HRSA HIV/AIDS Bureau (HAB) Logo                                                           
                                                                December 2002

 

HRSA Care ACTION

PROVIDING HIV/AIDS CARE IN A CHANGING ENVIRONMENT

New Bureau Director Emphasizes Steadfast Commitment to Underserved Populations, Accountability

In August of this year, Deborah Parham, Ph.D., R.N., was named director of the Health Resources and Services Administration’s (HRSA’s) HIV/AIDS Bureau. HRSA Care ACTION editor Richard Seaton recently talked to Dr. Parham about her vision for the Ryan White CARE Act and the work of providing services to people living with HIV disease. 

"When asked how her career choices led her to HRSA, Dr. Parham explained that she began her career as a nurse who "wanted to do public health nursing."

In those days," she added, "you had to work at a hospital for a number of years before you could pursue public health--which I did not want to do. I also knew I wanted to manage something and that I didn't have the necessary skills to do it. So I decided to continue my education and got a master's degree in health administration. I soon came to Washington and was turned on by the health policy world. I worked as a presidential management intern for the Health Services Administration, which was the predecessor to HRSA. Then I returned to the University of North Carolina School of Public Health and earned my doctorate in health policy and administration."

RS: Why public health?

DP: I think I was given a desire to help others from my parents, both of whom are health care professionals.

Until I was 10 years old I lived in Southeastern Ohio, in a corner of the Appalachian foothills. There were a lot of poor people in our community; many of them didn’t have indoor plumbing. I got into public health because I wanted to help people like those in that community. I felt patients in hospitals were going to get care, and I was more concerned about those people who never made it to the hospital, people in the community who remained in their homes, who were not engaged in the health care system. Those are the people I wanted to work with.

RS: The dovetail between your early work and the AIDS epidemic is interesting.

 

I felt patients in hospitals were going to get care, and I was more concerned about those people who never made it to the hospital.

DP: If you think about it, much of the population I work with now encompasses the same people I identified in my early 20s—the underserved populations that rarely, if ever, got any health care. I can’t say that I saw my career 20 years down the road when I made those decisions, but I’m glad I made them. I use everything today—I use my nursing background, my public health background, my management training, and my organizational theory training.

The HIV/AIDS Bureau and CARE Act Grantees

RS: Implementation of the CARE Act is a collaborative endeavor. What is the Bureau’s role?

DP: We’re the glue that holds it all together. That said, our administrative role, primarily, is to make sure that the money from Congress is distributed fairly and equitably and that the grantees have the resources they need to provide high-quality clinical care and support services to people living with HIV.

Congress passed the Ryan White CARE Act legislation in 1990 and reauthorized it in 1996 and again in 2000. A separate act of Congress appropriates the money on a yearly basis so that we can bring the CARE Act to life. Using the legislation as our guide, we translate policy into programs. We notify the communities and potential applicant organizations that this money is available and let them know how they can apply for it through a grant application. Once funds are distributed, we make sure grantees get the technical assistance they need to develop appropriate services for those who need help, and we monitor grantees to ensure that dollars are spent as they were intended.

We also help grantees develop services that are tailored to their particular communities. I say it like that because hundreds of different communities are affected by this epidemic. What happens in New York City is very different from what happens in Houston—both urban areas. The epidemic looks very different in Arizona than it does in Alabama, even though they are both fairly rural States. So it’s important that the people in different communities have the flexibility to develop programs specifically for people living with HIV/AIDS in those communities.

RS : Describe the relationship between the Bureau and the grantees.

DP: It must be a partnership. And it must be a proactive partnership. True, we distribute the money that Congress appropriates, but we are dependent on the grantees to make sure the services are available and accessible. They must have a say in how the funds should and should not be spent, what should and should not happen, and what the Federal government should and should not say about what they do. With this comes a certain level of healthy tension, not unlike in a marriage, because we don’t always agree. But we are all responsible for making sure that the dollars that are appropriated are accounted for: The grantees are accountable to us; we are accountable to Congress; Congress is accountable to the taxpayers.

