MN HIV Services Planning Council
Meeting Minutes for June 8, 2004
Redeemer Missionary Baptist Church

 

 

I.          Welcome and introductions; lighting of the candle

Paul called the meeting to order at 9:00.  Introductions were made.  Aaron Keith lit the candle in honor of his mentor and the person who got him interested in working in HIV, Jason French, and for all people living with HIV.

 

II.          Review the minutes and proposed agenda

The minutes for May 11 and May 18 were approved by unanimous consent.

 

III.   Co-chair update

Paul shared that a letter was composed to the Commissioner of DHS.  A response has not been received yet. 

 

Paul reminded members that the Planning Council is currently in the prioritization process.  For the last few months a variety of information has been gathered, disseminated, and considered.  When the Council gets to the decision making process, that will be left to Council members only.  Today the prioritization list will be determined.

 

IV.     Open Forum

Joe Larson, Scott Schlaffman, and others spoke on behalf of the Aliveness Project’s complementary care therapy program.  Points made included the importance of alternative care to the health and well being of PLWH/A.

 

V.          Cut/Add/Move discussion

Aaron Keith gave an overview of the proposed prioritization process as recommended by the Planning & Priorities Committee.  He then reviewed the process that will be used for the cut/add/move discussion.

 

Randy made a statement regarding his conflict of interest as a member of the Aliveness Project and someone who receives complementary therapies.  He then shared some history of the discussion that has happened regarding complementary therapies and his feelings about the merits of adding the service area back on the prioritization list.  Paul thanked Randy for stating his conflict and, as a reminder, asked others to keep that in mind when speaking.  Megan asked for some clarification about the discussion Planning & Priorities had about taking complementary care off of the list, which Aaron Keith provided; the HIV+ Committee had expressed an interest in giving additional weight to direct services.  Eric said he understands HRSA’s concern about covering primary medical care beyond any other service but expressed his personal feeling which is to keep it on the list, knowing it may not be funded.  Lee asked what the argument was for deleting any areas or activities.  Mary Doyle reported that other areas that have come off were because of not being funded or because they are funded by another source.  Jonathan provided additional information about culturally appropriate mental health services.  Currently the grantees are working with DHS to administer mental health services through another system, which would create better access statewide.  MOTION:  Randy moved Eric seconded that complementary care remain on the prioritization list for this year’s process.  Passed with one abstention (McIver).

 

Roger asked that Aaron Keith review information again about the services on the prioritization list for this year.  Aaron Keith reviewed the list of prioritized services in 2002 and the list that’s been devised for this year, also noting changes that are being proposed.  Paul shared that the Planning Council is given some mandates by HRSA – it is very clear that primary care and prescription drugs are the highest priorities.  He also reminded folks that Ryan White funding is not the only source of services for PLWH/A in the state.  In fact it represents a small portion compared to Medicare and is the payer of last resort.

 

BREAK

 

Discussion moved to the service activities that have been identified for Minority AIDS Initiative (MAI) funds.  Planning & Priorities has identified culturally appropriate primary care, health insurance counseling & assistance, medication adherence, care advocacy and outreach as the activities to prioritize for MAI funding. 

 

MOTION:  Megan moved David seconded approval of the proposed list for prioritization, with the addition of complementary care.  Passed with one abstention (Lewis).

 

MOTION:  Steven moved Debra seconded approval of the services proposed to be prioritized for MAI funding.  Passed unanimously.

 

VI.     Epi update – Luisa Pessoa-Brandao, MDH

Luisa gave an overview of the 2003 epidemiological results with particular emphasis on information that the Planning Council will be interested in for prioritization – prevalence and incidence, as well as some background on how Minnesota’s surveillance system works.  In a national context, Minnesota is still considered a low incidence state with respect to AIDS cases.  To insure consistent reporting by all states CDC uses the number of AIDS cases because not all states collect HIV cases.  At the end of last year 266 new infections were reported in Minnesota.  This is a 13% drop from 2002 – this is a pattern that’s been observed in the past and is not indicative of an overall decline in those becoming infected.  One third of cases reported were AIDS at first diagnosis, which has also been fairly steady in recent years.  The metro area has the highest concentration of those living with HIV/AIDS. 

As for new infections there has been an increase in suburban areas but the majority still live in Minneapolis and St. Paul. 

Males still make up the majority of those infected but women are making up a larger percent of new infections, particularly in communities of color. 

The rate of infection for the whole state is 99.5 per 100,000.  Currently the rate of infection of younger people has remained relatively low. 

MSM is still the most common mode of exposure although the number of heterosexual and unidentified mode of transmission, regardless of race or ethnicity, is growing.  Luisa shared that they are looking at those with unidentified transmission but some of the unknown transmissions are due to the fact that folks are not always speaking with a disease investigator. 

 

In terms of perinatal transmission our rates have stayed pretty constant at 2%.  Without proper care the risk of transmission tends to be around 25%.  With care the expected transmission rate is about 2%. 

Luisa then reviewed data for folks who are foreign born.  Those who are African born have the highest rates in the state.  One concern among those who are African born is that 40% of those diagnosed have AIDS at first diagnosis.  Luisa did additional research on those who are foreign born – national averages show that the rate of those who are diagnosed with AIDS at first diagnosis is about 40% as opposed to about 25% those who are American born.  Fifty two percent of African born persons who are positive are women.  This more closely mirrors the epidemic in African countries.  With respect to Latin/Caribbean women the rates more closely reflect rates consistent with the total number of infections among women in the United States.  Women of color account for 88% of all new infections in women this year.  The population living with HIV/AIDS continues to become more diverse with language and cultural being the biggest barriers to care.  Members then asked questions.

