human Services (HHS) announced that it would issue proposed rulemaking implementing Section 1557 of the Affordable Care Act (ACA)(Section 1557) that prohibits discrimination on the basis of race, color, national origin, sex, age, and disability in certain federally funded health programs and activities. The proposed rule affirms protections against discrimination on the basis of sex, including sexual orientation and gender identity, and reiterates protections from discrimination for seeking reproductive health care services. The Biden Administration is revising the nondiscrimination regulation after the Trump Administration issued rulemaking in 2020 that limited the scope and power of the Section 1557 protections. NASTAD submitted comments opposing the 2020 regulations and applauds the Biden Administration for taking steps to restore the nondiscrimination protections as Congress intended when passing the ACA.
In observance of National African American Hepatitis C Action Day (NAAHCAD) on July 25, NASTAD published a blog post in partnership with the National Black Leadership Commission on Health to highlight the significant impact of hepatitis C on African Americans and to discuss the resources available to support health departments and other partners to improve outcomes for this population.
“This information is intended as an aid for healthcare facilities and healthcare professionals developing plans for monkeypox virus infection treatment and prophylaxis for people with HIV.”
“HIVMA created this document as a reference for HIV clinicians and educators across the trainee and provider continuum to help improve the delivery of HIV care and prevention. The resources include guidelines, clinical decision-making tools, continuing education opportunities, provider directories and other resources.”
“HIV pre-exposure prophylaxis (PrEP) inequities in the US – both in terms of race and geographical location – have not only persisted in the last decade, but have increased, according to research presented to the 24th International AIDS Conference (AIDS 2022) by Dr Patrick Sullivan from Emory University.”
“From 2019 to 2020, overdose death rates increased by 44% and 39% among non-Hispanic Black (Black) and non-Hispanic American Indian or Alaska Native persons, respectively... Implementation of an evidence-based, culturally responsive, multisectoral approach is critical to reducing disparities in overdose rates. This includes addressing structural barriers and enhancing efforts such as linkage to care and harm reduction services.”
“Accelerating hepatitis B birth dose introduction, increasing coverage with the third dose of hepatitis B vaccine, and monitoring programmatic and impact indicators are essential for elimination of mother-to-child transmission of HBV.”
Georgetown O’Neill Institute/amfAR Issue Brief: Monkeypox and Meningococcal Disease Outbreaks Signal New Health Threats for Communities Heavily Impacted by HIV and Demand Immediate Action
In April 2022, a new variant of monkeypox virus infection was identified in the United Kingdom, and the first case was diagnosed in the U.S. in May. In June 2022, the Centers for Disease Control and Prevention (CDC) also announced that they were working with Florida public health authorities on a large and growing outbreak of meningococcal disease. Both outbreaks are currently concentrated among gay and bisexual men and other men who have sex with men. To meet this moment and underscore the growing threat of other infectious diseases on the horizon, the O’Neill Institute and amfAR are jointly releasing a new brief and one-page summary offering policy recommendations that include identifying emergency resources, broadening community engagement, and enhancing the outbreak response.
Fair and Just Prosecution Issue Brief: Drug-Induced Homicide Prosecutions
“This brief focuses on drug-induced homicide prosecutions. It describes why they are inherently problematic, while offering more effective, humane, and fiscally responsible alternatives. It is intended as a guide for prosecutors who are grappling with how to respond effectively to an increased number of overdose deaths in their communities and seeking to do so with evidence-based and compassionate approaches.”
“PrEP was approved for HIV prevention in the US in 2012; uptake has been slow. Black and Hispanic people have higher rates of new HIV diagnoses than White non-Hispanic people in the US. We describe the inequitable use of PrEP by race within US regions from 2012-2021.”
Cambridge University Press: Building Racial and Gender Equity into a National PrEP Access Program
“This commentary provides additional context and recommendations to maximize effectiveness of a national PrEP program for TGD, Black, and Latinx populations in the US.”
Clinical Infectious Diseases: Estimated number of people who inject drugs in the United States
“Using transparent, replicable methods and largely publicly available data, we provide the first update to the number of people who inject drugs in the U.S. in nearly ten years. Findings suggest the population size of PWID has substantially grown in the past decade and that prevention services for PWID should be proportionally increased.”
