When will Gregg Pane Get His Grade?

The Appleseed Reports on HIV/AIDS in the District have always carried a lot of weight. Former HIV/AIDS Administration Director Lydia Watts was fired by Gregg Pane just one week after the first Appleseed Report. When Marsha Martin became Director of the HIV/AIDS Administration, she received regular 'report cards' from DC Appleseed measuring the progress of the HIV/AIDS Administration.

The first report card covered August 2005 to March 2006. The second report card covered March 2006 to December 2006.

Then on January 1st Marcia Martin left the HIV/AIDS Administration when Mayor Fenty took office and chose not to keep her on board, at which time Gregg Pane took the reigns as Interim Director of the HIV/AIDS Administration.

We have yet to see a report card that measures progress made during Gregg Pane's time as Interim Deputy Director.

It remains to be seen whether the Appleseed Project will weigh in on Pane's work at the HIV/AIDS Administration. One has to wonder whether his 'grades' would be better or worse than the two Directors he fired.

Marsha Martin to leave DC Administration for HIV Policy & Programs

Marsha Martin, Director of the DC The Administration for HIV Policy and Programs, will be leaving that position. In a farewell e-mail, Martin wrote "As a Williams appointee, it is my time to leave the government and I do so with great respect and admiration for this agency. Together, you have changed and re-ignited the conversation about the HIV epidemic in Washington, DC."

Is anyone else out there as suprised as I am at this news?

During her tenure, AHPP launched an ambitious HIV screening program for the district. The program fell far short of it's goals, and of the 80,000 rapid HIV test kits that were purchased, the majority were either given away or expired without being used. Still, 20,000 were tested for HIV in a five month period which is a significant increase (twice that of an average year).

AHPP appeared to be steadily improving under Martin, and new staff members brought on board by Martin (some very recently) offer a lot of hope for the future. Unfortunately, some problems that plagued the office did continue. HIV/AIDS Surveilance continues to be a major problem. And a recent audit criticized AHPP's monitoring of local HIV/AIDS service organizations.

Yes, there are still many things that need to be fixed at AHPP. That said, I'm sad to see Marsha Martin leave. I felt like under her leadership we were moving in the right direction.

Finding a new Director of AHPP could take several weeks, or it could take several months. Once we do find a new director, there is no guarantee that the staff members Marsha Martin brought on board will want to remain under new leadership.

The thought of going several weeks or several months without a strong leader at AHPP terrifies me. We simply don't have that much time to spare.

An Overwhelmed D.C. Agency Loses Count of AIDS Cases

From the Washington Post: In late August, barely a month into her new job, Marie Sansone of the District's AIDS agency was astounded by what she discovered: five boxes of unexamined HIV and AIDS cases that had not been touched in more than a year.

In the boxes were records of 2,000 to 3,000 cases that had yet to be entered in the city's database. The records are mostly from 2004 and 2005, some from 2003. Who's getting sicker, who needs treatment, who died. All boxed up.

"Oh, my goodness," Sansone, surveillance chief for the city's Administration for HIV Policy and Programs (AHPP), remembers saying.

"We were flabbergasted, just flabbergasted," adds Sansone's boss, AHPP Director Marsha Martin.

That information is critical to managing a spreading epidemic, now in its 25th year. Under guidelines from the federal Centers for Disease Control and Prevention, AHPP is required to collect, maintain and distribute statistics on the disease, which dozens of community-based organizations depend on for their prevention and treatment programs.

City officials acknowledge that the District is behind in tracking new cases of HIV, as well as in reporting the number of deaths from AIDS complications.

