Researchers, advocates and public policy experts have gathered in Vienna, Austria to discuss the latest scientific developments and other issues related to HIV/AIDS at the 18th annual International AIDS Conference.

The biggest news focus coming out of the conference so far is about tenofovir gel, a vaginal microbicide. Tenovir has been part of the CAPRISA trial conducted in South Africa, and has shown some promise in preventing HIV transmission. According to a press release from the trial:

The microbicide containing 1% tenofovir—an antiretroviral drug widely used in the treatment of HIV—was found to be 39% effective in reducing a woman’s risk of becoming infected with HIV during sex and 51% effective in preventing genital herpes infections in the women participating in the trial. Should other studies of tenofovir gel confirm these results, widespread use of the gel, at this level of protection, could prevent over half a million new HIV infections in South Africa alone over the next decade.

The search for an effective microbicide has been ongoing for quite a few years now, as it could represent an important woman-controlled tool for reducing HIV infection, especially when women may not be able to insist on condom use. This is the first time a microbicide product has really been considered to show major promise for prevention.

As the New York Times explains, however, additional work will need to be done before this product becomes widely available to women who might benefit from it:

Broader trials are needed to confirm the results, and it will most likely be years before the product is publicly available, but if produced on a large scale the gel would cost less than 25 cents per application…Because the trial was relatively small and the gel was nowhere close to 100 percent effective, AIDS scientists and public health officials wanted to see another trial get similar results before they undertook the large fund-raising and public education efforts that would be needed to make billions of doses of the gel, as well as the applicators, which are more expensive, and then to persuade women to use them and governments of poor countries to adopt them.

Science magazine has made a paper with scientific details on the trial freely available to the public. The conference blog provides a number of relevant resources for those interested in learning more about this research.

Last night’s PBS Newshour had an interview with Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (part of the NIH), which I think did a great job of explaining the findings; a transcript of the video below is available online.

Also of interest is the Women ARISE coalition, consisting of international women’s groups and organizations whose stated mission is to:

…work together to galvanize and promote a common agenda on women and girls’ rights in the AIDS response and ensure that all women and women’s issues are central and visible in the objectives and program of the International AIDS Conference in Vienna.

The group’s founding document [PDF] outlines important principles and needs for addressing the concerns of women and girls in HIV/AIDS response efforts, including protecting and promoting the human rights (including reproductive and sexual rights) of women and girls, addressing violence against women as a cause and consequence of HIV, addressing sexual and reproductive health more broadly, developing the basic services needed by communities, including women’s leadership, and demanding accountability from the international community.

The International Women’s Health Coalition has also posted on the Women ARISE initiative in their post, Outspoken Women in Vienna Demand Rights and Inclusion, reporting directly from the conference on a demonstration at the conference plenary session intended to make it “clear that the only way to end this epidemic is through gender equality, empowering women, fulfilling our sexual and reproductive rights and health, and providing all young people with comprehensive sexuality education.”

Readers can get updates from the conference on Twitter (@aids2010), on Facebook, and on the conference blog.

View all Women’s Health Heroes. Voting closes May 14. Background info here.

Entrant: Steven Slosberg
Nominee: Betsy Ryan, RN

I’ve submitted a column I wrote about Betsy Ryan several years ago when I was a columnist for The Day, a daily newspaper in New London, Conn.

Betsy continues to work ardently as a nurse in the infectious diseases department at Lawrence & Memorial Hospital in New London, as well as in HIV/AIDS education and prevention in our community, and, as a breast cancer survivor, summons enviable energy in her commitment.

She is most deserving of this honor.

A reluctant hero on front lines of a long fight (originally published 10/01)

Knowing Betsy Ryan, I suspect the Alliance for Living first had to engrave and mail the invitations, post public notice in places beyond her reach and probably put a search party on standby before telling her she was going to be formally honored for her community service. There could be no way out of it.

Even then, says Peter Bowler, one of the Alliance for Living leaders, she tried to persuade the non-profit support group for people affected by HIV/AIDS in this region to give the award to more deserving folk or at least let them share it with her.

“I said, ‘Too late, Betsy,” said Bowler. “See you at the awards dinner.”

That would be next Wednesday night, at the Mystic Hilton, when Lizbeth Love Ryan, a registered nurse and longtime relentless advocate for HIV and AIDS education and prevention, is to receive the organization’s annual outstanding community service award as part of its Awards & Appreciation Night.

The thing is, Ryan, who works in Lawrence & Memorial Hospital’s infectious disease service, has yet to acknowledge that she will attend.

“If we have to track her down and hook her up to an ox and cart, she’ll be there,” said Bowler.

She is that modest, that reluctant to take a public bow, at least about her role in community HIV awareness, but absolutely not in her labors to make lives here better and safer.

There is Betsy Ryan, a slender figure, prim and proper might apply, standing in front of any group, demonstrating, step by step, the proper way to apply a condom, and candidly discussing spermicides and lubricants and why latex condoms are best because they’re man-made and the quality can be assured.

I saw her give such a demonstration for the first time before a roomful of politicians, educators, nurses and health care and human service agency workers at Ocean Beach one September day in 1989. She gave similarly straightforward demonstrations at Frank’s Place, a gay bar, in New London during the annual Celebration of Hope fund-raisers. She’s given hundreds and hundreds of them, all over the region.

She’s been admired as a caregiver and has served as an ad hoc spokeswoman for tracking HIV/AIDS here. Though not always the easiest person for a reporter to find at deadline, she has been consistently helpful in providing statistics, always protecting the confidentiality of those with the disease. She knows just what she can say and won’t be cajoled into saying more.

