NMAC Releases Blueprint for HIV Biomedical Prevention Part II

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Over the past two years, the O’Neill Institute has been working in partnership with NMAC to examine the status of biomedical HIV prevention research and implementation in the United States. The focus of this work has been to explore how to bring the promise of biomedical HIV prevention to all communities highly impacted by HIV and to ensure that communities of color in particular are not left behind. Biomedical HIV prevention offers a range of tools that can effectively prevent HIV infection. These tools include treatment as prevention (TasP), pre-exposure prophylaxis (PrEP), and post-exposure prophylaxis (PEP).

Last week, NMAC released a new report, “Expanding Access to Biomedical HIV Prevention: Tailoring Approaches for Effectively Serving Communities of Color,” as the second part of its two-part Blueprint for HIV Biomedical Prevention. Jeffrey Crowley and I prepared the report for NMAC. The report highlights the unique challenges that people of color face in HIV prevention, care, and treatment and gives ways to improve access to biomedical HIV prevention in communities of color.

The report outlines population-specific recommendations to more effectively meet the needs of transgender people of color, Black and Latino gay and bisexual men, women of color, and adolescents and young adults of color. It also includes further steps that can be taken separately in service of transgender women of color and transgender men of color.

Recommendations for Transgender People of Color

  • Build the capacity of the HIV clinical and non-clinical care systems to meet the needs of trans people of color
  • Hire trans people of color in our agencies
  • Generate high quality trans-specific data
  • Address safety concerns over HIV medications and hormones

Recommendations for Black Gay and Bisexual Men

  • Follow the science to bring evidence-based interventions, such HIV Prevention Trials Network (HPTN) 073, to scale in the real world
  • Actively counter mistrust of providers and the health system
  • Cultivate a diverse scientific and clinical workforce trained in applying multidisciplinary approaches
  • Educate the support systems for Black gay and bisexual men

Recommendations for Latino Gay and Bisexual Men

  • Bolster community resiliency through culturally responsive and linguistically appropriate interventions
  • Tailor HIV treatment and prevention efforts to specific Latino subgroups
  • Promote leadership among Latino gay and bisexual men to address issues disproportionately affecting their peers
  • Center the voices of undocumented Latinos

Recommendations for Women of Color

  • Tailor HIV prevention messages to reach women of color
  • Offer PrEP in family planning clinics
  • Educate providers about the importance of PrEP for women of color
  • Support the adoption of new models of trauma-informed primary care
  • Address unique issues related to juggling family, work, and other responsibilities

Recommendations for Adolescents and Young Adults of Color

  • Work to obtain FDA approval of PrEP for adolescents under age 18
  • Identify and share best practices for addressing consent, confidentiality, and cost barriers for PrEP
  • Work to augment resources dedicated to reach young people of color who need ART or PrEP and support them in staying in care and adhering to their medication
  • Disseminate HIV prevention information through youth serving organizations
  • Build support for comprehensive health education and the integration of PrEP information into health education curricula
  • Educate communities of color about state laws that affect the sexual health of young people

Increasing access to biomedical HIV prevention without reaching people and communities of color and understanding their needs, values, cultural backgrounds, and barriers to care will cause us to expand rather than shrink HIV-related disparities and health inequities. To learn more, you can read this report and the “Blueprint for HIV Biomedical Prevention: State of the State” report here.

Posted in HIV, National Healthcare; Tagged: , , , .


I Stand With Immigrants

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Image courtesy of Hardy Services.

I stand with immigrants. I stand with refugees. I stand with migrants the world over.

I stand with immigrants because outside the Cradle of Humanity, we are all immigrants. Even there, how many people trace their roots to the dawn of humankind, and how many come from someplace else?

I stand with Immigrants in my own country, the United States, this land of liberty, where we now betray the promise of justice for all – for where is the justice in breaking up families, or sending people back to countries where they may be killed, or forcing people driven by economic or other desperation away from the country of their birth to risk deadly desert treks in Texas and Arizona? I stand with refugees and all immigrants in my country because we must be the land of the Statue of Liberty, of Emma Lazarus’s “huddled masses yearning to breathe free,” the land of a torch of hope held high, not of high walls and hateful rhetoric. I stand because it is a fearful America that closes its doors, not a great America. A fearful America excludes. A great America includes. A fearful America hates. A great America loves.

