Letter to Secretary Michael Leavitt, Department of Health and Human Services
Secretary Michael Leavitt
Department of Health and Human Services
200 Independence Avenue SW
Washington, DC 20201
September 2, 2005
Dear Secretary Leavitt,
Along with the rest of the country, we are deeply touched by the rapidly emerging tragedy in the aftermath of Hurricane Katrina. We know you are actively engaged in leading the public health response to the emergency, and we offer our support and best wishes in that difficult task in the days, weeks and months ahead. We were pleased to hear your proclamation of a “public health emergency” in the area in recognition of the tremendous public health challenges that are part of this disaster.
As people living with HIV/AIDS, we are especially concerned about the especially vulnerable position of tens of thousands of our HIV+ brothers and sisters in the impacted area. There are many immediate, mid-term and long-term issues that will literally be life and death for people living with HIV/AIDS. We hope that you will make certain that these issues are addressed in a timely, effective manner.
Department of Health and Human Services
200 Independence Avenue SW
Washington, DC 20201
September 2, 2005
Dear Secretary Leavitt,
Along with the rest of the country, we are deeply touched by the rapidly emerging tragedy in the aftermath of Hurricane Katrina. We know you are actively engaged in leading the public health response to the emergency, and we offer our support and best wishes in that difficult task in the days, weeks and months ahead. We were pleased to hear your proclamation of a “public health emergency” in the area in recognition of the tremendous public health challenges that are part of this disaster.
As people living with HIV/AIDS, we are especially concerned about the especially vulnerable position of tens of thousands of our HIV+ brothers and sisters in the impacted area. There are many immediate, mid-term and long-term issues that will literally be life and death for people living with HIV/AIDS. We hope that you will make certain that these issues are addressed in a timely, effective manner.
1. The threat posed by treatment interruptions.
For people living with HIV/AIDS who are taking anti-retroviral therapy, prophylactic medication against opportunistic infections, and other life-saving medications, the consequences of even a short-term treatment interruption can be severe. The risk of viral resistance and re-emergence of opportunistic infections are but two of the potentially most negative consequences of a treatment interruptions.
Unfortunately, many people from the affected area will have only the most limited supplies of medications with them. Many are also likely to have lost their prescriptions, their medical records, and their documentation of coverage (private insurance, Medicaid, ADAP, etc). In many cases, it will be impossible to reach their health care providers or to find medical records to confirm prescription needs. In addition to anti-retroviral drugs and prophylactic treatments, many will also have a need for drugs for other co-morbid conditions (including Hepatitis C, mental health condition, methadone or other addiction treatment, and a host of other underlying conditions).
In the short term, how will the emergency response ensure that people will have immediate access to the life-saving medications that they need? How will this take place in the potential absence of medication or insurance documentation? Will people who leave their home state be able to access immediate health care benefits in the state where they seek refuge? What steps is HHS taking to prevention dangerous treatment interruptions?
How is the government communicating clear and consistent guidance to health care providers and funders about how various federal funds can be used to support care and treatment for refugees from the impacted areas?
2. The threat posed by infectious disease.
Many people living with HIV/AIDS are more vulnerable to a variety of infections and diseases because of the damaged state of our immune systems. The post-hurricane environment is holds special dangers for the spread of a variety of diseases, both in the areas directly hit by the hurricane and in the facilities where people will congregate for housing and services.
People with impaired immune systems will be exposed to a large variety of potentially dangerous pathogens in the post-hurricane and post-flood situation. The spread of diarrhreal diseases, tuberculosis, influenza, and countless other bacterial, fungal and viral infections will skyrocket in the post-hurricane period. This will be true not simply in the dangerous environment of flooded areas, but also in the crowded living facilities where people will be staying for many months.
What steps will HHS take to protect people, especially those with immune system suppression, from the spread of infectious diseases?
3. Continuity of care.
As people experience the disruption of their lives, being forced to move from their homes, they will also be removed from the established care and treatment relationships they already have. In many cases, they will be forced to leave the state they have been living in and receiving care from. In other cases, they may be losing a relationship with a specific clinic or provider.
How will HHS ensure that people are able to experience minimal disruption in their care and treatment? How will state eligibility for Medicaid, ADAP and other programs be transferred to a new place of residence? How will HHS help people find appropriate, knowledgeable care and treatment providers in their new communities?
4. Support for the care/treatment infrastructure in places where evacuees go
As people living with HIV/AIDS leave the most heavily impacted areas, they are seeking care and treatment services in the areas they are located. It is already clear that these clinics and organizations are going to have their resources quickly strained beyond on the breaking point. It is essential that these organizations and clinics receive additional and immediate support to absorb the added work they are taking on. Similarly, state ADAPs in affected areas will need additional financial support to bring on the additional enrollees they will be paying for.
