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Do Republican Spending Cuts Threaten Federal HIV Funding? For Some Programs, Yes.

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Grace Abels, PolitiFact
Tue, 14 Nov 2023 10:00:00 +0000

Republicans in Congress are “ to wipe out federal funding to end the HIV epidemic.”

President Joe Biden on Oct. 14, 2023, in remarks at the 2023 Human Rights Campaign National Dinner.

Are Republicans threatening to stop spending federal money to end one of the world's most pressing public health epidemics? That's what President Joe Biden said during a dinner hosted by an LGBTQ+ advocacy group.

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“In the United States Congress, extreme MAGA Republicans are trying to undo virtually every bit of progress we've made,” Biden said Oct. 14 at the Human Rights Campaign event. “They're trying to wipe out federal funding to end the HIV epidemic.”

Programs to treat HIV and fight its spread have enjoyed bipartisan funding support in recent years, experts said, so Biden's portrayal signals a significant departure.

When we asked the White House what Biden was referring to, it pointed us to reports of budget recommendations from House Republicans that call for large cuts to the Ending the HIV Epidemic initiative, a Trump administration-era program designed to reduce new HIV infections in the U.S., as well as other programs.

The Senate Appropriations Committee passed a separate spending plan. The recommendations will be subject to negotiation as the House and Senate face a Nov. 17 deadline to pass another spending bill.

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We found that although Republicans are recommending significant cuts to HIV prevention efforts across a number of public health agencies, the proposal keeps core funding intact. Meanwhile, political differences are eroding bipartisan support for global HIV-prevention funding.

Despite great strides in prevention and treatment since HIV was first reported in the U.S. in the 1980s, HIV remains at epidemic levels in the U.S. today, with approximately 1.2 million people living with HIV and around 30,000 to 35,000 new infections each year. Experts said cases are rising in the South and in rural , and new infection statistics show it is disproportionately affecting Black and Hispanic populations.

What Are the Proposed Cuts?

The AIDS Budget and Appropriations Coalition, a group of more than 100 public health advocacy that track changes in HIV-related federal spending, said a majority of the proposed cuts to domestic HIV funding stem from House Republicans' effort to eliminate the Ending the HIV Epidemic initiative.

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The program started in 2019 with the goal of reducing new HIV infections in the U.S. by 75% by 2025 and 90% by 2030. The program so far worked regionally, targeting areas that have the highest rates of HIV cases for funding.

In 2023, about $573 million was allocated for the program across various agencies, according to KFF's funding tracker.

  • $220 million to the Centers for Disease Control and Prevention.
  • $165 million to the Ryan White HIV/AIDS program. (It was named for a 13-year-old diagnosed with HIV in 1984 and is overseen by the Health Resources and Services Administration.)
  • $5 million to the Indian Health Service.
  • $26 million to the National Institutes of Health for research.
  • $157.3 million to community health centers, which have treated around 200,000 HIV annually.

The program lags its goals as it approaches the 2025 benchmark. “It's well designed, well planned, it has targets that makes sense,” said Jeffrey Sturchio, a researcher on a Center for Strategic and International Studies report.

Sturchio said the problem is not a fault of design, but funding, adding, “Congress has never fully funded the initiative.”

Sturchio pointed to a range of local and state “bureaucratic hurdles.” Jurisdictions that have pulled together sufficient resources have seen “tremendous progress,” he said, and overall indicators seem to be moving in the right direction.

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But reduced HIV testing and may have diverted public health efforts, CDC administrators said. KFF Health reported in April that stakeholders saw progress but worried that it won't be enough to make the 2030 deadline.

Democrats appear to share this concern. The spending bill proposed by the Democratic-controlled Senate Appropriations Committee maintained or slightly increased funding levels to all HIV-related programs. The committee requested more data about the program, describing its “lack of quantifiable data showing outcomes.”

The House has not yet passed the bill out of committee. We know of some proposed cuts from the bill, which the Republican-led House Appropriations Subcommittee released in July.

