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This issue brief, prepared for the Kaiser Family Foundation’s Capitol Hill Briefing Series on HIV/AIDS, provides an overview of key HIV/AIDS research issues and activities. It includes information about the types of HIV/AIDS research, who conducts HIV/AIDS research, funding for HIV/AIDS research, and remaining challenges for such research over the next several years.
Issue Brief (.pdf)
This issue paper updates the July 1999 report and provides a general overview of federal Medicaid eligibility policy for the low-income disabled population. This paper focuses on four broad groups of individuals with disabilities: children under 18; adults under 65 who are not living in institutions; adults under 65 who are living in institutions; and adults under 65 who are also eligible for Medicare. In addition, this paper includes the new eligibility options offered under the Ticket to Work and Work Incentives Act of 1999. This issue paper does not attempt to describe Medicaid eligibility policy for the low-income disabled in each state. Instead, the focus is on the federal policies that structure the eligibility choices that states make.
TV shows and movies are an important source of information for teens and others about sexual health issues. Many teens rank entertainment media as a top source of information about sexuality and sexual health. This fact sheet combines information from several Kaiser Family Foundation studies on the issues of teens and sex and the role popular television plays on this subject.
This chart book provides a comprehensive portrayal of information related to the uninsured, including trends and major shifts in coverage, a profile of the uninsured, an assessment of why so many Americans are uninsured, and data documenting the difference that health insurance makes in the lives of Americans. The chart book includes detailed tables with data broken down by demographics and by state.
The Impending Catastrophe: A Resource Book On The Emerging HIV/AIDS Epidemic in South Africa
A report prepared by Abt Associates South Africa, Inc. and commissioned by theloveLife program.
Click here for the full report, in PDF. Note: This 34-page document has lots of graphics and may download slowly.
Executive SummarySouth Africa is certain to experience severe consequences arising from its AIDS epidemic. Over 3.5 million people are currently estimated to be HIV infected, and this number is projected to more than double over the next decade – unless major behavioral changes are adequately promoted and realized. Younger people are most severely affected by the disease with around 60% of all adults who acquire HIV becoming infected before they turn 25.
Young women are particularly vulnerable. They are at greater risk of infection due to biological, social and economic factors; they are also more vulnerable to the various effects of the epidemic. While not fully representative, a recent KwaZulu-Natal voluntary survey of university students demonstrated infection rates of 26% in women and 12% in men, aged 20 to 24, and 36% in women and 23% in men, aged 25 to 29. These data further emphasize the need for priority prevention programmes for young people and women.
Orphans are perhaps the most tragic and enduring legacy of the HIV/AIDS epidemic. By 2005 there are expected to be around 800 000 orphans (under age 15). This figure will rise to more than 1.95 million in 2010. Models of providing support for these vulnerable children and their communities urgently need to be explored because traditional coping mechanisms are likely to break down.
The sharpest economic effect of the South African epidemic will probably be on wealth distribution rather than on the size of the economy as a whole. In the field of human and social development, however, the consequences are expected to be much more profound. Increased illness and deaths, and reduced life expectancy, will clearly compromise development objectives, while the survival of poor households will be made more difficult.
Increasingly, HIV/AIDS is expected to be a major determinant of the ability of households to extricate themselves from longstanding poverty. Virtually no research has been done on the impact of HIV at household level, and how government might most effectively target relief. Such relief is urgently required.
Also a priority is the provision of good information to people with HIV/AIDS, so that they can gain access to available support and allocate their resources in a way that reduces the effects of the disease on themselves and their households. There is also a need for efficient grant or other support systems, not only for the HIV-disabled, but also for the elderly and others involved in child support to relieve household economic hardships. It is important that available resources are targeted at the most vulnerable households, communities and sub-groups, and that the resources are directed towards supporting all affected people, not just those who are infected or ill. Every effort should also be made to reinforce traditional and new community- and family-based coping mechanisms.
The HIV/AIDS epidemic far outweighs any other threat to the health and well being of South African employees. AIDS deaths will soon exceed all other causes of death put together among the South African workforce. Although data on workforce infection levels is very limited, the number of employees lost to AIDS over the next ten years could be the equivalent of around 40 to 50% of the current workforce in some South African companies. Accelerated skills development in both young and working-age populations will be critical in containing the impact of the HIV/AIDS epidemic on the economy.
However, the high mortality rate among current and future employees implies that skills development without effective HIV/AIDS prevention might be a poor investment. South Africa already faces enormous challenges in human development owing to training backlogs, inherited inequities and inefficiencies in the education system. Substantial investment in preventing HIV transmission in trained workers is therefore warranted. Businesses have a key role to play in the area of prevention and also in reducing denial and stigma. The most significant costs of the epidemic for most companies are likely to be indirect, including increased absenteeism due to illness or funeral attendance, lost skills, training and recruitment costs, and reduced work performance and lower productivity.
