HIV AIDS Resource Guide/HIV-AIDS Resource Guide.iso/STAT/STATE/FLGOV.ASC

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STATE OF FLORIDA
Governor's Red Ribbon Panel on AIDS

January 19, 1993

Dear Governor Chiles,

I am writing this letter on behalf of the members of the Red
Ribbon Panel on AIDS and enclosing with it our report to you.

First, we all thank you for the privilege and opportunity to
serve you and the State of Florida in our capacity as panel
members. As Governor, your attention to the HIV/AIDS epidemic is
crucial and appreciated.

You asked us to bring to you recommendations on how to improve
HIV/AIDS prevention and education in Florida and how better to
care for AIDS patients in more cost effective manners.

We are mindful that HIV infection spread for many years before we
knew of its existence and that in order to prevent new infections
we must promote behavior changes that are difficult at best.

And, regretfully, the fight against HIV/AIDS is further hindered
by ignorance, prejudice, and political rhetoric. We are therefore
especially grateful to your direction that we put emotion aside
and save lives!

There is no vaccine, no cure, no law that can give us absolute
protection from HIV infection. And, government's role is to
encourage individual responsibility, not to take its place.

Although there are no easy solutions, we believe that there is
much we can all do to stem the spread of HIV infection and to
more effectively care for those persons already infected. Our
report contains numerous strategies that must work together
because in isolation they are not effective.

Finally, we will need the courage to face up to the truth of
HIV/AIDS. The consequences of not doing so will continue to
devastate too many young lives.

Respectfully,

Lois J. Frankel
Chair, Red Ribbon Panel on AIDS
GOVERNOR'S RED RIBBON PANEL ON AIDS

MEMBERS

Lois Frankel, Esq.
Searcy, Denney, Scarola, Barnhart, and Shipley
West Palm Beach
Chairperson

Michele Fitzhugh, R.N.
River Region Human Services, Jacksonville

Marie-Jose Francois, M.D.
Farmworker Association of Central Florida, Apopka

Mary Labyak, MSW, LCSW
The Hospice of the Florida Suncoast, Largo

Catherine Lynch
Health Crisis Network, Miami

Frances Mc Guire, R.N., M.P.H.
Florida Association of Community Health Centers, Orlando

Robert P. Nelson, Jr., M.D.
All Children's Hospital, St. Petersburg

Barbara A. Rienzo, Ph.D.
University of Florida, Gainesville

Barbara Russell, R.N., M.P.H.
Baptist Hospital of Miami

Allan H. Terl, Esq.
Ft. Lauderdale

Pedro Zamora
Body Positive Resource Center, Miami

Staff support provided by the HRS AIDS Program


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TABLE OF CONTENTS

EXECUTIVE SUMMARY   1
INTRODUCTION   3
PREVENTION AND EDUCATION STRATEGIES
 Summary and Rationale   8
 Prevention and Education in Schools    9
 Prevention and Education Activities in the Community  11
 Education in Health Care and Other Professions   12
 Prevention and Education in Prisons    12
 Recommendations for Prevention and Education Strategies    13
CARE AND TREATMENT AND LIVING WITH AIDS ISSUES
 Summary and Rationale   16
Recommendations for Care and Treatment and Living with
     AIDS Issues    16
COUNSELING, TESTING AND PARTNER NOTIFICATION
     Summary and Rationale    18
Recommendations for Counseling, Testing and Partner Notification
20
SUBSTANCE ABUSE AND PREVENTION
     Summary and Rationale    22
     Recommendations for Substance Abuse and Prevention     22
GOVERNMENTAL ACTION
     Summary and Rationale    23
     Recommendations for Governmental Action 23

EXECUTIVE SUMMARY
The recommendations of the Governor's Red Ribbon Panel on AIDS
provide strategies for preventing the spread of HIV/AIDS in
Florida and for improving the care of those already infected.
Each recommendation is not meant to stand alone, but together
they comprise a comprehensive approach for addressing the
critical challenge of HIV/AIDS.

The following is a list of the major recommendations submitted by
the Panel. More specific details of and the summary and rationale
for the recommendations are included in the body of the report.

PREVENTION AND EDUCATION
(Rationale and more specific recommendations found on pages 8-
15.)

-    Comprehensive health and HIV/AIDS education in grades K
through 12 should be a joint priority of the Department of
Education and the local school boards. This education effort
should be fully funded and should be taught by certified health
educators. The state should set instructional guidelines and
specific goals and outcomes for which the local school districts
are accountable and below which local school boards may not go.
Education should include emphasis on abstinence and monogamy;
however, prevention strategies should include non-penetration to
penetration protection.