How will resources be made available to these organizations and clinics that are taking on delivery of these essential services?
5. Rebuilding care/treatment infrastructure that has been damaged/destroyed.
Across the Gulf region, health clinics and AIDS service organizations were severely damaged or destroyed by Katrina and the ensuing floods. It will be essential that this infrastructure be rebuilt as people are able to return to their home communities.
How will HHS provide resources to ensure that this essential infrastructure is rebuilt in a timely manner?
6. Safe/ clean/ secure housing
As people are displaced from their homes, it will be essential that they are able to live in safe/ clean/ secure housing. While other agencies of the US government are primarily responsible for housing issues, it is our hope that these services will be well coordinated with health services. For people living with life-threatening diseases, housing is an essential part of good health. Living in crowded, cramped housing conditions (including large group shelters) leaves people vulnerable to a range of infections and diseases
What will HHS be doing to ensure that the health of vulnerable people is protecting by rapidly finding safe, clean, and secure housing?
7. Prevention
We know from documented experience around the world that the large-scale displacement of populations can be a significant risk factor for a spreading HIV epidemic. Clearly the circumstances necessary for increased HIV transmission are present in the current situation as hundreds of thousands of evacuees are uprooted from their home communities and thrown into uncertainty and chaos. An effective public health response to this crisis must address the need to prevent further infections during this challenging period.
What steps is HHS taking to provide prevention education and prevention tools to those who have been displaced by Katrina and in the impacted communities? How will HHS ensure that condoms and sterile injection equipment be made available to the evacuees?
8. Leadership
Part of responding effectively to the needs of people living with HIV/AIDS during this public health emergency must be through strong coordination and leadership. Without such leadership, there is a very real risk that the needs of people living with HIV/AIDS will be lost in enormity of the crisis.
Has HHS designated a lead for HIV/AIDS issues in the context of Katrina? If so, who is that and what will their range of responsibility and authority be? If not, who will be charged in ensuring that the needs of this critical population are addressed in the complex response ahead? If you have not already done so, we call on you to appoint a high level designee to coordinate the HIV/AIDS aspects of the Katrina response.
We stand fully ready to work with you to make certain that the public health response to this challenge is fully addressed. If you are to be effective in leading this response, it is essential that you call on the expertise and experience that exist in the community. We hope and count on being part of the effort to respond effectively and rapidly to this national crisis.
Sincerely
Terje Anderson
Executive Director
National Association of People with AIDS (NAPWA)
8401 Colesville Road #750
Silver Spring, Maryland 20910
240.247.0880
tanderson@napwa.org
cc: Dr. Cristina Beato, Assistant Secretary for Health (Acting)
Kerry Weems, Deputy Chief of Staff
Jennifer Young, Senior Counselor for Health Policy
Mark McClellan, Administrator, CMS
Betty Duke, Administrator, HRSA
Dr. Julie Gerberding, Director, CDC
Deborah Parham, Associate Administrator, HRSA
Christopher Bates, Acting Director, Office of HIV/AIDS Policy
Philo Hall, Office of the Secretary
For people living with HIV/AIDS who are taking anti-retroviral therapy, prophylactic medication against opportunistic infections, and other life-saving medications, the consequences of even a short-term treatment interruption can be severe. The risk of viral resistance and re-emergence of opportunistic infections are but two of the potentially most negative consequences of a treatment interruptions.
Unfortunately, many people from the affected area will have only the most limited supplies of medications with them. Many are also likely to have lost their prescriptions, their medical records, and their documentation of coverage (private insurance, Medicaid, ADAP, etc). In many cases, it will be impossible to reach their health care providers or to find medical records to confirm prescription needs. In addition to anti-retroviral drugs and prophylactic treatments, many will also have a need for drugs for other co-morbid conditions (including Hepatitis C, mental health condition, methadone or other addiction treatment, and a host of other underlying conditions).
In the short term, how will the emergency response ensure that people will have immediate access to the life-saving medications that they need? How will this take place in the potential absence of medication or insurance documentation? Will people who leave their home state be able to access immediate health care benefits in the state where they seek refuge? What steps is HHS taking to prevention dangerous treatment interruptions?
How is the government communicating clear and consistent guidance to health care providers and funders about how various federal funds can be used to support care and treatment for refugees from the impacted areas?
2. The threat posed by infectious disease.
Many people living with HIV/AIDS are more vulnerable to a variety of infections and diseases because of the damaged state of our immune systems. The post-hurricane environment is holds special dangers for the spread of a variety of diseases, both in the areas directly hit by the hurricane and in the facilities where people will congregate for housing and services.