The NIH Research Education Program (R25) supports research education activities in the mission areas of the NIH. The overarching goal of this Office of Research on Women’s Health R25 program is to support educational activities that complement and/or enhance the training of a workforce to meet the nation’s diverse biomedical, behavioral and clinical research needs. As sex and gender influence multiple domains of health, courses, curricula, and methods covering a broad range of topics are appropriate for this FOA, as long as sex, gender, or both is a primary domain of focus, including HIV and women, including HIV cure, prevention, and treatment.
Surveillance Section Chief – Sacramento, CA
This position supports the California Department of Public Health’s (CDPH) mission and strategic plan by working collaboratively with state and federal agencies, local health jurisdictions (LHJ), universities, and community-based organizations to ensure efforts to combat the HIV/AIDS epidemic are targeted and effective by leveraging data and technology to advance goals, inform action and accountability, strengthen the science base of our services, and expand surveillance systems for evidence-based decision making. The Research Scientist Supervisor II (RSS II) directs and manages all aspects of HIV case and incidence surveillance in California, including managing the activities of the Quality Management Unit (QMU) and the Medical Monitoring Project (MMP)
Viral Hepatitis Epidemiologist (Job ID: 26499) – Concord, NH
The State of New Hampshire, Department of Health and Human Services, Division of Public Health Services has a full-time vacancy for Program Specialist IV. This is a grant-funded position and is subject to renewal every two years. The Viral Hepatitis Epidemiologist conducts statewide surveillance activities within the STI/HIV/Viral Hepatitis Surveillance Program. Analyzes and interprets statewide data, policies, and procedures for use in identifying and monitoring trends. Makes recommendations for the planning and development of disease surveillance, prevention, and care program activities. Applications close August 6.
- Intern, Policy and Legislative Affairs
- The Policy and Legislative Affairs (PLA) Intern will assist the PLA team in the implementation of NASTAD’s legislative and policy positions on federal appropriations and authorization legislation related to HIV and hepatitis issues. The PLA Intern supports the day-to-day legislative activity needed to implement federal legislative and regulatory goals. The PLA Intern will assist in tracking, monitoring, researching, and preparing advocacy documents on relevant HIV and hepatitis policy issues and legislation and coordinate and participate in Hill visits.
- Manager, Prevention
- The Manager, Prevention, as part of NASTAD’s prevention team, supports the organization’s capacity to support health departments (HDs) and community-based organizations (CBOs) implementation of high-impact HIV prevention programs. The position works primarily on NASTAD’s CDC-funded Capacity Building Assistance (CBA) project to provide technical assistance to HDs implementing PS18-1802, and to CBOs implementing PS21-2102. The position is responsible for managing NASTAD’s outreach and relationship-building with CBOs in the southern United States.
End Hep C SF Strategic Director – San Francisco Public Health Foundation
The EHCSF Strategic Director will assist all work groups and members by supporting the overall execution of the initiative’s strategic plan while supporting the direction of day-to-day operations. This position will focus on engaging impacted populations through the community navigator program and community meetings, manage initiative grants and budgets, and conceptualize and execute EHCSF community events. Applications close August 19.
Harm Reduction Response Team, University of Wisconsin Madison
The Division of Infectious Diseases at UW-Madison, in collaboration with the Wisconsin Department of Health Services, Communicable Diseases Harm Reduction Section (CDHRS), seeks candidates to join a team that will provide mobile harm reduction outreach services in rural Wisconsin communities. These position are responsible for providing an array of mobile-based harm reduction services including intakes and ongoing assessments to people living with and at risk for hepatitis C virus infection (HCV), and HIV and other communicable infections (e.g., STI, COVID-19,). Apply by July 27.
Program Content and Training Specialist, Supporting Harm Reduction Programs (SHaRP) – University of Washington
This position is part of a cooperative agreement award from the Centers for Disease Control and Prevention to provide technical assistance about monitoring and evaluation to syringe services programs (SSPs) as part of the National Harm Reduction Technical Assistance Center. One of the primary projects of this award is to provide technical assistance (TA) to SSPs for monitoring and evaluation activities. The University of Washington is working in collaboration with the CDC, SAMHSA, NASTAD, the National Harm Reduction Coalition, and other TA partners to provide a suite of technical assistance support to individual programs.
Social Innovations Team Lead – Baltimore, MD
Baltimore City Health Department is seeking to fill the position of the Social Innovations Team Lead for the Bureau of Clinical Services and HIV/STI Prevention. The HIV/STI Social Innovations Team is a unique and visionary program at Baltimore City Health Department that utilizes a human-centered design approach to engage with the Baltimore community on issues related to HIV and Sexually Transmitted Infection (STI) prevention. The team creates innovative, original, and engaging programming to involve the community in the heart of the Health Department’s work.
