Written by Sarah Posner for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

A subcommittee of the House Judiciary Committee held a hearing Thursday on a bill that would impose an unconstitutional nationwide ban on abortions after 20 weeks post-fertilization. Four witnesses sat at the table during that hearing, but there was really only one person who mattered for the Republican lawmakers—whose aim, ultimately, is to outlaw all abortions. That person was Dr. Kermit Gosnell, the Pennsylvania physician now serving a life sentence for murder and manslaughter.

According to Rep. Trent Franks (R-AZ), chairman of the Subcommittee on the Constitution and Civil Justice, under whose jurisdiction the hearing was called, Gosnell is “not an anomaly in this gruesome Fortune 500 enterprise of killing unborn children.” The rogue doctor, who was roundly denounced by pro-choice activists as soon as the horrific conditions of his clinic came to light, is, for Franks, “the true face of abortion on demand in America.”

Using Gosnell as justification, Franks has retooled his proposed “Pain-Capable Unborn Child Protection Act”—previously introduced as a measure specific to Washington, D.C.—to apply to all 50 states. A D.C. 20-week ban has also been introduced in the Senate, although it is highly unlikely to come up for a vote.

If all abortion providers were like Gosnell, of course, they could be prosecuted under existing criminal laws, as Gosnell was. But they’re not—and that’s why House Republicans want to create a way to prosecute them. The Pain-Capable Act would subject doctors who perform abortions after 20 weeks to criminal prosecution, jail time, and monetary penalties. It would provide a cause of action for a woman who has an abortion after 20 weeks of pregnancy—or her husband, boyfriend, or one-night stand, as well as her family—to sue the doctor, including for punitive damages.

By pegging the gestational time-limit to disproven claims about fetal pain (which medical experts agree is not possible before the third trimester), the bill would lay the basis for limiting abortions even earlier in pregnancy, based on even more questionable science, as demonstrated at Franks’ hearing.

Maureen Condic, a University of Utah scientist who also opposes embryonic stem-cell research, testified that it is “uncontested that a fetus experiences pain as early as eight weeks.” By continually arguing that fetal pain is experienced far earlier than the established medical evidence, Condic did provide proof of something else: that Republicans’ ultimate goal is to outlaw abortion far earlier than 20 weeks.

The bill proposed by Franks contains no exceptions for the health of a woman who needs an abortion after 20 weeks, raising the specter of a woman (or the parents of a minor) suing a doctor who, in an emergency, saved her from horrific health consequences. It also provides no exceptions for rape or incest. The woman, the man by whom she is pregnant, or the woman’s family members could even seek a court order barring the doctor from performing abortions in the future.

Another of the Republicans’ three witnesses, anti-choice activist Jill Stanek, claimed that the Gosnell case is “evidence that the lines between illegal infanticide and legal feticide, both via abortion, have become blurred.”

By equating Gosnell’s criminal activity with all abortion, Franks and his supporters attempt to elide the fact that their bill is patently unconstitutional, as Rep. John Conyers (D-MI), noted. Just this week the Court of Appeals for the Ninth Circuit struck down a similar law out of Franks’ home state of Arizona.

Franks’ obvious aim is to test that conclusion, by forcing yet another legal challenge to Roe v. Wade. But he also seeks to enhance his position—at least in the court of public opinion—by attempting to persuade the public that if Gosnell, who performed illegal abortions and killed infants born alive, was found guilty of murder, all providers of abortion services must be similarly guilty.

Rep. Jerrold Nadler (D-NY), the subcommittee’s ranking member, strongly voiced his opposition to Franks’ claims. “[W]hat Dr. Gosnell did had nothing to do with abortion; it was murder,” Nadler said.

Calling the hearings a “farce,” Nadler noted that the Democrats, as the minority in the House, were not permitted by Franks to call more than one witness, while the three witnesses called by Republicans presented what Nadler called “false and misleading” medical evidence.

The one witness Democrats were permitted was Christy Zink, who recounted the heart-rending story of how she and her husband were informed during her 21st week of pregnancy that the fetus she was carrying had a lethal abnormality, agenesis of the corpus callosum. Zink said that if brought to term, her baby would have been born missing a part of its brain.

Zink called the bill a “lie”; if its purpose, she said, was to spare babies from pain, preventing women like her from having abortions would hardly accomplish that goal. “If the baby survived the pregnancy, which was not certain,” she said, “his condition would require surgeries to remove more of what little brain matter he had, to diminish what would otherwise be a state of near-constant seizures.”

Rep. Louie Gohmert (R-TX), showed little compassion for Zink. “Should we wait,” he mused, “and see if the child can survive, before we decide to rip him apart?”

With the Democrats so limited in their presentation of witnesses, Dr. Willie Parker of Physicians for Reproductive Health submitted written testimony to the subcommittee calling the bill “cruel legislation” that “abandons and endangers women by criminalizing safe abortion.” The civil and criminal penalty provisions, Parker added, “are clearly intended to intimidate health care providers from providing abortion care.”

As Parker noted, most abortions take place early in pregnancy. Only 12 percent of abortions take place at or after 13 weeks after a woman’s last menstrual period (LMP), Parker wrote, and only 1.4 percent occur after 21 weeks LMP. Yet in spite of their attempts to outlaw a tiny fraction of abortions—which are frequently the result of the discovery of lethal fetal abnormalities or threats to the life or health of the woman—the testimony of the Republicans’ medical and scientific witnesses seemed to suggest that abortion should be outlawed at virtually any time.

Dr. Anthony Levitano, who also testified for the Republicans, is an OB-GYN who used to perform abortions, and described in detail how the process of performing a 24-week abortion led him to oppose all abortion.

Levitano has recited these details before, appearing in the 2011 film, The Gift of Life, produced by Citizens United, the advocacy group whose activities led to the Supreme Court campaign finance decision. The film, which promoted the passage of laws that would give a fetus the rights of a person, attempted to demonize abortion providers by lionizing Levitano’s conversion to the anti-choice cause.

As Dr. Douglas Laube, board chair for Physicians for Reproductive Health, told Religion Dispatches in 2011, Levitano did not seem to take into account his patient’s situation. “I see it as a disconnect,” said Laube. “It does not connect logically with a reason not to support the right to choose. It’s his feelings versus her right to choose.”