In her time here she’s coordinated the New London AIDS clinic, has been a mainstay of the AIDS care program at L&M and was president of the Women’s Center of Southeastern Connecticut. She moved here in 1972 and, except for a short time in Hawaii, has been a nurse at L&M. She started out in the emergency room. She’s in her early 50s, was raised in western Pennsylvania and for the last 15 years has lived with Ken Abrahms, who owns Art Unlimited in Ledyard. They have a home in Groton and one in Watch Hill.

Donna M. Greene, president of the Alliance for Living board, has known Ryan for nine years, since Greene was involved with Helping Our People Endure Foundation Inc. (HOPE), which, in April 1998, merged with the Southeastern Connecticut AIDS Project (SECAP) to form the Alliance for Living.

Greene, who works at Pfizer, has not always agreed with Ryan’s positions, notably Ryan’s opposition to needle exchange programs. But Greene admires Ryan’s courage of her convictions.

“She’s a very firm believer in what she stands up for,” says Greene. “She’s got all the facts. She really knows her business.”

She and Bowler and Michael Rosenkrantz, the executive director of Allliance for Living, decided it was time for Ryan to face facts, and receive the recognition.

“She’s one of the few people, out there in daily contact, in the front lines, who never loses her sunny disposition and always has her client’s best interest at heart,” said Greene.

Others will be honored at the dinner for volunteer work and Dr. Frederick Altice, an HIV specialist at Yale-New Haven Hospital, will be the keynote speaker.

Betsy Ryan will be recognized for her abiding dedication, and maybe the only way to assure her being there is the opportunity, with all those people gathered in one room, for her to unroll one more condom and deliver her unflinching AIDS 101 presentation, once again.

View all Women’s Health Heroes. Voting closes May 14. Background info here.

Entrant: Maureen Reinsel
Nominee: John Varallo, MD, MPH, Senior Technical Advisor

Obstetricians and gynecologists choose to dedicate themselves to women’s health, but that alone does not qualify them as a Women’s Health Hero. A hero humbly exceeds the average expectations to create true and lasting positive change. Dr. John Varallo, through his selfless and untiring contributions to women’s health in the United States, Guyana, Tanzania, Uganda, Belize, Guatemala, and Australia, is a Women’s Health Hero.

While I know him through his work on cervical cancer prevention and treatment in Guyana, it is far from his only contribution to women’s health globally. Dr. Varallo works with the most vulnerable women, and inspires others to join him through education and collaboration.

Dr. Varallo has contributed to improved prevention and treatment of cervical cancer, particularly among HIV positive women. Cervical cancer, caused by the sexually transmitted Human Papilloma Virus (HPV), is a preventable disease that kills an estimated 253,500 women worldwide annually (National Cervical Cancer Coalition, www.nccc-online.org). The burden of disease is particularly onerous among HIV positive women, who have a more difficult time clearing the virus from their system and in whom the cancer moves significantly more quickly.

Dr. Varallo’s efforts have led to a considerable expansion in coverage of cervical cancer prevention, detection, and treatment. In Guyana alone, he has trained 23 physicians, advance practice nurses, and registered nurses in one year to detect and treat pre-cancerous lesions. His work in Guyana has led to the Ministry of Health instituting a national cervical cancer prevention and treatment program, and he was the principle author of the country’s cervical cancer prevention and treatment policy and guidelines.

Providers trained by Dr. Varallo have screened more than 5,000 women in one year, providing approximately 800 women with preventative treatment. In addition to his work in Guyana, Dr. Varallo has trained health care providers in cervical cancer prevention and treatment in five other countries, including the United States.

Read the rest of this entry »

Amanda Lenhart, senior research specialist at Pew Research Center’s Internet & American Life Project, has posted her presentation on social media and young adults that was delivered this week at the National STD Prevention Conference in Atlanta. The slideshow covers the latest data on electronic and digital communciation, including cell phone usage and sexting.

Presenting with Lenhart was Kicesie Drew, who provides sex ed information via YouTube; Sally Swanson from the Adolescent Pregnancy Prevention Campaign of North Carolina, a group that usess texting to answer questions about sexual health; and Cornelis Rietmeijer, director of the Sexually Transmitted Disease Control Program/Denver Public Health.

More health professionals are turning to innovative techniques and technologies to reach young and at-risk populations. I recently took part in a symposium, sponsored by Chicago Department of Public Health and the National LGBT Tobacco Control Network, on how public health workers can use social media to reach the LGBT community. We looked at some of the promises and obstacles that new communciation tools present. One of the most important lessons: Know how your audience uses technology, and go where they go.

I was honored to be on a panel with Lovette Ajayi, a superstar at Community Media Workshop and co-founder of the Red Pump Project, which raises awareness about the impact of HIV/AIDS on women and girls. And that brings me to the second point of this post: March 10 was National Women and Girls HIV/AIDS Awareness Day.

The Red Pump Project presents statistics about HIV/AIDS  and women — and the great disparities. Though black and Latina women represent 24 percent of all U.S. women combined, they account for 82 percent of the estimated total of AIDS diagnoses for women in 2005.  Consider that HIV is the:

* Leading cause of death for black women (including African American women) aged 25–34 years.
* 3rd leading cause of death for black women aged 35–44 years.
* 4th leading cause of death for black women aged 45–54 years.
* 4th leading cause of death for Latina women aged 35–44 years.
* The only diseases causing more deaths of women are cancer and heart disease.
* The rate of AIDS diagnosis for black women was approximately 23 times the rate for white women and 4 times the rate for Latina women.