RS: Let’s talk about your relationship with the advocacy community. Federal employees cannot lobby or advocate for particular policies. Yet, you must collaborate with organizations that lobby the Federal government and are often pushing the government to do more. What kind of relationship can you have with organizations whose work is devoted to advocacy?

DP: The genesis, the birth, of the Ryan White CARE Act came out of activism and the work of advocacy organizations, as did the push for new drugs and allowing these drugs to be used before FDA approval. There was a lot of yelling and screaming at the FDA, "We’re dying, why can’t we have access to these life-saving drugs?" Activism has played a role through-out the epidemic. Sometimes it may be uncomfortable, but people are living with a disease that is increasingly chronic but ultimately fatal, and we need to be pushed.

Our role is not to advocate, but to educate. The Federal role in administering the CARE Act can be mysterious to those outside the Bureau, and it is up to us to address the confusion.

Goals for the Bureau

RS: What are the HIV/AIDS Bureau’s goals and priorities? Where do you want the Bureau to go?

DP: We have many goals, but first I want to underline that we operate in the very large context of the Federal government. The HIV/AIDS Bureau sits within HRSA, which sits within the Department of Health and Human Services, which is one of the largest departments of the Federal government. Where I take the HIV/AIDS Bureau is largely dependent upon other forces that are in play.

Today, throughout the Federal government, we have an increased emphasis on accountability—accountability to taxpayers and accountability to people living with HIV disease. Our job is to ensure that funds are being spent where they can be most effective. We have to look not just at our own performance, but also at the performance of our grantees. There is an increased emphasis on having specific objectives and tying our success at meeting those objectives to future budgets.

The CARE Act programs currently provide services to many people living with HIV and AIDS (PLWH). However, the Centers for Disease Control and Prevention estimates that 40,000 people are infected with HIV each year and two-thirds of approximately 950,000 PLWH are not currently in care. For us in HRSA, that means we must provide outreach to identify, enroll, and maintain in care people who are HIV positive but not in care. We can’t prolong people’s lives and improve their productivity if we can’t get them into care early after infection.

As we work to reach those not currently receiving the care they need, we have to continue to ensure that clinical care evolves with the epidemic. Remember, HIV is not a static virus, and neither is the standard of care for HIV/AIDS treatment. As mutant strains of HIV continue to build resistance to treatment among many individuals, we must ensure that salvage therapy is available and that providers are trained to provide it. As high rates of conditions like addiction, hepatitis C, and mental illness continue to be seen among those living with HIV disease, we must continue to provide truly comprehensive care. Finally, the care we provide must embody the capacity to treat conditions like lipidemia and diabetes and the many other side effects associated with HIV/AIDS treatments.

Our efforts in all of these areas are being enhanced by our dedication to quality. The reauthorized CARE Act contains specific requirements regarding quality, and in response we are currently implementing a comprehensive initiative within the Bureau and across all CARE Act programs. Through this initiative, we intend to ensure that the products and services we offer meet the highest standards, whether we are talking about medical care, an essential support service, or how a planning body implements its legislative requirements.

These are some of the things we want to achieve and there are many others, but overall I want to make sure that the HIV/AIDS Bureau can respond to those increased internal requests for accountability and make sure that the grantees spend the funds in the way that Congress intends. Certainly everyone has read the stories of a subgrantee in some area where the grant dollars were misappropriated. That hurts everybody because it gives the impression that what’s happening in these communities is happening elsewhere. The vast majority of the CARE Act dollars are being spent as Congress has intended and as we in the Bureau have allocated them. Where they are not, we want to correct the problem and redistribute the dollars to provide services for people.

RS: Explain how the introduction of a therapy likeT-20 affects the CARE Act community.

