Posts Tagged ‘Department of Health’

Number of Floridians on AIDs-drug waiting list drugs drops dramatically

Posted on: December 2nd, 2011 by The American Independent No Comments

The Florida Department of Health announced Thursday that its AIDS Drug Assistance Program waiting list has dropped to a little more than 800 individuals.The AIDS Drug Assistance Program, a nationwide payer of last resort for people who cannot afford their HIV/AIDS medications, has been in a funding crisis since 2010, which prompted many states, including Florida, to implement cost containment measures such as waiting lists. (more…)

More is known on South Florida criminal HIV transmission case

Posted on: June 3rd, 2011 by The American Independent No Comments

A Broward Sheriff’s Office arrest report indicates that Daniel Hay Lewis, arrested on Monday for shoplifting and charged with the criminal transmission of HIV, physically resisted being placed in a sheriff’s car and attempted to bite a deputy. #

According to the report, Lewis is charged with HIV transmission because he knew he was HIV-positive when he attempted to bite the deputy. Broward Sheriff’s Office media relations office told The Florida Independent Lewis is still in custody at the main Broward County jail. #

The arrest report also indicates that Lewis was Baker Acted because he made suicidal remarks while resisting arrest. According to the report, Lewis also said he would rather be shot than go back to jail. #

According to the Kaiser Family Foundation, in 2008 Florida had the largest number of inmates with HIV/AIDS in custody of state or federal prison authorities (more than 3,600). The data shows that while 3.6 percent of Florida’s inmates were HIV positive, the U.S. average was 1.5 percent. #

The Florida Department of Health’s Bureau of HIV/AIDS estimates that rates of HIV/AIDS in correctional facilities are three to five times higher than in the general population, and that approximately 15 to 40 percent of inmates are infected with hepatitis C. #

The department also explains that prisons and jails are different. Prisons are funded and operated by the Department of Corrections, an average length of stay in one is between three and five years and prisons are mandated to provide a level of care commensurate with community standards and to test each inmate for HIV within 60 days of release. #

Jails, meanwhile, are operated and funded by local county governments, often the local sheriff’s office (Lewis is in Broward’s main jail), where the average length of stay is 23 to 46 days. There are guidelines for health care, but jails are not mandated to provide a certain level of care. #

Veda Coleman-Wright, from the Broward sheriff’s media relations office, tells the Independent the main jail is equipped to provide adequate medical care to Lewis but cannot disclose any specific information on the medications he may need due to confidentiality laws. She added that Armor Correctional Health Services manages inmate health care at Broward county’s main jail. #

Yeleny Suarez — senior account executive at Everett Clay Associates, a public relations firm — wrote in an email to the Independent that Armor “is fully equipped to meet specialized needs of all its patients.” #

Centers for Disease Control and Prevention FAQ explains that “only specific fluids (blood, semen, vaginal secretions, and breast milk) from an HIV-infected person can transmit HIV,” and that HIV transmission through a bite is “very rare.” #

Elton John urges Gov. Scott to protect Florida’s AIDS Drug Assistance Program

Posted on: June 1st, 2011 by The American Independent No Comments

Singer Elton John yesterday sent a letter to Gov. Rick Scott urging him to protect the AIDS Drug Assistance Program, which helps low-income HIV/AIDS patients receive vital medications. #

According to the South Florida Sun-Sentinel: #

John, founder of the Elton John AIDS Foundation, wrote to Scott Tuesday after hearing the Department of Health was considering changes in income eligibility. #

A department spokeswoman said there are no immediate plans to change the AIDS Drug Assistance Program, though it held hearings to discuss the possibility of lowering income requirements to participate. #

HIV/AIDS patient advocates, opposed to the eligibility cuts, recently told The Florida Independent that a final decision from the governor’s office on this proposal should come in August or September. #

The Miami Herald reports that Scott’s office has responded to emphasize that: #

* Gov. Scott did NOT veto any funding for AIDS-related programs in the budget signed last week. #

* Florida spends more than $200 million on AIDS drug assistance and other AIDS health initiatives each year. #

Scott’s response does indicate that the Department of Health has proposed to change the eligibility standard for the Drug Assistance Program from 400 percent of Federal Poverty Level to 200 percent. #

The Florida Bureau of HIV/AIDS held hearings in April and May to hear input on the proposed reduction. This latest cost-containment proposal would make it harder for HIV patients to access the federally funded Drug Assistance Program. If the bureau’s proposal is adopted, a patient would have to earn roughly $26,000 or less to qualify. #