These numbers illustrate the need for massive improvements in education, prevention and treatment — all topics the National STD Prevention Conference aims to address. High-priority issues are identified for each biennial conference, and this year’s top three issues couldn’t be more  relevant or directly worded.

The last point is a great reminder of how change is both incredibly simple and complex: “It is essential to find ways to move beyond our longstanding societal reticence to openly discuss sexual health issues and to normalize conversations around STD prevention.”

Plus: In related news, Washington, D.C. will make 500,000 female condoms available — for free. The condoms will be available in beauty salons, convenience stores and high schools in parts of the city with high HIV rates, reports the Washington Post. The project is funded through a $500,000 grant from the MAC AIDS Fund, a subsidiary of MAC Cosmetics.

Almost six months after receiving FDA approval as an HIV-prevention method, the FC2 female condom is now available in the United States.

The formal announcement was made in Atlanta last week at the Southeastern Urban Initiative for Reproductive Health Summit, a coalition of reproductive health advocates. The summit was hosted by SisterSong Women of Color Reproductive Health Collective.

The FC2 female condom is a second generation product developed by the Chicago-based Female Health Company. Currently available only to state health agencies and nonprofit organizations, the FC2 will be sold in CVS stores in the Washington, D.C. area starting in December, FHC’s senior strategic adviser Mary Ann Leeper told Reuters.

Washington, D.C. health officials released a report in March showing that at least 3 percent of District residents have HIV or AIDS — a rate that is on par with Uganda and some parts of Kenya.

Female Health Company is looking for a marketing partner to help promote FC2 directly to consumers.

“We need the other company to really make a dent into the consumer market,” said Leeper.

According to the Centers for Disease Control and Prevention (CDC), over the past two decades, the percentage of women among all people living with HIV in the United States has increased from 8 percent to 27 percent. African American women account for 66 percent of new AIDS cases among American women; they are 21 times more likely to contract HIV than white women, while Latino women are five times more likely.

“America’s HIV epidemic isn’t going away. In fact, it’s getting worse, and African American and Latino women are disproportionately impacted,” said Dazon Dixon Diallo, founder and president of SisterLove, a grassroots service organization that supports HIV/AIDS prevention and reproductive health programs for women in the Atlanta area. “It’s time to provide women in heavily impacted communities with expanded access to affordable women-controlled options, and the female condom becomes that choice. Women will use it if they have it.”

Female Health Company says the FC2 is thinner and quieter than its predecessor, the FC1 female condom. The FC2 is made of synthetic nitrile, a latex alternative, so it’s safe to use with both oil and water-based lubricants. Here’s information (pdf) about how to insert the condom. There’s also an animated video demonstration. More resources from FCH are available here.

FC2 may be purchased from the company’s two public sector distributors: Total Access Group, Inc. and Global Protection Corporation.

FHC has also launched a new site, www.fc2femalecondom.com, which includes tiered pricing information for ordering female condoms directly (minimum of 25,000). The maximum price of 82 cents per condom is 30 percent less than the price paid for FC1. A retail price has not been determined.

Though female condoms are not popular in the United States, the FC2 has been available in other countries since 2006. The U.S. Agency for International Development had lobbied for the FDA’s approval — a lengthy and expensive process – so it could be purchased for U.S.-funded global HIV-prevention programs.

Earlier this year, Audacia Ray, program officer for online communications and campaigns at the International Women’s Health Coalition, described other female condom prototypes that are being actively tested and promoted outside of the United States, especially in Africa.

We’ve written about the female condom – including the recently approved FC2 – several times in the past. Serra Sippel of the Center for Health and Gender Equity has an update on this topic at RH Reality Check, noting that Uganda is working on plans to reintroduce female condoms, with that nation’s government planning to promote the device beginning this fall.

Sippel explains that the Center for Health and Gender Equity and the Global Campaign for Microbicides recently met with:

…local leaders from HIV/AIDS, reproductive health, domestic violence, human rights and women’s rights groups in Kampala for an advocacy training targeted at donors and national government to ensure successful reintroduction of female condoms in Uganda. As part of the training, participants met with members of the Health Development Partnership Group, which USAID heads; with UNFPA and the Ministry of Health, demonstrating civil society support for the prevention method. Participants also learned about the history of the female condom in Uganda and how to move forward with advocacy efforts beyond the training.

After having received FDA approval to market the device in March, the FC2 female condom is expected to be available in the United States this September. PreventionNow! has additional resources on the topic of female condoms, including news and global promotion efforts.

Woman Shackled During Labor Sues State: A former inmate at the Washington Corrections Center for Women who was shackled while in labor is suing the state of Washington for violating her constitutional rights. Read the full complaint here (pdf).

The Seattle-based women’s rights organization Legal Voice filed the federal lawsuit last week on behalf of Casandra Brawley. According to the complaint, Brawley, who was serving a 14-month sentence for shoplifting, was shackled by a metal chain around her belly during transportation to the hospital. At the hospital, she was shackled to her hospital bed during several hours of labor. A physician demanded the leg iron be removed while he performed an emergency c-section. The shackles were replaced after the baby was born.

“It defies common sense – and the Constitution – to risk any pregnant woman’s health, safety, and dignity by shackling her while she is in the process of giving birth,” Sara Ainsworth, senior counsel at Legal Voice and co-counsel for Brawley, said in a release.

“Like Ms. Brawley, the majority of women incarcerated in Washington State are serving sentences for non-violent crimes. And the idea that labor presents an escape opportunity is absurd. There is simply no justification that outweighs the medical risks of this inhumane, demeaning practice.”