The views, conditions, or situations faced by women as patients similarly did not factor into Thursday’s hearing. That’s not surprising, given that under Franks’ view of the Constitution, fetuses have the right to life, liberty, property, and the due process of law, but women apparently do not. As he adjourned the hearing, Franks asked, “Are we prepared to say that such violence, visited on children year after year after year, is somehow the price of freedom?”

Written by Ashley Hartman for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

This election, I was proud to work with many young people to engage our communities and campuses in the issues that impact us. One issue that engaged many young women in the election work I did this year in Ohio was access to health care, especially pregnancy related services, such as pre- and post-natal care, maternity care, and abortion care. Sixty-five percent of 18-to-24 year-olds believe abortion should be legal all or most of the time, which is higher than any other age group. I am lucky to have employer-funded health insurance that allows me to access a full range of preventive services, including all pregnancy-related services.

Sadly, not all women — even women with insurance — have access to these services. Current law unfairly limits insurance coverage for abortion for women with government-funded insurance. This is because federal dollars are withheld from covering a woman’s abortion except in limited circumstance.

It seems unfair to withhold insurance coverage or try to influence a woman’s decisions about whether to end a pregnancy just because of the type of insurance she has. These are decisions best made by a woman, her family, faith and doctor, not politicians.

These laws also put the lives of women at risk. When a woman is pregnant, it is important that she has access to safe medical care. Providing insurance coverage insures she will be able to see a licensed, quality health care provider.

Even if we don’t personally agree with abortion, it is unfair to restrict insurance coverage, or try to influence a woman’s decision about whether to end a pregnancy, just because she has government-funded health insurance.

I care about women in Ohio, which is why I supported Barack Obama. He pledged to ensure all women have access to essential reproductive health care services.

Women and youth voters played a huge impact in Obama’s win this year. Not only did young people, 18-to-24 turn out for the president in 2008, they continued to turn out for him as they entered their late twenties. This demonstrates how important issues such as insurance coverage for abortion are to this generation.

Now my generation must hold Obama accountable to his commitments. That includes urging President Obama to submit a budget to Congress without unfair restrictions on coverage for abortion care. Obama Administration, take note that women will be watching to see if you live up to your commitments to women’s health care.

Written by Aimee Thorne-Thomsen for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

A common narrative in the political and cultural discussions of reproductive health focuses on reducing the number of abortions taking place every year. It’s supposed to be one thing that those who support abortion rights and those who oppose abortion can agree on, the so-called common ground. The assumption is that we can all agree that abortion itself is a bad thing, perhaps necessary, but definitely not a good thing. Even President Clinton declared (and many others have embraced) that abortion should be safe, legal and rare. According to the Guttmacher Institute, almost half of all pregnancies among American women in 2005 were unplanned or unintended. And of those, four in 10 ended in abortion. (http://www.guttmacher.org/pubs/fb_induced_abortion.html#1) In other words, between one-fifth and one-quarter of all pregnancies ended in abortion. Without any other information, those statistics can sound scary and paint a picture of women as irresponsible or poor decision-makers. Therefore reducing the number of abortions is a goal that reproductive health, rights and justice activists should work toward, right?

Wrong. Those numbers mean nothing without context. If the 1.21 million abortions that took place in 2005 (http://www.guttmacher.org/pubs/fb_induced_abortion.html#1) represent the number of women who needed abortions (and in my opinion, if a woman decides she needs an abortion, then she does), as well as the many women who chose to terminate pregnancies that they very much wanted but could not afford to carry to term, then that number is too high. The work of reducing the number of abortions, therefore, would entail creating an authentically family-friendly society, where women would have the support they need to raise their families, whatever forms they took. That could include eliminating the family caps in TANF, encouraging unionization of low-wage workers, reforming immigration policies and making vocational and higher education more accessible.

On the other hand, if those 1.21 million abortions represent only the women who could access abortion financially, geographically or otherwise, then that number is too low. Yes, too low. If that’s the case, then what is an appropriate response? How do we best support women and their reproductive health? Do we dare admit that increasing the number of abortions might be not only good for women’s health, but also moral and just?

What if we stopped focusing on the number of abortions and instead focused on the women themselves? Much of the work of the reproductive health, rights and justice movements would remain the same. We would still advocate for legislation that helps our families. We would still fight to protect abortion providers and their staffs from verbal harassment and physical violence. What would change, however, is the stigma and shame. By focusing on supporting women’s agency and self-determination, rather than judging the outcomes of that agency, we send a powerful message. We say that we trust women. We say we will not use them and their experiences as pawns in a political game. We say we care about women and want them to have access to all the information, services and resources necessary to make the best decisions they can for themselves and their families. That is at the core of reproductive justice. Not reducing the number of abortions. Safe – yes. Legal– absolutely. Rare – not the point.

Written by Amanda Marcotte for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

It was a small news item in Politico, but one that unwittingly revealed the truth behind one of the most persistent myths about the anti-choice movement, which is that they are “single issue” voters. The story is simple. A number of anti-choice groups have decided to target anti-choice Democrats who voted for health care reform, even though there’s no reality-based reason to think the law provides funding for abortion. In other words, the anti-choice movement is coming closer to coming clean about how they simply carry the water for the entire conservative movement, and cynically use fear-mongering over abortion to push for a whole host of right wing agenda items.

Let’s be clear: There is nothing “pro-life” about opposition to universal health care. In a reality-based world, in order to earn the moniker “pro-life”, one should support life, and few things do much better at achieving that goal than demanding inexpensive, efficient, universal health care. Even if you’re just pro-birth, you should love universal health care, since having it is the major reason most other industrialized nations have lower infant mortality rates than we do. If you’re motivated by loathing for sexually-active women, it’s hard to say why you should care much about health care reform in any direction, since the amount of health care dedicated to protecting the sexual health of women is a small amount of overall health care spending. If you’re a single issue voter on abortion, health care reform shouldn’t really matter to you one way or another.