Scott’s statement, published in the Herald, adds: #

* This change will ensure that Florida is allocating the dollars appropriated for AIDS drugs to those who are most needy and most vulnerable. Florida’s waiting list for AIDS drug assistance is currently more than twice as large as any other state. Florida also has a more generous eligibility standard than most other states. #

federal report, though, alleged that federal audits and site visits showed that Florida’s Bureau of HIV/AIDS failed to use “available resources in the best interest of people living with HIV and AIDS” while administering its Drug Assistance Program. The report, written by the U.S. Department of Health and Human Services’ Health Resources and Services Administration, alleges that administrative, service and fiscal concerns raised in prior audits and visits remain unresolved and unanswered. #

In June 2010, Florida’s HIV/AIDS bureau created the Drug Assistance Program waiting list, another cost-containment measure. Despite the fact that 13 states have a waiting list (.pdf), Florida has by far the longest in the nation. As of May 20, there were more than 3,900 HIV-positive Floridians on the state’s waiting list. #

Mercury, sulfates poisoning the Everglades

Posted on: May 2nd, 2011 by The American Independent No Comments

The use of sulfate in agricultural areas near the Florida Everglades is creating an enormous mercury problem — with seemingly no end in sight.

The Florida Everglades are often thought of as the state’s wildest and most untamed area, well-protected and far from the grind of urban civilization, a lush wetland with a folkloric reputation that separates it from the hustle and bustle of nearby Fort Lauderdale and Miami.

Some of the state’s most ubiquitous creatures call the area home: manatees, alligators, wading birds. But lurking below the surface, amid the highly diverse flora and fauna, is a surprisingly large amount of a notoriously toxic substance: Methylmercury.

According to scientists, the Methylmercury issue rivals other better-known ecological issues in the state, like nutrient overload in Florida waterways. Nutrients like phosphorus and nitrogen have long been thought of as villains in Florida waterways, due to their capacity to breed toxic algal blooms that lead to fish and dolphin kills.

Sulfate is often used as a means to kill those noxious algal blooms. In this process, sulfate (sulfur combined with oxygen) is added directly to water, eventually finding its way into Stormwater Treatment Areas, manmade wetlands that are specifically designed to filter pollution before it enters the Everglades.

The problem, according to scientists, is that the Stormwater Treatment Areas (known as “STAs”) only filter so much. “These STAs are not designed to filter sulfate. They’re designed to filter phosphorus,” says Dr. Melodie Naja, a water quality scientist at the Everglades Foundation, a nonprofit that aims to restore and protect the greater Everglades ecosystem.

Naja says that sulfate in South Florida canals can come from several sources, including groundwater, Lake Okeechobee water, soil oxidation and fertilizer. But the main sources of sulfate, according to a study conducted by Naja and her colleagues, are the latter two: soil oxidation and fertilizers.

In a paper published in 2011, Naja and other scientists found that high levels of Methylmercury (MeHg) are a serious problem in many wetland ecosystems worldwide:

In the Florida Everglades, it has been demonstrated that increasing MeHg occurrence is driven by the sulfate contamination problem. A promising strategy of lowering the MeHg occurrence is to reduce the amount of sulfate entering the ecosystem. High surface water sulfate concentrations in the Everglades are mainly due to discharges from the Everglades Agricultural Area (EAA) canals. [Emphasis added.]

In addition to using sulfate as a fungicide, farmers in the Everglades Agricultural Area use it as a fertilizer counter-ion, and to increase the acidity of the soil, making fertilizer more readily available to plants, which take in sulfate through their roots.

These practices result in sulfate runoff into canals that eventually makes its way to the marshes of the Everglades. Due to the anaerobic conditions of the sediment in the marshes, sulfate is eventually reduced to sulfide by bacteria. Naturally occurring mercury (often present in rainwater) mixes with the sulfide, creating a dangerous cocktail known to scientists as Methylmercury.

“Methylmercury is a problem,” says Naja. “Methylmercury bioaccumulates in the body of an organism, sticking to the cells of those who ingest it.”

According to the United States Environmental Protection Agency, the primary negative health effect of Methylmercury is impaired neurological development, specifically in fetuses. The substance doesn’t always kill directly, but it can drastically affect the human nervous system and also harm vision and speech and cause muscle weakness. In scientific studies, Methylmercury was found to cause kidney tumors in male mice.

Though some forms of sulfur, like hydrogen-sulfide (which is responsible for the rotten-egg smell near a marsh) are regulated by state environmental agencies, there are no limitations on sulfate flowing into wetlands.