It outlines a $1.6 billion cut to the CDC, including a $220 million reduction in “HIV/AIDS, viral hepatitis, sexually transmitted diseases, and tuberculosis prevention” and a $238.5 million cut from the Ryan White HIV/AIDS program. The Ryan White program provides medical care and support services to low-income HIV patients and serves more than half of those diagnosed in the U.S.

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The bill also proposes cutting funding to the Minority HIV/AIDS fund by more than half — from $60 million to $28 million. According to HIV.gov, the fund supports prevention and care projects targeting disparities that affect communities of color.

Additional details about how these cuts could affect programs are detailed in a committee report that has not been made public. PolitiFact and some advocacy organizations obtained copies of the report, but the House Appropriations Committee did not respond to questions about it. The report we saw recommended cutting all funding for the Ending the HIV Epidemic initiative.

And House Democrats, advocacy organizations, and KFF Health News have each reported that the Ryan White program and CDC cuts result from a plan to eliminate the Ending the HIV Epidemic initiative.

“If they cut funding, it's going to have a dramatic and draconian impact on the ability of all of the people who are working in these jurisdictions to improve public health,” said Sturchio, the researcher.

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Although the cuts would be dramatic, experts said, they would not eliminate all domestic HIV funding.

“There is certainly a demonstration and a commitment to some of the core HIV programs, but there are millions of dollars of proposed cuts in other areas,” said Lindsey Dawson, associate director for HIV policy at KFF. “These cuts would have a meaningful impact on the ability of programs to provide lifesaving interventions for both HIV care and treatment, as well as prevention.”

The cuts would mean a 16% cut to the CDC's division of STD prevention, a 9% cut to the Ryan White HIV/AIDS program, and a 53% cut to the Minority HIV/AIDS Fund from fiscal year 2023 to 2024.

These funding cuts are only proposals. They require a vote from the full appropriations committee and would have to pass the House and be negotiated with a Democratic-controlled Senate.

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“We've heard for a long time that HIV is a bipartisan issue. But what some people forget, is that that bipartisanship was hard fought for over the first decade of the HIV epidemic,” said Dawson.

Other Challenges to HIV/AIDS Spending

The U.S. commitment to global HIV prevention, meanwhile, is also under scrutiny. Rep. Chris Smith (R-N.J.) challenged reauthorizing the President's Emergency Plan for AIDS Relief, also known as PEPFAR, without first making some changes. Started in 2003 by President George W. Bush, the program distributes funds in more than 50 countries for HIV testing, prevention, treatment, and medications. It also strengthens health care to fight AIDS.

Funding for the program has grown over the past 20 years, totaling more than $110 billion. The program reported 25 million lives saved by medical intervention.

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Smith, who chairs the House Foreign Affairs subcommittee on Global Health, has expressed concerns that money is being given to nongovernmental organizations that support abortion rights and access.

U.S. law prohibits the direct use of overseas funding to provide abortions or to lobby for access to abortions. This has been the case since 1973. However, organizations that receive U.S. funding can do so with their own non-U.S. funding.

An official from the State Department, which runs the program, confirmed to PolitiFact that PEPFAR is legally restricted from funding abortion or lobbying for abortion access; the official cited the training of staff and partners and the monitoring of procedures to ensure compliance.

Other anti-abortion groups have favored a “Mexico City Policy,'‘ which has required foreign nongovernmental organizations to certify that they would not perform or promote abortion with funds from any source to be eligible for U.S. government funding. Trump applied the policy to PEPFAR, but Biden rescinded it.

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The failure to reauthorize PEPFAR would not eliminate the program, and Congress can continue to fund the program without reauthorization, but it could cause some provisions to lapse over the next few years.

The lack of a reauthorization would have significant symbolic impact, said Kellie Moss, KFF's associate director of global health and HIV policy. “It could make the program more vulnerable during funding discussions without a clear signal of bipartisan support.”

Although reauthorization is being held up, funding has progressed. On Sept. 28, the House passed a State Department and Foreign Operations Appropriations bill, which would fund PEPFAR for another year but implement a Mexico -like policy provision on all global health funding. This bill would also extend the lapsing provisions for another year.