Yet you have the anti-choice movement working as a single beast to attack Democrats who, by and large, give anti-choicers all sorts of support in their "forced childbirth/punish the sluts" goals. Poor Bart Stupak, for instance, couldn’t catch a break with these people. He bore a heavy load for anti-choicers, shoring up the single issue credentials they crave and bashing everyone female in sight, from internet feminists to pro-health care nuns. His reward was that they harassed him and called him a “baby killer”. Why? He didn’t change his mind on abortion. (Still against it.) He didn’t change his attitude towards women. (Still condescending.) He voted for a series of regulations and bureaucratic adjustments that have no real relationship to abortion, for better or for worse. But he and all other anti-abortion Democrats are targets.

The official excuse for why anti-choice groups can campaign against life-saving health care reform while still wearing the farcical label “pro-life” is that they believe that the law provides federal funding for abortion. But they could not have come to this conclusion through a sober-minded assessment of the facts, since such a sober assessment would lead one to the truth, which is that Congress and the President went out of their way to stop federal funding for abortion precisely to placate the anti-choice Democrats. So if this belief isn’t grounded in reality, where are they getting it?

The most logical explanation is that anti-choice groups believe something that isn’t true about the law because they oppose health care reform, and want a politically expedient and even Christian-sounding reason to oppose it. Coming right out and opposing health care reform for the standard issue conservative reasons—i.e., their real reasons—would blow the cover story that many anti-choice groups have, which is that they’re interested in “life” or human welfare. Groups like the Susan B. Anthony List try to steal the identity of feminism, for instance, in order to promote an agenda that’s anti-woman and anti-life. Their cover story of pro-feminism is weak to begin with, but coming straight out against health care reform for the standard conservative reasons would make their already ludicrous claims to be anti-abortion feminists even more ludicrous. After all, how “pro-life” and “pro-woman” is it to support a system where getting breast cancer means getting kicked off your insurance? Can you really continue to front like you’re pro-life if you’re supporting a system where small children can’t get health insurance because of pre-existing conditions, where many infants and mothers die unnecessarily because of gaps in maternal care, where thousands die every year from lack of health insurance?

Most importantly, if you think that insurance company profits are more valuable than the lives of living, breathing people, then your enthusiasm for stripping women’s rights away looks cruel indeed. It’s clear then that this is the ranking in your mind: profits, embryos, real people, women’s rights.

The breath-taking cynicism of the anti-choice movement is on full display with this campaign against anti-choice Democrats. It’s hard to take anti-choice claims that they feel deeply for fetuses seriously when they use abortion as nothing more than a tool to distort and raise emotional stakes on issues that have little to do with abortion. Anti-choice leaders increasingly use “abortion” as a buzzword to rally the troops against whatever issue the larger conservative movement worries about, if they can even find the slimmest of an angle.

The use of abortion as a cynical political ploy does great things for individual politicians on the right, who need some way to wrap themselves in a humanitarian cloth while pushing policies that don’t do much good for most people. But for the shock troops of the anti-choice movement, I see no real benefits. Most people lured into opposing health care reform with dishonest, scandalizing language about abortion probably stand to benefit from the legislation in the long run. Few of us are independently wealthy, and so we can’t get out of engaging in the increasingly dysfunctional health care system.

Still, even setting aside this specific example, you have to wonder about a movement that lies to its base to motivate them. Most anti-choicers are already stalwart, across-the-board conservatives, and yet here their leadership is lying to them about abortion and health care reform to get them to open their wallets and dedicate their time to throwing out anti-abortion Democrats. I don’t know about you, but I’m not usually one to enjoy having my leaders lie to me in order to get me motivated.

Written by William Smith for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

April is National STD Awareness Month and sexual and reproductive health organizations throughout the country urge you to Get Yourself Tested!!  RH Reality Check has partnered with The National Coalition of STD Directors (NCSD) to produce a series of articles on the importance of STD prevention and treatment among populations throughout the United States.  Other articles in this series include one by Sandra Serna-Smith, Dana Cropper Williams and Peter Leone and a feature article by William Smith published earlier this week.

Last week, and as part of STD Awareness month (April), I and several other colleagues wrote about just how significant the STD situation is in our country. It might not be in the headlines everyday, but we’ve got very serious STD epidemics affecting the most vulnerable in our society. This week, I want to pick up on a theme from my own article and that of my colleague Peter Leone in North Carolina: The issue of the resurgent syphilis epidemic in the United States.

Headlines were made recently about the shockingly high rates of syphilis among men who have sex with men. These rates are indicative of behaviors—such as not using condoms–that put people at risk for other sexually transmitted diseases, including HIV. But that is just one aspect of the resurgent syphilis epidemic. Another is the equally disturbing trends of syphilis infection passed along to babies by their mothers, known as congenital syphilis.

On April 16^th, the CDC released new data about the rates of congenital syphilis (CS) and the trends are going totally in the wrong direction. From 2003 to 2005, there were roughly 339 cases per year in the United States. In 2008, however, nearly 100 additional cases of CS were reported for a total of 431 that year. That means nearly 500 children being born in 2008 with a totally preventable life-threatening illness.

CS is preventable. Treating maternal infection 30 days prior to delivery is highly successful in reducing or eliminating transmission. The CDC reports, however that in about a quarter of CS cases where maternal infection was detected within this 30-day window for treatment, an identified infection was left untreated. In another quarter of cases, infection was identified less than 30 days out from delivery and in about 30 percent of cases, no prenatal care was provided and infection was identified at the time of delivery.

What is worse: This isn’t just about babies born sick and easily treated with an “all’s well” ending. In 2007 and 2008, 54 babies born with CS were stillborn and another 7 died within thirty days of birth.

Drill down into the data a bit deeper and we find the same persistent and disturbing trends in terms of how this infection and its outcomes disproportionally affect the southern part of the country. Nearly 60 percent of all cases of CS in 2008 are in the South.

And of course behind the numbers of CS cases are also women whose sexual health is already compromised, particularly black women. Nearly 50 percent of all cases of CS were among those born to black mothers. An even more astonishing statistic provided by the CDC analysis that brings these two pieces of data to appalling convergence – 79 percent of those black mothers involved in CS transmission were from the South.

