The Senate on Monday by unanimous consent approved a bill (S 901 ) that would reauthorize through 2012 three federal programs that provide services to rural and underserved areas, CongressDaily reports. The legislation, proposed by Senate Health, Education, Labor and Pensions Committee Chair Edward Kennedy (D-Mass.), would provide $12.9 billion over five years to community health centers and other similar rural health care services. The bill also allocates a portion of the money to the National Health Service Corps , which assigns physicians and nurses to serve residents living in rural and underserved areas (CongressDaily, 7/22).Sen. Orrin Hatch (R-Utah), a co-sponsor of the legislation, said that since 2001, additional funding provided under the bill has allowed health centers in more than 750 communities nationwide to provide care to about four million new patients. Hatch said, "These centers provide affordable and quality care to at-risk Americans who otherwise might have to do without" (Salt Lake City Deseret News , 7/22). Committee ranking member Mike Enzi (R-Wyo.) said that community health centers "ensure that people can get the primary health care services they need and cut down on costs for everyone by reducing the need for expensive emergency room care" (CongressDaily, 7/22).

The Senate Finance Committee canceled a vote scheduled for Wednesday on a resolution to block Bush administration rules limiting the expansion of SCHIP, after being informed by the Senate parliamentarian that the deadline for "privileged" status of the resolution had passed, CQ Today reports (Wayne, CQ Today, 7/22). The bipartisan resolution, signed by 41 senators, would prevent guidelines issued by CMS on Aug. 17, 2007, from taking effect next month. According to the guidelines, before expanding SCHIP eligibility to children in families with incomes greater than 250% of the federal poverty level, states first must demonstrate they have enrolled at least 95% of eligible children with family incomes below 200% of the poverty level. The Bush administration in May sent letters to state health officials to clarify that states can use data on Medicaid, SCHIP or private insurance to demonstrate they had reached the 95% requirement (Kaiser Daily Health Policy Report , 7/18). The parliamentarian in a memo to the senators wrote that the resolution should have been filed by July 8 to qualify for privileged consideration and thus be protected against delay tactics under the Congressional Review Act. The CRA requires a 60-day period for congressional review of new rules (Edney, CongressDaily, 7/23).

Comments A Republican Senate aide said, "By missing the filing deadline, [Senate Finance Committee Chair Max Baucus (D-Mont.)] lost fast-track protection," adding, "This may cause it to fall off the agenda" (CQ Today, 7/22). Baucus in a statement said, "There's more than one way to skin a cat, and I fully intend to work ... to get rid of this wrongheaded rule." A Baucus aide said supporters of the resolution are considering ways to proceed with efforts to block the SCHIP rules, such as adding it to any appropriations bills with a good chance of passing. Sen. Jay Rockefeller (D-W.Va.) in a statement said, "Every member of Congress should be outraged by the ease at which the administration circumvented the law and Congress as an institution," adding, "Instead we have had some members fight us every step of the way on nullifying this illegal policy in an ill-advised attempt to protect this administration from the lawsuits filed by several states stemming from the Aug. 17 rule" (CongressDaily, 7/23).

The Fiji Australia Business Council and UNAIDS on Monday agreed to a partnership under which they will develop a business coalition in Fiji to strengthen the private sector's response to HIV/AIDS, the Fiji Times reports (Fiji Times, 7/22). According to FABC President Caz Tebbutt Dennis, the business coalition will help companies develop policies such as voluntary HIV/AIDS testing among workers. According to Tebbutt Dennis, the economic loss from HIV/AIDS in Asia is about $10 billion and could increase to $24 billion in the next few years if adequate steps are not taken to address the disease (Australian Broadcasting Corporation , 7/21). Steven Vete, development subregional coordinator for UNAIDS' Asia Pacific Leadership Forum on HIV, said, "The involvement of private sector leaders is crucial if we are to succeed in reversing the tide of HIV in the Pacific. It is crucial for a number of reasons: At the global level, nine out of 10 people living with HIV are adults in their most productive years. Two out of three people living with HIV go to work every day. In the Pacific, the majority of the people infected with HIV are between 15 and 44 years, meaning the loss of breadwinner is devastating for the family" (Fiji Times, 7/22).Dennis added, "HIV and AIDS is an issue for business worldwide, not just because there is an expected corporate social responsibility aspect to this global epidemic and a need for business leadership, but because HIV and AIDS affects the most important asset of all business -- work force" (Fiji Times , 7/21).According to PACNews, UNAIDS has provided assistance to the Training Productivity Authority of Fiji to develop a training course to offer to businesses. In addition, the International Labour Organization is working with Fiji's Tripartite Forum on implementing the Employment Relation Promulgation, which makes it compulsory for employees to implement HIV programs in the workplace (PACNews, 7/21).Also under the agreement, Australia will spend 188 million Australian dollars, or about $183 million, on programs to prevent the spread of HIV/AIDS in 2008 and 2009. Australia's HIV Ambassador Murray Proctor said Australia is a strong advocate for business involvement in curbing the impact of HIV/AIDS. According to the Fiji Times, there are 256 confirmed cases of HIV in the country, up from 182 in December 2004 (Fiji Times, 7/22).