Continue Reading this article in the Washington Post:

D.C. falls short of goal in testing for HIV

From the Washington Blade: The city will fall far short of meeting its ambitious goal of screening all residents for HIV between the ages of 14 and 84 — about 400,000 people — between June 27 and Dec. 31, District health officials said. Gregg Pane, director of the D.C. Department of Health, said the city’s widely publicized HIV testing initiative resulted in about 20,000 people being tested during a five-month period as of Dec. 1. The figure represents more than twice the number of tests normally administered in the District in a full year, according to Pane. “We certainly set a stretched goal, which was really to make the test available to anyone who wanted it between the ages of 14 and 84,” Pane said. “It was pretty ambitious.” Marsha Martin, director of the Administration for HIV Policy & Planning, an arm of the health department, set the 400,000-test goal. Martin has said her aim was to reverse the city’s status of having the nation’s highest rate of new HIV infections each year. Martin said the city purchased 80,000 rapid HIV test kits and initiated an aggressive public education campaign to promote the testing initiative. She said an undetermined but significant amount of HIV tests have been administered in private doctors’ offices and clinics in addition to the 20,000 known tests conducted through city public health programs. She said she was confident the city would make “good progress” toward reaching the testing goal in the coming months. AIDS administration spokesperson Michael Kharfen said the HIV testing initiative has a budget of $1.3 million, with $800,000 going to the purchase of “rapid” HIV test kits and $500,000 going to a public outreach campaign to encourage people to get tested.

Catania calls for firings at AIDS office

the following article appeared in the Washington Blade print edition this week but did not appear on their website. I thought it was worth posting here..

City AIDS administration officials came under sharp questioning at a D.C. Council hearing Monday following the release of a city audit that showed the agency failed to properly monitor millions of dollars in grants to vendors providing services to people with the disease.

Marsha Martin, head of the Administration for HIV Policy & Programs (AHPP), and Department of Health Director Gregg Pane fielded the inquiries. The audit found that 14 vendors providing AIDS-related services were operating illegally because they did not have the required license to conduct business in the District of Columbia. Others were not certified to provide Medicaid-related services to clients that the city paid them to assist, the audit found. The report did not identify the problem vendors described in the audit.

The D.C. Office of the Inspector General, which conducted the audit, is investigating one of the vendors for possible criminal prosecution after determining it was not performing any of the work the city was paying it to do, an official with the office said.

According to the audit, grant managers at AHPP failed to conduct required onsite visits and did not keep sufficient records to adequately assess whether the vendors were doing the work specified in the grants and contracts the city had awarded them.

D.C. Councilmember David Catania (I-At-Large), who called the hearings in his role as the chair of the council’s Committee on Health, expressed outrage that the newly released audit uncovered some of the same internal management problems at AHPP that a similar audit discovered a little more than a year ago.

FINDINGS UNACCEPTABLE

While pointing to significant improvements at AHPP since September 2005, when Martin took office, Catania called the latest audit findings “unacceptable.” He called on Martin and Pane to fire grant monitors and other employees found to be negligent in performing their duties.

“I want to hear they’re no longer with this government because we cannot continue to pour old wine in a new bottle,” Catania said.

Catania released additional information he obtained from the city’s chief financial officer showing that AHPP failed to spend about $5.6 million in federal funds for AIDS programs in 2006.

Details about lingering problems as well as improvements at AHPP under Martin’s first year in office surfaced in a 31-page report released last week by the Office of the D.C. Inspector General, which outlines the findings of the audit.


William DiVello, a spokesperson for the Office of the Inspector General, said the office has a policy of not releasing the names of organizations or individuals that are subjects of audits. He said his office is investigating the vendor found not to be performing its work to determine whether criminal charges should be filed against it.

But in response to Catania’s questions, Inspector General officials identified the vendor under investigation for allegedly not performing its duties as Our Children, Inc., a community-based organization located on Good Hope Road in Southeast Washington.

Bridget Johnson, a spokesperson for the group, told the Blade in an Oct. 25th interview that officials with the group believe investigators with the Inspector General’s office “went to the wrong address” when they sought to verify Our Children’s work related to its AHPP grant.

“Their information was wrong,” Johnson said. “We have done the work.” Johnson declined to provide further details, saying the group’s executive director would issue a statement later.

Martin and Pane acknowledged the problems outlined in the Inspector General’s report and audit and promised to take immediate steps to correct them. Pane said he was especially troubled over the AHPP’s inability to disburse and spend federal funds in a timely manner.