 

VII.   Title I update - Jonathan Hanft

Jonathan gave the report.  Currently, all requested conditions of award have been sent to HRSA.  Jonathan also provided a fourth quarter spending report.  Overall, 94% of funds were spent.  He’s estimating that carryover will be $215,000 to $265,000.  Once they have a firm number, a plan will be presented to Planning & Priorities for discussion and approval (with subsequent review, discussion, and approval by the full Planning Council).  Mary Doyle added that if anyone has ideas for carryover funding please send them to the Planning & Priorities co-chairs (Megan Ellingson and Aaron Keith Stewart) or Mary Doyle.  Jonathan clarified HRSA’s carryover policies – they don’t like to see carryover used to start new programs; they like to see it used for innovative, new ideas. 

Jonathan also gave a training update – the third in the series of culturally competency training took place and was well received.  The next part of the series will focus on women of color and the last day of the series will be tying it all together.  Additional provider training is being planned; more information will be available at the next Planning Council meeting.

 

VIII.Title II and ADAP update – Amy Moser

At the May meeting more budget information from DHS was requested which was provided via email and was also handed out today.  Amy briefly explained the information passed out and said members could call her or Dave (651-634-2296) with any questions.

 

Title II carryover is currently being calculated and is usually quite small, compared to Title I.  The responses to the ORR and integrated health grant grants that DHS applied for are anticipating in late August or September.  HIV Comprehensive trainings (formerly Case Managers training) will be held being June 18^th and will have presentations from reps from different health insurance programs to give updates on what’s happening in their programs.  July 23^rd the presentations will be on worker resiliency.  Any questions, call Michelle Sims.

 

Amy reported that anyone who is on a cost-sharing program has been notified and the first and second month’s invoices have been mailed.  Currently 300-350 of those who’ve received letters have called DHS.  The case management programs have been given some leeway to work with folks who don’t have case managers to get additional assistance to folks with questions or in need of assistance due to cost-sharing and other changes in ADAP.  The letter to the Commissioner has been received but they currently have no further information to report.  Dave had a meeting with administration last Thursday but there is still no new information.  There continues to be a $2.1 million shortfall for state FY 2005.  Amy further reported that there has been a series of community forums on ADAP over the last month and a half or so.  They will continue to take place, along with monthly formulary meetings.  Information about upcoming forums is available on DHS’ website which is www.dhs.state.mn.us/contcare/hiv.  The AIDSLine has also been very helpful getting information out to folks.  Projected revenue from cost sharing is approximately $500,000.  Amy reported that other administration changes would make up the additional shortfall difference of approximately 1.3 million.  Members asked questions. Aaron Keith asked where DHS is in the process of looking at the benefits of becoming a direct purchase state as opposed to a rebate state.  Amy said that they are looking into the benefits of changing to a direct purchase state.  Jonathan asked if at the next meeting DHS report on how many premiums have been paid and also some more information about the types of calls they’ve been receiving from consumers.

 

IX.          Committee written reports;time for questions, discussion

·        Planning and Priorities Committee Update Change to Prioritization schedule

Aaron Keith recapped the changes that have been made to the prioritization process schedule.  The biggest change is the July 13^th meeting – time will be spent receiving more information and an additional meeting will be held on July 20^th at Hennepin/Powderhorn Partners in which final voting forms will be collected.

·        HIV Positive Committee

·        Needs Assessment and Evaluation Committee

·        Community Participation Committee

·        Operations Committee Action Item Planning Councilco-chair discussion  

Debra reported that the Operations Committee is recommending suspension of the by-laws this year with respect to co-chair terms.  Historically one of the co-chairs has been a more experienced second term co-chair to work with the newer first term co-chair.  The recommendation is to suspend the by-laws for one term to allow Paul to be on the ballot for this year’s election.  Sarah R. clarified that this in no way invalidates other potential co-chair nominees.  Dan suggested having staggered co-chair terms to help alleviate this situation in the future.  MOTION:  David moved Eric seconded suspending the by-laws with respect to the two-year co-chair term limit.  Passed unanimously.

 

X.          Announcements, next agenda, meeting evaluation

Sarah R. announced that there is a letter from the Minnesota AIDS Project about the ADAP situation that is a call to action in thinking about ways to advocate to ensure that ADAP is funding is maintained at high levels that have been previously established.  Phone calls to your local legislators are crucial at this point.

 

Mary Doyle added that there are postcards from the CAEAR Coalition to lobby for Ryan White CARE Act funds that can be sent to congress people to support funding at the Federal level.

 

Luisa announced that MDH, in conjunction with the CDC, would be conducting surveys at PRIDE to collect behavioral information.  She will forward information to staff to distribute to members.  They are currently looking for folks to do the survey and for volunteers to help with interviewing.

 

Mary Doyle added that conflict of interest forms are available today for those who have not filled one out yet.

 

Documents distributed at or before the meeting:

·        Agenda and May 11 and May 18, 2004 meeting minutes

·        Complementary care information provided by the Aliveness Project

·        HIV/AIDS Epidemiology Update for 2004

·        Written committee reports (summaries)

 

MOTION:   David moved Debra seconded adjournment of the meeting.  Passed unanimously.

 

Adjourned at 9:10 pm