DP: The potential impact on the AIDS Drug Assistance Program (ADAP) could be huge. Right now we are trying to estimate how many people currently enrolled in the ADAP need salvage therapy. We don’t know that yet. When we have an estimate, we will have to reconcile it with a budget whose development was begun 2 years ago. Current estimates are that T-20 may cost $10,000 to $12,000 per client per year. And those costs are in addition to the $10,000 to $12,000 already spent per client annually on HIV medications. And while it is important to adhere to projections and plans made 2 years ago, we must also respond to the changes in the epidemic and advances in therapies so that we always provide the highest quality therapy. Granted, it is expensive, but we owe it to the people living with HIV and AIDS.

RS: What changes can we expect at the Bureau over the coming months?

DP: We want to facilitate more cross-title learning and collaboration. There has been less of this than we had hoped to have when we put the Bureau together in 1997. Internally, we are looking at how we can manage ourselves differently so that what is learned in the Title IV programs is applied in the Title I programs, for example, and what is learned by the Special Projects of National Significance grantees is learned by all the other grantees.  We’re beginning to look at that now, prompting some organizational changes within the HIV/AIDS Bureau.

Another way to look at the overall issue is to remember that many CARE Act directly funded community based organizations (CBOs) are located in Title I areas. These CBOs can seek funding from the Title I grantee and not rely solely on their direct Federal grant. We can increase our productivity and the reach of our programs when we all have the big picture, when we are all aware of what each other is doing. So we have to look more broadly at the context of care in a particular community. Take another example: All of the CARE Act title programs are in a Title II area (i.e., a State or territory). So if you know that the State Medicaid budget is under stress and you know that the State Title II ADAP funds are under stress, then you can understand why your Title I, III, or IV program is having trouble getting its regular clients into the ADAP program.

RS: This sounds like you are looking for synergy among the various parts of the CARE Act and that you also want to reduce duplication.

DP: Exactly. We all have to see this work in the context of what’s going on in the larger community and health care environment, and not just at the level of the individual grantee. This will help the project officers and program managers know what challenges they are facing, and it also makes the project officers better able to suggest technical assistance.

We must ensure that salvage therapy is available and that providers are trained to provide it.

The Epidemic

RS: What do you see in the epidemic today in terms of what must be reflected in the CARE Act programs?

DP: First, we’re in our third decade of AIDS in the United States. We are dealing with a generation that has buried friends, patients, family members, and neighbors, but we still see 40,000 HIV infections every year. There were more AIDS cases reported in 2002 than there were in 2001. So we are not done. We cannot stop.

This is an epidemic that is dynamic. The HIV epidemic, clinically, is very different in 2002 than it was in 1997, and certainly in the 1980s. Keeping up with all of that is a challenge. There are different subpopulations that are increasingly affected—it is increasingly becoming an epidemic among black and brown people, women, MSM, YMSM.* All of this overlaps with a growing syphilis epidemic in many cities and problems like hepatitis, substance abuse, and mental illness.

AIDS is a public health problem, and all public health problems have social implications. This is the case with HIV. The disease is still very stigmatized, and because of that, there are some people who do not feel comfortable coming in for care. That stigma not only exists among family, community, and church members but also, I believe, among some health care providers. The question is really simple: Are we welcoming to everybody, or do we prefer to take care of someone who has heart disease as opposed to HIV disease? We must find ways to lessen and eventually eliminate the stigma associated with this disease.

RS: What role does the CARE Act community have to play in fighting HIV/AIDS abroad?

DP: There are an estimated 950,000 people in the United States living with HIV. That compares with the estimated 40 million people living with the disease worldwide. Do we have a responsibility to share what we know? I believe that we do.

Having said that, I want to emphasize that the Ryan White CARE Act is purely a domestic program and all CARE Act dollars are spent domestically. There is a separate appropriation for global AIDS program funds. We in the HIV/AIDS Bureau are working in the context of the Federal Response to needs abroad. We have provided training to health care providers and technical assistance mostly in the area of monitoring and evaluation of home and community based care programs. There are many other areas in which we have something to offer and something to learn. For example, the success of the CARE Act is due in large part to the involvement of the community at the local level, and we know that community involvement is essential to fighting community problems. Transferring what we know about community participation can result in more effective interventions in countries grappling with HIV disease at staggering levels.

RS: What would you say to us about moving forward?

