HIV meds program on state’s chopping block

Ending assistance could cost communities millions in added ER care and hospitalization, advocates say

DAVID TAFFET | Staff Writer
taffet@dallasvoice.com

Some of the more extreme budget cutters would like to eliminate the program that helps people without insurance receive life-sustaining medications, as the Texas Legislature struggles to pass a balanced budget.

“That would be called legalized murder,” said Don Maison, president and CEO of AIDS Services Dallas.

Among the more likely proposals being floated in Austin is to add only 400 to 500 people to the Texas HIV Medication Program (THMP) over the next two budget cycles, which runs four years.

Bret Camp

Local HIV healthcare providers said the proposed number is low compared to the number who will need the program.

Texas is a direct purchase state, according to Bret Camp, associate executive director of health and medical services for the Nelson-Tebedo Clinic at Resource Center Dallas. Camp explained that the state buys HIV medications and distributes them through a network of about 400 pharmacies throughout the state.

To qualify for THMP, a client must be diagnosed HIV-positive, be a Texas resident, be uninsured or under-insured for drug coverage, have income below 200 percent of the poverty level, and not receive Medicare.

Medicare recipients get their medication through the State Pharmacy Assistance Program.

In 1996, 5,100 people in Texas received their medication through THMP. Last year, the estimated number was 14,000.

Camp said he is concerned that increasing the number of eligible people over the next four years by just 400 would leave too many without the medications they need.

Camp said he expects the number of people needing assistance to increase significantly.

“The state is being responsible and promoting HIV testing,” he said. “The more testing, the more cases we’re likely to see.”

Just how much the state is spending on providing drugs for about 14,000 Texans with HIV is not known. Camp said that the state negotiates a price with the drug companies but does not publish the negotiated price.

“Nobody really knows what the price is,” Camp said.

Randall Ellis is the senior director of government relations for Legacy Community Health Services in Houston, formerly known as Montrose Clinic. He said that Texas probably pays in the range of $6,000 per year for someone in the program.

Individuals who have to purchase the drugs themselves or have insurance cover part of the price would pay closer to $24,000 or more.

Camp said that eliminating the program would save little when compared to the overall budget shortfall. But he said that the cost of caring for people who would have to make multiple emergency room visits and have extended hospital stays would be much higher than keeping them healthy in the first place.

Ellis said another problem is that the oversight committee, made up of stakeholders from around the state, sunsetted last fall. To reinstate the committee, the commissioner of Health and Human Services would simply have to repost the rules.

The committee made recommendations to the health department such as what drugs should be included in the program and what the eligibility requirements should be.

The commissioner, Ellis said, usually followed the committee’s recommendations. But the commissioner didn’t always want that input, he said.

“They want our input when it looks good to have community input,” Ellis said. “But when we ask tough questions, they’d rather not have us.”

Ellis does not expect all funding for THMP to be cut. He said that the state receives some funding through the federal AIDS Drug Assistance Program.

Camp said other states have thousands of people on waiting lists for ADAP programs.

“Florida is sorry right now,” he said. “They have dis-enrolled people.”

Florida has more than 3,000 waiting for medication. Unless those people find another way to get their medication, most will become sick, Ellis said, adding that if they are left untreated, those people will die.

Camp said that after recent hearings in the Senate Finance Committee, senators “seemed to leave with questions” that were on a level he hadn’t heard since early in the AIDS crisis.

On Tuesday, Feb. 15, the Texas HIV-AIDS Coalition is sponsoring Advocacy Day at the Capitol in Austin. A Dallas contingency will join groups from Houston, San Antonio and other cities as far as El Paso to talk to legislators about the need to fund the program.

For more information or to register for Advocacy Day, go TexasHIV.org.

—  John Wright

WATCH: Capacity crowd marks Transgender Day of Remembrance at Cathedral of Hope

DAVID TAFFET  |  Staff Writer
taffet@dallasvoice.com

A capacity crowd filled the Interfaith Peace Chapel at Cathedral of Hope to mark Transgender Day of Remembrance on Sunday night, Nov. 21.

Nell Gaither, a steering committee member for GEAR, served as MC. She noted the recent spate of suicides among gay youth. GEAR is the transgender program of Resource Center Dallas.

Among transgender adults, 40 percent have attempted suicide, a rate 25 times higher than among the rest of the community, she said.

She said 20 percent of transgender people had been refused healthcare treatment and even more experience harassment in a medical setting.

Among transgender people of color, 35 percent live below the poverty level.

A portion of the memorial was dedicated to Alexander Allison, a local trans man who committed suicide this year.

Among the speakers were Resource Center Dallas Executive Director Cece Cox.

Cox thanked the transgender community for answering her many questions so she can be a better ally. She also commented on the growing visibility of the transgender community.

“When someone tries to make me feel invisible, it makes me feel ‘less than’ and that doesn’t feel good,” she said.

Former Mayor Pro Tem John Loza said the community needs to do more than just tell LGBT youth that in 10 years it will get better — it also must provide the tools for them to get there.

“But there is reason for hope,” he said.

He listed recent gains the transgender community has made, including the election of the first transgender judge in California and Houston Mayor Annise Parker’s appointment last week of Phyllis Frye as a municipal court judge. He lauded Dallas Independent School District’s new enumerated anti-bullying policy that includes gender identity and expression.

As Aaron Barnes and Dorian Mooneyham read the names of 30 transgender victims of violence, members of the community lit candles and laid red roses on a table. Two of those victims were from Houston.