Extra Sentence for Pregnant, HIV-Positive Woman: Rachel Mehlsak, a legal intern at the National Women’s Law Center, wrote a good summary of a court case involving a 28-year-old pregnant woman from Cameroon. A judge in Maine had sentenced the woman — who pleaded guilty to possessing false immigration documents — to a prison term longer than the maximum suggested under federal sentencing guidlines to ensure she would deliver her baby in prison. Why? Because she is HIV-positive, and the judge rationalized that she would receive better care behind bars, thus reducing the risk of HIV transmission. No joke.

The woman was recently released while her appeal to the 1st U.S. Circuit Court of Appeals is pending in Boston. Margo Kaplan of the Center for HIV Law and Policy has more.

New Push for Fetal Homicide Law: Another example of an ill-conceived attempt to protect the fetus comes by way of New Mexico, where the murder of a 22-year-old pregnant woman has led to talk of a fetal homicide law.

“Most crimes of this nature are prosecuted under state law, and according to the National Conference of State Legislatures, at least 36 states have fetal homicide laws (variously known as the Fetal Protection Act, the Preborn Victims of Violence Act and the Unborn Victim of Violence Act). Some laws apply to the killing of a fetus at any time after conception, while others only apply to a fetus that is capable of surviving outside the womb,” writes Gwyneth Doland of the New Mexico Independent.

There are, of course, hefty consequences:

“What we’ve discovered is that the minute one of these laws passes, the first people who are prosecuted are not batterers, but pregnant women themselves,” says Lynn Paltrow of National Advocates for Pregnant Women, a women’s rights organization that has fought against fetal homicide laws.

“These cases are always presented as a response to violence against women. But not a single state has ever looked at whether these laws have done anything to decrease the epidemic of violence against women. And no state should pass another law like this until that research is done,” Paltrow says.

Paltrow says that similar laws in other states are used to prosecute pregnant women who suffer from substance abuse problems.

In particular, she points to South Carolina, where a fetal homicide law has been used to prosecute dozens of pregnant women struggling with substance abuse. In one case, a 22-year-old homeless woman whose pregnancy resulted in a stillbirth was convicted of murder and sentenced to 12 years in prison, even though health experts said there was no evidence her drug problem caused the stillbirth.

A Model Program: I recently learned about the work of Women’s Equity in Access to Care and Treatment (WE-ACTx), which began working in Rwanda in early 2004 to help genocide rape survivors, many of whom had contracted HIV from their attackers. Today, WE-ACTx focuses on increasing women’s and children’s access to comprehensive HIV/AIDS care and services, education and training.

Earlier this month, WE-ACTx held its 4th annual celebration of Day of the African Child (commemoration of the 1976 child uprising in Soweto against apartheid) with more than 400 children with HIV and their families.

In addition to running several medical clinics, the organization educates people affected by HIV/AIDS  about their legal rights, and empowers them to take action to resolve legal problems they may face. Here’s the English version of the WE-ACTx Community Handbook on Health-Care Rights and Other Laws (pdf). If you’re looking for an organization to support, take a look at WE-ACTx.

Resources on HIV Testing: National HIV Testing Day was June 27, and the Kaiser Family Foundation has released new and updated materials on attitudes toward HIV testing. First, take a look at the 2009 Survey of Americans on HIV/AIDS, the Foundation’s seventh major survey of the American public’s attitudes, knowledge and experiences related to HIV/AIDS.

Two new survey briefs were prepared as a follow-up: The first, on views and experiences with HIV Testing, looks at the U.S. public’s attitudes about experiences with HIV testing, including which groups are most likely to report being tested for HIV, reasons for being tested/not being tested, communication with doctors and partners about HIV/AIDS and more. The second brief examines more closely African American’s views and experiences with HIV testing.

Finding “Common Ground” on Abortion – How’s That Working?:  “President Obama has accomplished a lot in his first 100 days in office, but one campaign promise he’s been unable to keep is a vow to make peace in one of the most polarizing issues in all of American politics: abortion,” reports NPR.

Lines in the Sand: Speaking of the elusive common ground, On the Issues magazine chose “lines in the sand” as the theme for its current issue.

An email to readers said the choice was “provoked by today’s too-prevalent sentiment to compromise principles in the interests of seeking ‘common ground’ and reconciliation with opposing views. In these articles we explore the feminist and progressive values that must be held tightly, the ‘lines in the sand’ that we refuse to erase.”

Publisher and Editor-in-Chief Merle Hoffman says reproductive freedom is “the front line, the bottom line and the everlasting line in the sand,” in her editorial “Higher Ground, Not Common Ground.”

Also look for essays by Gloria Feldt, Loretta Ross and many more writers and artists.

Economics, Race and Pollution: A study by researchers at the University of Massachusetts and the University of Southern California tracking toxic emissions from factories confirms what we already know: poor, minority communities are disproportionately affected by harmful pollution. The Milwaukee Journal Sentinel reports on the findings. View the full report (PDF) here.

Public Attitudes Toward HIV/AIDS as a Health Issue: Kaiser Family Foundation has released its 2009 Survey of Americans on HIV/AIDS. In the United States, the sense of urgency about HIV/AIDS as a national health issue has decreased significantly. Residents’ concerns about the disease as a personal risk also has declined, even among some high-risk groups. This press release summarizes the findings. The study comes less than a year after the CDC  announced that there were 40 percent more new HIV infections each year than previously believed.

Egypt’s FGM Ban, One Year Later: In the year since Egypt outlawed female genital mutilation, the government hasn’t prosecuted a single case, Iman Azzi writes at Women’s eNews. Still, some activists say the law is a tool, among others, for gradually dismantling an ancient tradition.