DP: Transmission of HIV is preventable! However, we have to acknowledge that it’s very difficult to change people’s behavior. We know that smoking is not a good thing, yet people continue to smoke. Exercise is a good thing, yet people continue to be sedentary.

We also need to recognize the importance of our successes. Reducing perinatal transmission is a very positive thing. Having more medications available is a very positive thing, even with the pill burden and the devastating side effects. People are living longer. HIV is now a chronic disease, not the acute crisis it was a few years ago.

But it is difficult to keep in the forefront of people’s brains that we still have an epidemic here, that we still see new infections. We must continue to distribute prevention messages, we still must develop services for people who contract this disease, and we must continue in all types of HIV/AIDS research.

And we should keep HIV/AIDS in the context of a broader public health issue and a medical response, and treat it like every other disease. It’s a disease, and we treat people who have diseases. Yes, we encourage them to be abstinent, be faithful (i.e., monogamous), and use condoms, but we should stop blaming people for diseases with which they present.

RS: Given the stigma and the intransigence of many problems associated with HIV disease, why do you do this very difficult work? What comes back to you?

DP: Some of it’s intangible. A lot of it is that you’re helping people that a lot of folks don’t care about. I go back to where I started, which is that there are marginalized people in this society—and in every society—and it’s the very people who are poor, the very people who are minorities, who are disproportionately represented in this epidemic, as they are disproportionately represented in many epidemics. We talk about being a faith-based society—taking care of the least of these, my brothers and sisters. We need to "walk the talk." And I think that is what drives and motivates many of us who are in this work: to use the best that we have to take care of those who are most in need.

*MSM = men who have sex with men; YMSM = young men who have sex with men

And I think that is what drives and motivates many of us who are in this work: to use the best that we have to take care of those who are most in need.

2001 Year-End HIV/AIDS Surveillance Report Available

The latest edition of the HIV/AIDS Surveillance Report, which includes data reported through December 2001, was released in September 2002. A total of 43,158 AIDS cases were reported in the United States and its territories during 2001,1 and 362,827 people were estimated to be living with AIDS in the United States at the end of last year.2 About 15,603 people died from AIDS during 2001; more than half (51.5 percent) of those who died were black, and approximately one-third (35.5 percent) were in the men who have sex with men (MSM) exposure category.3,4 The  most recent report, along with earlier issues, is available at http://www.cdc.gov/hiv/stats/hasrlink.htm. 

References

1. Centers for Disease Control and Prevention (CDC). HIV/AIDS Surveillance Report. 2001; 13(2):8.Table 2.

2. CDC. HIV/AIDS Surveillance Report. 2001;13(2):37. Table 29.

3. CDC. HIV/AIDS Surveillance Report. 2001;13(2):38. Table 32.

4. CDC. HIV/AIDS Surveillance Report. 2001;13(2):39. Table 33.

Reported Adult/Adolescent AIDS Cases, 2001, by Gender and Race

Reported Adult/Adolescent AIDS Cases, 2001, by Gender and Race, bar chart

Reported AIDS Cases, 2001, and CARE Act Clients, 2000, by Race

Reported AIDS Cases, 2001, and CARE Act Clients, 2000, by Race, bar chart

National HIV Prevention Conference Planned for July 2003 

The 2003 National HIV Prevention Conference will take place July 27 30, 2003, at the Hyatt Regency Atlanta Hotel in Atlanta, Georgia. 

The conference is noted for bringing together prevention programs and science, a blend not duplicated at other meetings. Attendees include researchers; policy makers; community leaders; practitioners working to prevent the spread of HIV/AIDS; and local, regional, and national decision makers. 

Additional information is available at http://www.2003HIVPrevConf.org or through the toll-free conference hotline at 866-277-6313.

Leaders in the Fight Against AIDS Recognized at the Bureau’s 2002 All-Titles Meeting

The HIV/AIDS Bureau’s National Grantee Honor Awards recognize individuals and organization who contribute significantly to the lives of people living with HIV disease (PLWH) through their work with the Ryan White CARE Act. The 2002 awards were presented at the Ryan White CARE Act All-Titles meeting in Washington, DC, in August.