Our Ruling

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Biden said that Republicans in Congress are “trying to wipe out federal funding to end the HIV epidemic.”

A subcommittee of House Republicans has proposed cutting some HIV prevention programs anywhere from 53% to 9% in fiscal 2024, depending on the program.

A committee's draft report cited by advocacy and policy groups shows these cuts stem from the elimination of the Trump-era Ending the HIV Epidemic initiative, although the committee did not respond to questions about that.

Taken together, these cuts would not eliminate — or “wipe out” — all federal domestic HIV spending, but they do represent a significant cut.

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Meanwhile, the House has not moved ahead to reauthorize PEPFAR, which supplies U.S. dollars for global HIV prevention, over Republican concerns about where organizations that the money stand on abortion access. But the House has passed one year of PEPFAR funding with some conditions about how it is distributed, which it can do without reauthorizing the program.

Biden's statement is partially accurate in that significant funding cuts have been proposed by House Republicans, but he exaggerates by saying these efforts would “wipe out” federal funding.

We rate this claim Half True.

KFF Health News Southern correspondent Sam Whitehead contributed to this report.

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Our Sources

Email interview with a White House spokesperson, Oct. 17, 2023 

Email interview with a State Department official, Oct. 18, 2023 

Email interview with Michael Finan, communications director for Rep. Chris Smith, Oct. 16, 2023

Interview with Kellie Moss, associate director of Global Health & HIV policy at KFF, Oct. 17, 2023

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Interview with Lindsey Dawson, associate director of HIV policy at KFF, Oct. 18, 2023

Interview with Nick Armstrong, manager of advocacy and government affairs at the AIDS Institute, Oct. 18, 2023

Interview with Carl Schmid, executive director of the HIV + Hepatitis Policy Institute, Oct. 18, 2023

Interview with Jeffrey Sturchio, senior associate of the Global Health Policy Center at the Center for Strategic and International Studies, Oct. 25, 2023

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AHEAD, “The Six EHE Indicators — Incidence,” accessed Oct. 31, 2023

AIDS United, “The HIV Safety Net Is Under Attack,” accessed Oct. 31, 2023

The Associated Press, “Republican Opposition to Abortion Threatens Global HIV/AIDS Program That Has Saved 25 Million Lives,” Sept. 11, 2023

Center for Family and Human Rights, “Dear Colleague, President Biden has hijacked PEPFAR, the $6 billion a year foreign aid program designed to mitigate,” June 6, 2023

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Center for Family and Human Rights, “PEPFAR Coalition Letter,” May 1, 2023

Center for Strategic and International Studies, “Can the Ending the HIV Epidemic in the U.S. Initiative Succeed?” Aug. 26, 2022

Centers for Disease Control and Prevention, “Core Indicators for Monitoring the Ending the HIV Epidemic Initiative,” Oct. 17, 2023

Centers for Disease Control and Prevention, “Dear Colleagues: What's New | About the Division of HIV/AIDS Prevention,” May 24, 2022

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Centers for Disease Control and Prevention, “EHE Accomplishments,” Sept. 21, 2023

Centers for Disease Control and Prevention, “Transgender Women Urgently Need More HIV Prevention and Treatment Services, New CDC Data Show,” April 15, 2021

Centers for Disease Control and Prevention, “2021 HIV Incidence | NCHHSTP Newsroom,” May 23, 2023

Centers for Disease Control and Prevention, “Estimated HIV Incidence and Prevalence in the United States, 2017-2021: National Profile,” May 23, 2023

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Congress.gov, “Senate Appropriations LHHSE Committee Report,” July 27, 2023 

Fox News, “Biden Administration ‘Hijacking' George Bush AIDS Program to Push Abortion in Africa: GOP Congressman,” June 10, 2023

HIV.gov, “Ending the HIV Epidemic,” Aug. 1, 2023

HIV.gov, “Expanding PrEP Coverage in the United States to Achieve EHE Goals,” Oct. 18, 2023