Legalization – The “X” Factor: On May 1, thousands of activists took to the streets in favor of expanding immigrants rights. Suman Raghunathan, an immigration and public policy analyst, describes what immigrant women, particularly those who are undocumented, need: “A legalization program that’s broad, fair and workable for both immigrants and immigration officials.”

Raghunathan goes on to note that current federal immigration policy leaves it up to states to decide whether to provide free or low-cost health care to their undocumented residents. Several states, including New York, have expanded prenatal and neonatal care to undocumented women and children.

“Legal status,” she writes, “would mean that undocumented women are no longer left to the mercy of state legislatures and no longer denied appropriate nursing and doctoring.”

Plus: The L.A. Times reports on how some California counties are eliminating non-emergency health services for undocumented immigrants.

“We are mortgaging the future to scrape through the present,” said David Hayes-Bautista, professor of medicine and director of UCLA’s Center for the Study of Latino Health and Culture.

HRT and Heart Health: A study in the May issue of the journal Medical Care (abstract) looks at whether the decreased use of HRT has affected the rate of cardiovascular health outcomes, according to this release. The number of heart attacks in menopausal women has decreased, though it’s not conclusive that there’s a link. Researchers did not find a difference in the rate of strokes.

Before 2002, physicians believed HRT reduced the risk of coronary heart disease by up to 50 percent in menopausal women. As a result, physicians prescribed it broadly to treat many of the symptoms of menopause, as well as to protect women against cardiovascular disease. However, a report by the Women’s Health Initiative in 2002 revealed that HRT actually had the opposite effect — it increased the risk of heart attack in these women.

“After the 2002 report, the use of HRT in women aged 50 to 69 declined from more than 30 percent to less than 15 percent,” said lead study author Kanaka Shetty, M.D.

All in one week, Kathleen Sebelius was approved as HHS secretary, we learned Supreme Court Justice David Souter is retiring, Sen. Arlen Specter switched parties and President Obama hit his 100-day mark, causing some furor over his comments on the Freedom of Choice Act. Moving right along …

Who Will Fill Souter’s Chair?: The New York Times looks at the type of justice Obama might nominate. The story features photos and short bios of the people whose names we’ve been hearing mentioned a lot lately — mostly women in high-level government, academic or legal positions. The Washington Post has a list of contenders.

NPR’s Nina Totenberg said Sunday on “Weekend Edition” that some of the names “are kind of a shout-out with no real chance that they’re going to be picked.” She wasn’t pressed on which ones. She also said this is Obama’s best shot to nominate someone who is very liberal.

Obama Picks Goosby For Global AIDS Position: Obama last week announced he would nominate Dr. Eric Goosby as head of the Office of Global AIDS Coordinator and Ambassador at Large. Goosby, CEO and chief medical officer of the Pangaea Global AIDS Foundation, was director of the Office of HIV/AIDS Policy in the Clinton administration. He is also a medical professor at the University of California, San Francisco. Jodi Jacobson has more.

Earlier this year, we noted the brouhaha surrounding Secretary of State Hillary Clinton’s decision to request the resignation of Mark Dybul, who held the position as Global AIDS Coordinator during the Bush administration. Goosby was first mentioned as a successor back then.

Budget Blueprint Gets Stamp of Approval: Congress on Wednesday approved a $3.4 trillion spending plan, “setting the stage for President Obama to pursue the first major overhaul of the nation’s health-care system in a generation along with other far-reaching domestic initiatives,” reports the Washington Post. Democrats also reached agreement on using budget reconciliation to advance health care reform, which ensures Republicans won’t be able to filibuster the legislation.

Tough Times Ahead: “How hard is it to remake the nation’s health care system? It’s so hard that even if policymakers do everything right, most observers still don’t give them more than a 50-50 chance of getting a bill passed,” reports NPR.

Then there’s a shortage of doctors, which only complicates matters.

Arlen Specter on Health Care: Ezra Klein on what Specter The Democrat means for health care reform.

Take Action
DFA/MoveOn: Take part in an emergency online briefing Monday, May 4 at 9 p.m. ET with Dr. Howard Dean.  Click to follow the briefing, “What We All Need to Know to Win on Health Care This Year,” Monday night.

National Women’s Law Center: One woman on the highest court in the land is not enough. Urge President Obama to nominate a woman committed to upholding and enforcing women’s legal rights and protections.

I was away last week, so no Political Diagnosis, but it’ll be back to business on Monday …

Court Strikes Down Iowa Law Banning Same-Sex Marriage: The unanimous state Supreme Court decision means same-sex couples will be allowed to marry in Iowa by the end of the month — and the doors will be open to couples from other states. The decision seems pretty solid for now. Unlike California, voters in Iowa cannot directly initiate constitutional amendments. Instead, an amendment would have to be taken up by the state Legislature, and Democrats, who control both chambers, show no interest in making it a priority.

Here’s the Supreme Court summary and the full decision (both pdf).

Mammogram Benefits Under Debate: “The conventional wisdom about breast cancer screening is coming under sharp attack in Britain, and health officials there are taking notice,” writes Roni Caryn Rabin in The New York Times. “They have promised to rewrite informational fliers about mammography after advocates and experts complained in a letter to The Times of London that none of the handouts ‘comes close to telling the truth’ — overstating the benefits of screening and leaving out critical information about the harms.”