-    Educators should be required to complete HIV/AIDS education.

-    Parents should be educated about HIV/AIDS.

-    A major initiative should be jointly undertaken by the
government and the private sector to provide adult supervised
after-school activities for adolescents.

-    The number of school health services should be expanded.

-    HIV/AIDS education should be required in Florida's
universities and community colleges.

-    Peer education should be promoted.

-    Efforts to target HIV/AIDS prevention activities with
sensitivity to cultural and language differences should be
intensified.

-    Promote AIDS/HIV education in the workplace.

-    The development and distribution of state-of-the-art,
culturally specific prevention materials should be pursued.

-    Condoms and condom skill training combined with efforts to
encourage peer acceptance must be made available wherever
appropriate.

-    Increase efforts to address HIV in women.

-    HIV/AIDS education should be required for attorneys, judges,
in-court and county jail personnel.

-    HIV/AIDS education for health care providers should not be
weakened, but should be coordinated.

-    Funding for HIV/AIDS prevention and education efforts should
be increased.

CARE AND TREATMENT AND LIVING WITH AIDS ISSUES
(Rationale and more specific recommendations found on pages 16-
17.)

-    Provide universal health care coverage for all Floridians.

-    Increase the number of health care providers willing to
provide medical and dental care for HIV-infected patients.

-    Increase the number of nursing homes that accept HIV/AIDS
patients and develop alternative housing arrangements for PWAs.

-    Facilitate greater access to drug therapies for treatment
and prevention therapy, including marijuana when medically
indicated.

-    Confront the issue of health care for illegal aliens.

-    Promote nutrition counseling.

-    Determine the best course for establishing pediatric and
adolescent HIV/AIDS care statewide.

-    Address the spread of tuberculosis among HIV-infected
persons.

-    Expand case management of patients and coordination of
client services.

-    Expand the AIDS Insurance Project statewide and continue the
Medicaid Waiver Program.

COUNSELING, TESTING AND PARTNER NOTIFICATION
(Rationale and more specific recommendations found on pages 18-
21.)

-    Increase and advertise the availability of confidential and
anonymous testing. Testing should continue to be with informed
consent and with pre- and post-test counseling.

-    Avoid mandatory testing policies.

-    Increase efforts to promote voluntary counseling and testing
programs as part of primary health care, for child-bearing women
and newborns, and in prisons.

-    Partner notification should remain voluntary, confidential
and without revealing the name of the source.

-    Do not require mandatory name reporting by law, but increase
efforts to encourage the use of the Department of Health and
Rehabilitative Services (HRS) voluntary partner notification
programs by the patients of private physicians.

-    Maintain and expand laws which prohibit discrimination
against persons with or perceived to be HIV infected.

-    Develop mechanisms to clarify current Florida laws regarding
testing, including allowing physicians to do anonymous testing in
their offices.

SUBSTANCE ABUSE
(Rationale and more specific recommendations found on page 22.)

-    Remove legal barriers which prevent clean needle exchange in
conjunction with drug abuse treatment programs.

-    Increase drug abuse treatment programs and strengthen
education efforts for drug abuse and mental health counselors.

GOVERNMENTAL ACTION
(Rationale and more specific recommendations found on page 23.)

-    Establish a permanent HIV/AIDS Advisory Panel and appoint an
HIV/AIDS Policy Advisor.

-    Increase ethnic minority participation in the HRS AIDS
Program at the state level.

-    The Governor should call a leadership conference ~n HIV/AIDS
to educate Florida's leaders on the seriousness of HIV/AIDS
prevention.

-    Increase funding at all levels of HIV/AIDS prevention,
education and care.




INTRODUCTION

HIV/AIDS is one of the most critical challenges facing the world
today. It is especially tragic because it is striking young
people during the most productive years of their lives. The
proportions of this epidemic have created an urgent need for all
of us to join together in the fight against the further spread of
the disease.

Florida has seen more than its share of the HIV epidemic. Florida
continues to rank third in the nation in the cumulative number of
reported AIDS cases and second in the nation in pediatric cases.
A cumulative total of 24,976 AIDS cases were reported in Florida
as of December 31, 1992, with 8,742 of these persons presumed
living and requiring care. In addition, an estimated two to three
times as many persons require medical attention for HIV-related
diseases. Based on 1990 estimates, 120,000 Floridians are
currently living with HIV. Approximately 70-80% of these persons
are thought to be unaware of their infection.