The current National Plan to Eliminate Syphilis sets a goal of reducing the rate of congenital syphilis to fewer than 3.9 per 100,000 births by 2010. It is highly unlikely that we will meet it. In 2008, the rate was 10.1 per 100,000 births. That is a huge gap to close when the evidence is all around that ground is being lost – not gained.

So, we have yet another window into a disturbing increase of syphilis in this country and it is part of a clarion call to renew and refresh our domestic commitment. This renewed effort must focus on greater efficacy of delivering treatment to pregnant mothers and the CDC recommends this going forward. The great success in preventing mother-to-child transmission of HIV is a good model to look to and the impact of health care reform may also hold promise. After all, good access to prenatal care could facilitate a dramatic drop in rates of syphilis and of CS. But we must focus these efforts and resources in the south where the ugly intersection of history and poverty allow syphilis to thrive.

A decade ago, we were on the precipice of a major public health success story in eliminating syphilis. In fact, syphilis rates in 2000 were the lowest since 1941 when it first became a reportable disease. Now, with insufficient resources and too much politics that has set back behavioral interventions and access to sexual and reproductive healthcare services, we have a big mess on our hands.

But it is a mess we can fix. And fix it we must.

Written by Robin Marty for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

A funny thing happened on the way to healthcare reform.  Not only did a woman’s right to choose get thrown under the bus in an effort to woo anti-choice democrats to vote yay, but a funny little loophole showed up in the final bill. 

[A]bortion opponents are not satisfied with the restrictions on abortion already in the measure, particularly those on abortion coverage in private plans that will be sold in the new marketplaces known as health "exchanges." So they are pushing one particular aspect of the new law. It lets states ban all abortion coverage in the exchanges.

Charmaine Yoest, president and CEO of anti-abortion group Americans United for Life, said her group wasted no time drawing up a model state law to that effect. They sent it out the day after Congress approved the health bill.

"It was a part of the legislation that states could opt out, and so we had a heads-up that this would be a window for us," she said. "So we moved right in to make sure that we could equip states with the tools that they need to have the most effective opt-out possible."

It happened more quickly than we could have imagined.

The first drumbeat started in Kansas in February, when the state legislature tried to pass a ban on abortion coverage for all insurance providers in the state, regardless of whether the coverage was public or private.  That bill was defeated when pro-choice advocates attached amendments declaring the need for supplemental insurance for smokers or people who use erectile dysfunction drugs.

Unfortunately, that appears to have set the stage for our current batch of states, all anxious to jump on the bandwagon and eliminate insurance coverage for abortion. 

Louisiana’s House Insurance Panel met recently and voted to ban all elective abortion coverage from any new policies written in the state. 

The new law allows states to prohibit abortion coverage in the plans that are offered as part of insurance exchanges established to allow consumers to buy policies from private companies. The exchanges will not be online until Jan. 1, 2014. Hoffman’s bill goes beyond the abortion opt-out provision by extending the prohibition to all insurance companies in Louisiana as soon as the bill becomes law.

Those who are fighting the policy note that extending the ban to all policies is a moot point, since insurers are unlikely to want to deal with the logistical nightmare of having different policies for those who are on the exchange versus those who are just purchasing private plans, meaning essentially eliminating it from the exchange means eliminating it all together.

Even worse, the Insurance Committee has yet to define what they consider to be an "non-elective" abortion, stating that mental health and a mother’s health may not actually qualify as exceptions.  The bill’s sponsor says he is willing to possibly look at other considerations but he’s "…not going to open doors that we don’t need to open."

Of course, it comes as little shock that this move is mostly about political face, and little else.  It turns out private insurance plans in Louisiana already don’t cover elective abortion.

Rep. Chuck Kleckley, committee chairman, says he doesn’t know of any private insurance plan in Louisiana that covers abortion, except when a mother’s life is in danger. That exception remains in the bill.

Tennessee has also begun passing legislation to eliminate abortion coverage from the public exchange, claiming that Obama’s executive order is nice, but it’s not binding.

The state House of Representatives passed the bill Monday, banning any use of state government funds to pay for an abortion.

Now the Senate companion bill has cleared the Senate Commerce Committee on a unanimous vote.

One argument against the state bill has been that President Barack Obama signed an executive order barring abortion funding under the federal health care reform.

But Gallatin Republican Diane Black, who’s sponsoring the state measure, says the executive order is just a statement, not a law.

“That’s what people think, that that is the case, that if the president writes an executive order that, that will be the same as having something in statute, and we all know that that is not so.”

Unlike the Louisiana legislation, this does not yet go the additional step to mandate separate coverage in all private insurance plans.  But, as opponents in Tennessee noted, once it occurs in one insurance plan, the additional administrative headaches would make it easier to streamline all plans to match.

In Virgina, meanwhile, Governor Bob McDonnell is also using an abortion funding ban as an attempt to woo social conservatives, in this case without actually creating much change in funding at all.

Gov. Bob McDonnell proposed Wednesday to bar state funding for abortion services — except as required by federal law — a gesture to social conservatives that likely will have limited effect. Neither the governor’s office nor Planned Parenthood said they believed the measure would restrict state Medicaid dollars for the top abortion provider, which religious leaders are pushing to be defunded.

McDonnell, a long-time abortion foe, proposed the broadly written restriction as part of a larger set of amendments to Virginia’s two-year budget. Lawmakers will have a week to consider the governor’s alterations before returning Wednesday for a one-day reconvened session in which they can override the amendments or write them into law.

Under the federal Hyde Amendment, federal dollars can be used to end a pregnancy only in the case of rape, incest, or when the mother’s life is at risk.

As more states wrap up their legislative seasons, will we see more Americans United For Life’s "model state law" popping up across the country? 

We’ll definitely be watching.

During the intense health care reform debate President Obama occasionally mentioned HIV infections and AIDS-related illnesses as among those pre-existing conditions that could no longer be used by health insurance companies to automatically exclude consumers from health insurance coverage. Yet the broader scope and crisis of the HIV and AIDS epidemic in America failed to garner much attention.

Some HIV and AIDS activists and healthcare providers, meanwhile, are experiencing that crisis as if it were the early 1980s when the Reagan administration expressed little concern about the early AIDS epidemic even as the death toll mounted.