People with impaired immune systems will be exposed to a large variety of potentially dangerous pathogens in the post-hurricane and post-flood situation. The spread of diarrhreal diseases, tuberculosis, influenza, and countless other bacterial, fungal and viral infections will skyrocket in the post-hurricane period. This will be true not simply in the dangerous environment of flooded areas, but also in the crowded living facilities where people will be staying for many months.
What steps will HHS take to protect people, especially those with immune system suppression, from the spread of infectious diseases?
3. Continuity of care.
As people experience the disruption of their lives, being forced to move from their homes, they will also be removed from the established care and treatment relationships they already have. In many cases, they will be forced to leave the state they have been living in and receiving care from. In other cases, they may be losing a relationship with a specific clinic or provider.
How will HHS ensure that people are able to experience minimal disruption in their care and treatment? How will state eligibility for Medicaid, ADAP and other programs be transferred to a new place of residence? How will HHS help people find appropriate, knowledgeable care and treatment providers in their new communities?
4. Support for the care/treatment infrastructure in places where evacuees go
As people living with HIV/AIDS leave the most heavily impacted areas, they are seeking care and treatment services in the areas they are located. It is already clear that these clinics and organizations are going to have their resources quickly strained beyond on the breaking point. It is essential that these organizations and clinics receive additional and immediate support to absorb the added work they are taking on. Similarly, state ADAPs in affected areas will need additional financial support to bring on the additional enrollees they will be paying for.
How will resources be made available to these organizations and clinics that are taking on delivery of these essential services?
5. Rebuilding care/treatment infrastructure that has been damaged/destroyed.
Across the Gulf region, health clinics and AIDS service organizations were severely damaged or destroyed by Katrina and the ensuing floods. It will be essential that this infrastructure be rebuilt as people are able to return to their home communities.
How will HHS provide resources to ensure that this essential infrastructure is rebuilt in a timely manner?
6. Safe/ clean/ secure housing
As people are displaced from their homes, it will be essential that they are able to live in safe/ clean/ secure housing. While other agencies of the US government are primarily responsible for housing issues, it is our hope that these services will be well coordinated with health services. For people living with life-threatening diseases, housing is an essential part of good health. Living in crowded, cramped housing conditions (including large group shelters) leaves people vulnerable to a range of infections and diseases
What will HHS be doing to ensure that the health of vulnerable people is protecting by rapidly finding safe, clean, and secure housing?
7. Prevention
We know from documented experience around the world that the large-scale displacement of populations can be a significant risk factor for a spreading HIV epidemic. Clearly the circumstances necessary for increased HIV transmission are present in the current situation as hundreds of thousands of evacuees are uprooted from their home communities and thrown into uncertainty and chaos. An effective public health response to this crisis must address the need to prevent further infections during this challenging period.
What steps is HHS taking to provide prevention education and prevention tools to those who have been displaced by Katrina and in the impacted communities? How will HHS ensure that condoms and sterile injection equipment be made available to the evacuees?
8. Leadership
Part of responding effectively to the needs of people living with HIV/AIDS during this public health emergency must be through strong coordination and leadership. Without such leadership, there is a very real risk that the needs of people living with HIV/AIDS will be lost in enormity of the crisis.
Has HHS designated a lead for HIV/AIDS issues in the context of Katrina? If so, who is that and what will their range of responsibility and authority be? If not, who will be charged in ensuring that the needs of this critical population are addressed in the complex response ahead? If you have not already done so, we call on you to appoint a high level designee to coordinate the HIV/AIDS aspects of the Katrina response.
We stand fully ready to work with you to make certain that the public health response to this challenge is fully addressed. If you are to be effective in leading this response, it is essential that you call on the expertise and experience that exist in the community. We hope and count on being part of the effort to respond effectively and rapidly to this national crisis.
Sincerely
Terje Anderson
Executive Director
National Association of People with AIDS (NAPWA)
8401 Colesville Road #750
Silver Spring, Maryland 20910
240.247.0880
tanderson@napwa.org
cc: Dr. Cristina Beato, Assistant Secretary for Health (Acting)
Kerry Weems, Deputy Chief of Staff
Jennifer Young, Senior Counselor for Health Policy
Mark McClellan, Administrator, CMS
Betty Duke, Administrator, HRSA
Dr. Julie Gerberding, Director, CDC
Deborah Parham, Associate Administrator, HRSA
Christopher Bates, Acting Director, Office of HIV/AIDS Policy
Philo Hall, Office of the Secretary
For more information about the National Association of People with AIDS contact Press Secretary LaWanda Johnson at 240-247-1024 or email her at ljohnson@napwa.org.