HIV/AIDS has quickly become a statewide challenge. Although 60
percent of the adult cases in Florida have been reported from the
southeastern counties of Dade, Broward, Palm Beach and Monroe,
all of Florida's 67 counties have reported one or more cases of
AIDS.

The face of AIDS is changing. State data show that the HIV/AIDS
epidemic has disproportionately affected minorities. Although
black and Hispanics compose only 25 percent of Florida's
population, they represent 51 percent of all reported AIDS cases
in the state.

Florida's AIDS cases differ in significant ways from the national
averages. Six percent of the nationwide cases have been
heterosexually transmitted compared with 17 percent in Florida.
In addition, women represent ~ 1 percent of the total number of
cases nationally compared to 16 percent in Florida.

In response to this increasing challenge, on November 24, 1992,
Governor Lawton Chiles commissioned a Red Ribbon Panel to develop
specific recommendations on ways to bolster the state's HIV/AIDS
education and prevention programs, as well as to address the many
needs of persons with HIV/AIDS and their families. Governor
Chiles asked the Panel to put aside emotion and to be objective
in its mission. The purpose of the report submitted by the Panel
is not political, but is intended to present recommendations
which will save lives.




The Governor's Red Ribbon Panel on AIDS represents a diverse and
multidisciplinary group. This membership was intended to bring
together a broad range of expertise, opinions and cultural
experiences. The 11 members came from all parts of the state and
included two physicians, three nurses (two of whom also have
Master's Degrees in Public Health), two attorneys, two persons
with HIV disease, an educator with a doctorate in sexology and
two administrators of relevant patient service programs (one in
patient medical services and the other in hospice services). With
this solid and broad foundation on AIDS issues, the Panel went to
the community for input on innovative and effective strategies
for fighting this disease. The Panel held forums in Tallahassee,
Jacksonville, Tampa and Ft. Lauderdale and received testimony on
a wide range of issues. Written testimony was also received and
considered.

The testimony received by the Panel gave clear and convincing
evidence of the complexity and wide-ranging impact of HIV and
AIDS on Florida's communities. Testimony from throughout Florida
reinforced the need to treat HIV and AIDS comprehensively.
Fighting AIDS can not and should not be addressed in isolation
from other social problems.

The Panel repeatedly heard testimony that HIV/AIDS educational
efforts need to be more consistent, more accurate, and more
intensive. Surveys indicate that even when people are informed
about HIV, they do not always change behaviors to protect
themselves from infection.

Without a vaccine, the key to preventing the further spread of
HIV is education and prevention strategies that promote healthy
behaviors and reduce risk-prone behaviors. Our reluctance to talk
about sex and controversial lifestyles causes information to be
withheld which can save lives.

From across the state, the Panel heard testimony about the
problems in accessing health care. Many voiced concerns about
long waiting lists and limited access to care. Although much has
been done to provide care and treatment for persons with HIV
infection, much more needs to be done.

Testimony heard by the Panel also emphasized the benefits of
anonymous and confidential HIV counseling and testing services as
an important tool in preventing the spread of HIV infection. The
Panel heard repeated testimony on the reality of discrimination
against persons with HIV infection and how the fear of
discrimination may prevent a person from coming forward to be
tested. Anonymous and confidential testing remove this obstacle.

Many persons involved with drug rehabilitation programs came
forward with testimony for the Panel. With one exception, all
testified that a clean needle exchange program should be part of
a comprehensive dm abuse treatment program to break the link
between dirty needles and HIV infection.

Although the government should play a major role in preventing
the further spread of HIV/AIDS, there is no substitute for
personal responsibility. There is no magic wand. Behavior change
has been documented as very difficult to influence. Government
can and should play a major role in facilitating conditions to
encourage citizens to behave in ways that promote health and
reduce the risk of contracting HIV/AIDS. There must be a united
campaign both in the public and private sectors if we are to win
this battle.

AIDS is a public health emergency and is different in many ways
from other diseases. The implications of AIDS affect everyone.
Although AIDS is a sexually transmitted disease, it is not like
other sexually transmitted diseases. Just listen to the voices of
Floridians who are infected with HIV. Unfounded fears and
ignorance surround this disease and hinder our fight.

We must face up to HIV/AIDS with the courage to tell the truth
and the strength to fight the disease, not people with the
disease. Otherwise, the consequences will become increasingly
more devastating.