Mo Snow gave closing remarks. “I don’t want to be the reason my partner is discriminated against,” he said, calling her the most loving person he’d ever met.

For the third year, the Women’s Chorus of Dallas ensemble MosaicSong opened and performed during the ceremony. Voice of Pride winners Mel Arizpe and Laura Carrizales also performed.

—  David Taffet

LSR Journal: Because they still need us

ROBERT MOORE  Team Dallas Voice

Robert Moore Team Dallas Voice
ROBERT MOORE Team Dallas Voice

I left the office and went out for lunch today.  Not an uncommon occurrence. I go out almost every day. The biggest challenge I have before I leave the building is deciding where to eat. Dallas is a restaurant town, you know.

Where to eat? How much to spend? How far to travel? How much time do I have in my schedule today? So many decisions to be made just for a simple lunch.

Not today.

Today I had lunch with Jennifer Hurn, the client services manager for Resource Center Dallas, one of the beneficiaries of Lone Star Ride Fighting AIDS, along with AIDS Services of Dallas and AIDS Outreach Center of Tarrant County.

I had called Jennifer and told her I was riding Lone Star Ride this weekend and I wanted to meet some of the clients at the Hot Meals Program, which she oversees. Ultimately, when you are holding out your hand and asking people for money to support a cause, your cause, you want to know and see that the money they hand over to you is doing some good.

The RCD’s Hot Meals Program serves between 100 to 150 clients every weekday. Today’s menu was barbeque chicken, green beans with potatoes, garlic toast, a salad, plus cake for those, like me, that have a sweet tooth.

To be eligible for the meal, a client must be HIV-positive, have an income at or below 300 percent of the poverty level and fall under Ryan White funding.

“We see some people once a week and some every day,” Hurn explains. “The numbers always go up at the end of the month when the social security money starts to run out. Always. We have a total of over 900 clients who are eligible for the meal.

If they all showed up on a single day, I don’t know what we would do.”

Jennifer doesn’t want to face that prospect and I understand her fears. Most of the chairs are taken.

After going down the serving line, we sit down with Edward, a longtime client. Edward lives in Oak Cliff and takes the bus on his daily trip to RCD. The journey takes him an hour-and-a-half to two hours each way.

“I have been coming here for years. I’m an old-timer at this place. Plus I’m 60 years old,” he says, shaking his head with a grin, something of an acknowledgment he didn’t expect to be around this long. He notes that while the trip is onerous because he walks with a back brace and the help of a cane, he looks forward to it.

“If I don’t come here I may not see many people. I try to get to know people, especially the new folks who may not be comfortable at first.” Edward is the welcoming voice closest to the serving line.

While Edward holds court, Jennifer and I change tables to meet some of the other diners. Rick and Mike are longterm AIDS survivors.  Rick became positive in 1997, Mike in 1987.

They both were successful businessmen who held professional jobs and never expected to be clients of a non-profit like Resource Center, but HIV has taken its toll and neither are able to work. Now, they live together to look after each other, have some company and help with living expenses.

“This place is important to me,” Rick states firmly. “I take a lot of medication and, well, it can make me confused,” he confides. “I really like to cook. I used to cook all the time, but now, well, many times I start cooking but I can’t finish what

I’m cooking. I don’t remember what to do next so I just give up. But then the medicine makes you sick if you are not eating.

This lunch solves a lot of problems for me.”

Rick looks straight at me, and I realize that he is about to say something he hates to admit: “Plus this place gives me a reason to get up and get dressed and gets me out. If I didn’t come here I might never go outside.”

Mike nods his head in agreement. “The interaction at the table is very important. There are people going through what you are going through, or maybe you can help somebody with a problem that you had once. Maybe you can teach them about Social Security or how to make it through a day at Parkland. Living on charity is not an easy way to live.

“There are homeless people here. They can get groceries from the Food Pantry but if you have no place to cook, how are you going to eat a hot meal? At least the kids on the street can get one hot meal a day.”

Mike knows a few of the homeless kids who got sick and went back home to stay. Their parents thought they just had a sick kid, then they found out they had a gay kid too, so they just turned them out on the street. “Isn’t that wrong?” he asks in disgust.  “Is to me.”

Edward and Mike and Rick turn a few questions to me. Why are you here? Why are you taking notes? I explain that I am doing Lone Star Ride, writing this installment of LSR Journal and, most importantly, asking people for money to keep programs like Hot Meals going.

“The great thing about the ride is that it a very public statement,” Mike says. “You let people know that AIDS is still here. It’s still with me, that’s for sure.”

Jennifer asks how Lone Star Ride fundraising is going. She knows it is tough out there raising money. “Whatever you raise, we will make it go as far as possible,” she promises.

Indeed she does. For that thirty bucks I spend on a typical business lunch, Jennifer can feed an RCD client a hot lunch every weekday for a month. On thirty bucks. Amazing.

The crew and the riders who come together to make events like Lone Star Ride Fighting AIDS work ultimately are there because they want to help people like Edward and Mike and Rick, and all the clients and the programs of the three beneficiaries.

We ride for those who cannot.  I am determined to ride every mile.

As I get up to leave, Rick stands up and shakes my hand, and invites me back. I accept. I tell him we’ll share a table again. Because like Rick says, “I like going out for lunch.”

Robert Moore is captain of Team Dallas Voice. Donate to him online at LoneStarRide.org.

This article appeared in the Dallas Voice print edition September 24, 2010.

—  Kevin Thomas