Participate in a Sign-On Letter to Ensure That Infectious Diseases Are Not Left Out of Health Reform Prevention Funding

Organizations are asked to sign-on to the letter below, addressed to Department of Health and Human Services Secretary Kathleen Sebelius, which requests that infectious diseases prevention activities be eligible for the $500 million Prevention and Public Health Fund that was included in the health reform law for FY2010.

As you are aware, HIV, viral hepatitis, STD, and TB were not eligible for the $650 million prevention and wellness funding in the stimulus bill formerly known as the American Recovery and Reinvestment Act (ARRA) of 2009. We do not want this to happen with the Prevention and Public Health Fund, and time is of the essence: Folks from the White House and the Department of Health and Human Services are meeting to determine the parameters of this funding.

Please note: This is an organizational sign-on letter only. Organizations wishing to sign-on are asked to send an e-mail Felicia Monahan at fmonahan@nastad.org by Friday April 23rd with the following information:

Name of the organization
City and state

Sign-On Letter

April 22, 2010

The Honorable Kathleen Sebelius
U.S. Department of Health and Human Services
Hubert H. Humphrey Building
200 Independence Avenue, SW, Room 120 F
Washington, DC 20201

Dear Secretary Sebelius:

We the undersigned organizations write today to thank you for your leadership in making health reform a reality. The new law makes significant strides in expanding access to care and prevention and modernizing our health system. A 21st century U.S. health system must include universal access to public health services that protect the health of all Americans throughout their lives, including infectious disease prevention services and treatment. As you begin implementation of the law we urge you to include infectious diseases prevention activities as eligible for the Prevention and Public Health Fund. Specifically we seek to ensure that HIV, viral hepatitis, STD and TB prevention efforts have an opportunity to be enhanced.

As you are aware, infectious diseases programs did not receive any of the $650 million in prevention and wellness funding authorized under the American Recovery and Reinvestment Act of 2009. As such we have significant concern that in an effort to obligate the $500 million by September 30, 2010, the Department will fund existing grant applications for the ARRA chronic prevention grants. This would be unacceptable to our communities. We fear that ignoring the burden of these infectious diseases will only serve to further limit the ability of the nation's public health system including state and local health departments and community-based organizations to turn the tide in preventing new infections.

HIV, viral hepatitis, STDs and TB are communicable infections that cause significant public health, economic, and social burdens for the nation. The infections are preventable through effective evidence-based public health interventions and strategies. Eligibility and access to these funds is critical to addressing the chronic underinvestment in infectious disease prevention that has resulted in sustained transmission, severe health disparities, and spiraling healthcare costs.

The Obama Administration has prioritized the importance of reenergizing the governmental response to the HIV epidemic in our nation through the development of a National HIV/AIDS Strategy (NHAS). This strategy, which we expect to be released this spring, will provide a roadmap for drastically cutting the number of new HIV infections in our nation. We also expect the NHAS to provide input on decreasing common co-infections that occur with HIV, such as many STDs and viral hepatitis. However, it will be necessary to ensure that adequate resources are available for implementation. The Prevention and Public Health Fund provides an opportunity to ensure that additional resources are available.

These infectious diseases continue to disproportionately impact racial and ethnic minorities due to a complex set of social determinants. These include stigma related to infection and related risk behaviors, poverty, unemployment, and a lack of access to care. Seventy-one percent of AIDS cases diagnosed in 2007 were among African American and Hispanic communities. The rate of AIDS diagnoses among African American women was 22 times higher than that of white women. In 2007, the rate of syphilis among African American women was more than 14 times higher than among white women. Approximately half of persons with chronic hepatitis B are Asian Americans and hepatitis C infection is 2 to 3 times as prevalent among African Americans as it is among whites. In 2007, eighty-one percent of TB cases were in communities of color.

Investments in infectious diseases will reduce healthcare costs and improve the health of Americans. Undiagnosed infections drive up medical care costs due to disease complications and ongoing transmission. It is imperative that we make individuals aware of their infections to increase quality of life and decrease costs. The cost of HIV treatment and lost productivity is largely borne by the public sector and can reach $1 million per infection. Individuals who are aware of their HIV infection are far less likely to transmit the virus; in fact they have an estimated transmission rate of 1.7 percent to 2.4 percent in contrast to estimated transmission rates of 8.8 percent to 10.8 percent for those who are unaware that they are infected with the virus. At least 3 million Americans are chronically infected with hepatitis C virus. The projected direct and indirect costs of this epidemic, if left unchecked, will be over $85 billion for the years 2010 through 2019. For every dollar spent on STD prevention, $43 is spent each year on STD related treatment costs. Treatment costs for multidrug-resistant (MDR) TB range from $100,000 to $300,000, which can cause a significant strain on state public health budgets.