Do People Who Support “Traditional Values” Value Pregnant Women?: Lynn Paltrow writes at Huffington Post –  “I have to thank Andrea Lafferty, of the Traditional Values Coalition for her response to a piece I wrote opposing Personhood USA’s efforts to give full constitutional rights to the unborn from the moment of fertilization. In her commentary she hopes to discredit my organization, National Advocates for Pregnant Women (NAPW) by exposing our commitment to all pregnant women, including those who love their children but are unable to overcome a drug problem in the short term of pregnancy …”

The Search for a Donor: Frances Kissling, the former president of Catholics for a Free Choice and a visiting scholar at the Center for Bioethics at the University of Pennsylvania, will soon need a kidney. This is her story about learning how to ask.

Birth Centers Advocacy Update: As we previously mentioned, American Association of Birth Centers was looking for 100 physicians to sign a letter in support of legislation to mandate the facility fee in Medicaid. There are 102 signatures so far and counting …

Women Pay Higher Price For Health Insurance: NPR reporter Sarah Varney writes about a past experience seeking health insurance (a completely frustrating process) and the higher insurance rates women pay in some states. The piece concludes with some important news for workers laid off after Sept. 1, 2008:

If you had employer-sponsored health insurance and qualified for COBRA coverage, under the new stimulus bill, the federal government will pay 65 percent of your premium for up to nine months.

And that even includes laid-off workers who initially turned down COBRA coverage because they thought it was too expensive. They now have a second chance to sign up.

Plus: Also from NPR — the hidden costs of cancer treatment, even with insurance. And The New York Times offers tips for people with pre-existing conditions, whether you’re currently covered or shopping for insurance.

Congress Approves Budget: The House and Senate approved budget blueprints on Thursday that include funding for expansion of health care coverage; now the hard work begins in conference committee.

America Going Quiet on HIV/AIDS: A new Kaiser Family Foundation survey found that the percentage of people in the United States who say that they have seen, heard or read a lot about HIV/AIDS in the United States has fallen from 34 percent five years ago to just 14 percent today. The percentage of African Americans reporting this has fallen from 62 percent to 33 percent.

Global Women & Health Salon: President Obama this year has signed executive orders eliminating the “Global Gag Rule” and restoring U.S. funding for the United Nations Population Fund. “Now that [these two goals] have been met what else should the Obama administration do to promote the health and welfare of women worldwide?” asks Mark Goldberg, in the kick-off post for the After the Gag Rule Salon sponsored by RH Reality Check and UN Dispatch.

Afghan Law Criticized: UN and Western aid agencies are urging Afghan President to repeal a law he signed last month that reverses freedoms won by Afghan women, reports BBC News. Human rights activists say the law legalizes rape within marriage, and women will need permission from their husbands to leave their homes.

The Female Health Company is announcing [PDF] today that the FDA has approved the company’s FC2 Female Condom for preventing pregnancy, HIV/AIDS, and other sexually transmitted infections.

The company notes that the approval will “enable the United States Agency for International Development (USAID) to procure FC2 for distribution to global HIV/AIDS programs,” and that changes in the material and manufacturing as compared to their original female condom should make the product more affordable. The device has been available in other countries since 2006, but FDA approval apparently means that it can now be purchased for U.S.-funded prevention programs worldwide.

Although the approval documents are not yet available on the FDA website, they should be available here sometime in the near future for examination.

The FDA’s Obstetrics and Gynecology Devices Panel reviewed and recommended approval of the product last December. For further discussion of this and other female condom prototypes, see our recent guest post from Audacia Ray of the International Women’s Health Coalition.

Stimulus Bill Passes House & Senate: Congress tonight approved the $787 billion economic stimulus bill. The House voted 246-183. The Senate followed hours later, 60-38. As expected, passage rested almost entirely on Democrats, who persuaded only three Senate Republicans to cross party lines — and not one Republican in the House — despite numerous concessions. President Obama is expected to sign the bill on Monday.

The National Women’s Law Center today offered this assessment of the bill while urging support :

We are proud that the final bill contains many of the crucial provisions we fought so hard to include. The bill includes new funds to address the needs of women and families, including funding for child care and Head Start, child support enforcement, health care, education and job training. It strengthens the safety net for low-income families, helps eliminate barriers that disqualify women from claiming unemployment insurance benefits, and provides funding to enforce important worker protections, including civil rights laws. And it provides additional tax benefits for low- and middle-income people; the expansion of the refundable Child Tax Credit alone will help the families of 13 million children.

NWLC has more analysis of the final compromise agreement, including details on measures in the bill that are especially important to women and their families.

Health Care for Women Act: “Sens. Debbie Stabenow and Jan Schakowsky have introduced a resolution that recognizes reproductive health care as fundamental to women’s ability to lead healthy lives and to ensure that women’s health care concerns, including reproductive health needs, are included in the push for national health reform,” writes Emily Douglas at RH Reality Check.

If approved, Congress would commit to passing “within 18 months of adopting the resolution, legislation that guarantees health care for women and all individuals and establishes coverage that enables women to attain good health that they can maintain during their reproductive years and throughout their lives.”

Plus: Columbia University’s Mailman School of Public Health released a report, “Women’s Health and Health Care Reform: The Key Role of Comprehensive Reproductive Health Care” (pdf). Co-authors Wendy Chavkin from Columbia University and Sara Rosenbaum from George Washington University use data and evidence to show that “reproductive health is a key determinant of women’s overall health, and therefore, that the treatments and services that promote reproductive health should be part of any national health plan.”

Keeping Tabs: The Congressional Budget Office on Tuesday announced that unless there are changes to federal policy, the number of Americans without health insurance will grow from about 45 million this year to about 54 million in 2019, reports the Associated Press.

