Harry J. Heiman

The New Invincibles: HIV Screening among Older Adults in the U.S

Background Thirteen percent of the U.S. population is ages 65 and older, a number projected to reach 20% by 2030. By 2015, 50% of Human Immunodeficiency Virus (HIV)-infected individuals in the U.S. are expected to be ages 50 and older. Current Centers for Disease Control and Prevention guidelines recommend “opt-out” HIV screening for individuals ages 13–64. The purpose of this study was to assess the occurrence and barriers to HIV screening in older adults, and to evaluate the rationale for expanding routine HIV screening to this population. Methods The study used 2009 National Health Interview Survey (NHIS) data. A total of 12,366 (unweighted) adults, ages 50 and older, participated in the adult section of the NHIS and answered questions on the HIV/AIDS, Sexually Transmitted Diseases, and Tuberculosis components. Associations between HIV screening, socio-demographic variables, and knowledge of HIV-related disease were examined using logistic regression models. Results The HIV screening rate within this population was 25.4%. Race had no statistically significant effect. Low risk perception of HIV exposure (84.1%) accounted for low likelihood of planned screening (3.5%) within 12 months post survey. A routine medical check-up was the single most common reason for HIV screening (37.6%), with only about half (52.7%) of the tests suggested by a health care provider. Conclusion It is imperative that practices and policies are developed and implemented to increase HIV awareness and screening in the older adult population. Increased health care provider awareness of the importance of HIV screening, especially for those 65 and older, is critical. Health policies and clinical guidelines should be revised to promote and support screening of all adults.

The Influence of Race and Comorbidity on the Timely Initiation of Antiretroviral Therapy Among Older Persons Living With HIV/AIDS

OBJECTIVES We examined whether the timely initiation of antiretroviral therapy (ART) differed by race and comorbidity among older (≥ 50 years) people living with HIV/AIDS (PLWHA). METHODS We conducted frequency and descriptive statistics analysis to characterize our sample, which we drew from 2005-2007 Medicaid claims data from 14 states. We employed univariate and multivariable Cox regression analyses to evaluate the relationship between race, comorbidity, and timely ART initiation (≤ 90 days post-HIV/AIDS diagnosis). RESULTS Approximately half of the participants did not commence ART promptly. After we adjusted for covariates, we found that older PLWHA who reported a comorbidity were 40% (95% confidence interval = 0.26, 0.61) as likely to commence ART promptly. We found no racial differences in the timely initiation of ART among older PLWHA. CONCLUSIONS Comorbidities affect timely ART initiation in older PLWHA. Older PLWHA may benefit from integrating and coordinating HIV care with care for other comorbidities and the development of ART treatment guidelines specific to older PLWHA. Consistent Medicaid coverage helps ensure consistent access to HIV treatment and care and may eliminate racial disparities in timely ART initiation among older PLWHA.

The Affordable Care Act and low-income people living with HIV: looking forward in 2014 and beyond.

Winston Abara, MD, PhD, is a Health Policy Fellow, Satcher Health Leadership Institute, and Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia. Harry J. Heiman, MD, MPH, is the Director, Division of Health Policy, Satcher Health Leadership Institute, and an Assistant Professor, Department of Family Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA. There are approximately 1 million people living with HIV (PLWH) in the United States, with an estimated 50,000 new HIV infections occurring annually (Centers for Disease Control and Prevention [CDC], 2012a). Racial and ethnic minorities, sexual minorities, and low-income populations bear a disproportionate burden of HIV (CDC, 2012a; 2012b). In the United States, African Americans and Hispanics/ Latinos accounted for 44% and 21% of all new HIV infections in 2010 respectively, while men who have sex with men comprised an estimated 63% of all new HIV infections in the same year (CDC, 2012a). In an effort to address the HIVepidemic in the United States, the Obama administration put forward the National HIV/AIDS Strategy (NHAS) in 2010 with a vision for the ‘‘United States to become a place where new HIV infections are rare, and when they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, gender identity, or socioeconomic circumstance will have unfettered access to high-quality, life-extending care, free from stigma and discrimination’’ (CDC, 2012c, p. vii). This vision drives the goals of the NHAS to reduce new HIV infections, increase access to care, optimize health outcomes, and reduce HIV-related health disparities. Unfortunately, not all PLWH have access to highquality care and treatment (Hall et al., 2013) despite extant data and clinical guidelines that show that HIV