The International Labour Organization recently called on some Middle Eastern countries, including the United Arab Emirates, to end discrimination against people living with HIV/AIDS, The National reports. ILO in partnership with UNAIDS and the International Organization for Migration also proposed a code of practice for governments in dealing with migrant workers who become HIV-positive.Currently, UAE law requires all migrant workers arriving in the country to undergo an HIV test before visas are issued. Those who are found to be HIV-positive are deported. In addition, anyone planning to marry, undergo surgery at a government hospital, start a new job or has tuberculosis must be tested for HIV, and those who test positive are reported to the police. Khawla Mattar, an employment rights specialist for ILO, said the new guidelines encourage UAE officials to abandon the practice of automatically deporting expatriates who are living with HIV/AIDS. Under the proposal, titled "HIV and International Labour Migration," officials are encouraged to "ensure there is no discrimination on the grounds of HIV status in the context of entry requirements, immigration, employment or reintegration procedures." The proposal also urges health care officials to ensure that "labor migrants and their families have the same access as nationals to gender-, language- and culture-sensitive HIV services."According to The National, the call from ILO comes in light of research from the United Arab Emirates University , which found that young people in the country have "alarming" knowledge gaps about HIV/AIDS and a widespread "fear and intolerance" of people living with the disease. A survey of first-year students at UAE University found that more than 50% believed HIV could be spread through food, 62% said it could be spread by sharing a comb or brush, and 91% said the virus could be spread through a mosquito bite. One-third of the students surveyed knew there is no cure for HIV/AIDS. In addition, more than 50% of the survey participants thought people living with HIV/AIDS should live apart from the rest of society, 73% thought children with the disease should not be allowed to attend school and almost all the participants said that people entering the UAE should be tested for HIV."This is a pretty serious problem," Peter Barss, an associate professor of community health at UAE University, said, adding that the students "believe [HIV] can be transmitted through casual contact, which means they would likely have an undue fear." Barss said, "I can only assume the students were not receiving valid information." He added, "People need to understand [HIV/AIDS]. If you bring in new legislation, you need to know what people actually believe" (Reinl/Todd, The National, 7/20).

Taboos about sex in Pakistan make it difficult to address HIV/AIDS and are hindering efforts to curb the spread of the disease, according to a study published recently in the Lancet Infectious Diseases, the New York Times reports. According to the study, seven times as many men as women are reported to be living with HIV in Pakistan, and UNAIDS says that at least 85,000 people are HIV-positive in the country. The study, conducted by researchers from two universities in Pakistan, says that although India and Bangladesh have similarly conservative Muslim cultures, those two countries have more openly addressed HIV/AIDS. Many people in Pakistan believe that HIV/AIDS is not an issue in Muslim countries because Islamic law forbids sex outside marriage, the researchers said, adding that sex education therefore is rare in the country. In addition, sexual relationships between men and networks of male sex workers do exist, according to the study. Specialized subcultures of hijiras and zenanas are now a "highly stigmatized group" of men who dress as women and are the receptive partners in anal sex, the researchers wrote, adding that there are areas where it is traditional to use young boys as sex partners. According to the study, the use of condoms, which cannot be displayed in stores, is low, and some sex workers believe that HIV is "divine punishment" for their actions (McNeil, New York Times, 7/22). The study is available online .

The XVII International AIDS Conference on Monday announced some of the world leaders, researchers and advocates who will participate in next month's conference in Mexico City, Bangladesh's New Nation reports (New Nation, 7/22). About 25,000 people are expected to participate in the conference, which will take place from Aug. 3 to Aug. 8. Speakers at the conference include:Mexican President Felipe Calderon Hinojosa;Mexican Secretary of Health Jose Angel Cordova Villalobos; United Nations Secretary-General Ban Ki-moon; Director-General of the World Health Organization Margaret Chan; UNAIDS Executive Director Peter Piot; Advocate Mony Pen; Prime Minister of St. Kitts and Nevis Denzil Douglas; Former President of Botswana Festus Mogae; First Vice-President of Spain Maria Teresa Fernandez de la Vega; Youth advocate Keren Gonzalez;Former U.S. President Bill Clinton;President of the Carso Health Institute and Senior Fellow at the Bill & Melinda Gates Foundation Julio Frenk;NIAID Director Anthony Fauci;Mark Harrington of the Treatment Action Group ;Vuyiseka Dubula of the Treatment Action Campaign ; and Frika Chia Iskandar of the Asia Pacific Network of People Living with HIV/AIDS (AIDS 2008 release , 7/21).

