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This post was written by Sean Bland and Safura Abdool Karim, a 2017 Global Health Law LL.M. Candidate at Georgetown University Law Center.

On March 24, 2017, Jeffrey S. Crowley and Sean Bland of the O’Neill Institute for National and Global Health Law and Connie Garner of Foley Hoag LLP released a new report, “The Ryan White HIV/AIDS Program: Protecting and Advancing HIV Public Health Gains During Health System Reform.” Although the HIV no longer dominates headlines as it once did, it continues to affect many people within the United States. The Ryan White HIV/AIDS Program is an integral part of ensuring that Americans living with HIV have access to treatment and the support they need. Given the current uncertainty about the future direction of the United States (US) health system, effective continuation of the Ryan White Program is critical to ensuring we maintain all the progress made against the HIV epidemic thus far.

How does the Ryan White HIV/AIDS Program work?

The Ryan White HIV/AIDS Program is a federal program that provides medical care, prescription drugs, and support services to more than a half a million uninsured and underinsured people living with HIV/AIDS in the US. Although most Ryan White clients (80% in 2015) have some form of insurance coverage, the Ryan White Program affords them access to critical and important services that are not covered by their insurance. The program provides models for integrated care that brings together physical and mental health services. It also provides mechanisms to monitor health outcomes and ensures capacity to provide HIV medical care across the country through both technical assistance and funding.

The Ryan White Program operates as a safety net to ensure patients with HIV get access to the medical care and services they need in a cost effective and coordinated manner.

What has the Ryan White HIV/AIDS Program done?

The Ryan White HIV/AIDS Program began in 1990 and was initially an emergency response to the growing HIV epidemic in the US. Since its inception, the Ryan White Program has continued to receive bipartisan support and has been reauthorized by Congress four times. With each reauthorisation, the program has evolved to better respond to the changing HIV epidemic. Although the Program’s authorization has now lapsed, it has continued functioning under its prior authority and has been funded through annual Congressional appropriations. Since the last reauthorization in 2009, there have been meaningful scientific developments. The Affordable Care Act has also expanded insurance coverage to many people with HIV, which has prompted many states to shift the focus of their programs to focus on other issues, including mental health and substance abuse treatment as well as cost-sharing assistance. The role of the Ryan White Program will likely become even more critical as the health system changes.

The Ryan White Program has led to tangible improvements in health outcomes including increasing rates of viral suppression and reducing health disparities. These outcomes have the further benefit of reducing new HIV infections. This is because when people with HIV are virally suppressed – i.e. the amount of HIV virus within their blood is undetectable – they do not transmit the disease to other people. In fact, The Partners of People on ART–A New Evaluation of the Risks (PARTNER) Study, a European observational study of serodiscordant partners (one partner was HIV positive and one was HIV negative), recently found that no transmissions resulted from virally suppressed individuals.

Preventing HIV infections also results in reducing health care costs. The estimated medical cost saved by avoiding one HIV infection is $229,800. In 2014, there were 8,500 fewer HIV infections than in 2008.  That difference in annual infections alone will result in $2 billion in less national health care spending.  If these trends of fewer infections continue, the savings to the nation will grow exponentially. However, these costs are only avoided if people living with HIV continue to achieve viral suppression.

Given evidence regarding the importance of viral suppression in prevention efforts, consideration should be given to how the Ryan White Program could increase population-level HIV viral suppression by leveraging program data to address populations and communities with the most urgent needs. Promoting and expanding access to pre-exposure prophylaxis (PrEP) for HIV prevention is another potential role the Ryan White Program could fulfill in the future. Policy makers could also consider whether there could be a role for the Ryan White Program to be expanded to address other health issues such as Hepatitis C.

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


The Differential Treatment of FGCS & FGM/C: A Legal Double Standard?

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This post was inspired and informed by the collaborative research conducted by Ranit Mishori, Kevin FitzGerald, Sam Wu and Holly Hedley as part of the Georgetown Complex Moral Grant.

Image courtesy of The Telegraph

After a three year investigation, the UK’s Crown Prosecution Service (CPS) announced in late February of 2017 that it would not prosecute a surgeon and psychiatrist involved in a clitoris removal operation performed on an adult woman. Both physicians published a case study about the operation in 2012 and after reading it, another physician urged the CPS to investigate the case because it appeared to breach the UK’s law banning female genital mutilation/cutting (FGM/C). The case highlights some of the difficult questions that physicians and policymakers are currently considering as they struggle to reconcile a growing culture of female genital cosmetic surgery (FGCS) with the definitions included in well-established laws prohibiting FGM/C.

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


Obamacare Is the Law of the Land… Now What?

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This post was written by Andrew Hennessy-Strahs, a 2017 Global Health Law LL.M. Candidate at Georgetown University Law Center. Any questions or comments can be directed to adh75@georgetown.edu.