I stand in wonder at the beauty and intonations of languages that I do not understand, words in languages of lands near and far that I hear around the corner, that my neighbors speak in my building. Hear the music. If you have trouble connecting with words, connect with a smile. Bask in your fortune that people from parts of the world to which your travels may never take you have come to you instead, these once foreign, once unfamiliar, gifts of sharing and learning and understanding. Welcome.

I stand with refugees and other migrants because I am ashamed of my country. The United States has historically been the greatest contributor to climate change, which is now disrupting rainfall pattern and leading to economic dislocation that drives people to leave countries in West Africa. People are forced to leave their homes in part because of us. Yet we offer refuge to so few.

I stand because I am proud that people want to come to my home, a land of many cultures and languages and peoples. The fabric of America is the fabric of the world. Unweave that fabric, unweave America. A nation homeless.

I stand with the asylum seekers in the United States who flee gang violence in Central America. I stand will all immigrants who are here now and want America to be home, who call America home, who know America is their home.

I stand with refugees because my grandparents survived the Holocaust. They were refugees welcomed by Sweden, then the United States. My family is a family of immigrants to America. My father came in January 1952 by way of the torch held high.

I stand with asylum-seeking immigrants in Israel, fleeing the totalitarian regime of Eritrea and the recently genocidal regime of Sudan, yet finding themselves now in a land that treats them as criminals. Is this the country of tikkun olam, repair the world, of a people who were slaughtered when the world denied them refuge? A strong Israel welcomes. A strong Israel treats African and Palestinian and Jew alike, with dignity.

I stand with the Rohingya of Burma and the people of Syrian, who more than 70 years after “never again” flee genocide and crimes against humanity. On our watch.

I stand with the refugees fleeing mass atrocities in South Sudan and the Democratic Republic of Congo, the refugees who fear the Taliban in Afghanistan, the refugees who are turned away from Australia, the Palestinian refugees in Gaza, the West Bank, and beyond, refugees generation after generation.

I stand with internal migrants too, including those Chinese laborers and their families whom the Beijing government has deemed “low-end people.”

I stand for the human rights of all immigrants, of all migrants, for their rights to health care, education, employment, their right to be integrated into civil and political life, because they are people. When they adopt a new home, their new home should adopt them. “Them” is “us.” “They” are “we.”

All rise.

Posted in Human Rights; Tagged: , , , , , , .


Legal Barriers, Stigma and Discrimination Drive TB Among Migrants

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Image: radiocampuslorraine.com


Globally, the number of international migrants continues to increase. Yet, gaping health barriers continue to impede the realization of their right to health and undermine efforts in the fight against TB. In 2017 there were 258 million international migrants, an increase of 49% since 2000.[1]

Migrants face many barriers accessing health services, including TB prevention, testing, treatment and support, during transit and upon arrival in the destination country.[2] They are often also exposed to conditions which significantly increase their risk of TB, including detention in immigration centers, where they may not have access to adequate nutrition, sanitation, ventilation and TB testing and treatment.

Social and economic inequality and discrimination in law, policy and practice impedes migrants’ ability to safeguard their health, lives and well-being. Many migrants arrive in the destination country with low socioeconomic status, and may have insecure working arrangements (e.g., domestic workers), lack meaningful legal protection from occupational and safety hazards (e.g., miners), increasing their risk of acquiring TB and imposing challenges accessing health services.[3] Stigma, xenophobia and language and cultural barriers may lead to exclusion from and avoidance of health systems, including discriminatory treatment by health workers. Given these and other barriers, it is unsurprising that migrants experience disproportionately high rates of TB.

While most of the available research focuses on TB and migration from low- to high-income countries and not migration between low-income countries, the available data highlights the need to strengthen continuity of care across borders and ensure that legal frameworks enable migrants to access TB-related health services, including beyond initial entry into the destination country. A few relevant statistics:

  • In 2005, two-thirds of the TB cases in Norway were among immigrants; TB rates were 7-9 times the general population.[4]
  • A 2013 study of high-income countries found that foreign-born individuals made up over half of all TB cases with incidence rates 8.7-18.4 times that seen in the local-born population.[5]
  • In 2014, more than half (62.4 %) of all TB patients in Germany were immigrants.[6]
  • TB rates declined only gradually among Somali immigrants in Denmark during the first seven years,[7] highlighting the ongoing barriers faced by migrants and the need to address migrant’s determinants of health.