Clinton Announces Africa Trip Ahead of AIDS Conference In related news, Clinton on Tuesday announced that he will travel to Africa ahead of the AIDS conference to promote HIV/AIDS and malaria programs run by the Clinton Foundation , AFP/Google.com reports. Clinton said that he will begin the trip next week with visits to Ethiopia, Liberia, Rwanda and Senegal, where he will meet with local officials and foundation staff. He added that on his way back to the U.S., he will attend the Mexico City AIDS conference. "This year, I am excited to take our work to the next level with new projects that will make a tremendous difference in turning the tide of HIV/AIDS, improve lives and help people work toward a brighter future," Clinton said (AFP/Google.com, 7/22). Kaisernetwork.org is the official webcaster of the XVII International AIDS Conference in Mexico City. Click here to sign up for your Daily Update email during the conference.

HIV/AIDS among the Hispanic community in the U.S. is reaching what some public health experts are calling a "simmering public health crisis," the Washington Post reports.According to the Post, Hispanics account for about 14% of the U.S. population but represented 22% of new HIV/AIDS diagnoses in 2006. However, the 22% figure includes data from only 33 states and Puerto Rico, so the actual percentage could be higher, the Post reports (Connolly, Washington Post, 7/23). According to the Kaiser Family Foundation 's statehealthfacts.org , Hispanics living in Washington, D.C., have the highest rate of new HIV/AIDS cases nationwide -- about 109.2 cases per every 100,000 people (Constable, Washington Post , 7/23). In addition, as many as one in four Hispanic men who have sex with men who live in major U.S. cities are HIV-positive.According to the Post, language difficulties, cultural barriers and legal issues associated with immigration make the Hispanic community unique in terms of providing HIV prevention, education and treatment. Only two of 17 CDC programs target Hispanics, but the agency has implemented a Spanish-language hotline, confidential testing sites and other initiatives aimed at addressing HIV/AIDS among the Hispanic population. "Hispanics are overrepresented in this epidemic, and we need to target our efforts to them," CDC epidemiologist Kenneth Dominguez said.Frank Galvan of the Charles Drew University of Medicine and Science said that the U.S. needs to "make a dent" in reducing HIV/AIDS among Hispanics or the epidemic "will continue to spread to other populations." Oscar De La O, president of the Hispanic service group Bienestar, said U.S. officials "need to stop downplaying or ignoring what's happening among" Hispanics. De La O added that he is concerned U.S. immigration policies toward HIV-positive people will create "another underground in which [HIV-positive] people cannot access treatment but will not leave the country."According to the Post, the "nexus of AIDS and migration" will "gain fresh prominence" next month at the XVII International AIDS Conference in Mexico City. "Migrants tend to be lonely, separated from their family or partners," Dominguez said, adding, "They do not have health insurance. They may turn to drugs or alcohol. All of these put a migrant at higher risk."This Post story also profiles Hispanics affected by HIV/AIDS in the U.S. The article was supported by a Kaiser Family Foundation mini reporting fellowship (Connolly, Washington Post, 7/23). In addition, a second Post article profiled the group La Clinica del Pueblo and its efforts to provide HIV education and prevention to Hispanics living in the district (Constable, Washington Post, 7/23). Kaisernetwork.org is the official webcaster of the XVII International AIDS Conference in Mexico City. Click here to sign up for your Daily Update e-mail during the conference.

CDC on Tuesday announced that it will release new estimates of annual HIV incidence in the U.S. in the Aug. 3 issue of the Journal of the American Medical Association, Reuters reports. "These new incidence estimates are based on direct measurement of new HIV infections and will provide the clearest picture to date of incidence," the agency said (Fox, Reuters, 7/22).CDC for more than 10 years reported that 40,000 new HIV infections occur annually in the U.S. and said that the HIV epidemic in the U.S. is stable. In recent years, the agency has developed new testing technology and has updated its methodology to yield more accurate data (Kaiser Daily HIV/AIDS Report , 12/3/07). When announcing the release of the new data, CDC said, "These more precise estimates are possible now only because of breakthrough technology developed by CDC that can distinguish recent from long-standing HIV infections." The agency added that because the system is new, it had to "receive rigorous scientific review." In addition, the "process took longer than we anticipated, but, in the end, it had produced estimates that are more reliable and scientifically sound than would have occurred without the independent review," CDC said (Reuters, 7/22). A new CDC fact sheet on HIV/AIDS surveillance is available online .