“Obamacare is the law of the land,” spoke Paul Ryan late Friday afternoon, following the collapse of support for his proposed legislation, the American Health Care Act (AHCA), which would have massively reshaped the health care landscape. The Onion, admittedly a satirical newspaper, proclaimed, tongue-in-cheek, “GOP Makes Good On 2009 Promise To Block President’s Healthcare Bill.” The AARP proudly issued a statement: “Controversial Health Care Bill is Pulled: Voices of Americans were Heard.”   Nancy Pelosi, House Minority Leader, forcefully opposed the proposed vote on her twitter account: “Every single Republican who votes for #TrumpCare will have this moral monstrosity tattooed to their foreheads forever. Every. Single. One.” She then celebrated the withdrawal of the AHCA, also on twitter: “This was a victory for all Americans. Democrats — united by our shared values — have stood strong against the disastrous #TrumpCare bill.”  Even the Heritage Foundation, the standard-bearer for the Conservative movement, led with the headline: “Broad Conservative Criticism Mounts Against GOP Health Bill.”

What was the AHCA? Why was it so lampooned? And most importantly, what is the future of health reform in the United States?

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Posted in Health reform; Tagged: , , .


World Salt Awareness Week: innovative regulations to reduce salt intake

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Although it may seem like a harmless part of everyday life, high salt intake contributes to serious health risks that cause millions of deaths each year. This World Salt Awareness Week, we examine the health impacts of excess sodium intake, key sources of sodium in our diets, and an innovative regulatory intervention that can help reduce this “forgotten killer.”

Recommended levels of sodium

Most of the sodium we consume comes from salt. The World Health Organization (WHO) recommends that adults consume less than 2,000 mg of sodium, or 5 grams of salt, per day. This equates to less than one teaspoon of salt. The 2015-2020 Dietary Guidelines for Americans recommended that people aged 14 years and older consume less than 2,300 mg per day.

Globally, and within the United States, the majority of people consume too much sodium. Global average salt intake is estimated at 9 – 12 grams per day, double WHO’s recommended levels. In the United States, adults consume an average of more than 3,400 mg each day. Nearly 90% of US children consume more sodium than recommended.

Key sources of sodium

According to the CDC, more than 75% of sodium consumed by Americans comes from processed, prepackaged, and restaurant foods. More than 40% comes from 10 types of food, including bread, deli meats, pizza, poultry, and pasta dishes. Around 5% of dietary sodium is added during at-home meal preparation and 6% is added to food at the table. Read More

Posted in Non-communicable diseases; Tagged: , , .


Why You Should Attend This Year’s Health Rights Litigation Intensive

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Image courtesy of O’Neill Institute

“Participating in the Health Rights Litigation course in September of 2013 granted me the opportunity to interact with some of the best minds on health and human rights in the world. I was among forty-four participants who were representative of twenty-four countries from around the world. I attended the course at a time when KELIN had a court case challenging the wrongful imprisonment of two TB survivors, who had interrupted their treatment. Plans were also underway to file a case to safeguard the rights of five women living with HIV who had been subjected to forced and coerced sterilization.

Listening to Manuel José Cepeda Espinosa, former Chief Justice of Colombia’s Constitutional Court, helped shape my thoughts on how to frame some of the remedies that I was seeking in relation to the two cases. Given that Colombia had similar constitutional provisions as Kenya, I could relate to the great talk by the learned Justice. The TB case was successful and some of the structural remedies that we included, based on what I learned, were granted by the court. I made connections with representatives of the International Community of Women Living with HIV- Global (ICW-Global), and they have since joined onto our ongoing cases as an interested party. Other global health professionals have joined onto the case as friends of the court. This is attributed to the global platform provided by this intensive but informative course. I recommend it to anyone keen to make a change in health by using the law.”

-Allan Maleche, Executive Director of KELIN

“Attending the Health Rights Litigation course on sexual and reproductive health and rights (SRHR) litigation in November of 2014 enabled me to engage with advocates with different political contexts and legal backgrounds from other countries and regions. As an SRHR advocate in Brazil and Latin America, I was able to deepen my knowledge of the historical and political differences and controversies between the sexual rights and the reproductive rights movements, share lessons learned at a historical moment, following the ICPD beyond 2014 review process, and discuss major gains and challenges remaining 20 years after the adoption of the Cairo Program of Action. We were also able to learn about pioneering legal research on the impact of SRHR litigation in different countries, advances in comparative law, new and emerging SRHR themes, and successful litigation strategies employed in countries like India, Colombia and Argentina.

In the months following the course, through my organization Ipas and with key support from the organizers of the Health Rights Litigation course and other regional partners such as Promsex and CLACAI, I was able to organize a regional workshop directed towards legal scholars and advocates from different countries in Latin America and aimed at sharing lessons learned and promoting the use of strategic litigation on SRHR based on recent progressive decisions from national and regional courts, building on decades of political struggle, mobilization and advocacy in the region.”

-Beatriz Galli, Senior Regional Policy Advisor for Latin America at Ipas

Applications for the 2017 Health Rights Litigation Intensive are available here and are due April 10, 2017.

Additional information about the course can be found here, including scholarship opportunities.

Posted in Human Rights; 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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