PREVENTION AND EDUCATION STRATEGIES

SUMMARY AND RATIONALE

We do not know the cure for HIV/AIDS disease, but we do know that
it is preventable. Transmission of HIV is the result of certain
well-documented behaviors, to wit: exchange of infected body
fluids (semen,  vaginal secretions and blood) during sexual
contact, sharing of HIV contaminate needles, from an HIV infected
mother to her fetus and to her newborn by breast feeding, and
through exposure to infected blood products or blood such as with
serious needle sticks.

Therefore, if we can successfully prevent certain dangerous
behavior, we can drastically reduce the number of new infections.
The key to reducing the spread of HIV, at this time, is
education, education, and more education.

When we say education, we mean more than the sharing of
information. We are talking about education and prevention
strategies that promote healthy behavior, that deter risk prone
behavior, that promote a safe work environment, and that reduce
the unfounded fears that lead to discrimination against persons
with HIV/AIDS.

Our message must be clear that HIV/AIDS is everbody's problem. It
is a disease that affects heterosexual men and women as well as
gay men and IV drug users. It is a disease caused by behavior . .
. not status, sex, skin color, sexual orientation, or age.

Our panel heard repeatedly from persons testifying that our
education efforts need to be more consistent, more accurate, and
more intensive. Our reticence to talk about sex, and to talk
about controversial life-styles causes us to withhold lifesaving
information even from those people we love the most: our
children.

For us to have a chance to stop HIV infection, we  must all join
together and be willing to face the truth and tell the truth.
Political, social, educational, religious and health leaders,
schools, community based organizations, religious institutions,
civic clubs, and media organizations must all play a role in our
fight against HIV/AIDS.

And we must do more. The average lifetime cost of caring for one
AIDS patient is $103,000. The money we spend now on prevention is
well worth the cost. In the past decade, the average AIDS patient
was likely t be well-educated and to have a career. As the
epidemic affects more persons who are disenfranchised, a smaller
proportion of these patients will be financially self -sufficient
or insured, increasing the cost to state and local governments.
Even or persons with medical insurance, there may be treatments
which are not covered by insurance. There will be loss of
earnings and eventually complete disability. This imposes not
only a financial cost to the patient, but to society when
individuals can no longer perform as productive members of
society. There are also non-treatment related costs incurred by
health care providers, such as expenses for additional supplies,
training, and testing.

Prevention and Education in Schools

Our hearings revealed that Comprehensive Health Education,
including AIDS education required by Florida law, is inconsistent
and of varying quality around the state. Local politics often
interfere with providing our youth with the information,
guidance, and skills that they need to live healthy productive
lives.

Quality comprehensive health education programs, which include
HIV/AIDS prevention as a component, are minimally 50 hours in
length at each grade level and taught by trained certified health
educators. One -time ("everyone to the auditorium") AIDS
education by itself is not an effective means of fighting the
spread of this disease because the prevention message needs to be
constant and repetitive.

The Florida Youth Risk Behavior Survey Report issued in February
1992 presents an alarming picture of Florida students. Of those
surveyed, approximately 47 percent of ninth graders and 80
percent of twelfth graders had had sexual intercourse. Less than
50 percent had used a condom the last time they had sexual
intercourse.

These statistics, which are consistent with national surveys,
mean that parents and teachers must take their heads out of the
sand and face up to the reality of their children's activities.
Therefore, although controversial, condoms and condom skill
training, as well as specific prevention strategies which address
the range of sexual activities (i.e., penetration vs. non-
penetration), are necessary parts of a comprehensive health
program. (By law in Florida, parents are allowed to opt their
children out of comprehensive health education. Although we
discourage parents from exercising this option, it should be
available.)

Condoms should never be viewed as a substitute for education on
abstinence and monogamy as first choices or as a substitute for
the supervision of our children by responsible adults. A recent
study by the Carnegie Council on Adolescent Development reported
that half of America's 20 million children between the ages of 10
and 15 go unsupervised after school, leaving too much time to
join gangs, do drugs, and have sex. Florida currently has 750,000
children between the ages of 10 and 15. The more hours that our
children are engaged in activities that promote healthy behavior
such as sports, drama, debate clubs and community service, the
less time they will have to be sexually active and at risk for
HIV infection.

School based health services have also proven to be effective in
promoting healthy children. Studies show that where students have
access to primary health care at school they are healthier and
more productive.