Since 2007, activists have clamored for a national strategy on AIDS. And now they are pleading for emergency help as the economic downturn forces drastic cuts in the budgets of non-profit AIDS organizations while new HIV infection rates rise and more people need services.

Where is the sense of urgency in the Obama White House to manage the confusion and handle the crisis, they ask?

In 2006, candidate Obama seemed to understand the need for urgency calling for “an all-hands-on-deck effort.” The first priority of the candidate’s HIV and AIDS platform was to develop a national HIV/AIDS strategy “in the first year of his presidency,” a strategy “designed to reduce HIV infections, increase access to care, and reduce HIV-related health disparities” with “measurable goals, timelines, and accountability mechanisms.”

President Obama outlined the scope of the crisis on the front page of the National Office of AIDS Policy (ONAP) website: “When one of our fellow citizens becomes infected with HIV every nine-and-a half minutes, (emphasis added) the epidemic affects all Americans.”

NOAP recently stressed the impact of HIV on women:

The statistics are sobering: Every 35 minutes, a woman tests positive for HIV in the United States. While women in the U.S. represented 8 percent of AIDS diagnoses in the 1980’s, they now account for 27 percent. The HIV epidemic in the U.S. disproportionately impacts women of color: HIV/AIDS is one of the leading causes of death among black women and Latinas.

The demographic disparities of AIDS cases (as of 2007) are dramatic: Whites, who make up 66 percent of the population, account for 30 percent of AIDS cases; Blacks/African Americans, 12 percent of the population, account for 49 percent of AIDS cases; Hispanic/Latino, 15 percent of the population, account for 19 percent of AIDS cases. Asians, American Indians/Alaska Native and Native Hawaiian/Other Pacific account for less than one percent of the AIDS cases.

The CDC statistics for men who have sex with men (MSM) are alarming. Though only an estimated 4 percent of the U.S. male population (ages 13 and older), MSMs account for nearly half (48 percent) of the more than one million people living with HIV and more than half (53 percent) of all new HIV infections each year. The CDC reports that new infections have declined among heterosexuals and injection drug users, but the “annual number of new HIV infections among MSM has been steadily increasing since the early 1990s,” which the CDC attributes to complacency resulting from the availability of antiretroviral treatment and reduced use of condoms. (See CDC Surveillance breakdown here).

But the headline-grabbing news came in August 2008 when the CDC discovered they had been underreporting the annual rate of new HIV infections. They estimated that there were approximately 56,300 new HIV infections in 2006, about 40 percent higher than the 40,000 new infections per year the CDC previously reported.

Dr. Kevin Fenton, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, made it clear that the new estimate did not represent an actual increase in the number of new HIV infections, but resulted from more sophisticated monitoring systems.

Richard Wolitski, then-acting director of the CDC’s division of HIV/AIDS prevention, said the new estimates "reveal that the U.S. epidemic is — and has been — worse than previously estimated and serve as a wake-up call for all Americans.”

But the wake up call has been largely ignored, according to a survey released by the Kaiser Family Foundation in April 2009. That study found that “Americans’ sense of urgency about HIV/AIDS as a national health problem has fallen dramatically,” as had concern for personal risk of HIV infection.

There are consequences for complacency. Newsweek reported on February 26 — citing a recent report in the New England Journal of Medicine — conditions in Washington, D.C. remain near-overwhelming:

More than 1 in 30 adults in Washington, D.C., are HIV-infected—a prevalence higher than that reported in Ethiopia, Nigeria, or Rwanda. Certain U.S. subpopulations are particularly hard hit. In New York City, 1 in 40 blacks, 1 in 10 men who have sex with men, and 1 in 8 injection-drug users are HIV-infected, as are 1 in 16 black men in Washington, D.C. In several U.S. urban areas, the HIV prevalence among men who have sex with men is as high as 30 percent—as compared with a general-population prevalence of 7.8 percent in Kenya and 16.9 percent in South Africa.

Additionally, “more than 20 percent of the estimated 1 million HIV-positive Americans are unaware of their status.” Newsweek concluded: “It’s time to admit that HIV is still a major threat to Americans.”

Last April, NOAP launched a new five year AIDS Awareness campaign and on April 1 the CDC announced an expansion of their HIV testing initiative by $31.5 million, for another three years to approximately $142.5 million over all. The CDC said they tested over 1.4 million Americans since the initiative began in 2007, with more than 10,000 people newly diagnosed with HIV and “the vast majority” linked to care.

There are other signs the Obama administration is trying to respond to the crisis. This February, the White House released its proposed budget for fiscal year 2011 with increases for domestic HIV and AIDS programs. The total U.S. government-wide spending on HIV and AIDS wouldincrease from $26 billion to $27 billion and the total discretionary funding for the Department of Health and Human Services spending on HIV and AIDS wouldincrease from $6.9 billion to $7.1 billion in 2011. The funding calls for an expansion and focus on treatment, care and prevention “consistent with the President’s pledge to develop a National HIV/AIDS Strategy.” In addition to funding for HIV testing, the budget proposes funding for collaborative efforts to help people with HIV with co-infections of tuberculosis, hepatitis, and sexually transmitted diseases.

The budget proposal also calls for:

• $40 million increase in funding for the Ryan White HIV/AIDS Program for care and treatment programs to a total of $2.3 billion, of which $679 million is for Ryan White Part A medical and support services in eligible metropolitan areas and transitional grant areas and $855 million is for the AIDS Drug Assistance Program – an increase of $20 million;
• an increase of $37.9 million for prevention at the CDC;
• a $98.7 million increase for the National Institutes of Health for research for a total of $3.2 billion in 2011.

Obama also proposes a $5 million increase to  $340 million for the Housing and Urban Development (HUD) Housing Opportunities for Persons with AIDS (HOPWA) program and a request (emphasis added) for $19 billion for the Housing Choice Voucher program to help more than two million extremely low- to low- income families with rental assistance. Obama’s budget also includes $117 million for the Substance Abuse and Mental Health Services Administration Budget.

There has also been some movement on the development of a national strategy on AIDS. The White House convened three consultations plus an inter-agency meeting which is posted online — and ONAP held 14 community meetings with the intention of presenting the national strategy on AIDS by June.