Title I

The Hank Carde Award for Metropolitan Services, named after one of Washington, DC’s most effective AIDS activists, was awarded to Wilbert C. Jordan, M.D., M.P.H., director, OASIS Clinic, for his work in establishing an innovative partnership between the clinic and the Office of AIDS Programs and Policy in the Los Angeles Eligible Metropolitan Area.

Title II

The Dr. Nicholas Rango Award for State Services is named after the architect of New York State’s strategic plan, which was developed in the 1990s to combat AIDS through the creation of new treatment models. This year’s award was presented to Lois Lux, M.S., R.N., the Title II Administrator, Community and Family Health, of the Washington State Department of Health. Ms. Lux was honored for her dedication and skill in advancing networks of HIV services in the State.

Title III

The Gabe Kruks Award for Early Intervention Services is awarded for leadership in the planning, implementation, and evaluation of a Title III Early Intervention Services program as well as advocacy on behalf of all PLWH. This year, the award was given to Montgomery AIDS Outreach, Inc., of Montgomery, Alabama, for implementing innovative approaches to managing and preventing HIV disease. James Wade, executive director, accepted the award on behalf of the organization.

Title IV

The Rebecca Denison Award for Family Care Services was presented to Sara Abdirahman, founder of the HIV University of Oakland (California), which teaches women how to live with HIV disease. She was honored for her work as a role model for immigrant African women and their families affected by HIV.

SPNS

The Russell E. Brady Award for Innovative Services Delivery was presented to Project Bridge of the Miriam Hospital in Providence, RI. Project Bridge’s innovative program model ensures that HIV-positive clients being released from prison and drug detoxification programs receive a continuum of care. Leah Holmes, program director, accepted the award on behalf of the project.

AETCs

The AIDS Education and Training Centers Award recognizes a person whose leadership and commitment to the instruction of health care professionals has strengthened HIV/AIDS education throughout the United States. The award was presented to Michael E. Reyes, M.D., program director of the Pacific AETC, for his efforts to improve the quality of life for PLWH through health care provider training.

Career Awards

The HIV/AIDS Bureau’s Associate Administrator’s Award was presented to Terje Anderson, M. S. W., for his contributions to the health, spirit, and empowerment of PLWH. Mr. Anderson is the executive director of the National Association of People with AIDS and has extensive experience in HIV prevention and policy.

Finally, the HIV/AIDS Bureau’s Career Achievement Award was awarded to three former Bureau employees who provided outstanding contributions and commitment to the goals set forth by the Ryan White CARE Act legislation:

  • Capt. Eugenia "Jeannie" Foster Adams (Ret.) of the U.S. Public Health Service (PHS) was honored for her outstanding performance as a leader and educator in the field of HIV care services and her commitment to developing innovative approaches to increasing awareness of the HIV epidemic. 

  • Andrew Kruzich was recognized for his professional and personal commitment to improving health care and services for PLWH. Mr. Kruzich served in many CARE Act positions, including deputy branch chief in the Planning and Technical Assistance Branch, Division of Service Systems, and branch chief for Title III in the Division of Community Based Programs.

  • Comdr. Maria Lago (Ret.) of the PHS was honored for her 20 years of commitment to creativity in expanding care and services to PLWH, particularly poor and underserved populations.

News Briefs

The Health Resources and Services Administration, HIV/AIDS Bureau, recently announced the following Ryan White Comprehensive AIDS Resources Emergency (CARE) Act grants and cooperative agreements:

Title III, Early Intervention Services: 27 new grants totaling $9.5 million to help communities provide outpatient and primary care services to people living with or at risk of HIV infection. Grant recipients include community based clinics and medical centers, hospitals, public health departments, and universities in 17 States. A press release on the grants, which includes a list of the new grantees, is available at http://newsroom.hrsa.gov/releases/2002 releases/eis.htm.