Paging a New Secretary: “The leadership void at the top of the Department of Health and Human Services (HHS) is affecting more than President Obama’s health reform agenda,” writes Jeffrey Young at The Hill. “Though the department is capable of fulfilling its day-to-day responsibilities as guardian of the nation’s public health, pharmaceuticals, foods, medical research and other areas, the continued lack of a secretary and of leaders at key agencies will delay the Obama administration from putting its stamp on the massive bureaucracy.”

Hillary Clinton and the End of the Compromise Era on AIDS: Last week we wrote about the controversial removal of Mark Dybul from the Office of Global AIDS Coordinator. In an article published Thursday at The American Prospect, Michelle Goldberg writes that the removal shows that under Secretary of State Hillary Clinton, the era of compromising with the religious right on global HIV prevention is over.

SCHIP Reauthorized, What Comes Next?: Now that Obama has signed the Children’s Health Insurance Program Reauthorization Act of 2009 into law, Kaiser Network hosted a webcast with a panel of experts who address the next steps in children’s coverage, including such questions as: What is included in the new legislation? What impact will the new legislation have on coverage of uninsured children? What new tools will states have to reach and enroll uninsured children in Medicaid and CHIP? How will new funding affect state efforts to move forward? How will the deepening recession affect these efforts? What does reauthorization mean for broader health reform?

Watch, listen or read the transcript (pdf) of the webcast.

Action Items
* Say No to Abstinence-Only Programs
As President Obama begins work on his fiscal year 2010 budget, urge him to stop funding abstinence-only programs and direct our scarce public health resources to evidence-based programs that actually work.
Contact the White House (National Partnership for Women & Families)

A weekly look at what’s happening in Washington and in the new Obama administration related to women’s health and well-being …

Stimulus Bill Makes Progress in Senate: Senate Democrats Friday night struck a deal with Republicans over the economic stimulus bill, paving the way for a vote early next week. The Senate and House versions will have to be reconciled, but House Democratic leaders aren’t thrilled with the Senate cuts, reports the Washington Post.

The Senate changes bring what had been a $920 billion package down to about $820 billion. Among the largest cuts: $40 billion from a $79 billion fund aimed at helping states preserve school funding as they try to balance their budgets. And negotiators cut in half $15 billion in “incentive grants” for states that meet certain goals for their initial education allotment.

“Education took a big hit here,” said  Sen. Kent Conrad (D-N.D.).

The compromise also would cut $5 billion from a plan to help unemployed workers pay for health-care coverage, reducing the amount the federal government would pay for COBRA premiums to 50 percent from 65 percent. And it would cut $2 billion from a plan to help critical-access hospitals computerize medical records.

Sex and the Stimulus: A proposal to allow states to extend Medicaid funding for family planning was nixed from the stimulus package last week, but conservative Republicans and some clueless members of the media were still using it Friday an example of unnecessary padding in the bill.

Writing in The New York Times Economix blog on Thursday, Nancy Folbre, an economics professor at the University of Massachusetts, Amherst, defended the proposal and explained what the economic benefits would have been.

“Increased spending on family planning (including contraceptives) would generate about as many direct and indirect jobs as any other health expenditures, and probably more than an equivalent tax cut. But the short-term effects are less important than benefits down the road,” writes Folbre.

“Ironically, the proposal that was originally part of the stimulus plan did not actually call for increased spending. It simply stipulated changes that would make it easier for states that wanted to expand their Medicaid-financed family planning services to do so. In other words, it would cut red tape,” Folbre adds. “That’s another economic benefit. But the Obama administration should look beyond the current stimulus debate to develop a long-run plan to increase public support for family planning.” Amen.

Daschle’s Gone, What’s Next?: Democrats don’t know who President Obama is going to pick to be secretary of Health & Human Services, a position that was all but former Sen. Tom Daschle’s before he withdrew from consideration over unpaid taxes.

“There were no other names,” an ally of the administration told the Washington Post. Still, there’s cautious optimism that the urgent need for reform will propel members of Congress:

For every one percentage point that unemployment rises, an additional 1.1 million people lose health insurance, said Karen Davis, president of the Commonwealth Fund, a private health research foundation. That means that health care, always a top concern of American voters, has risen on the agenda, she said.

Drew E. Altman, president and chief executive of the nonprofit Henry J. Kaiser Family Foundation, said that economic fears, Democratic control of both the White House and Congress, and the desire in the corporate world to rein in health costs are powerful forces in favor of reform.

But the recession could also sap the time or political energy to tackle it right now, Altman said. And if action is postponed until 2010, when members of Congress will be focused on their own re-election campaigns, the prospects will dim, he added.

One of the names mentioned this week as a potential contender for the HHS post is Tennessee Gov. Phil Bredesen, but health advocates are already criticizing the suggestion (see the action alert below). From Politico:

Driving the outrage is Bredesen’s 2005 decision to cut about 170,000 adults from Tennessee’s expanded Medicaid program. Bredesen’s past as a managed-care executive and continued ties to the health insurance industry haven’t won him many admirers within the progressive health reform community.

Of all the opposition research circulating Friday, one of the favorite nuggets among critics was the fact that BlueCross BlueShield of Tennessee, a company with major state dealings, donated $150,000 to the renovation of the governor’s mansion.

“A lot of elected officials are in bed with the insurance industry, but Phil Bredesen doesn’t stop there. He let them pay to redecorate his mansion. We can’t think of anyone more wrong for health care reform or more wrong for America,” said Jacki Schechner, spokeswoman for Health Care for America Now.