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HIV.gov, “HIV & AIDS Trends and U.S. Statistics Overview,” Oct. 3, 2023

HIV.gov, “Minority HIV/AIDS Fund in Action,” May 16, 2023 

HIV.gov, “What Is the Minority HIV/AIDS Fund?,” Sept. 25, 2019

House Appropriations Committee, “FY24 LHHSE Appropriations Bill Summary,” July 13, 2023

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House Appropriations Committee, “House Approves H.R. 4665, The Department of State, Foreign Operations, and Related Programs Appropriations Act,” Sept. 28, 2023

House Democrats Appropriations Committee, “House Republican Funding Bill Kicks Teachers Out of Classrooms, Takes Away Job Opportunities, and Harms Women and Children,” July 13, 2023 

KFF, “PEPFAR Reauthorization: The Debate About Abortion,” Sept. 21, 2023

KFF, “PEPFAR Reauthorization 2023: Key Issues,” March 13, 2023

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KFF, “The Mexico City Policy: An Explainer,” Jan. 28, 2021

KFF, “The U.S. Ending the HIV Epidemic (EHE) Initiative: What You Need to Know,” Feb. 9, 2021

KFF, “The U.S. Government and International Family Planning & Reproductive Health: Statutory Requirements and Policies,” Oct. 27, 2023

KFF, “The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) ,” July 26, 2023

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KFF, “U.S. Federal Funding for HIV/AIDS: Trends Over Time,” March 5, 2019

KFF Health News, “In Move to Slash CDC Budget, House Republicans Target Major HIV Program Trump Launched,” Sept. 8, 2023

KFF Health News, “US Officials Want to End the HIV Epidemic by 2030. Many Stakeholders Think They Won't,” April 24, 2023

National Alliance of State and Territorial AIDS Directors, “FY2024 Appropriations for Federal HIV/AIDS Programs,” July 28, 2023

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NBC News, “How Tennessee Axed Millions in HIV Funds Amid Scrutiny From Far-Right Provocateurs,” Feb. 2, 2023

NBC News, “Tennessee Blocked $8 Million for HIV, Now Ends Up With $13 Million, Stunning Advocates,” April 21, 2023

NBC News, “U.S. Progress in HIV Fight Continues to Trail Many Other Rich Nations,” May 23, 2023

NPR, “What's Behind the Debate to Re-Authorize PEPFAR, the Widely Hailed Anti-HIV Effort?” Sept. 29, 2023

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Planned Parenthood, “The Quickie: Tennessee to Pull Federal Funding for HIV Prevention to Avoid Giving Grants to Planned Parenthood,” Jan. 27, 2023 

Reuters, “US State Dept Slams Congress for Failure to Renew Anti-AIDS Program,” Oct. 3, 2023

Roll Call, “PEPFAR Reauthorization Debate Highlights Splits in GOP,” Sept. 21, 2023

Ryan White HIV/AIDS Program, “Available Care & Services | Ryan White HIV/AIDS Program,” Feb. 2022

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Ryan White HIV/AIDS Program, “Home page,” accessed Oct. 31, 2023

Ryan White HIV/AIDS Program, “Ryan White HIV/AIDS Program Annual Client-Level Data Report 2020,” December 2021

San Francisco AIDS Foundation, “Devastating Cuts Proposed to Federal HIV Budget — San Francisco AIDS Foundation,”  July 14, 2023

The Heritage Foundation, “Reassessing America's $30 Billion Global AIDS Relief Program,” May 1, 2023

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The New Yorker, “Abortion Opponents Are Targeting a Signature G.O.P. Public-Health Initiative,” Aug. 24, 2023

The New York Times, “Tennessee's Rejection of Federal Funds to Curb HIV Alarms Prevention Groups,” March 24, 2023

The Washington Post, “Lifesaving PEPFAR Program Faces a New Threat: U.S. Abortion Politics,” July 29, 2023

The Washington Post, “Opinion | George W. Bush: Michael Gerson's Words Make the Case for Saving PEPFAR,” Sept. 13, 2023

