Here We Go Again: Early Morning Amendments Threaten HIV Prevention, Research, Reproductive Health

Jodi Jacobson

Amendments to the House FY 2010 Labor-H Appropriations bill will attempt to prohibit syringe exchange, rescind funding for HIV research and defund reproductive health programs. What they are and how you can take action.

UPDATE 1:43pm ET – Both the Souder Amendment, to prohibit any money in the appropriations bill from being used to fund needle exchange programs, and the Pence Amendment, to prevent any money in the bill from funding Planned Parenthood, were introduced and spoken on for 10 minutes shortly after 1:00pm ET today.  Votes on both amendments were postponed.  

UPDATE 2:45pm ET – Congress overwhelmingly defeated (by a vote of 247 – 183) the Pence amendment to H.R. 3293, the Labor, Health and Human Services and Education Appropriations bill. The amendment, if passed, would have denied family planning services to millions of women, men and teens by restricting Title X federal family planning funds from going to Planned Parenthood affiliate health centers.

The Souder amendment, aimed at maintaining the longstanding federal ban on funding of needle exchange programs, failed by a narrow 211-218 vote.

The HHS-Labor-Education appropriations bill subsequently passed 264-153.

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Here we go again:

Several amendments introduced by Republican conservatives for this morning’s House vote on the House FY 2010 Labor, Health, and Human Services, and Education Appropriations bill (Labor-H) are intended to roll back recent legislative gains on HIV prevention, evidence-based programs, and reproductive health.

If you are nostalgic for the anti-science, anti-intellectualism of the previous administration, you will have ample opportunity to walk down memory lane by watching these votes.

Attempt to ban syringe exchange 

On Thursday, July 23rd, the Rules Committee approved for a vote an amendment to the appropriations bill proposed by Representative Mark Souder (R-IN) which would prohibit HHS funding for programs which distribute sterile needles or syringes for hypodermic injection of any illegal drug.  The amendment flies in the face of evidence-based approaches to preventing the spread of HIV and other infections both among drug users as well as from users of drugs to others.

Safe and certain access to sterile syringes is widely regarded as among
the most effective methods for preventing the spread of HIV and
hepatitis B and C viruses among injection drug users (IDUs)

If this amendment passes it will almost certainly ban federal funding
of syringe exchange in the U.S. and may disrupt current syringe
exchange operations, thereby unnecessarily consigning people to infection and disease.

Attempt to de-fund research among marginalized populations

Rep. Darrell Issa (R-CA) plans to offer an amendment Labor-H bill that would rescind the funding for the following three currently funded, peer-reviewed grants that that focus on HIV/AIDS prevention.  He contends these are an example of "wasteful spending."

Grants Cong. Issa seeks to defund:

1)   Substance Abuse Use and HIV Risk Among Thai Women:

The proposed collaboration study between Ms. Usaneya Perngparn, Chulalongkorn University, Thailand and Dr. Nemoto, Public Health Institute, California, will investigate the sociocultural contexts of HIV risk behaviors and drug use among Thai female and male-to-female transgender (kathoey) sex workers in Bangkok. Research is currently needed to develop and adapt HIV prevention models that take into account sociocultural factors so that the further transmission of HIV and sexually transmitted infections can be averted.  Participation in these types of studies also can provide a way for persons suffering from the health consequences of illicit sexual activity to receive treatment while contributing to our knowledge of prevention and treatment outcomes in these populations.

2)    HIV Prevention for Hospitalized Russian Alcoholics

Investigators are adapting a prevention approach that has been demonstrated to be effective in decreasing high-risk HIV related behaviors in the U.S. for use in Russia, a country with a rapidly expanding incidence of HIV.  The approach, called Health Relationships Intervention, involves the development of a plan of action for each client to increase social support and reduce high-risk behaviors.  This includes the disclosure of information to family and friends on the client’s health, social needs and condition thereby assisting the client in maintaining low risk behaviors.