Speaking of Filling Open Positions …: Secretary of State Hillary Clinton’s decision last month to request the resignation of Mark Dybul, head of the Office of Global AIDS Coordinator, drew praise from some health advocates. Dybul was in charge of the President’s Emergency Plan For AIDS Relief (PEPFAR), which was accused of misspending millions of dollars on ideologically driven abstinence-until-marriage prevention programs.

Criticism of Dybul was far from unanimous, however. The San Francisco Chronicle was among those who argued that Dybul did a lot of good and was treated unfairly by the Obama administration.

It’s still unknown who will replace Dybul, though there is some speculation Clinton has already identified a successor. Meanwhile, a coalition of 68 HIV/AIDS organizations have asked Clinton to form a committee to identify candidates.

“That’s a sharp rebuke given the substantive role of the Clinton Foundation in global AIDS affairs,” writes public health expert Josh Ruxin. “At the same time, it’s a promising turn for the activists themselves. They’re insisting on transparency and a merit-based approach, well aware that the fight against AIDS globally cannot flag and will be with us for decades to come.”

Baby Steps: President Obama on Wednesday signed a bill reauthorizing the State Children’s Health Insurance Program. It extends health coverage to 4 million additional uninsured children, bringing the total to 11 million children. Obama also issued a memo to HHS lifting some controversial enrollment rules imposed by the Bush Administration in August 2007, reports the Wall Street Journal.

Supreme Court Choices: We learned this week that Supreme Court Justice Ruth Bader Ginsburg has been diagnosed with pancreatic cancer. She is planning on returning to the court soon, but her illness sparked discussion of who Obama might consider for the nation’s highest court.

According to the Washington Post, there’s also some speculation that another justice might announce his departure this year. Advisers have already begin drafting a short list of replacements that is said to include Harvard Law School Dean Elena Kagan, who has been nominated to serve as solicitor general; Judge Sonia Sotomayor of the Court of Appeals for the 2nd Circuit; Judge Diane Wood of the 7th Circuit; and Stanford University law professor Kathleen M. Sullivan.

Senate Discovers Women: “The U.S. Senate is taking a welcome step: empowering a subcommittee specifically charged with global women’s issues,” writes Nicholas Kristof. “It’s the first time a subcommittee has had that mandate, and it will be led by Barbara Boxer of California, who will surely use her voice and spotlight to do some good on these issues.”

Action Items
* Ask  President Obama to appoint a secretary of Health and Human Services who actually believes in health and human services
Contact the White House (National Women’s Health Network)

Guest post by Audacia Ray, International Women’s Health Coalition

Demand for newer and better devices that protect against pregnancy and sexually transmitted infections is constant — partly due to the fact that the process of development, testing and approval takes forever, and partly because what’s on the market often leaves something to be desired.

The polyurethane female condom (FC) has been available for 15 years now, and it’s gotten a lot of mixed reviews. It is the only barrier method available that is designed for female initiation, but it’s three times as expensive as a male condom, unwieldy, and can squeak during use (not sexy). Male condoms, of course, have their imperfections; loss of sensation and ill-fit are chief among the complaints.

This past December, the new and improved FC2 was recommended to the FDA for approval (see OBOB post). It should be on the market in the United States within the next year. The FC2 is made of a latex alternative, which is by all accounts a thinner, quieter, lower-cost material than polyurethane.

However, there are also other prototypes out there that are being actively tested and promoted outside of the United States, especially in Africa. In early December Jen Wilen, a program officer for Francophone Africa at the International Women’s Health Coalition (IWHC), ventured to the 15th International Conference on AIDS and STIs in Africa (ICASA) in Dakar, Senegal, where she got to check out two different prototypes for new female condoms.

One of these new condoms is the VA w.o.w. Condom Feminine (pictured left), a latex female condom made by the same company that produces the popular Inspiral male condom, which is extra roomy around the glans of the penis to increase male pleasure.

The most striking feature of the w.o.w. (worn-of-woman) FC is that it has a soft sponge where FC and FC2 has an internal ring. The sponge acts as an anchor to hold the female condom in place. The w.o.w has been available in Southern Africa since 2004 and is also available in the UK.

The second female condom (pictured right) was designed by a Seattle-based company called PATH, which has a contract to move forward with making the device available in China by 2010.

This FC is made of nitrile and has something of a parachute effect — its applicator capsule dissolves once it is inside the vagina and the FC expands to its full size.

This particular version is being tested through Family Health International — the packaging warns that it is “limited by law to investigational use only. This product may fail during use and must not be relied upon for contraception or sexually transmitted disease prevention.”

One of IWHC’s partners, Society for Women Against AIDS in Africa, Cameroun Chapter (SWAAC), has been a major advocate for the female condom. They regularly host sexuality education sessions — some in very public places (see below and here) — that teach women and men about how to use the female condom.

Audacia Ray is program officer for online communications and campaigns at the International Women’s Health Coalition.

EngenderHealth has put together an excellent video providing a straightforward and simple explanation of the global gag rule and its effects on world health.

The organization is encouraging others to sign a petition asking President-Elect Obama to rescind the global gag rule during his first 100 days in office.

Relatedly, the “Open Government” section of the Change.gov website presently includes the “Global Health Council Recommendations to President-elect Barack Obama on US Global Health Policy and Programs,” with documents recommending rescinding the Global Gag Rule via Executive Order and restoring UNFPA funding, among other HIV/AIDS-related recommendations.

The Global Health Council website provides more background on the development of the recommendations to the Obama team, and individuals can leave their thoughts and support in the presently skimpy comment section.