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The White House, “Remarks by President Biden and First Lady Jill Biden at the 2023 Human Rights Campaign National Dinner,” Oct. 14, 2023

U.S. Congressman Chris Smith (R-N.J.), “Biden Has Hijacked PEPFAR to Promote Abortion,” Sept. 28, 2023

U.S. Senate Committee on Appropriations, “FY 24 LHHS Report,” July 27, 2023

U.S. Senate Committee on Appropriations, “Senate Appropriations Committee Approves Defense, Interior-Environment, LHHS, and Homeland Security Bills,” July 27, 2023

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U.S. State Department, “Results and Impact — PEPFAR,” accessed Oct. 31, 2023

U.S. State Department, “The United States President's Emergency Plan for AIDS Relief,” accessed Oct. 31, 2023

YouTube, “Biden Has Hijacked PEPFAR to Promote Abortion,” Sept. 28, 2023

——————————
By: Grace Abels, PolitiFact
Title: Do Republican Spending Cuts Threaten Federal HIV Funding? For Some Programs, Yes.
Sourced From: kffhealthnews.org/news/article/fact-check-biden-republicans-congress-hiv-aids-funding/
Published Date: Tue, 14 Nov 2023 10:00:00 +0000

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Kaiser Health News

The Lure of Specialty Medicine Pulls Nurse Practitioners From Primary Care

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Michelle Andrews
Fri, 17 May 2024 09:00:00 +0000

For many patients, seeing a nurse practitioner has become a routine part of primary care, in which these “NPs” often perform the same tasks that patients have relied on for.

But NPs in specialty care? That's not routine, at least not yet. Increasingly, though, nurse practitioners and physician assistants are joining cardiology, dermatology, and other specialty practices, broadening their skills and increasing their income.

This worries some people who track the health workforce, because current trends suggest primary care, which has counted on nurse practitioners to backstop physician shortages, soon might not be able to rely on them to the same extent.

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“They're succumbing to the same challenges that we have with physicians,” said Atul Grover, executive director of the Research and Action Institute at the Association of American Medical Colleges. The rates NPs can command in a specialty practice “are quite a bit higher” than practice salaries in primary care, he said.

When nurse practitioner programs began to proliferate in the 1970s, “at first it looked great, producing all these nurse practitioners that go to work with primary care physicians,” said Yalda Jabbarpour, director of the American Academy of Physicians' Robert Graham Center for Policy Studies. “But now only 30% are going into primary care.”

Jabbarpour was referring to the 2024 primary care scorecard by the Milbank Memorial Fund, which found that from 2016 to 2021 the proportion of nurse practitioners who worked in primary care practices hovered between 32% and 34%, even though their numbers grew rapidly. The proportion of physician assistants, also known as physician associates, in primary care ranged from 27% to 30%, the study found.

Both nurse practitioners and physician assistants are advanced practice clinicians who, in addition to graduate degrees, must complete distinct education, , and certification steps. NPs can practice without a doctor's supervision in more than two dozen states, while PAs have similar independence in only a handful of states.

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About 88% of nurse practitioners are certified in an area of primary care, according to the American Association of Nurse Practitioners. But it is difficult to track exactly how many work in primary care or in specialty practices. Unlike physicians, they're generally not required to be endorsed by a national standard-setting body to practice in specialties like oncology or cardiology, for example. The AANP declined to answer questions about its annual workforce survey or the extent to which primary care NPs are moving toward specialties.

Though data tracking the change is sparse, specialty practices are adding these advanced practice clinicians at almost the same rate as primary care practices, according to frequently cited research published in 2018.

The clearest evidence of the shift: From 2008 to 2016, there was a 22% increase in the number of specialty practices that employed nurse practitioners and physician assistants, according to that study. The increase in the number of primary care practices that employed these professionals was 24%.

Once more, the most recent projections by the Association of American Medical Colleges predict a dearth of at least 20,200 primary care physicians by 2036. There will also be a shortfall of non-primary care specialists, including a deficiency of at least 10,100 surgical physicians and up to 25,000 physicians in other specialties.

