Paul Kawata

By Paul Kawata on August 30, 2011 12:13 PM | 1 Comment

The take home messages from the 2011 National HIV Prevention Conference (NHPC) were: 

1.  Funding is Shrinking
2.  Prevention Is Changing

The question is “Are You Ready?”

The Federal Budget for 2012 has not been finalized.  However, we do know that Congress and the Obama Administration have agreed to more then $2 trillion in cuts to federal spending.  As one federal official let me know, in terms of the 2012 reductions, “all cards are on the table, there are no sacred cows.”

As you’ve probably read, Congress has created a 12 member deficit reduction committee, also known as a “Super Committee” This committee is responsible for identifying/negotiating federal budget cuts.  If they can’t reach an agreement, then there will be automatic tax increases and across the board budget cuts that neither party wants.

Continue reading What’s Your Game Plan?.

By Paul Kawata on August 9, 2011 1:25 PM | No Comments

Are You Ready to start Treatment As Prevention (TasP)?  What is your agency’s role in the implementation of this promising new HIV prevention tool?  How will it change your community’s prevention agenda?  HIV Prevention Trial Network (HPTN) study 052 showed us that starting HIV-positive individuals in a treatment regimen early and reducing their viral load to undetectable can cut the risk of HIV transmission by as much as 96 percent.

Next week is the National HIV Prevention Conference (NHPC).  In advance of this meeting, I want to share my thoughts on TasP.  Without any inside information from the Centers for Disease Control and Prevention (CDC), my personal belief is that they may retool HIV prevention programs to make TasP a cornerstone for our work.  Behavioral interventions like “Prevention for Positives” will continue to be important, and HIV testing will need to remain a top priority, but now these programs will support TasP and the National HIV/AIDS Strategy (NHAS).

TasP needs a Plan with Guiding Principles. 052 worked in the study’s controlled environment – now its time for real life application.  Planning may differ depending on the region, but certain guiding principles should be consistent everywhere.  This is essential for both protecting the rights of People with AIDS (PWAs) and for ensuring the integrity of TasP.

Guiding Principles For Implementing TasP:

1. Transparent Planning Process
2. Can’t Force People Onto Treatment
3. Treatment May Not Be For Everyone
4. Treatment Education Is Essential
5. Ensure Mechanism For Payment
6. Support To Stay Compliant
7. Regular Viral Load Testing
8. Stable Housing
9. PWAs Should Lead The Way

Continue reading Guiding Principles For Treatment as Prevention: Are you Ready?.

By Paul Kawata on July 18, 2011 1:49 PM | 9 Comments

Wouldn’t it be ironic if People with AIDS (PWAs) were the reason we stopped the epidemic?! After all of the blame, all of the discrimination, all of the judgment, there is something quite wonderful about the prospect of PWAs bringing an end to this devastating disease.

At the 6th International Conference on HIV Pathogenesis, Treatment and Prevention, you can feel the excitement as people talk about HIV Prevention Trial Network study 052 or Treatment As Prevention (TAP). At a panel this afternoon, a researcher called it the “light at the end of the tunnel.”

TAP is about lowering a community’s viral load to stop the spread of HIV/AIDS. It’s about getting PWAs to an undetectable viral load as a way to support their individual health and end this epidemic. It’s not without challenges, but as one of the speakers said “we may be at the beginning of the end.” However, it’s going to take PWAs leading the way.

There is something so perfect about this solution. Not only could it stop the epidemic, but it would also benefit individuals living with HIV/AIDS. Researchers also say the solution isn’t just for wealthy countries. Treatment As Prevention should be a global goal. With the recent United Nations’ commitment to provide HIV treatment to 15 million people by 2015, we may be able to end this epidemic in my lifetime.

Continue reading Isn’t It Ironic?.

By Paul Kawata on June 28, 2011 10:52 AM | 2 Comments

2014 is the year for full implementation of the Affordable Care Act (ACA). What does this mean to HIV services? Are you ready?

As we continue to examine the transformation of our movement, what could your agency do to get ready for the ACA? How will it impact your clients? …budget? …future?

I don’t know the answers; however, I do know its time to start planning. It can get overwhelming. In my 22 years at the National Minority AIDS Council (NMAC), I’ve never seen so many critical issues coalesce at the same time.

Health Resources and Services Administration (HRSA) recently noted “the transition of HIV to a treatable chronic disease calls for increased provision of HIV/AIDS services by health centers (HC)…” They made recommendations to increase integration of HIV/AIDS services across HC programs by:

1. Adopting electronic health records (EHR),
2. Collecting and meaningfully using HIV/AIDS related data, and
3. Becoming patient-centered medical homes for patients living with HIV or at increased risk for HIV infection.

For many, HIV/AIDS has become a manageable, chronic condition, but it is also an infectious disease. Unlike heart disease, cancer and other chronic diseases, HIV can be transmitted to otherwise healthy individuals. HIV is an infectious disease that is also a chronic disease. The ACA seems to promote transitioning HIV care into medical centers like Community Health Centers (CHC). What does this mean for your agency?

Continue reading HIV Medical Services and the Affordable Care Act.

By Paul Kawata on June 15, 2011 12:22 PM | No Comments

In the June 3, 2011 Morbidity and Mortality Weekly Report (MMWR), the Centers For Disease Control and Prevention (CDC) estimated that at the end of 2008 there were 1,178,350 Americans living with HIV. This number includes approximately 236,400 people who do not know they are HIV positive. The CDC also estimated that 350,000 HIV infections were averted due to HIV prevention efforts. Research has shown that avoiding these infections saved over $125 billon in medical costs.

Unfortunately, CDC also estimates that more than 56,000 Americans are infected with HIV every year. More than half of the new infections are among gay men and/or men who have sex with men (MSM) and half are African Americans.

What do these numbers mean to your agency? Are you ready?

Continue reading What the Numbers Mean to Your Agency: Are You Ready?.

By Paul Kawata on June 8, 2011 9:33 AM | No Comments

Recently I asked “Are You Ready?” It was the beginning of a new series of musings written to support community based organizations (CBOs) through expected or unexpected transitions like: 

1. Affordable Care Act (ACA)
2. National HIV/AIDS Strategy (NHAS)
3. 12 Cities Project
4. Enhanced Comprehensive HIV Prevention Plans (ECHPP)
5. Update of Funding Formula for Housing Opportunities For Persons With AIDS (HOPWA)
6. Ryan White Reauthorization (RWCA)
7. HHS Action Plan for the Prevention and Treatment of Viral Hepatitis
8. HHS Action Plan to Reduce Racial and Ethnic Health Disparities

These musings are not my usual evocative writing; in fact, the suggestions are kinda mundane. I want my life to be committed to fighting this virus, saving lives and changing the world. Who wants to do everyday chores? Come to find out, those everyday chores are essential components for building a strong economic engine. It may not be as grand as changing the world, but without it there will be no agency.

Continue reading What is Your Economic Engine?.