Naja and the team at the Everglades Foundation studied the amount of sulfate in the Everglades, comparing actual amounts to the Comprehensive Everglades Restoration Plan target amount. What they found was striking: “The target amount is one milligram per liter. The reality is 30 to 50 milligrams per liter.”

“The phosphorus issue has really taken center stage, and it is a problem. But phosphorus affects 20 percent of an ecosystem. Sulfate affects 60 percent,” says William Orem, a scientist with the United States Geological Survey. “Mercury is rampant.”

According to Orem, the population of wading birds in the Florida Everglades has decreased by 90 percent since 1900, and Methylmercury is a likely culprit. “The decrease isn’t all due to Methylmercury, but it plays a big role over time,” says Orem.

University of Florida Professor Peter Frederick published the results of an in-depth study of one species of wading bird found in the Everglades, the White ibis, in December 2010.

The study found that the ibis population was declining in large part due to altered mating habits, a direct result of mercury consumption. Mercury not only affected the ibis’ courtship habits, but also altered hormones, which led to a high percentage of male birds mating with other males. This particular study was the first that documented mercury’s effects on a bird’s sexual preference.

Frederick’s study followed four different groups of birds, each put on a different diet, with a different level of mercury. Surprisingly, even the group ingesting the lowest levels of mercury (amounts comparable to fish purchased at the grocery store) displayed homosexual behavior and tended to mate earlier in the breeding season.

“The effect was exaggerated the higher the dose, so about 55 percent of those ingesting the highest dosage of mercury had their sexual development affected,” Frederick says. “But even 25-35 percent of those who ingested supermarket-grade levels displayed similar behaviors.”

Even the birds who didn’t display a change in sexual preference showed signs of hormone imbalances. “Even those that did mate male/female didn’t do a good job of parenting,” he says. “They failed to tend eggs or watch their nest. Overall, we found a 35 percent decrease in productivity of the heterosexual nests.” Oftentimes, the males didn’t display good courtship behavior, which led to less female attraction.

Frederick says the ibis case is unlike other homosexual displays between animals, like the famous “gay penguins” of the Central Park Zoo. In some cases, animals mate with their own sex because there are fewer choices of the opposite sex in a captive environment. “That’s not what happened here,” he says. “The ibises had many available females, but the males would court together, build a nest together and stay in the nest for weeks at a time. It was a long-term commitment to the nest.”

Frederick says that mercury is, gram-for-gram, one of the most powerful elements known to man, in how it can alter development.

Mercury is known to cause fetal damage, and pregnant or lactating women are often advised against consuming carriers, such as certain types of fish and shellfish. But it affects more than just fetuses. Frederick says that “even very small amounts of mercury can hinder cognitive development” in “young children.”

The U.S. EPA recommendation’s is to not exceed 0.3 milligrams of Methylmercury per kilogram of fish tissue. Because of the high levels of Methylmercury in fish, the Florida Department of Health regularly issues advisories (.pdf) on consuming fish from the Everglades.

Consumption of Everglades-caught fish by humans isn’t prevalent, but some members of the Haitian community and the Native American Miccosukee tribe are thought to fish in area canals.

But the relevance of Frederick’s study is rooted in wildlife. If mercury leads to hormonal imbalances and a change in sexual preference among birds, it  has the power to drastically reduce reproductive output. In short, it is a very serious problem — one that is not being addressed.

“Birds can’t taste mercury, and they can’t avoid it,” says Frederick. “Twenty-five percent of birds just eating supermarket-level mercury experience a change in sexual preference. The message is a very strong one.”

Anywhere from 90 to 98 percent of mercury found in all fish is methylated and, because it is nearly impossible to take mercury out of the Everglades, the natural solution is to get rid of the sulfate. But, like the issue of removing nutrients from Florida waterways, that is easier said than done.

The majority of sulfate comes from Everglades Agricultural Areas, where farmers harvesting products like sugarcane continue using protocol from the 1960s.

In a February 2009 article published in Earth, Orem opined that the Methylmercury problem in the Everglades is still misunderstood:

At the moment, scientists do not know how much sulfate originates from natural sulfur and how much sulfur is locked in the soil due to past agricultural practices. Soil oxidation may be releasing this sulfur, allowing it to run off into the canals that discharge into the Everglades.

According to Orem, recent studies have shown that elemental sulfur is no longer even effective for agriculture because soil is changing so much over time. Even a slight reduction in the use of sulfate could help lower the amount of Methylmercury contamination in the area.

Another solution, says Orem, would be to redesign the Stormwater Treatment Areas, so that they not only filter out phosphorus, but sulfate as well.