Project Data Manager, Syringe Service Program – University of Washington
We are hiring for a Project Data Manager (Research Consultant) to work closely with the principal investigator, project coordinator, survey site staff, CDC personnel, and other support staff to enact all data-related components of Project NEXUS. This position will supervise the NEXUS data team, including two research assistants, lead data analysis, and be the main point of contact for the CDC data management team. They will also provide support for the Dave Purchase Memorial Survey and the National Harm Reduction TA Center as needed.
Communicable Disease Epidemiologist – Cheyenne, Wyoming
This position will serve as the Communicable Disease AIDS Drug Assistance Program (ADAP) Coordinator, Wyoming TB Controller, and Disease Intervention Specialist (DIS) for the Communicable Disease (CD) Treatment Program. Assist in outbreak response to ensure the safety of Wyoming residents; by interviewing cases for exposure information, updating news outlets on the progress of outbreak control, and analyzing exposure data utilizing epidemiological and statistical methods.
Hepatitis Surveillance Data Analyst – New Orleans, Louisiana
This position is responsible for the data analysis activities for the Louisiana Office of Public Health STD/HIV/Hepatitis Program (SHHP), in the Hepatitis Surveillance unit. Data utilized for Hepatitis Surveillance activities include Hepatitis laboratory data, Case Report Forms, Provider Report Forms, Linkage to Cure data, investigation data, Medicaid data, and data from related sources and programs. This position will implement and coordinate data analysis activities to monitor and evaluate progress toward meeting hepatitis elimination within the state. All activities must be completed in accordance with the security and confidentiality guidelines required by the Centers for Disease Control and Prevention (CDC) and SHHP.
Assistant Commissioner - Health Department – Baltimore, Maryland
The Baltimore City Health Department (BCHD) is seeking an Assistant Commissioner to lead the Bureau of Communicable Disease and Outbreak Control. This senior management position will lead a talented team responsible for communicable disease investigation, outbreak control and emergency preparedness programming. The incumbent will also be responsible for developing and implementing agency-wide policies related to health department readiness to respond to public health emergencies. The incumbent will report directly to the Deputy Commissioner for BCHD’s Division of Population Health & Disease Prevention.
Open Positions – New York State
The New York State Department of Health, in partnership with Health Research, Inc, has various job openings, including some within the AIDS Institute. Please visit this link to learn about their current opportunities.
“Perhaps then the 10th anniversary of the FDA’s approval of Truvada for PrEP, or pre-exposure prophylaxis, on July 16, 2012, might be a cause to celebrate. It could have been an opportunity to look back on how a biomedical intervention altered queer culture and helped eradicate HIV once and for all. With 99 percent effectiveness with consistent adherence—which for the bulk of the past 10 years meant sticking to a daily pill, as well as doctor’s visits every three months and regular lab work—PrEP is theoretically as useful as a vaccine against HIV…But sheer data suggests that said sexual liberation—“Sex Without Fear,” as Tim Murphy’s seminal 2014 New York article described it—remains reserved for a privileged class.”
“Overdose death rates in the U.S. increased dramatically in 2020 as the Covid-19 pandemic arrived, especially among Black, American Indian and Alaska Native individuals, according to a new report from the Centers for Disease Control and Prevention, as deadly synthetic opioids flooded the nation and access to treatment remained elusive for millions of Americans. The rates rose 44 percent in 2020 for Black people and 39 percent for American Indian and Alaska Native people, compared to 22 percent for white people.”
“Clinics that treat sexually transmitted diseases — already struggling to contain an explosive increase in infections such as syphilis and gonorrhea — now find themselves on the front lines in the nation’s fight to control the rapidly growing monkeypox outbreak. After decades of underfunding and 2½ years into a pandemic that severely disrupted care, clinic staffers and public health officials say the clinics are ill-equipped for yet another epidemic.”
“A key piece of the Affordable Care Act is on trial Tuesday as a group of Texans challenge the law’s requirement that insurers cover preventive services — everything from STD screenings and HIV prevention drugs to depression checks and flu shots.
The case before Judge Reed O’Connor — the author of several anti-Obamacare rulings — at the U.S. District Court for the Northern District of Texas is the latest conservative-led legal effort to undermine the 12-year-old law, and could determine whether insurance companies are allowed to deny coverage or charge sky-high copays for common preventive care going forward.”