On Friday, (April 9), ONAP released a summary of those meetings and online suggestions in a report, Community Ideas for Improving the Response to the Domestic HIV Epidemic, which cites “a core set of common themes…including: improving access to care, reducing stigma surrounding HIV, and coordinating HIV prevention and treatment.”  ONAP Director Jeffrey S. Crowley said he hopes the report “will serve as a resource as we strive to develop a new strategic approach to tackling the HIV/AIDS epidemic in the United States and take steps to better coordinate the federal government’s response.”  

But Obama’s budget has yet to be approved by Congress and many AIDS activists are frustrated that there is still no overall coordinated AIDS strategy. Crowley promised a plan by the end of 2009 but instead issued a “Call to Action” that appeared to go largely unheeded.

The Coalition for a National AIDS Strategy issued its own call and came up with its own set of recommendations for a strategy. Jeffrey King, executive director of In The Meantime Men, an HIV-focused wellness group for African American MSMs, said the community meeting in Los Angeles occurred on the same Sunday as AIDS Project Los Angele’s popular AIDS Walk. King said only about 100 people attended, many of whom were from an HIV housing facility begging for help not to be closed. It closed anyway.

King said he is trying to keep his small agency afloat during the economic downturn. But finding funding is difficult and the director of the California Office of AIDS plays politics with funding grants, he said. The L.A. County Office of AIDS Programs and Policy has been very helpful, however.

Pedro García, director of Youth Services & Proyecto Orgullo at BIENESTAR, a grass-roots Latino-oriented non-profit that helps underserved communities of color disproportionately impacted by HIV/AIDS (including straight and LGBTs immigrants and a large transgender cliental) said his organization is also facing financial difficulties.

“The cuts in funding that took place last year impacted BIENESTAR heavily. We lost complete funding for the Youth Program from the [LA County] Office of AIDS Programs and Policy. We also were heavily impacted in cuts for Care Services programs such as Case Management, Peer Support, Treatment Education and Housing, to name a few. And in addition, BIENESTAR currently has NO funding for Latina Women at Sexual Risk – however, services for this population have not been interrupted. This is the type of commitment that BIENESTAR has toward the Latino Community.”

“What this decreased funding for programs and services translates to is more cases of HIV infection occurring in the Latino population and making the work that BIENESTAR does, that much harder to achieve,” said Oscar De La O, Executive Director of BIENESTAR.

Ronald Johnson, the African American HIV-positive deputy director of AIDS Action Council, countered the prevailing perception.

“Actually there is a sense of real urgency within the White House both by the President and the National Office of AIDS Policy,” Johnson said. “I realize its taking longer than some of us thought to see a draft [of the Strategy] but it’s our understanding that the draft is underway and I think any delay – and certainly the focus on health care reform – which benefits people living with HIV/AIDS – is a factor.”

Johnson said that evidence of the urgency is in the sheer amount of work the White House is doing to reverse “eight years of absolute neglect of the domestic HIV epidemic from the previous administration.”

He noted that for the first time, the CDC is funding prevention messages that target MSM and the new national surveillance system resulted in the revised estimates of new HIV infections each year.

Further evidence might be the April 5 announcement by Health and Human Services Secretary Kathleen Sebelius of the release of more than $1.84 billion in grants though Health Resources and Services Administration, which oversees the Ryan White HIV/AIDS program.

“These grants help ensure Americans, especially those in underserved rural and urban communities, affected by HIV/AIDS get access to the care they need through quality health care and support systems," Sebelius said in a press release.

The grants are allocated in three areas of the Ryan White program: Part B gets about $1.145 billion sent to states and territories, with $800 million of that total designated for ADAP, with other money going to 16 states based on a formula (list of Part B awards here). Part A gets $652 million for primary care and support services, including $44.8 million for the Minority AIDS Initiative and Part C receives more than $48.1 million for early intervention services administered by community-based organizations.

But Michael Weinstein, president of the Los Angeles-based global treatment and advocacy AIDS Healthcare Foundation is not overly impressed. “The combination of flat funding and steep drug price rises has put the ADAP program in great jeopardy,” Weinstein said. “We should be able to expect something much better from the Democrats on AIDS.”

Johnson said AIDS Action Council and other AIDS groups are gearing up for the expected budget fight as Congress takes up appropriations. “We are going to press the case that even though there are increases in the president’s budget, the need and the epidemic are such that even greater funds are called for.”

But an even larger issue looms: figuring out how to integrate the AIDS appropriations into the National AIDS Strategy – overlayed with the new heath care reform bill, which Johnson said they are still reading, with its implementation “down the road. That is the work we are doing now.”
For instance, the health care reform bill eliminates the coverage cap – otherwise known as the “hole in the donut” for Medicare Part D Prescription drugs  by 2020. While non-HIV infected Americans who need prescription medications may have difficultly deciphering the year changes in the plan, for people living with HIV and AIDS the issue is expensive and could mean life or death.

“We’re still asking ourselves what this means,” Johnson said. Immediately, some people will be eligible for a $250 rebate. “It’s small but in these times, every 50 cents helps for some people,” especially since many people living with AIDS are not able to get out of the donut hole. In 2011, the 50 percent discount for name brand drugs will go into effect for people in the coverage gap.

“People living with HIV/AIDS can use ADAP to count for the true out of pocket expenses requirement,” Johnson said. But reminded that many state ADAPs are in danger of being cut for lack of funding, Johnson said, “above and beyond health care reform, we’ve strongly advocated for a $126 million emergency appropriations for ADAP this year and also for the appropriations bills that Congress will be developing for the fiscal year that begins October 1. The funding situation for ADAP continues to be a critical issue.”

With rising HIV infection rates, with budget shortfalls severely impacting the local service agencies at a time when more services are needed, with state governments cutting funding to deal with their own financial woes, and with a lack of an overall emergency strategy – the day may soon come when AIDS activists will no longer feel as if they were living in the early 1980s – they may actually be reliving them.

Written by Charlotte Taft for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

I am the director of the Abortion Care Network, a non-profit organization that supports independent abortion providers and challenges the stigma associated with abortion. I have worked with independent abortion providers for more than 30 years. I don’t have firsthand knowledge of Dr. Kermit Gosnell’s practice in Philadelphia, so my comments are not directed to the particulars of his clinic. But when I read media accounts of women coming forward to report terrible experiences with their abortions, I feel sad and scared that these women may have settled for far less than they deserve.