Public Health Policy Is Political

In his article,1 Goldberg provides a very cohesive critique of why concern over politicization of public health policy as a justification for preferring a narrow to a broad model of public health is a nebulous argument. To achieve its mission of assurance, public health is obligated to engage broadly with the spectrum of factors that impact health outcomes, most importantly the social and environmental determinants. Avoiding the political implications of these factors has never been possible. Even the “basic 6” services defined under the narrow model of public health2 have never been free of politics. Several recent and ongoing controversies illustrate this point. Firstly, recent H5N1 research,3,4 with clear implications for controlling communicable disease and epidemic preparedness, became controversial largely as a result of US national security concerns, a political matter. Secondly, the ongoing challenges regarding abortion rights in multiple state legislatures and the recent debate regarding coverage of contraception in the Affordable Care Act, both of which clearly fall within the purview of maternal health, remain a political quagmire. Lastly, sexual education, an important health education issue, has always been highly political. Thus, even issues within the “basic 6” have always been of a political nature. As a result, the “narrow model” not only fails to carry any less risk of politicization, it also fails to address some of the most critical public health issues. The idea that any model of public health can avoid politics and political concerns, as Goldberg points out, is unfounded. In our view, the conversation needs to be about how the policymaking process can be more inclusive of the growing body of evidence showing the intimate relationship among population health and social and environmental factors and inequities. The challenge for public health professionals is to ensure that these discussions, however political, are informed with the best available science. In addition, we must develop the capacity of public health professionals to navigate the political landscape and advocate for the public’s health. Finally, we must engage across sectors and silos to ensure that assessments of the impact of policies on population health and health equity are integral components of all policy decisions. Then, and only then, will we truly be able to advance the nation’s health.

Health Policy Training: A Review of the Literature

The context within which health care and public health systems operate is framed by health policies. There is growing consensus about the need for increased health policy leadership and a health professional workforce prepared to assume these leadership roles. At the same time, there is strong evidence supporting the need for a broader policy lens and the need to intentionally target health disparities. We reviewed the published literature between 1983 and 2013 regarding health policy training. From 5124 articles identified, 33 met inclusion criteria. Articles varied across common themes including target audience, goal(s), health policy definition, and core curricular content. The majority of articles were directed to medical or nursing audiences. Most articles framed health policy as health care policy and only a small number adopted a broader health in all policies definition. Few articles specifically addressed vulnerable populations or health disparities. The need for more rigorous research and evaluation to inform health policy training is compelling. Providing health professionals with the knowledge and skills to engage and take leadership roles in health policy will require training programs to move beyond their limited health care-oriented health policy framework to adopt a broader health and health equity in all policies approach.

Disparities in pediatric oncology patient education and linguistic resources: results of a national survey of pediatric oncologists.

Extensive patient and family education is required at the time of a new diagnosis of pediatric cancer yet little data exist regarding the availability and linguistic competency of new cancer diagnosis education provided by pediatric oncology institutions.

Understanding health policy leaders’ training needs

Purpose We assessed the training needs of health policy leaders and practitioners across career stages; identified areas of core content for health policy training programs; and, identified training modalities for health policy leaders. Methods We convened a focus group of health policy leaders at varying career stages to inform the development of the Health Policy Leaders’ Training Needs Assessment tool. We piloted and distributed the tool electronically. We used descriptive statistics and thematic coding for analysis. Results Seventy participants varying in age and stage of career completed the tool. “Cost implications of health policies” ranked highest for personal knowledge development and “intersection of policy and politics” ranked highest for health policy leaders in general. “Effective communication skills” ranked as the highest skill element and “integrity” as the highest attribute element. Format for training varied based on age and career stage. Conclusions This study highlighted the training needs of health policy leaders personally as well as their perceptions of the needs for training health policy leaders in general. The findings are applicable for current health policy leadership training programs as well as those in development.

Disparities in pediatric oncology patient education and linguistic resources

Extensive patient and family education is required at the time of a new diagnosis of pediatric cancer yet little data exist regarding the availability and linguistic competency of new cancer diagnosis education provided by pediatric oncology institutions.

Disparities in pediatric oncology patient education and linguistic resources: Results of a national survey of pediatric oncologists: Disparities in Patient Education

Extensive patient and family education is required at the time of a new diagnosis of pediatric cancer yet little data exist regarding the availability and linguistic competency of new cancer diagnosis education provided by pediatric oncology institutions.

Developing Health Leaders to Combat Sexual Health Disparities

Health disparities, including sexual health disparities, remain pervasive in our society. The Satcher Health Leadership Institute at Morehouse School of Medicine, through its Sexual Health Scholars and Health Policy Leadership Fellowship Programs, is preparing the next generation of health leaders with the necessary knowledge and skills to combat health disparities.