One roadblock is the jurisdiction of the mercury problem: The South Florida Water Management District and the Florida Department of Environmental Protection are at odds over who is responsible for the problem.

“It’s really both of their responsibilites,” says Orem. “I think there’s a certain amount of reluctance from upper-level management to even address the issue. The numeric nutrient criteria have caused such heated arguments, and this is potentially an even bigger issue.”

Florida AIDS Advocacy Network reducing AIDS Drug Assistance Program eligibility makes no fiscal sense

Posted on: April 27th, 2011 by The American Independent No Comments

The proposed reductions to the AIDS Drug Assistance Program are a bad idea, and make no fiscal sense, says Jesse Fry, co-chair of the Florida HIV/AIDS Advocacy Network. #

Fry, who testified in Tallahassee this Monday at the first of a series of public forums hosted by the state’s Bureau of HIV/AIDS to discuss eligibility reductions, tells The Florida Independent that proposed changes to the drug assistance program eligibility  have negative workforce implications. #

“If you cut the eligibility from [the current] 400 percent of  the federal poverty level to 200 percent of the federal poverty level, that takes out a large income range where people can work and advance in their careers, accept promotions and eventually leave the ADAP system,” Fry says. #

Fry says that with these eligibility cuts, if you work at the same place for three years and are offered a promotion that pays about $35,000 you would have to turn it down because you would have to leave the AIDS Drug Assistance Program and would not be able to afford HIV medications. He estimates that there are about 1,500 to 1,600 Florida Drug Assistance Program clients that would be in this situation if the eligibility reductions are approved. #

According to Fry, virtually everyone who spoke at the Monday forum — attended by Tom Liberti, chief of the Bureau of HIV/AIDS, and staff members Suzanne Stevens and Joe May — opposed these proposed changes based on humanitarian and fiscal reasons. #

These public forums — more will be held in Miami and Tampa in the coming week — are the first phase of the bureau’s administrative process to change eligibility rules. #

“I just advocate what is in the best interest of the state and the patient,” Fry says about the process. “I advocate what a horrible idea it would be to change the eligibility. I gave them every reason that I could. It doesn’t make any sense to reduce the capacity of the very two programs of among everything in Ryan White [program] that would allow people to grow in their jobs, advance in their careers and get out of the system.” #

GLBT Democratic Caucus head slams Florida for alleged mismanagement of AIDS funds

Posted on: April 26th, 2011 by The American Independent No Comments

Responding to a federal report obtained by The Florida Independent that alleges that Florida has mismanaged funds for a program meant to supply HIV/AIDS medications to low-income citizens, Michael Rajner — legislative director of the Florida GLBT Democratic Caucus — says the state has downplayed how neglect has played an important part in its AIDS Drug Assistance Program’s ongoing funding crisis. #

He also says that the U.S. Department of Health and Human Services’ Health Resources and Services Administration report shows how the state failed to maximize the impact federal and state dollars could have on the health of people living with HIV. #

The Independent revealed Monday that the report indicates, among many other findings, that salaries for employees whose work is not related to the AIDS Drugs Assistance Program were paid with Drug Assistance Program dollars. #

Rajner says that is unacceptable, “something that needs to be investigated further.” #

“I would add that Florida missed revenue opportunities off this program,” Rajner says. “When the state pays off someone’s drugs, if they paid the copay and the premium, they qualify for the pharmaceutical rebate. Florida has missed out on the opportunity to recover millions of dollars that would have gone to expand access and medications to people who are critically ill, improving the overall health of the HIV/AIDS community in Florida.” #

According to the report, if Florida’s Drug Assistance Program implemented an AIDS insurance assistance program and “funded co-pays and deductibles in addition to health insurance premiums, the State would be eligible for millions of dollars in rebates. Many states throughout the country recoup as much as a dollar to two dollars on pharmaceutical rebates for every dollar spent in an AIDS assistance insurance program.” #

“This federal report will help individuals to become involved, and really understand how this impacts them,” Rajners says. “For the almost 4,000 people on the Florida ADAP waiting list, the question is: Was the ADAP funding deficit really a funding shortage? Could it have been averted? Could we have mitigated the impact and have a 1,000-person wait list?” #

“We are at a critical time,” he says. “We almost need to go back to our roots as an AIDS community. Given the complexity of funding, given the fear of AIDS service organizations to speak out against the state and organize their clients, we need to engage as individuals. We are losing a lot and will lose more if people living with HIV/AIDS continue to have a codependent relationship on service providers. Those providers need to find a way despite … fear of state retaliation to ensure that all the resources are provided to clients to empower and engage them to ensure access to treatment.” #