One of the many prices women pay for the stigma attached to abortion is that they don’t realize they have a right to medical skill, kindness, and a clean attractive abortion facility, just as they do with any other health care. If they are keeping secrets, they may not tell even other women about bad experiences—or good experiences. So each woman who is thinking about abortion is on her own. And they may not report substandard care to health authorities because they don’t want to jeopardize their own confidentiality. Or they may not even realize that they deserve better.

As with any kind of service, some abortion facilities are better than others. Ironically the anti-choice movement with its righteous judgment creates an atmosphere of secrecy where a bad clinic could thrive. Sometimes it actually seems as though the angry picketers target the better clinics. If abortion were talked about as the normal, common, experience that it is, bad abortion providers would go out of business the same way bad restaurants do—because people would tell each other not to go there. Abortion is still treated as such a shameful secret that many women don’t even know that their sister or cousin or aunt may have been to a clinic herself, and have information to share. In a room with 10 women, at least three of them have had an abortion—and all of them have known and loved someone who has. What would it be like if we reached out to each other so that this important life decision wasn’t such a lonely one?

My organization, the Abortion Care Network has a section on its website called “Considering Abortion." This and “How to choose a Quality Clinic” gives you very important information about what you should expect from an abortion provider. As you are reading this, someone you care about needs this information, so please pass it on.

One thing that good abortion providers have in common is that they truly care about the women they serve. You may not realize that before abortion became legal there really were no outpatient clinics. Independent Abortion Providers pioneered the model of offering excellent outpatient medical care so that it could be more economical and much less time consuming than in a hospital. Outpatient care also guarantees a supportive staff, which can be quite a challenge in a hospital where staff may not be dedicated to providing excellent abortion care.

Abortion providers pioneered the idea of including counseling with medical care, and the opportunity to talk about feelings that many clinics offer is still very special. We were among the first to develop the idea of informed consent in which a patient had the right to full information about the procedure she was choosing and possible risks. In the past 30 years the anti-choice movement has brainwashed our society so relentlessly that it could be easy to forget that an early abortion (90 percent of abortions are done under 12 weeks) is many times safer than continuing a pregnancy to term. More than 50 million women in this country have had an abortion. Women know that they have both the right and the responsibility to make the best choices they can about when and whether to bring new life into the world through their bodies. Legal abortion has allowed many women to care better for the children they already have, to complete their educations, and to delay parenthood until they are truly ready.

For the past 37 years Independent Abortion Providers have been partners with women giving kindness, excellent medical care, and support. We trust that our patients are good women doing the best they can. There are many other things you may not know about those who provide abortion care. Come visit at Abortioncarenetwork.org and see the wonderful resources we have for patients and their families.

Written by Jen Heitel Yakush for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

Last summer, the $50 million-a-year federal Title V abstinence-only-until-marriage grant program died a quiet death. Despite vocal protestations from the extreme right wing, which wanted to continue funneling money to abstinence-only-until-marriage programs and speakers across the country, Congress correctly decided not to renew funding due, in large part, to the overwhelming evidence that these programs are ineffective and entail serious ethical concerns.

Now, however, like a shambling, mindless zombie, the Title V abstinence-only-until-marriage program is going through a grotesque rebirth and is included in the healthcare reform bill that was recently signed by President Obama. How this program could go from being left on the scrap heap like so much garbage to being included in the most ambitious and progressive social legislation in decades should baffle anyone who believes in putting science- and evidence-based decision making ahead of cheap political gimmicks.

To understand fully why it is so ridiculous that the Title V abstinence-only-until-marriage program was included in healthcare reform, it helpful to understand why it was eliminated in the first place.

Abstinence-only-until-marriage programs don’t work – Numerous studies, including one conducted by Mathematica Policy Research Inc. on behalf of the U.S. Department of Health and Human Services, found no evidence that abstinence-only-until-marriage programs increased rates of sexual abstinence. In addition, students in the abstinence-only-until-marriage programs in the study had a similar number of sexual partners as their peers not in the programs, as well as a similar age of first sex. Scientific evidence simply does not support an abstinence-only-until-marriage approach.

Abstinence-only-until-marriage programs contain harmful information – Aside from simply not achieving their stated goals, these programs are generally rife with misinformation, gender stereotypes, and outdated materials.  The programs also use fear and shame to promote abstinence-until-marriage, in some cases comparing young people who have had sex to petal-less flowers, dirty sneakers, glasses of spit, and presents opened before Christmas morning.

Title V and other federal abstinence-only-until-marriage funding is a colossal waste of taxpayer money –  Despite the fact that no study in a professional peer-reviewed journal has found these programs to be broadly effective, between 1996 and federal Fiscal Year 2009, Congress funneled over $1.5 billion dollars (through both federal and state matching funds) to abstinence-only-until-marriage programs through several funding streams including the Title V abstinence-only-until-marriage program.

The Title V abstinence-only-until-marriage program was on its way out anyway – At the time that the program was allowed to expire at the end of June 2009, nearly half the states had opted out of the program for reasons ranging from the fiscal burden it created to serious ethical concerns about foisting a failed programs onto young people.

For all of these reasons, the Title V abstinence-only-until-marriage was allowed to lapse and take its place in the musty crypts of failed federal legislation.

So, what has changed so drastically in the past nine months that warrants reviving the program?

Well… nothing. Congress had it right last year when they pulled the plug, and the programs, right-wing extremists, and their agenda remain the same.  Unfortunately, the programs were reinserted in health reform for unknown–but clearly political–reasons only.

Still, this should not, and cannot, be the end of the fight to defeat funding for these programs. Congress will always have the opportunity and ability to cut funding for the program, and they should exercise that ability as soon as possible. It is ironic that at a time when so many Democratic representatives were willing to risk their political careers to support healthcare reform, that they did not remove a program that is ineffective, inefficient, and unpopular.  Similarly, states that had opted out the Title V abstinence-only-until-marriage previously should remain out of the program, and any other state that cares about its young people having a healthy and safe future should join them.

