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News & Notes

April 1999

NYS Budget Update | Managed Care Consumer Cuts | Pastor on Trial for Gay Ceremony | Health of Gays and Lesbians Overlooked | 3TC Recommended for Hepatitis B | Elective Caesareans

New York State Budget Update

On March 17, the New York State Assembly proposed a budget plan for 1999­2000 that rejected Governor George Pataki's sweeping cuts to AIDS and other health-related programs.

The Assembly budget plan would add $12.4 million to the AIDS services budget. The Pataki plan had proposed to cut $1 million from the permanency planning program, which helps parents smooth the transition of their children into new families in the event of their deaths; $1 million from treatment adherence programs that help people stick to the new and complex drug therapies; and $400,000 from supportive housing for people with HIV. The Assembly would restore all of those funds and add another $10 million for community-based HIV-related services.

The State Senate has not yet put forward a budget plan of its own. Referring to the Assembly proposals, Assemblymember Richard N. Gottfried, co-chair of the Assembly­Senate conference subcommittee that will negotiate the health budget, notes, "This budget plan now has to be negotiated with the State Senate. The biggest obstacle is Governor Pataki. Last year, we negotiated a pretty good budget with the Senate, but then Pataki destroyed a lot of our work with his veto ax. If we are going to protect programs that really matter to ordinary New Yorkers, we need to get him to the negotiating table."


Managed Care Consumer Cuts

While George Pataki tries to take needed healthcare services away from New York State residents, in New York City Mayor Rudolph Giuliani is the one who's economizing at the expense of citizens' basic needs. In his preliminary budget for FY 2000, Giuliani has eliminated funding for the Managed Care Consumer Assistance Program (MCCAP). A few months ago, advocates fought hard to save partial funding for this $1.5 million initiative when it fell hostage to the Mayor's fight with the City Council over last year's budget. The community-based program educates Medicaid and private insurance consumers about managed care and helps them gain access to coverage and solve problems with their HMOs. The Council is currently holding a series of hearings on the FY 2000 prelimary budget, and AIDS advocates are rallying their constituencies to lobby Health Committee Chair Victor Robles and others in support of this program.

Pastor on Trial for Gay Ceremony

As March draws to a close, a jury of thirteen Methodist ministers in the Chicago area are preparing to sit in judgment of the Rev. Gregory Dell, who is charged with "disobedience to the order and the discipline" of the church.

The charges stem from a September 19 "service of holy union" performed by Dell for two gay men at his Broadway United Methodist Church in Chicago. The cremeony is not recognized under Illinois law. If found guilty, Dell could face censure, suspension, defrocking, or other penalties. "It couldn't be clearer," according to the Rev. Stephen C. Williams, who will prosecute the case, "that Greg Dell violated his ministerial vow to uphold the church's teachings." For his part, Dell, who has spent 28 years in the pulpit, has expressed his hope that the trial will spur discussion about the church's views on gays.

Health of Gay Men and Lesbians Often Overlooked by Medical Schools

Medical school curricula will not be complete until physicians teaching in medical schools and in residency programs create educational programs that address gay men and lesbians' specific healthcare needs, says a review article published in a recent issue of the Journal of the Gay and Lesbian Medical Association.

"Strategies for Reducing Homophobia During Medical Training," by James Lock, M.D., Ph.D., an Assistant Professor in the Department of Psychiatry and Behavioral Sciences at Stanford University in Palo Alto, California, highlights the extent to which gay and lesbian health remains an overlooked area in most medical school curricula.

One survey of American medical schools found that, on average, medical students received only three hours of information on homosexuality in all four years of medical school. Further, a second survey found that, despite clear statements by the American Medical Association and the American Psychiatric Association that homosexuality is not an illness, less than half of the adult and child psychiatry training directors said they believe homosexuality is normal.