The House Energy and Commerce Health Subcommittee on Tuesday plans to hold a hearing that "might turn up the heat on congressional leaders to include Medicaid relief for states in a second economic stimulus package," CongressDaily reports. According to an advisory sent on Monday by committee Democrats, the hearing will examine the effects of the current economic conditions on state Medicaid programs and whether additional federal funds would help. Subcommittee Chair Frank Pallone (D-N.J.) and committee Chair John Dingell (D-Mich.) in February proposed a bill (HR 5268 ) that would increase temporarily the federal medical assistance percentage states receive for Medicaid by almost three points, and Pallone hopes to include the legislation in the second stimulus package. Pallone spokesperson Andrew Souvall said, "Congressman Pallone strongly supports including FMAP language in the second economic stimulus," adding, "He has been pushing for its inclusion." A spokesperson for House Speaker Nancy Pelosi (D-Calif.) said that the second stimulus package could include additional federal funds for state Medicaid programs.Subcommittee ranking member Nathan Deal (R-Ga.) has not taken a position on whether the second stimulus package should include additional federal funds for state Medicaid programs but has concerns about the cost, according to Deal spokesperson Chris Riley. In addition, the Republican Study Committee on Monday released a policy brief in opposition to a temporary increase in FMAP. The brief stated, "A second 'temporary' increase would only provide additional incentive for states to expand their Medicaid entitlement spending, knowing that the federal government will provide additional funding to make up their own budgetary shortfalls" (Edney, CongressDaily, 7/22).

Broadcast Coverage American Public Media's "Marketplace Morning Report " on Tuesday reported on the possibility that the second stimulus package could include additional federal funds for state Medicaid programs. The segment includes comments from Stan Dorn of the Urban Institute and New Jersey Department of Health Commissioner Heather Howard (Henn, "Marketplace Morning Report," American Public Media, 7/22).

A CMS proposal under consideration would limit a practice used by pharmacy benefit managers known as "lock-in pricing" that can increase costs for beneficiaries enrolled in the Medicare drug benefit and bring them into the so-called "doughnut hole" coverage gap more quickly, the Wall Street Journal reports. The doughnut hole begins when total annual drug spending by beneficiaries and their health insurers reaches $2,510. When in the doughnut hole, a beneficiary is responsible for 100% of prescription drug costs until total spending reaches $5,726 for the year.Under lock-in pricing, PBMs charge a higher rate to insurers with whom they have contracted to administer their drug benefit than what they pay pharmacies to dispense the drugs to beneficiaries, according to the Journal. The PBMs then keep the difference. Beneficiaries can reach the doughnut hole faster under lock-in pricing because the insurer is charged more than a drug's actual cost, increasing total annual spending more quickly. According to the Journal, the proposal would mitigate that effect by requiring insurers to break down PBM payments into two rates: the cost of the drug and an "administrative" cost. The administrative cost would be the difference between a PBM's drug price and the insurer's payment. The proposal would not ban lock-in pricing.CMS estimates that about 19% of drug benefit plans are using lock-in pricing. The agency says the practice affects about 14% of the 25.8 million beneficiaries enrolled in the drug benefit program. According to the Journal, the price difference from using lock-in pricing is much higher for generic drugs than brand-name drugs. The Journal reports that CMS officials have been attempting to counter the effect of lock-in pricing almost since the inception of the Medicare drug benefit. Abby Block, director of the Center for Drug and Health Plan Choice at CMS, said that the agency thought lock-in pricing was prohibited when the drug benefit was created. "We thought we had a clear policy," Block said, adding, "We learned that there are different ways of interpreting a policy statement." CMS plans to make a final rule later this summer that would go into effect in 2010.

PBMs, Insurers Defend Practice According to the Journal, some PBMs defend lock-in pricing, saying that it is common in the private insurance market and that they use the extra money to encourage beneficiaries to use less expensive drugs. Some insurers say they will be forced to increase premiums if they are not permitted to add the extra charge to plans' total annual drug spending, the Journal reports. Steve Littlejohn, a spokesperson for the PBM Express Scripts , said the company's overall per-prescription profit margin from using lock-in pricing is a "single digit" percentage. He also said that the company's pricing on generics "is generally far better than (uninsured) cash-paying customers obtain on their own" (Rubenstein, Wall Street Journal, 7/22).