We are, of course, pleased that the final healthcare bill includes the Personal Responsibility Education program, which would provide $75 million for a state grant program for more comprehensive approaches to sex education.  However, spending $75 million to promote comprehensive sex education and $50 million for abstinence-only-until-marriage programs is like spending $75 million on improving the nutritional quality of school lunches, and then $50 million poisoning them.

We call on all parents, young people, educators, advocates, and policy makers to stand up against this perversion of the spirit of the health care reform bill.  Programs that put young people’s health and lives at risk by denying them important information about contraception and condoms had no place in legislation dedicated to making Americans healthier. We applaud the months of effort that went into crafting this historic piece of legislation, but Congress should be just as troubled as we are that this health care reform package has been tarnished by reintroducing federal funding for abstinence-only-until-marriage programs. We have the best opportunity in a generation to improve the future health of all Americans, and abstinence-only-until-marriage programs should have no place in that future.

This post is republished with permission from RH Reality Check content partner, Science & Sensibility, a Lamaze International blog

It sounded like an April Fools joke, except the story broke two days early. Doctors in North Carolina induced and ultimately performed a cesarean on a woman who wasn’t pregnant.

The case happened in 2008 but we all learned about it this week because the North Carolina Medical Board finished their investigation and issued “letters of concern” to the doctors involved. Public letters of concern appear to be the least punitive disciplinary action performed by the state Medical Board, according to their list of published board orders (PDF).

To which I respond: Letters of concern? Seriously???

The consensus on Facebook and around the web was that if midwives had been involved in an incident of this magnitude, they would have had their licenses revoked post-haste. Why? Because all kinds of disciplinary actions are made against midwives, whether they are practicing safely or not. Very often, the complaint is issued by a physician rather than a patient. It’s all part of what Marsden Wagner, perinatal epidemiologist and former director of Women’s and Children’s Health in the World Health Organization, in an editorial in the Lancet, called:

a global witch-hunt…the investigation of health professionals in many countries to accuse them of dangerous maternity practices. This witch-hunt is part of a global struggle for control of maternity services, the key underlying issues being money, power, sex, and choice.

Midwives practicing in states that refuse to license direct-entry midwives are the most vulnerable. Consider the case of Ohio Mennonite midwife, Freida Miller, who was jailed for appropriately administering a life-saving medication, pitocin, to a woman experiencing a postpartum hemorrhage. For cultural and religious reasons, the women in the community Miller served would be unlikely to accept routine hospitalization for childbirth unless the benefits clearly outweighed the risks, which for many women they don’t. Rather than equip the midwife with a drug (pitocin) that is considered so essential for women’s safety that it is given routinely to all women birthing in hospitals, the government removed the community’s midwife altogether. In the name of public safety.

Even when midwives are licensed, they are not immune from predatory disciplinary action. A licensed midwife in California was issued a cease and desist order at gunpoint and ultimately had to surrender not just her midwifery license but her licenses to practice as a registered nurse and a nurse practitioner. The complaint was made by a physician in the community, not a patient. Among the board’s findings: she performed a vaginal exam before labor (routine practice in most obstetric offices), failed to obtain informed consent before performing an episiotomy (true of approximately 25 percent of all episiotomies performed in hospitals, according to the Listening to Mothers II survey), and failed to clearly chart the course of treatment for a patient (Didya ever hear the one about the doctor with bad handwriting?). To be fair, the investigation revealed evidence of other, more serious transgressions, but the scale of the disciplinary action seems out of proportion with the evidence, especially when we consider what obstetricians have to do to have their licenses revoked. (Seriously, googling “obstetrician license revoked” yields surprisingly few cases and most include drinking on the job, having sex with patients, or having a pattern of many preventable bad outcomes.)

Midwives who have avoided disciplinary action by state boards may be arbitrarily deemed unsafe by hospital administrators. By publicly citing safety concerns but keeping the details sufficiently vague, hospitals succeed in forcing midwives out. Cases that have been analyzed in the research literature reveal economic motives, however. A hospital in California recently suspended the privileges of a group of nurse-midwives, stating that the absence of a neonatal intensive care unit at the hospital rendered its patients safe only in the hands of obstetricians. Never mind that the only randomized, controlled trial reporting admission to a special or intensive care nursery showed higher rates in the physician group than the midwife group (9.4% vs. 7.9%).

Is Disciplinary Action the Best Way to Protect Patient Safety?

We need to stop the predatory use of state and hospital disciplinary action against midwives, and equalize the process for all categories of care providers. But whether disciplinary action is against midwives or physicians, is punishment the best way to deal with breaches in patient safety? After several high-profile cases in which health care professionals went to jail for making medical mistakes, the patient safety community is rallying around alternatives to punishment, and producing evidence that these alternatives are in fact more effective.

As nurse and patient safety expert, Barbara Olson, argues in one of the posts that made me fall in love with her blog (the other post being her birth story), punitive actions, especially when they are the only actions taken, do not address the root causes of unsafe care, nor do they make care safer.

We can and will argue about what constitutes the safest kind of care. But perhaps we should instead be asking what kind of maternity care system can most reliably deliver safe care. Achieving such a system will take a collaborative effort among all types of health care professionals and the women they care for. Fortunately, some brilliant minds have been hard at work determining what such a collaborative effort might look like. The Institute for Healthcare Improvement is sponsoring a webinar on April 8 titled, “Momentum for Maternity of the Safest Kind.” The speakers, who include Maureen Corry and Rima Jolivet from Childbirth Connection, will discuss the recent work of the Transforming Maternity Care Project. If you have been eager to hear more about this work, this is a great opportunity.

So, should the doctors who performed the ultimate in unnecesareans have gotten more than letters of concern? Probably. Maybe. It’s hard to know without knowing what the root cause analysis – please tell me they did one - revealed. But there must have been other opportunities for such a breach of safety to have been avoided. A system that can so completely lose sight of patient safety desperately needs to have its assumptions, routines, and safeguards examined.

When preventing avoidable harm is a fundamental aim of a maternity care system, the logical strategy is to address the root causes of injury, and to arrange care and resources to keep women and babies safe.  That’s exactly what midwives do, yet instead of embracing them, our system marginalizes them.