"The lack of instruction on gay and lesbian health and professors' negative attitudes toward homosexuality go hand in hand with the lack of research on the specific health needs of the gay and lesbian community," says Lock. "Medical schools must begin addressing this problem and start educating medical students about homosexuality as the health of the gay and lesbian community will be, literally, in their hands." To incorporate gay and lesbian health into medical school curricula, Lock recommends that educational programs designed to reduce the prejudice and stigma surrounding homosexuality be included throughout medical students' training in subjects such as pediatrics, adolescent medicine, infectious diseases, and obstetrics/gynecology.

"Lesbian and gay health issues can be integrated into virtually all medical school courses in myriad positive ways," says GLMA President Kathy Oriel, M.D., an Assistant Professor of Family Medicine at the University of Wisconsin. "But, due to continued ignorance about homosexuality, there remain medical school professors who still promote negative and damaging beliefs about gay men and lesbians to their students.

"Studies have shown that gay and lesbian individuals often don't seek healthcare because they fear discrimination," continues Oriel. "Physicians' antigay prejudice is a health hazard, and for far too long medical schools haven't been willing to take responsibility for their role in perpetuating this problem."

The San Francisco-based Gay and Lesbian Medical Association is an organization of 2,000 lesbian, gay, bisexual, and transgender physicians, medical students, and their supporters in all fifty states and twelve countries. Founded in 1981, GLMA works to combat homophobia within the medical profession and in society at large and to promote quality healthcare for lesbian, gay, bisexual, and transgender patients.

3TC Recommended for Hepatitis B

According to an Associated Press report, advisors to the Food and Drug Administration have unanimously recommended that the AIDS drug 3TC, also known as Epivir, be approved for use in the treatment of hepatitis B. If the FDA follows the advisory committee recommendations, which is expected, a hepatitis-appropriate dose, lower than that given to patients who have HIV, will be marketed by Glaxo Wellcome under the brand name Epivir HBV.

The advisory committee cautioned that Epivir cannot cure hepatitis B, but appears to target an enzyme important for the reproduction of the virus that causes it. This lowers the amount of hepatitis in the patient's blood and improves the liver's health. It is unclear how long hepatitis patients should stay on the drug or whether it helps those with advanced hepatitis.

Until now, the only FDA-approved treatment for hepatitis B has been injected interferon. Epivir would become the first oral therapy for the liver-destroying disease.

In a year-long study of Americans with mild to moderate hepatitis B infection, 55 percent of those on Epivir showed improvement as measured by liver biopsies, compared to only 25 percent of those on a dummy pill. According to the FDA's Dr. Heidi Jolson, hepatitis patients would have to be tested for HIV before beginning therapy on Epivir, because those with both infections would need to take the higher HIV dose. She also warned that it is unclear whether stopping Epivir could cause a dangerous hepatitis flare-up.

The hepatitis B virus infects an estimated 1 million Americans.

Elective Caesareans

Recent research from the United States National Institutes of Health scheduled for publication in the March 31 issue of the New England Journal of Medicine has important implications for HIV-positive pregnant women.

The best way to lower the chances of transmitting the virus from mother to newborn is through a combination of AZT therapy and elective caesarean section delivery. An analysis of fifteen studies of more than 8,000 births between 1982 and 1996 found a transmission rate of 7 percent with AZT alone and 10 percent with elective caesarean alone, but only 2 percent when both were used.

Earlier findings that caesareans did not reduce transmission were not based on elective procedures, according to researchers. To be effective in cutting transmission, the surgery should be performed before the pregnant woman's membranes rupture and labor begins. An estimated 70 percent of HIV transmissions to infants occur during childbirth, when the child is exposed to the mother's bodily fluids in several ways, including swallowing. Medically necessary caesareans typically are performed after the mother's membranes have ruptured and she is in labor. Performing the surgery before that happens cuts down significantly on the amount of the mother's bodily fluids to which the infant is exposed.

Back to the April 1999 Issue of Body Positive Magazine.

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This article was provided by Body Positive. It is a part of the publication Body Positive.