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When it to the actual work performed, the lines between primary and specialty care are often blurred, said Candice Chen, associate professor of health policy and management at George Washington .

“You might be a nurse practitioner working in a gastroenterology clinic or cardiology clinic, but the scope of what you do is starting to overlap with primary care,” she said.

Nurse practitioners' salaries vary widely by location, type of facility, and experience. Still, according to data from recruiter AMN Healthcare Physician Solutions, formerly known as Merritt Hawkins, the total annual average starting compensation, including signing bonus, for nurse practitioners and physician assistants in specialty practice was $172,544 in the year that ended March 31, slightly higher than the $166,544 for those in primary care.

According to forecasts from the federal Bureau of Labor Statistics, nurse practitioner will increase faster than jobs in almost any other occupation in the decade leading up to 2032, growing by 123,600 jobs or 45%. (Wind turbine service technician is the only other occupation projected to grow as fast.) The growth rate for physician assistants is also much faster than average, at 27%. There are more than twice as many nurse practitioners as physician assistants, however: 323,900 versus 148,000, in 2022.

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To Grover, of the AAMC, numbers like this signal that there will probably be enough NPs, PAs, and physicians to meet primary care needs. At the same time, “expect more NPs and PAs to also flow out into other specialties,” he said.

When Pamela Ograbisz started working as a registered nurse 27 years ago, she worked in a cardiothoracic intensive care unit. After she became a family nurse practitioner a few years later, she found a job with a similar specialty practice, which trained her to take on a bigger role, first running their outpatient clinic, then working on the floor, and later in the intensive care unit.

If nurse practitioners want to specialize, often “the doctors mentor them just like they would with a physician residency,” said Ograbisz, now vice president of clinical operations at temporary placement recruiter LocumTenens.com.

If physician assistants want to specialize, they also can do so through mentoring, or they can “certificates of added qualifications” in 10 specialties to demonstrate their expertise. Most employers don't “encourage or require” these certificates, however, said Jennifer Orozco, chief medical officer at the American Academy of Physician Associates.

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There are a number of training programs for family nurse practitioners who want to develop skills in other areas.

Raina Hoebelheinrich, 40, a family nurse practitioner at a regional medical center in Yankton, South Dakota, recently enrolled in a three-semester post-master's endocrinology training program at Mount Marty University. She lives on a farm in nearby northeastern Nebraska with her husband and five sons.

Hoebelheinrich's new skills could be helpful in her current hospital job, in which she sees a lot of patients with acute diabetes, or in a clinic setting like the one in Sioux Falls, South Dakota, where she is doing her clinical endocrinology training.

Lack of access to endocrinology care in rural areas is a real problem, and many people may travel hundreds of miles to see a specialist.

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“There aren't a lot of options,” she said.

——————————
By: Michelle Andrews
Title: The Lure of Specialty Medicine Pulls Nurse Practitioners From Primary Care
Sourced From: kffhealthnews.org//article/nurse-practitioners-trend-primary-care-specialties/
Published Date: Fri, 17 May 2024 09:00:00 +0000

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Clean Needles Save Lives. In Some States, They Might Not Be Legal.

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Ed Mahon, PA and Sarah Boden, WESA
Fri, 17 May 2024 09:00:00 +0000

Kim Botteicher hardly thinks of herself as a criminal.

On the main floor of a former Catholic church in Bolivar, Pennsylvania, Botteicher runs a flower shop and cafe.

In the former church's basement, she also operates a nonprofit organization focused on helping people caught up in the drug epidemic get back on their feet.

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The nonprofit, FAVOR ~ Western PA, sits in a rural pocket of the Allegheny Mountains east of Pittsburgh. Her organization's home county of Westmoreland has seen roughly 100 or more drug overdose deaths each year for the past several years, the majority involving fentanyl.

Thousands more residents in the region have been touched by the scourge of addiction, which is where Botteicher comes in.

She helps people find housing, , and , and works with families by running support groups and explaining that substance use disorder is a disease, not a moral failing.