One of the most obvious economic consequences of the HIV/AIDS epidemic is the need for increased resources to care for the sick and dying. Both public and private health sectors will be seriously affected. Projected expenditure will almost certainly not be sustainable, given public and private sector affordability constraints. This implies that some rationing will have to occur to reconcile needs with available resources. It is possible that HIV-related disease sufferers will experience a greater degree of rationing than other health service users. The challenge for both public and private sectors is to shift to more cost-effective modes of therapy for HIV/AIDS sufferers, rather than resorting to irrational or even discriminatory exclusion from services. These cost effective modes will need to include a re-orientation towards lower cost hospice type care instead of acute hospitalization, as well as consistent and substantial support to community-based care initiatives. These interventions have not yet received much attention from the public sector.
At the primary care level, widespread secondary prevention programmes, such as TB and pneumonia prophylaxis, should be urgently implemented. South Africa’s TB control programme is already over-extended and new strategies to respond to the increased burden of TB cases are urgently required. Widespread use of anti-retroviral therapy for AIDS-sick people does not appear at this stage to offer a realistic solution. Even in the relatively wealthy private sector, large price reductions would be required before net savings in health care costs could be expected. AIDS activists and international agencies would spend their time more effectively by advocating delivery of basic programmes of care, and continue efforts to promote anti-retrovirals to prevent mother-to-child transmissions.
With no prospect of an AIDS vaccine in the foreseeable future, HIV prevention requires sustained promotion of healthier and safer sexual behaviour. Achieving this within a context of many situations and cultures is a complex task, requiring integrated inter-sectoral approaches implemented at all levels of society. Prevention programmes must create a social consciousness and environment that leads to appropriate behavioral change. This requires active efforts to reduce stigma and discrimination around HIV/AIDS. While the vast majority of those at high risk in sexually active age groups have already been infected, considerable opportunity still exists to prevent new HIV infections amongst succeeding waves of teenagers. This group presents important opportunities for targeted interventions.
The Impending Catastrophe: A Resource Book on the Emerging HIV/AIDS Epidemic in South Africa
Indications show that South Africa’s 15-25 year olds are the most severely affected by the continuing spread of the HIV disease in that country. According to a report released May 11, 2000, by Abt Associates (South Africa) Inc., an international consulting firm, the rate of new infections among this group is as high as 60%, with young women being particularly vulnerable. Over 3.5 million people are currently estimated to be HIV infected in South Africa, and this number is projected to more than double over the next decade unless major behavioral changes are adequately promoted and realized. This report is a resource book and offers detailed analysis and data of the disease s impact on South Africa’s health, economic and social systems.
Georgetown’s Report on External Review of Health Plan Decisions: An Update
External Review of Health Plan Decisions: An Update, prepared for the Kaiser Family Foundation by Geraldine Dallek and Karen Pollitz of The Institute for Health Care Research and Policy, Georgetown University. In November 1998, the Kaiser Family Foundation released a report prepared by Georgetown University on external review programs in 13 states and the Medicare program. In the last year and a half, the number of state external review programs has more than doubled to include 32 states and the District of Columbia, and many private health plans have voluntarily provided external review programs. This report analyzes the current trends and features of state external review programs.
The Uninsured and Their Access to Health Care
Drawing on data from the updated Uninsured in America: A Chart Book (May 2000), this fact sheet outlines the problem of the uninsured in America, providing data on the growing number of uninsured Americans and a profile of the uninsured population. It also explores causes of uninsurance and synthesizes studies on the effects of going without health coverage.
The National Survey on the Uninsured from The NewsHour with Jim Lehrer and the Kaiser Family Foundation is this year’s first nationwide survey on Americans’ attitudes about the growing uninsured population and the difficulties uninsured people face getting medical care. The survey also assesses public attitudes on options to address the problem.
This report provides in-depth descriptions of the case studies in these states. The case studies are based on interviews conducted in the fall of 1998 with state officials, provider and plan representatives, and advocates. This report provides an overview of each state’s Medicaid program, followed by an analysis of the structure and impact of various program features, such as whether capitated and/or PCCM programs are offered; whether the programs are mandatory or voluntary for people with disabilities; whether disabled people are covered by mainstream managed care or by a separate specialized program; and whether behavioral health is offered under a managed arrangement or an alternative approach. (Publication #2163) A companion paper, A Closer Look (Publication #2179), presents an overview of the findings and summarizes the results of the case studies.