3) Venue-based HIV and Alcohol Use Risk Reduction Among Female Sex Workers in China 

Research has provided evidence linking alcohol-related, high risk sexual behavior with HIV and other sexually-transmitted infections.  Research has also provided rich descriptions of social, cultural, and economic contexts in which people engage in alcohol-related sexual risk behaviors.  More specifically, alcohol use characteristics (e.g., binge drinking) have been linked with sexual risk-taking that occurs in a range of high risk environments. The investigators have proposed a 5-year study to develop, implement, and evaluate a theory-guided, multiple components, and venue-based HIV and alcohol use risk reduction intervention among commercial sex workers (FSWs) in China.

Given that HIV/AIDS is a global epidemic that has already killed more than 25 million men, women, and children and 33 million people worldwide are currently living with HIV, it is clear that prevention of HIV infection should be a priority area of research funding.

"The research is easy to ridicule if it is taken out of its public health context," says one advocate involved in the process.  "The fact is, scientists need to explore a range of research avenues in vulnerable populations around the world to learn the best ways to control the transmission of HIV."

Researchers and advocates point out the following:

  • NIH uses a rigorous peer review process to determine which grant applications to fund.
  • NIH’s scientific peer review process is the gold standard for determining the quality and relevance of grant proposals. 
  • Thousands of scientists each year submit applications to the NIH requesting funding for their scientific proposals. Applications are evaluated initially by the NIH’s Center for Scientific Review and peer review groups composed of scientific experts from around the U.S. and the world.  These groups (also called “study sections”) assess and rate the scientific and technical merit of the proposed research or training projects. 
  • Projects reviewed in a particular session are scored and ranked in relation to each other.  The applications are then assigned to one of the 27 institutes and centers at NIH. 
  • A second level of peer review is conducted by the NIH National Advisory Councils of the respective funding Institutes or Centers, which are composed of both scientists from the research community and public representatives.  These councils ensure that the NIH receives advice from a cross-section of the U.S. population in its deliberation and decision-making.
  • This system ensures that research conducted and supported with taxpayer dollars is scientifically meritorious and serves to improve the lives of all people equally. Approximately 70 percent of meritorious, scientifically valid proposals do not receive funding through this process.   The grants that receive funding, however, are the best in their fields.
  • In response to previous congressional concerns about whether sexual health research should be funded by the agency, NIH reviewed the entire NIH sexuality portfolio in 2004. That investigation found that all of the NIH grants in areas of sexual health met the rigorous standards of scientific and ethical quality, that they were not funded out of proportion to the public health burden of these diseases, and that the merit review system had been followed.


Amendment to defund Planned Parenthood

And then we have an amendment by Congressman Mike Pence to defund Planned Parenthood.

The Pence amendment states:

"None of the funds made available
under this Act shall be available to Planned Parenthood for any purpose
under title X of the Public Health Services Act." 

In short, Pence, who professes to be "pro-life," wants to de-fund the single largest publicly funded source of preventive reproductive health care in the United States. 

Planned Parenthood has more than 850 affiliate health centers across the country, providing primary and preventive care. Every year, they provide nearly one million cervical cancer screenings, more than 850,000 breast exams, contraception to nearly 2.5 million patients, more than three million tests and treatments for STDs, including HIV, and nearly 50,000 colposcopies.

According to a recent report
by the Guttmacher Institute, more than six in 10 patients who receive
care at a women’s health center like Planned Parenthood consider it
their primary source of health care.

One in four women
who receives contraceptive care does so at a women’s health center. 
One in six women who obtain a Pap test or a pelvic exam does so at a
women’s health center, as do one-third of women who receive counseling,
testing or treatment for sexually transmitted diseases, including HIV.

Cutting off contraceptive care…..good way to reduce the need for abortion?

Sum total of these amendments?  Yet one more strike against evidence, against public health, and against reality.

Hopefully, there will be enough common sense in the room to defeat them.

If you want to take action, here’s a way to do more:

To defeat the ban on syringe exchange, click here.

To support NIH funding of research on HIV prevention, click here.

 

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