As an example, Rajner cites the fact that the federal report was given anonymously to the Independent. #

“This is a public record, and the anonymity just demonstrates how weak the HIV/AIDS advocacy community is in Florida,” he says. “It also shows how threatened these advocacy groups are by the state to possibly have their funding targeted.” #

The state’s Bureau of HIV/AIDS yesterday launched a series of public hearings to discuss proposed changes to Drug Assistance Program eligibility. #

Rajner says those hearings — information on upcoming Miami and Tampa hearings is available below — are an opportunity for citizens, doctors and heath care leaders to step up to develop recommendations to solve the Drug Assistance Program crisis. #

Workshop schedules

Federal report: Florida mismanaged HIV/AIDS money

Posted on: April 25th, 2011 by The American Independent No Comments

A January 2011 federal report provided to The Florida Independent on the condition of anonymity alleges that federal audits and site visits show that Florida’s Bureau of HIV/AIDS failed to use “available resources in the best interest of people living with HIV and AIDS” while administering its AIDS Drug Assistance Program, which provides HIV/AIDS medications to low-income citizens. (more…)

With possible eligibility cuts, funding shortages, Florida’s AIDS Drug Assistance Program remains in crisis

Posted on: April 25th, 2011 by The American Independent No Comments

On Monday, the Florida Department of Health will hold the first of several public debates to decide whether to reduce eligibility to Florida’s AIDS Drug Assistance Program (aka ADAP) from 400 percent of the federal poverty level to 200 percent. #

In other words: A person who earns $30,000 a year would not qualify for ADAP. HIV/AIDS drugs cost between $10,000 and $20,000 a year. #

Florida already has the longest waiting list in the U.S. for people seeking to receive their HIV/AIDS medication through the state- and federally funded ADAP. #

Michael Rajner, legislative director of the Florida GLBT Caucus, tells The Florida Independent that if reduced eligibility is approved, anybody above 200 percent of the federal poverty level will have to go off their medications, causing drug resistance. #

Rajner, who relies on ADAP himself, says that if the eligibility reduction is approved he would not qualify for drugs and would not be financially capable of affording his medicine, forcing him to perhaps discontinue all HIV treatment. He says that he is already suffering from an opportunistic infection, and that his health would continue to decline. #

“It is great that the state is allowing an opportunity for public input on these changes to ADAP,” Rajner adds, “but any changes to the program at the state level will dramatically impact and harm local programs” throughout the state. #

As an example of this impact, Rajner says that the state is also looking to reduce eligibility according to the number of a person’s T-cells. If your T-cells are below 500, you qualify for treatment, but Florida is looking to reduce this. So unless your T-cells fall below 200, which is a way to define AIDS, you will not receive access to your medications. #

The AIDS Institute released a statement Thursday calling on all Floridians to oppose the Florida Department of Health’s Bureau of HIV/AIDS proposal to reduce eligibility for HIV/AIDS patients. #

Michael Ruppal, executive director of The AIDS Institute, said in a written statement: #

“With almost 8,000 people on ADAP waiting lists nationwide and 3,807 of those in Florida alone, it is clear that the need is significant. Reducing the eligibility to further limit the number of people accessing services only compounds the problem and puts many more lives at risk.”  He went on to say, “This is a time to take action and tell the state how reducing the eligibility criteria for HIV/AIDS services will hurt those in need.” #

The statement adds that the AIDS Insurance Continuation Program, as well as the Housing Opportunities for Persons with AIDS and possibly more HIV/AIDS programs and services are also looking at reductions. #

Will Rothschild works for Rothschild and Maultsby Media, which handles media relation for Welvista, a South Carolina-based health care network that provides medications at no cost to the uninsured who do not qualify for Medicaid, Medicare or V.A. insurance, and those who cannot afford to pay for insurance coverage on their own. He says the sustainability of ADAP in Florida and 10 other states is in jeopardy. ADAP ran out of money last year, and the federal allocation is not going up this year. #

“It is likely the Florida ADAP will completely run out of money by December or January,” Rothschild says. #

“In Florida, the legislature is just removing themselves of taking care of their citizens,” says Mark King, who manages My Fabulous Disease. “I have been living with HIV for 30 years. I know I wouldn’t be alive today if it wasn’t for medications. We are always telling people know your status, because there are treatments to help you, but then, well you have to be on a waiting list if you want any of those.” #

“It is astounding that Florida would have such a huge waiting list,” King says. “Rather than address the waiting list by funding things properly, they decided to get rid of the waiting list by changing the eligibility requirements, by knocking everybody on it off the program all together.” #