October 4, 2017
The Honorable Don Wright, Acting Secretary
U.S. Department of Health and Human Services 200 Independence Avenue, SW
Washington, DC 20201
Dear Acting Secretary Wright,
Disasters are public health emergencies that affect entire communities. They disrupt the entire public health infrastructure. Our thoughts are with everyone affected by the tragedies of the hurricanes impacting Texas, Florida, Puerto Rico, and the U.S. Virgin Islands. We watch as valiant efforts are underway by Federal, state, local, and tribal public health organizations to restore order and vital public health and healthcare systems.
We recognize that interventions to disasters of this scale must be implemented on a population basis; yet, going forward, we would be remiss if we did not draw your attention to the unique needs of people living with HIV in those areas impacted by the recent hurricanes, particularly Puerto Rico and U.S. Virgin Islands. Our organizations are working hard to coordinate and assist in any way possible to help ensure that people living with HIV who are impacted by these hurricanes can access medical care and necessary medications.
Overall, there are over 17,000 and 550 people living with HIV in Puerto Rico and the U.S. Virgin Islands, respectively. Puerto Rico has 14 Ryan White HIV/AIDS Program grantees that serve over 13,000 people living with HIV and 10 Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention (DHAP) grantees. The U.S. Virgin Islands has two Ryan White HIV/AIDS Program grantees that serve over 230 people living with HIV and two CDC DHAP grantees. HHS, in coordination with the Health Resources and Services Administration (HRSA), must prioritize medical care for these individuals. Treatment adherence—which involves consistent daily use of antiretroviral therapy (ART)—is critically important to improving individual health outcomes and reducing new HIV infections. Without access to medical care, these patients will be
unable to obtain these life-saving medications. While we do not yet have a comprehensive understanding of the situation in Puerto Rico and the Virgin Islands for people living with HIV, we understand that there has been widespread devastation to health departments, medical facilities and HIV support agencies. The Puerto Rico Health Department has had to move its supply of HIV medications for the island because of damage to its warehouse. Loss of roads, lack of HIV clinics and loss of medications is alarming both for individual health and the long-term infectious disease public health infrastructure in the two territories.
As is widely known, states across the country, particularly Florida and New York, are expected to see many evacuees who will need medical care and/or medication assistance, not to mention basic needs of food, clothing, and shelter. We encourage HHS, the Centers for Medicare and Medicaid Services, and HRSA to work with these jurisdictions and provide them with the greatest amount of flexibility as they work to provide HIV medical care for these individuals. During a natural disaster, the Ryan White HIV/AIDS Program-funded public health departments, clinics, AIDS services organizations and CDC HIV prevention programs serve to reduce harm and work to
protect public safety, health, and well-being. These public health programs play a critical role in ensuring the health and safety of community members.
In addition, we ask that HHS ensure that the FDA prioritize the availability of HIV antiretrovirals as they continue to assess loss of manufacturing facilities and production delays in Puerto Rico. Both Janssen, a pharmaceutical company of Johnson & Johnson, and AbbVie, a subsidiary of Abbott Laboratories, manufacture critical HIV antiretrovirals in Puerto Rico. A shortage of these medications, which are all central components of common HIV regimens, would affect the entire nation.
There are many stories of personal perseverance and determination to overcome these difficult circumstances—too numerous to mention. We remain dedicated to assisting your work wherever possible.
If you have any questions, please contact Ann Lefert, Senior Director of Policy and Legislative Affairs at NASTAD, at alefert@NASTAD.org or 202.434.7138. Thank you for your consideration.
ADAP Advocacy Association, Washington, DC, African American Health Alliance, Dunkirk, MD AIDS Action Baltimore, Baltimore, MD
AIDS Alabama, Birmingham, AL
AIDS Alliance for Women, Infant, Children, Youth & Families, Washington, DC AIDS Foundation of Chicago, Chicago, IL
AIDS Research Consortium of Atlanta, Atlanta, GA AIDS United, Washington, DC
API Wellness, San Francisco, CA APLA Health, Los Angeles, CA AVAC, New York, NY
American Academy of HIV Medicine, Washington, DC CAEAR Coalition, Washington, DC
Callen-Lorde Community Health Center, New York, NY Cascade AIDS Project, Portland, OR
CenterLink: The Community of LGBT Centers, Fort Lauderdale, FL Community Access National Network, Washington, DC
DC Fights Back!!, Washington, DC Georgia AIDS Coalition, Snellville, GA
GMHC (Gay Men’s Health Crisis), New York City, NY God’s Love We Deliver, New York City, NY
Harm Reduction Coalition, New York City, NY Health GAP, Brooklyn, NY
HealthHIV, Washington, DC
HIV Dental Alliance, Atlanta, GA
HIV Medicine Association, Arlington, VA HIV Prevention Justice Alliance, Chicago, IL
Hispanic Health Network, New York City, NY Housing Works, New York City, NY
Howard Brown Heath, Chicago, IL
Human Rights Campaign, Washington, DC Latino Commission on AIDS, New York City, NY Latinos in the Deep South
Lifting Up Westchester, White Plains, NY LLHC, New Orleans, LA
NAACP, Washington, DC
NASTAD (National Alliance of State & Territorial AIDS Directors, Washington, DC National Association of County & City Health Officials, Washington, DC
National Black Gay Men’s Advocacy Coalition, Washington, DC
National Working Positive Coalition, New York City, NY National Coalition of STD Directors, Washington, DC NMAC, Washington, DC
Positive Women’s Network-USA, Oakland, CA
Presbyterian AIDS Network (PAN) PHEWA, Prebyterian Church (PC USA) , Washington, DC Prevention Access Campaign, Brooklyn, NY
Project Inform, San Francisco, CA
Racial and Ethnic Health Disparities Coalition, Dunkirk, ND San Francisco AIDS Foundation, San Francisco, CA Southern AIDS Coalition, Birmingham, AL
Southern HIV/AIDS Strategy Initiative, Durham, NC TOUCH – Together Our Unity Can Heal,Inc., Congers, NY TransSOCIAL, Inc., Miami, FL
Treatment Action Group, New York City, NY VillageCare, New York City, NY
CC: Richard Wolitski, HHS, ASH/OHAIDP Seema Verma, HHS, CMS
Brenda Fitzgerald, HHS, CDC George Signounas, HHS, HRSA Jonathan Mermin, HHS, CDC Laura Cheever, HRSA HAB