But she has also talked publicly about how she has made sterile syringes available to people who use .

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“When that person comes in the door,” she said, “if they are covered with abscesses because they have been using needles that are dirty, or they've been sharing needles — maybe they've got hep C — we see that as, ‘OK, this is our first step.'”

Studies have identified public health benefits associated with syringe exchange services. The Centers for Disease Control and Prevention says these programs reduce HIV and hepatitis C infections, and that new users of the programs are more likely to enter drug treatment and more likely to stop using drugs than nonparticipants.

This harm-reduction strategy is supported by leading groups, such as the American Medical Association, the World Health Organization, and the International AIDS Society.

But providing clean syringes could put Botteicher in legal danger. Under Pennsylvania law, it's a misdemeanor to distribute drug paraphernalia. The state's definition includes hypodermic syringes, needles, and other objects used for injecting banned drugs. Pennsylvania is one of 12 states that do not implicitly or explicitly authorize syringe services programs through statute or regulation, according to a 2023 analysis. A few of those states, but not Pennsylvania, either don't have a drug paraphernalia law or don't include syringes in it.

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Those working on the front lines of the opioid epidemic, like Botteicher, say a reexamination of Pennsylvania's law is long overdue.

There's an urgency to the issue as well: Billions of dollars have begun flowing into Pennsylvania and other states from legal settlements with companies over their role in the opioid epidemic, and syringe services are among the eligible interventions that could be supported by that money.

The opioid settlements reached between drug companies and distributors and a coalition of state attorneys general included a list of recommendations for spending the money. Expanding syringe services is listed as one of the core strategies.

But in Pennsylvania, where 5,158 people died from a drug overdose in 2022, the state's drug paraphernalia law stands in the way.

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Concerns over Botteicher's work with syringe services recently led Westmoreland County officials to cancel an allocation of $150,000 in opioid settlement funds they had previously approved for her organization. County Commissioner Douglas Chew defended the decision by saying the county “is very risk averse.”

Botteicher said her organization had planned to use the money to hire additional recovery specialists, not on syringes. Supporters of syringe services point to the cancellation of funding as evidence of the need to change state law, especially given the recommendations of settlement documents.

“It's just a huge inconsistency,” said Zoe Soslow, who leads overdose prevention work in Pennsylvania for the public health organization Vital Strategies. “It's causing a lot of confusion.”

Though sterile syringes can be purchased from pharmacies without a prescription, handing out free ones to make drug use safer is generally considered illegal — or at least in a legal gray area — in most of the state. In Pennsylvania's two largest , Philadelphia and Pittsburgh, officials have used local health powers to provide legal protection to people who operate syringe services programs.

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Even so, in Philadelphia, Mayor Cherelle Parker, who took office in January, has made it clear she opposes using opioid settlement money, or any city funds, to pay for the distribution of clean needles, The Philadelphia Inquirer has reported. Parker's position signals a major shift in that city's approach to the opioid epidemic.

On of the state, opioid settlement funds have had a big effect for Prevention Point Pittsburgh, a harm reduction organization. Allegheny County reported spending or committing $325,000 in settlement money as of the end of last year to support the organization's work with sterile syringes and other supplies for safer drug use.

“It was absolutely incredible to not have to fundraise every single dollar for the supplies that go out,” said Prevention Point's executive director, Aaron Arnold. “It takes a lot of energy. It pulls away from actual delivery of services when you're constantly having to find out, ‘Do we have enough money to even purchase the supplies that we want to distribute?'”

In parts of Pennsylvania that lack these legal protections, people sometimes operate underground syringe programs.

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The Pennsylvania law banning drug paraphernalia was never intended to apply to syringe services, according to Scott Burris, director of the Center for Public Health Law Research at Temple University. But there have not been court cases in Pennsylvania to clarify the issue, and the failure of the to act creates a chilling effect, he said.

Carla Sofronski, executive director of the Pennsylvania Harm Reduction Network, said she was not aware of anyone having faced criminal charges for operating syringe services in the state, but she noted the threat hangs over people who do and that they are taking a “great risk.”