A focus on community prevention is critical to addressing HIV, viral hepatitis, STD and TB. This could include long term investments, such as Health Renewal Zones, to address antecedents of risk that facilitate HIV, viral hepatitis, STDs and TB transmission by providing an array of behavioral, social and structural interventions for those structural factors which create vulnerability to these infectious diseases, as well as other health conditions.

At a time when our nation is facing new public health threats, governmental public health agencies are struggling to carry out their core responsibilities with a workforce that has lost over 11,000 employees in the last year and will likely lose thousands more this year. Health departments across the nation are experiencing budget shortfalls and in addition to being forced to reduce staff are providing fewer public health services. Investments in training, information systems, laboratories, and new technologies would increase efficiency, ensure program effectiveness and protect the health of future generations. Our nation's public health infrastructure must be shored up to adequately address the prevention of new HIV, hepatitis, STD and TB infections.

We thank you for your continued leadership on the implementation of the health reform law and support for prevention of infectious disease. We welcome the opportunity to work with you on the implementation of this critically important law.

Sincerely,

ACT UP Philadelphia, Philadelphia, PA
AID Upstate, Greenville, DC
AIDS Action Baltimore, Inc., Baltimore, MD
AIDS Action Committee of Massachusetts, Boston, MA
AIDS Alabama, Birmingham, AL
ALERT Health, Inc., North Miami, FL
American Association for the Study of Liver Diseases, Washington, DC
American Social Health Association, Washington, DC
Asian Pacific Liver Center of St. Vincent Medical Center, Los Angeles, CA
C.O.R.E. Medical Clinic, Inc., Sacramento, CA
California Hepatitis Alliance and the Center for Health Improvement, Sacramento, CA
Capitol Community Health Network, Sacramento, CA
Caring Ambassadors Program, Oregon City, OR
Children's Hospital & Research Center, Oakland, CA
Chinese Hospital, San Francisco, CA
Common Ground ? the Westside HIV Community Center, Santa Monica, CA
Community HIV/AIDS Mobilization Project, New York, NY / Providence, RI
Community HIV/Hepatitis Advocates of Iowa Network, Des Moines, IA
Dab the AIDS Bear Project, Wilton Manors, FL
Education for Healthy Choices, Sacramento, CA
Georgia AIDS Coalition, Snellville, GA
Harlem United Community AIDS Center, New York, NY
HealthHIV, Washington, DC
Help & Education for Liver Patients, Santa Cruz, CA
Hep C Connection, Denver, CO
Hepatitis B Foundation, Doylestown, PA
Hepatitis C Association, Scotch Plains, NJ
Hepatitis Foundation International, Silver Spring, MD
Hepatitis Support Network of Hawaii, Honolulu, HI
HIV Dental Alliance, Atlanta, GA
HIV Law Project, New York, NY
HIV Medicine Association, Arlington, VA
HIV/AIDS Alliance for Region Two, Inc., Baton Rouge, LA
HIVictorious, Inc., Madiston, WI
Immunization Action Coalition, Saint Paul, MN
L.A. Gay & Lesbian Center, Los Angeles, CA
Latino Commission on AIDS, New York, NY
Los Angeles Hepatitis Intervention Project, Los Angeles, CA
Lower East Side Harm Reduction Center, New York, NY
Maryland Hepatitis Coalition, Baltimore, MD
Minnesota AIDS Project, Minneapolis, MN
Missouri Hepatitis C Alliance, Columbia, MO
National Alliance of State & Territorial AIDS Directors, Washington, DC
National Association of People with AIDS, New York, NY
National Coalition for LGBT Health, Washington, DC
National Coalition of STD Directors, Washington, DC
National Pediatric AIDS Network, Boulder, CO
North Shore Health Project, Gloucester, MA
Okaloosa AIDS Support and Informational Services, Inc. (OASIS), Walton Beach, FL
Project Inform, San Francisco, CA
Ryan White Medical Providers Coalition, Arlington, VA
Sexuality Information and Education Council of the U.S. (SIECUS), Washington, DC
South Carolina HIV/AIDS Council, Columbia, SC
Status C Unknown, Medford, NY
The ACCESS Network, Inc., Ridgeland, SC
The AIDS Institute, Washington, DC / Tampa, FL
The American Academy of HIV Medicine, Washington, DC
The Center for HIV Law & Policy, New York, NY
Treatment Access Expansion Project, Jamaica Plain, MA
Treatment Action Group (TAG), New York, NY
Triad Health Project, Greensboro, NC
Urban Coalition for HIV/AIDS Prevention Services, Washington, DC
VillageCare, New York, NY
Wings for Life, Orinda, CA

cc: Jeff Crowley, ONAP
Howard Koh, ASH
Chris Bates, OHAP
Caya Lewis, OHR
Speaker Nancy Pelosi
Chairman David Obey
Chairman Tom Harkin
Chairman Henry Waxman