“I take full responsibility,” he said. “I know it is not acceptable to her and it’s not acceptable to me,” Pane said, referring to his and Martin’s effort to improve procedures for grant management and the expenditure of funds.

Pane hired Martin as head of AHPP in September 2005 shortly after he fired her predecessor, Lydia Watts, for failing to improve the trouble-plagued AIDS office.

Watt’s firing came 11 months after Mayor Anthony Williams appointed her to head what was then called the HIV/AIDS Administration, or HAA. Williams named Pane as head of the Department of Health around the same time he appointed Watts.

Many of the longstanding problems associated with HAA during Watt’s tenure and the tenure of her predecessors were uncovered during a series of oversight hearings Catania conducted in 2004 and 2005. Martin, a former health official in the Clinton administration and the former executive director of AIDS Action, a national AIDS advocacy group, has been praised by gay and AIDS activists as an experienced and committed champion for people with HIV/AIDS.

To continue reading this article, pick up a copy of this week’s Washington Blade

A Million Condoms for DC

Today I attended the Washington Times Citizens Forum on HIV/AIDS. (for pictures from the event, see the FightHIVinDC Flickr Page)

Congresswoman Eleanor Holmes Norton noted that despite good efforts, we still have the highest HIV infection rate in the country. Norton urged participants to think critically about new approaches and new directions we should take to address the pandemic.

I won't give you a blow-by-blow of the event, because the full text of the forum will be printed in the Washington Times next week. I will mention, though, that the event was moderated Walter Smith of DC Appleseed, and included comments by Barbara Chin of Whitman Walker, Greg Payne of the DC Department of Health, Ann Wise of Metro Teen AIDS, and Jennifer Kates of the Kaiser Family Foundation.

There wasn't a lot of new information or discussion at this event. Hearing the history of Metro Teen AIDS or Whitman Walker is quite interesting if you haven't heard it before. Unfortunately, for most of the people in this small Saturday Morning crowd, that was not the case.

Two things you might not have heard about yet, came from Marsha Martin at the Administration for HIV Policy and Programs:

First, AHPP is planning to purchase and distribute a million condoms in the District. This may be kind of a gimmicky number, but I think it's really good news. When I attended the recent Freedom Plaza Event, I noticed a staff person from the Washington Free Clinic stashing away condoms from exhibitor tables. When I inquired about it, I learned that they've been having a challenging time securing enough condoms for their clients. So ... any effort to make more condoms available to DC resident is greatly appreciated.

Second, Dr. Marsha Martin from AHPP mentioned the possibility of having a BIG town hall style event on HIV/AIDS in the end of January. And by big, she was talking about as many as 5,000 people. I think it's the perfect time to engage the city. By then, we will have a lot of useful information from the HIV screening campaign, and a clearer picture of the epidemic in DC. Also, we'll have a new Mayor and City Council members, so it's a great time to talk about goals and objectives for fighting the epidemic. I hope this idea comes to pass.

Washington DC Meeting of the Presidential Advisory Committee on HIV/AIDS

On Monday, October 16 and Tuesday, October 17, the Mayor’s Task Force on HIV and AIDS will be hosting the thirty-first meeting of the President’s Advisory Council on HIV and AIDS (PACHA). The Presidential Advisory Council on HIV/AIDS provides advice, information, and recommendations to the Secretary of the US Department of Health and Human Services regarding programs and policies intended to promote effective prevention of HIV disease, and to advance research on HIV disease and AIDS.

The meeting will be held at Howard University, Blackburn Conference Center, West Ballroom. Dr. Marsha Martin, DC Administration for HIV Policy & Programs, writes "The Task Force is pleased to host this meeting and engage PACHA with our local community. It is our hope that PACHA members will come away from the meeting with an understanding of the successful programs and organizations that work on behalf of people living with HIV in our city and of the coordinated response to HIV in the nation’s capital."

To download a draft of the meeting agenda as a PDF file, click here.

