April 15, 2020

Progress on Building Support for HR 5806

Here’s a dose of encouraging news in these frightening and exhausting times. As readers may recall, we have been working – even before its formal introduction on February 7 – to advance legislation entitled, “the HIV Epidemic Loan-Repayment Program Act of 2020” (or HELP Act, HR 5806 for short).  Background on this bill is available here, in a previous column entitled, “Finally, a Chance to Bring More HIV Health Care Providers Into the Field.”

Congressmembers are now at their home offices for a District Work Period until April 20, when they will return to DC. To take advantage of this, I am collaborating with HIVMA to make virtual appointments with Representatives serving on the Energy and Commerce Committee to discuss why they should support and ultimately vote for HR 5806. So far, four committee members have co-signed the bill. We need to get twenty so that the bill can move to the full House of Representatives for consideration.

Because this bill is a high priority issue for us, we are contacting Academy and HIVMA members who live in the districts of the remaining 16 Committee members. We ask for only about 15 minutes of their time to join us on a conference call with their Representative’s staff to introduce them to HR 5806 and explain why passing it matters to the people of their district. Five of our members have been available and willing to join us on these calls and tell their stories.

Tracy Hicks, a professor and a nurse practitioner in Texas, described the mental illness work she does in a local Ryan White Health Center that is seriously understaffed. One woman, she reported, was off her medications for two months because no health care provider was available to see her. This, she told us, was just one example of their constant, serious understaffing.

Esther Fasanmi, a clinical pharmacist in the same district, told us that providers are stretched to provide services to the hospital and an HIV clinic with a case load of about 1500 patients, as well as about 30 patients incarcerated in their local county jail on a monthly basis. Because of the limited amount of HIV providers within their hospital system, she was able to assist in managing incarcerated PLWH on top of her role with managing patients in their Ryan White funded clinic.

It was clear during the Texas conference call that the health legislative assistant was more powerfully affected by these first-person descriptions than would have been possible if she had spoken only to the lobbyists.  First-hand accounts from constituents always engender more urgency and credibility than statistics.

A week later, we met nurse practitioner Les Harmon and physician assistant Kara McGee. Les is the former director (now retired) and Kara is the current director of the HIV specialty program for nurse practitioners at the Duke University School of Nursing in Durham, North Carolina. They both manage rural patients living with HIV infection at a Ryan White clinic in Henderson, NC. They volunteered to join our conference call with Representative Butterfield’s staff, as did Michelle Ogle, a physician with decades of experience in responding to HIV in the south, especially in rural North Carolina. With more HIV healthcare providers aging out of the field than entering it, she explained, we now have serious workforce shortages. This is bad news, she added, because even though HIV rates are going down in most of the state they are still rising in a few counties.

Kara reported that several students at Duke’s Nurse Practitioner program would like to specialize in HIV but can’t afford the additional courses required to complete the HIV Specialty program – especially in light of the low salaries they have to expect if they choose to stay in HIV along with the huge debt they have incurred.

Les pointed out that even as providers are aging out of the HIV workforce and retiring, young physicians who choose to go into infectious disease are more likely to specialize in transplant medicine or emerging infections rather than HIV. Studies also show that the quality of care provided by NPs and PAs in the field of HIV is on par with care provided by physicians, and they are uniquely positioned to help fill the workforce gap. We also need to consider that NP and PA enrollment increases during times of economic hardship as people go back to school to expand their skill sets. With a recession looming now, it’s a good time to offer NP and PA tuition reimbursement in exchange for commitments to join the HIV workforce upon graduation.

Finally, we were joined by Carolina Abuelo, MD, a constituent of Rep. Joseph Kennedy, III, in the Boston area. She recounted to Kennedy’s aide her own experience of doing a one-year HIV fellowship after graduation. There, she had co-workers and friends who wanted to continue specializing in HIV but couldn’t because ”people can’t provide that care if they can’t afford to support themselves due to giant debts.”

When constituents were on the calls, it was fascinating to hear regional accents and common concerns emerge when constituents talked to legislative aides in their shared districts. The resonance, it seems to me, was triggered by more than the aide’s obligation to be welcoming to voters in their home district. It is also “gut-level,” especially the conversational tone that arises among participants who share a common setting and culture. That rapport makes a difference and helps to “bring home” the reality of the stories our volunteers are telling about their work.

If you can join us when we contact your legislators about this bill, please e-mail me at anna@aahivm.org. It’s quick, only taking a few minutes to talk about what’s happening where you live regarding HIV care. You can help to change the future of HIV care in the U.S. just by sharing what you have seen to the people who are paid to represent you. I hope you will give it a try!