While legal barriers and discrimination impedes migrants’ ability to access health services, enabling laws provide an environment which safeguards their right to health. Not all legal frameworks are clear cut–in some countries the extent to which the law protects the right to health of migrants is unclear and/or not meaningfully enforced in practice.

The legal status of migrants in the destination country and lack of documentation are significant barriers, particularly for undocumented migrants who may also fear deportation, detention, or other punitive or adverse immigration implications if they seek health services.[8] Insufficient legal protection against discrimination, lack of clear provision in law guaranteeing the right to TB and other health services for migrants, lack of/non-realization of labour protections and occupational and safety standards, among other legal and policy barriers, create a situation in which migrants are at high risk of TB; yet are simultaneously excluded from public health systems.

In the lead up to the UN High-Level Meeting on Tuberculosis this September and beyond, and to meet Sustainable Development Goals to end TB by 2030, countries should review their immigration-related, public health, criminal, constitutional, non-discrimination and other relevant laws and policies against human rights standards, ensuring that they are enabling rather than punitive and discriminatory including by:

  1. Repealing laws which are discriminatory, punitive or have adverse immigration consequences for people with TB and/or communicable diseases (i.e. laws prohibiting entry or allowing for detention or deportation of migrants with TB, laws impeding the right to health services on the basis of legal status and/or having documentation); and
  2. Enacting, implementing and enforcing laws and policies which enable migrants to meaningful realize the right to the highest attainable standard of physical and mental health, inter alia, that:
    • clearly provide for a justiciable right to health and access to health services for migrants;
    • facilitate coordination of TB services across borders to ensure migrants have continuity of care;
    • clearly provide for labour protections for migrants, including occupational health and safety standards, without adverse immigration or other consequences;
    • address social determinants of health that increase the risk of TB for migrants including education, employment, housing, nutrition, sanitation and poverty, among others; and
    • address language and cultural barriers within health systems.





[1] https://www.un.org/development/desa/publications/international-migration-report-2017.html.

[2] http://stoptb.org/assets/documents/resources/publications/acsm/KP_Mobile_Spreads.pdf.

[3] http://stoptb.org/assets/documents/resources/publications/acsm/KP_Mobile_Spreads.pdf.

[4] https://academic.oup.com/ije/article/34/5/1005/645880

[5] https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-016-0595-5.

[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4754836/.

[7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730343/.

[8] http://stoptb.org/assets/documents/resources/publications/acsm/KP_Mobile_Spreads.pdf.

Posted in Global Health, Human Rights, TB; Tagged: , .


Rethinking Obstetric Violence: Is Criminalization Really the Only Way Forward?

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Image courtesy of http://www.may28.org/

This post was written by Isabel Barbosa and Rebecca Reingold in honor of the International Day for Maternal Health and Rights.

Obstetric violence is disrespectful, abusive, and neglectful treatment by health providers during the provision of health care related to pregnancy, childbirth, and the post-partum period in both public and private settings. Experiences of obstetric violence include: physical abuse; humiliation or verbal abuse; coercive or unconsented practices; refusal of treatment or admission to a health facility; unnecessary use of medication; failure to maintain confidentiality or obtain informed consent; detention in facilities for failure to pay; discrimination based on race, ethnic or economic background, age, HIV status, gender non-conformity, etc; among others.

Such practices can be a powerful disincentive for women to seek and use maternal health care services and may have direct adverse consequences for both the mother and infant. They also result in violations of not only ethical principles that guide health providers’ behavior but also women’s human rights, including their rights to health, integrity, autonomy, equality, freedom from discrimination, and information.

Read More

Posted in Human Rights; Tagged: , , , , , , .


O’Neill Institute Co-Sponsors Oral Health Convening Focusing on Children with Special Health Care Needs

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A few weeks ago I posted a blog about Deamonte Driver, a twelve year old boy who died of a toothache in Maryland in February 2007. It is hard to believe a child can die in the United States from an untreated cavity, especially so close to the nation’s capital. While Deamonte’s death sparked outrage and change in Maryland, much still needs to be done in the District, especially for children with special health care needs.

Americans face barriers to accessing dental health care. This is especially true for those that are uninsured, low-income families, communities of color, and people with disabilities. Over 48 million people live in areas in the United States with dentist shortages. While 72 million children and adults rely on Medicaid and the Children’s Health Insurance Program (CHIP), only about one-third of dentists accept public insurance.