Panel Discussion on CDC Testing Guidelines

Yesterday the Kaiser Foundation held a panel discussion on the new CDC HIV Testing Guidelines in Health Care Settings. Pictured on the left are two of the panelists: Frank J. Oldham Jr, Executive Director, National Association of People with AIDS; and Dr. Marsha Martin, Senior Deputy Director, Administration for HIV/AIDS Policy and Programs, DC Department of Health. (two pictures from the event are up on the FightHIVinDC Flickr Stream.

The new recommendations for HIV testing in Health Care Settings are pretty long. You can read the whole thing on the CDC website. A few of the key points from the recommendations:

• HIV screening is recommended for patients in all health-care settings after the patient is notified that testing will be performed unless the patient declines (opt-out screening).
• Persons at high risk for HIV infection should be screened for HIV at least annually.
• Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient to encompass consent for HIV testing.
• Prevention counseling should not be required with HIV diagnostic testing or as part of HIV screening programs in health-care settings.

It appears that this opt-out testing approach would significantly increase the number of folks who are tested for HIV nationwide in comparison to the out-in testing most currently used. It also seems to be more align with the changing epidemic. In one Kaiser Foundation Poll, 65% of those polled agreed that "HIV testing should be treated just like routine screening for any other disease, and should be included as part of regular check-ups and exams.

The new recommendations are very much in alignment with Washington DC's "Come Together DC: Get Screened for HIV" campaign. Dr. Marsha Martin from the Administration for HIV/AIDS Policy and Programs spoke about the success of the campaign.

Some community concerns still persist however. There are three I would like to highlight.

1. If these new testing recommendations succeed in identifying HIV positive individuals in the United States, we simply don't have the money and capacity at present time to treat them. This is not as much of a problem for Washington DC, but it is clearly a concern for states that ALREADY have folks on waiting lists for their AIDS Drug Assistance Programs. Internationally with the PEPFAR, increased testing is tied to increased treatment availability. It would be great to see that happen here.

2. When done correctly, Prevention Counseling during HIV testing works and succeeds in reducing risk behaviors and HIV transmission, so why are we dropping it? Bernard Branson from the CDC stated during the event that since most of the time it isn't done correctly, and most of the time it doesn't work. I don't buy that argument completely. After all condoms are not all that effective when used incorrectly and improperly, but I don't hear the CDC saying - let's give up on condoms, eh?

3. Finding out you're HIV positive is still fundamentally different from finding out you have diabetes. HIV/AIDS related prejudice, stigma, and discrimination is still alive and well in many communities. Getting rid of a separate informed consent and switching to opt-out instead of opt-in is a slippery road that means it's more likely that in some settings, folks will sign paperwork and get an HIV test without realizing it. Finding out your're HIV positive can be a pretty overwhelming experience. Nobody should be given the test without their consent. These recommendations state that explicitly, but they also elminiate some of the assurances we've had in the past two make sure that doesn't happen.

All in all though, I think it's a good thing. I think the message that everyone needs to get screened for HIV is accurate and positive, and will mean more people get tested, and more HIV positive individuals are identified early when treatment has the biggest impact.

There's an interesting article about the forum here

DC Lunch Forum on CDC's New HIV Testing Recommendations

On Tuesday October 3rd, the Kaiser Family Foundation will host a panel discussion on the CDC's new HIV Testing Recommendations. As you've probably have seen in the news, the CDC now recommends routine HIV testing for all patients (ages 13-64) in health care settings. This is very much in line with DC's current testing campaign.

Panelists will include Dr. Marsha Martin from the DC Administration for HIV/AIDS Policy and Programs; Frank Oldham, Executive Director of the National Association of People with AIDS; and David Holtgrave, professor and chair, Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health.

The lunch forum will take place from noon to 2:00 PM at the Barbara Jordan Conference Center, Kaiser Family Foundation Building, 1330 G Street, NW, Washington, D.C. (one block west of Metro Center).

If you would like to come to this event you must RSVP by September 29th. RSVP to Tiffany Ford at tford@kff.org or (202) 347-5270.