Title IV, Women, Infants, Children, Youth and their affected families: four cooperative agreements totaling $1.5 million to improve access to medical care and support services for children, youth, and women living with HIV and their affected families. Funding recipients will undertake a variety of training and technical assistance activities with HAB grantees, care providers, planning bodies, and other constituents. The four recipients are

  • AIDS Alliance for Children, Youth and Families, Washington, DC ($850,000);

  • National Pediatric and Family HIV Resource Center at Francois-Xavier Bagnoud Center, University of Medicine and Dentistry of New Jersey, Newark,($275,000);

  • Parents’ Place of Maryland, Baltimore, ($281,258);and 
  • University of Miami School of Medicine, Miami, FL ($113,453).

Dental Education: 66 grants totaling $9.9 million to help dental education programs provide oral health services for people living with HIV. The grants were awarded to eligible dental schools, postdoctoral dental education programs, and dental hygiene education programs. For a press release on the grants, which includes a list of the new grantees, go to http://newsroom.hrsa.gov/releases/2002releases/dental.htm.

In addition, HRSA has awarded 13 grants totaling $4.9 million to create new health center sites and expand services at existing centers. Eight grants went to Community Health Centers; the other awards include three grants to support services for homeless individuals and families, one migrant health center grant, and one public housing primary care grant. The awards are part of a 5-year plan to add 1,200 new and expanded health center sites and eventually double the number of patients they treat. For more information, go to http://newsroom.hrsa.gov/releases/2002releases/accessfinal.htm.  

New Bureau Publications Available Online

HIV/AIDS Disease Training Manuals, jointly developed by the Institute for Healthcare Improvement and the HIV/AIDS Bureau, are now available on the HAB Web site. More than 80 health centers, clinics, and hospitals worked together to develop the manuals, which include various models and specific tools. To access the manuals, go to http://hab.hrsa.gov/tools/manuals.htm. 

The updated Title I Planning Council Primer, a guide for new Planning Council members, is now available on the HAB Web site. Copies will be mailed to all grantees and Planning Councils. To view the Primer, go to http://hab.hrsa.gov/tools/pcp.htm. 

The Chief Elected Official Guide outlines the duties of Title I and Title II chief elected officials (CEOs), such as mayors and governors, in administering their funds and working with planning bodies in their areas. The Guide is part of the forthcoming Title I Manual and Title II Manual and is being sent to CEOs in Title I and II areas; to view the document, go to http://hab.hrsa.gov/tools/ceoguide.htm. 

Information on two SPNS initiatives is now available on the HAB Web site. Overviews, grantee lists, and project abstracts are available for the Prevention with Positives in Primary Care Settings initiative and the Innovative HIV Care Programs for American Indians and Alaska Natives initiative. To view the materials, go to http://hab.hrsa.gov/special/evaluation2g.htm. 

The HIV/AIDS Bureau’s Progress Report, population-based fact sheets, and fact sheets on the CARE Act are available through the HRSA Clearinghouse at 1-888-ASK-HRSA or through the HAB Web site, at http://hab.hrsa.gov. 

Conference Publications

Summaries of sessions from the U.S. Conference on AIDS, which took place in October, are available on the National Minority AIDS Council Web site. The archived issues of the conference newsletter include reports on plenary sessions and other conference events. To view the newsletters, go to http://www.nmac.org/conferences/usca2002/newsletter.html.

Webcasts of the Clinical Pathway, a 2-day series of lectures conducted as part of the Ryan White CARE Act (RWCA) All-Titles Conference this past August in Washington, DC, are now available. The Clinical Pathway focused on current clinical issues in HIV management and was designed for physicians, nurses, and others who are involved in direct patient care in CARE Act programs. The lectures were sponsored by the International AIDS Society-USA and were conducted in collaboration with HAB. The webcasts are available at http://www.you-niversity.com/. 

Other HIV-Related News

In September, the Centers for Disease Control and Prevention (CDC) held a consultation on the implementation of rapid HIV testing. A summary of the consultation, which includes An overview of and background on rapid HIV testing, information on the review and approval process for rapid HIV tests, a discussion of counseling issues, findings from pilot projects, and other resources, is available at http://www.cdc.gov/hiv/pubs/rt.htm.  (See the related article on the OraSure rapid HIV test, below.)