In 2016, the CDC flagged three Pennsylvania counties — Cambria, Crawford, and Luzerne — among 220 counties nationwide in an assessment of communities potentially vulnerable to the rapid spread of HIV and to new or continuing high rates of hepatitis C infections among people who inject drugs.

Kate Favata, a resident of Luzerne County, said she started using heroin in her late teens and wouldn't be alive if it weren't for the support and community she found at a syringe services program in Philadelphia.

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“It kind of just made me feel like I was in a safe space. And I don't really know if there was like a come-to-God moment or come-to-Jesus moment,” she said. “I just wanted better.”

Favata is now in long-term recovery and works for a medication-assisted treatment program.

At clinics in Cambria and Somerset Counties, Highlands Health provides free or low-cost medical care. Despite the legal risk, the organization has operated a syringe program for several years, while also testing patients for infectious diseases, distributing overdose reversal medication, and offering recovery options.

Rosalie Danchanko, Highlands Health's executive director, said she hopes opioid settlement money can eventually support her organization.

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“Why shouldn't that wealth be spread around for all organizations that are working with people affected by the opioid problem?” she asked.

In February, legislation to legalize syringe services in Pennsylvania was approved by a committee and has moved forward. The administration of Gov. Josh Shapiro, a Democrat, supports the legislation. But it faces an uncertain future in the full legislature, in which Democrats have a narrow majority in the House and Republicans control the Senate.

One of the bill's lead sponsors, state Rep. Jim Struzzi, hasn't always supported syringe services. But the Republican from western Pennsylvania said that since his brother died from a drug overdose in 2014, he has come to better understand the nature of addiction.

In the committee vote, nearly all of Struzzi's Republican colleagues opposed the bill. State Rep. Paul Schemel said authorizing the “very instrumentality of abuse” crossed a line for him and “would be enabling an evil.”

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After the vote, Struzzi said he wanted to build more bipartisan support. He noted that some of his own skepticism about the programs eased only after he visited Prevention Point Pittsburgh and saw how workers do more than just hand out syringes. These types of programs connect people to resources — overdose reversal medication, wound care, substance use treatment — that can save lives and lead to recovery.

“A lot of these people are … desperate. They're alone. They're afraid. And these programs bring them into someone who cares,” Struzzi said. “And that, to me, is a step in the right direction.”

At her nonprofit in western Pennsylvania, Botteicher is hoping lawmakers take action.

“If it's something that's going to help someone, then why is it illegal?” she said. “It just doesn't make any sense to me.”

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This story was co-reported by WESA Public Radio and Spotlight PA, an independent, nonpartisan, and nonprofit newsroom producing investigative and public-service journalism that holds power to account and drives positive change in Pennsylvania.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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By: Ed Mahon, Spotlight PA and Sarah Boden, WESA
Title: Clean Needles Save Lives. In Some States, They Might Not Be Legal.
Sourced From: kffhealthnews.org/news/article/clean-needles-syringe-services-programs-legal-gray-area-risk-pennsylvania/
Published Date: Fri, 17 May 2024 09:00:00 +0000

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Kaiser Health News

Watch: John Oliver Dishes on KFF Health News’ Opioid Settlements Series

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Fri, 17 May 2024 09:00:00 +0000

Opioid manufacturers, distributors, and retailers are paying tens of billions of dollars in restitution to settle lawsuits related to their role in the nation's overdose epidemic. A recent of “Last Tonight With John Oliver” examined how that money is being spent by and local governments across the United States.

The segment from the KFF Health “Payback: Tracking the Opioid Settlement Cash.” You can learn more about the issue and read our collection of articles by Aneri Pattani here.

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Title: Watch: John Oliver Dishes on KFF News' Opioid Settlements Series
Sourced From: kffhealthnews.org/news/article/watch-john-oliver-kff-health-news-payback-opioid-settlements-series/
Published Date: Fri, 17 May 2024 09:00:00 +0000

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