Day 3: DC at the US Conference on AIDS

Day Three at the US Conference on AIDS. Pictured on the left are Dr. Marsha Martin and Tiffany (whose last name I can't remember at the moment) in the exhibit hall at the DC Administration for HIV Policy and Programs Booth. More pictures from the conference are available on the Flickr Photo Stream.

There has been a lot of discussion here about DC's ambitious HIV testing program. I'll write more about that tomorrow (late for a plenary already) but for now, let me share with you goals of DC's testing campaign.

• To encourage all Washington DC residents to know their HIV status by December 31, 2006
• To raise awareness among DC residents on the importance, availability, and ease of HIV testing
• To expand access/availability of confidential HIV screening, with the goal of making HIV screening routine in all medical settings
• To identify previously undiagnosed persons living with HIV and connect them to immediate care and treatment
• To coordinate the medical and community resources necessary to sustain an on-going HIV screening program
• To reduce transmission of HIV in Washington DC
• To establish a model for other cities around the world

DC has come a long way forward since this campaign was first launched in June of 2006, but we still have a long way to go if we are going to meet these goals by December 31st.

Day 2: DC at the US Conference on AIDS

It's day two of the US Conference on AIDS. Pictured on the left are staff members from the Washington DC based organization AIDS Action, who participated in the UCHAPS Institute at the US Conference on AIDS today.

What is UCHAPS, you ask? Well it's the Urban Coalition for HIV/AIDS Prevention Services and it's comprised of seven cities (or urban areas) that have been hit hard by this epidemic including: Los Angeles, Philly, San Francisco, Houston, New York City, Chicago, and of course Washington DC.

UCHAPS is a pretty oool partnership between local health departments and concerned community members who are involved in local Ryan White Planning Councils (a treatment focused advisory board) or Community Planning Groups (a prevention focused advisory board).

Representing DC were several folks from our DC Administration for HIV/AIDS Policy and Programs including Dr. Marsha Martin, and several community folks. Catalina Sol and Toni Young were there representing the local DC Community Planning Group. Danielle Pleasant was there from the Planning Council.

The meeting focused on collaborations between the prevention side (Community Planning Groups) and the treatment side (Planning Council). Several cities shared their experiences with this including DC. Not suprisingly, other cities are ahead of us when it comes to building these connections between prevention and care. But fortunately, DC is definitely moving in the right direction.

One thing that stood out. In DC both the planning council (which actually serves a larger region beyond just DC) and the DC Community Planning Group have a large number of vacant seats. We need more concerned community members willing to get involved in the fight against HIV/AIDS in DC. If you want to find out more about how you can get involved, drop me a line, or just post a comment below.

Could the 2010 International AIDS Conference Take Place in DC?

This morning I attended a Debrief of the International AIDS Conference sponsored by the Kaiser Family Foundation and the Center for Strategic and International Studie. Many of the speakers commented on the focus on prevention at the conference, the role of 'celebrity' advocates like Bill & Melinda Gates, Bill Clinton, and Richard Gere.

Speakers were also expressed their desire to see the Conference (which is held in locations around the world) return to the United States. Unfortunately, our immigration and travel policies make it difficult for HIV positive individuals to enter the United States. The Immigration & Nationality Act makes applicants for a visa or for admission the United States inadmissible if they have a "communicable disease of public health significance" and HIV is currently included in that category.

There are some exceptions to the rule. Most notably HIV Positive Individuals attending a United Nations HIV/AIDS Meeting were granted a waiver. Still, as long as the policy stands, the International AIDS Conference will not be returning to the United States.

Marsha Martin, Director of the DC The Administration for HIV Policy and Programs, and a number of other folks in the room, expressed interest in working to overturn this policy. Dr. Martin went one step further, suggesting that Washington DC would be a good location to host the 2010 International AIDS Conference.

It's a bold suggestion, but one that is entrely possible. If there is a strong push for Congress to overturn this policy, it could be overturned before 2008. And DC is as well-equipped as any city to host a conference of this magnitude. Will it happen? We will see, but it would be a big boost to the city and to our efforts to fight HIV in the District.