Also in September, the CDC reported that the most recent Youth Risk Behavior Survey (YRBS)—a national survey of high school students—found a decline in sexual risk behavior among high school students. Between 1991 and 2001, the percentage of U.S. high school students who ever had had sexual intercourse fell from 54.1 percent to 45.6 percent. At the same time, among students who had had sexual intercourse during the 3 months prior to the survey, condom use increased from 46.2 percent to 57.9 percent. The trends held for female and male students in 10th, 11th, and 12th grades as well as for black and white students. The 2001YRBS was released in June 2002 and is available at http://www.cdc.gov/nccdphp/dash/yrbs/2001/youth01online.htm. 

Although the YRBS findings are encouraging, the CDC reported in November that rates of primary and secondary syphilis have increased slightly for the first time in more than a decade. The November 1 Morbidity and Mortality Weekly Report reported that cases of primary and secondary syphilis in the United States rose by 2 percent between 2000 and 2001 (5,979 cases in 2000 to 6,103 cases in 2001). The total U.S. syphilis rate increased from 2.1 per 100,000 people to 2.2 per 100,000 people, the first such increase since 1990. Syphilis rates are considered a harbinger of new HIV infections.

A report on a 3-year study funded by the National Institute of Justice documents that tens of thousands of inmates are being released into the community every year with undiagnosed or untreated communicable and chronic diseases and mental illness. The study found that it would be more cost-effective to treat inmates for several diseases while they are incarcerated. To access the report, go to http://www.ncchc.org/. 

The Substance Abuse and Mental Health Services Administration (SAMHSA) has awarded 72 grants totaling $33.9 million to provide substance abuse treatment and HIV/AIDS services to African American, Hispanic, and other minority communities affected by substance abuse and HIV/AIDS. Approximately $12 million will fund 26 grants in metropolitan areas previously not served by SAMHSA’s Center for Substance Abuse Treatment TCE/HIV or HIV Outreach programs; the remaining $21.8 million will fund 46 grants in areas with high rates of HIV/AIDS.

SAMHSA also awarded 48 grants totaling $16.2 million to support substance abuse prevention services that are integrated with HIV prevention services for youth and other at-risk populations in minority communities. In addition, SAMHSA awarded 46 infrastructure grants totaling $5.65 million. For press releases on the awards, go to http://www.samhsa.gov/news/news.html. 

FDA Approves Rapid HIV Test

In November, the U.S. Food and Drug Administration (FDA) approved a new rapid HIV test kit, which provides results in just 20 minutes. The OraQuick Rapid HIV-1 Antibody Test, manufactured by OraSure Technologies, requires less than one drop of blood and needs no specialized equipment.

The test requires a finger stick sample of blood, which a technician collects from the person being tested. The sample is mixed in a vial with a solution, and the test device, which resembles a dipstick, is inserted. If HIV-1 antibodies are present in the solution, two reddish-purple lines are displayed in a small window on the device. If the test is positive for HIV antibodies, a different, confirmatory test is performed.

Announcing the test’s approval, HHS Secretary Tommy G. Thompson noted that "each year, 8,000 HIV-infected people who come to public clinics for HIV testing do not return a week later to receive their test results. With this new test, in less than half an hour they can learn preliminary information about their HIV status, allowing them to get the care they need to slow the progression of their disease and to take precautionary measures to help prevent the spread of this deadly virus."

Currently, the test must be given only in laboratories approved under the Clinical Laboratories Improvement Act of 1988 (CLIA), and only CLIA-approved laboratory technicians or medical staff may administer the test. Secretary Thompson urged the manufacturer to apply for an FDA waiver that would allow the test to be administered in a wider variety of settings.

Additional information on the OraSure test is available on the FDA Web site at http://www.fda.gov and on the OraSure Web site at http://www.orasure.com/news/. 

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