Last week with generous support from the George E. Richmond Foundation, Georgetown University’s Health Justice Alliance, the O’Neill Institute, and the Harrison Institute for Public Law hosted a convening focusing on barriers to accessing oral health care for children with special health care needs in Washington, DC. The event gathered professionals and scholars working in health care and oral health to bring awareness to the lack of access to oral health care for children with special health care needs, particularly those from low-income areas in Washington, DC.

The convening served two purposes: (1) to draw attention to the fact that there are a number of barriers to accessing oral health care for children with special health care needs in Washington, DC; and (2) to identify possible solutions to these barriers.

One of the highlights of the day was the morning panel, which set the stage for the day and consisted of two parents of children with special health care needs—Jana Monaca and Eva Scheer—and Dr. Grant-Anamelechi, a practicing dentist. The panelists shared their personal experiences and identified some of the barriers to accessing oral health care in the Washington, DC area.

Jana Monaco is an advocate and a mother of four, two of which have a rare inborn metabolism called Isovaleric Acidemia. Her son, Stephen, 20, suffered severe brain damage at the age of 3 ½ leaving him with severe disabilities and complex medical issues due to a lack of comprehensive newborn screening at birth. Eva Scheer, has two sons. Her son Cade, 17, has autism and attends high school in Montgomery Country’s autism program.

These women shared powerful stories of how they advocate for their children and the importance of oral health for the overall well-being of their children. They shared anecdotes of both good and bad experiences taking their sons to the dentist. Going to the dentist can be a scary experience for any child, but this is especially true for children with physical and/or mental disabilities. One particular example Eva shared is that the use of a weighted blanked really helped her son Cade feel safer and more secure at the dentist. They shared how noises can be very distracting and scary for children with disabilities, especially at the dentist.

Dr. Grant-Anamelechi is the owner of Children’s Choice Pediatric Dentistry and Orthodontics in New Carrollton, MD. She practiced for a number of years prior to opening her own practice. Dr. Grant was recently named one of America’s Top Pediatric Dentists by Consumers’ Research Council of America. Her patients range in age from five days old to twenty-six years old. Dr. Grant has an acute awareness of her patients’ needs, and this extends to her patients with special health care needs. During the panel she shared some of the tools she has implemented at her practice to ensure a safe and enjoyable dental experience for children with special needs and their parents. This starts from scheduling the appointment, where her staff asks about special accommodations or requests that will help make her patients feel more comfortable. Dr. Grant spoke to the importance of being aware of when a child enjoys stimulation versus when a child does not. For some of her patients that are bothered by noises, she implements a quiet time right before the child arrives for his or her appointment that lasts until the patient leaves. This includes shutting off the television or any music that may be playing in the waiting room or dental suite. Another tool Dr. Grant has found useful is creating a PowerPoint presentation for her patients with photos of her staff and the office so her patients can become familiar with the people and the environment prior to their dental visit. For many of her patients, this helps ease tension and anxiety about going to the dentist.

The morning panel was followed by breakout sessions where participants had opportunities to delve deeper into five main barriers related to accessing oral health care. The five breakout session topics were: (1) transportation, (2) case management oversight, (3) financial incentives, (4) scope of practice, and (5) school-based health centers.

Following the breakout sessions was the afternoon panel titled Where to Go from Here: Improving Oral Health in the District and Beyond, which included two dentists and public health experts, Dr. Joan I. Gluch (UPenn Dental) and Dr. Jay Balzer (Dental Public Health, NYU Langone Hospital and Medical School in New York) who discussed their experiences working in oral health in their cities. They recommended policy solutions that have been utilized in their respective communities including engaging both the private and public spheres and universities to help ensure access to oral health services for children with special health needs. Dr. Gluch shared her experiences of integrating a mobile oralhealth unit as well as training health care workers to provide certain oral health treatments which helped increase access to oral health care and cut costs in Philadelphia. Dr. Balzer emphasized the importance of bringing oral health facilities to the people that need them the most, rather than forcing patients to find their way to dentists themselves, which is burdensome for low-income individuals and people with disabilities.

The day ended on an optimistic note with promises of continuing this important conversation long after the convening. The participants were highly engaged in the day’s events and the organizers hope to build on this momentum to make positive policy changes to ensure improved access to oral health care for children with special health care needs in the District and beyond.

Posted in Health reform, National Healthcare, Resources; Tagged: , , .


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The views reflected in this blog are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.

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