The recommendations of the Panel reflect the fact that as schools
prepare for the 21st century, their academic role has enlarged to
include consideration of social, health, mental health, and
support services for children and families. Changed demographics,
growing poverty, more people with multiple problems, and a rising
demand for skills to survive in society, bring pressure to the
system. Support for the role of schools in addressing these
issues is justified for a variety of reasons: the adverse effect
of non-school problems on school performance, the adverse impact
of poor educational performance on individual and national
economic success, and the high cost of public dependency
resulting from education, health, and social deficits. However,
schools do not operate in a vacuum and should not be expected to
take on further services with no or even short- term
discretionary funds. New approaches attempt to draw schools in as
equal partners with health and social services agencies: each
sector must contribute resources.

Research indicates that information alone or a fear based
approach in education may increase knowledge, but is largely
ineffective in changing behavior. Literature indicates only a
modest relationship among changes in knowledge, attitudes, and
behavior. When such programs lead to behavior change, the changes
are often small and usually involve delaying the onset of a
behavior, rather than preventing it altogether. Furthermore,
studies show that neither provision of sexuality education nor of
condoms through school-based health services results in the
increase or earlier onset of sexual behavior.

These recommendations reflect over ten years of research which
documents that achieving better outcomes for children and their
families requires at least three elements: comprehensive
services, increased involvement of parents, and changes to make
schools and agencies more responsive to children and families.
This research indicates how difficult it is to change behavior
through traditional classroom-based approaches that do not
include these three elements and shows that to employ these
elements can lead to a change in student behavior.

The most up-to-date programs involve curricula that are based on
social learning theories that provide students with information
as well as training in social skills to resist pressures from
peers, family, or the media; with skills to make thoughtful
decisions about health behaviors; and with opportunities to role-
play and practice their skills. When these more comprehensive
programs have been combined with efforts to enlist parental,
community, and media support, there is evidence that these
broader initiatives are effective in reducing health risk
behavior, including affecting problems related to sexual
behavior.

Prevention and Education Activities in the Community

HIV/AIDS education is most effective when it is targeted,
culturally specific and involving messengers (peer educators) who
have the ability to bond with the receiver of their
communication. Analysis of health indicators is useful in
targeting education efforts toward populations most at risk.
During testimony, the Panel heard some complaints that education
materials were sometimes ineffective due to a reticence to use
explicit materials.

There is a large segment of the population which is outside the
mainstream of public and private school educational efforts. This
is particularly true of our migrant communities, who are often
geographically and socially isolated.

Education in the workplace can be a valuable tool, both in
prevention and in fighting discrimination. Persons infected with
HIV remain otherwise healthy and productive for many years until
weakened by the disease.   Workplace HIV/AIDS education would
enable workers to learn lifesaving prevention strategies for use
in their private and working lives (i.e., responding to an
injured co-worker), as well as to minimize disruptions in the
workplace.

Condom availability and skill training in usage are crucial
prevention strategies. Mere knowledge that a condom reduces the
risk of HIV transmission and the availability of condoms are not
sufficient strategies alone. Knowledge and availability must be
combined with peer influence and correct usage. Only when condom
use becomes culturally accepted as required behavior for sexually
active persons will safer sex become prevalent in our society.

Education in Health Care and Other Professions

Florida law requires HIV/AIDS education for numerous health care
professionals and others such as cosmetologists, law enforcement
officers, and drug abuse counselors. Testimony was heard
concerning the need to coordinate these educational efforts.

Due to the changing face of HIV/AIDS and the increasing incidence
of AIDS cases, additional education for some and new requirements
for other professions were recommended by persons testifying.
There is a special urgency that health care workers who come into
regular contact with women of child-bearing age be informed of
the signs and symptoms of HIV disease in women and be alerted to
counsel them on prevention. There was a concern expressed that
due to the increasing number of legal issues related to HIV
disease, lawyers, judges, in-court personnel, and jailers should
be required to complete an HIV/AIDS education course. Educators
should also be required to complete a HIV/AIDS education course.

Prevention and Education in Prisons

There is a higher proportion of infected persons in the prison
population than in the general population. This is especially due
to IV  drug use among men and trading of sex for drugs by women.
HIV/AIDS education in prisons is currently required by Florida
law.

RECOMMENDATIONS FOR PREVENTION AND EDUCATION STRATEGIES

-The public and private sectors must face up to the seriousness
of HIV disease by joining together in the fight against it.  This
will require a multitude of sustained efforts with a willingness
to face up to the truth or be ready for devastating consequences.

-Comprehensive health and HIV/AIDS education as mandated by
Florida law in grades K through 12 should be a joint priority of
the Department of Education (DOE) and local school boards. In
this regard:

It must remain mandated by state law;

It must be fully funded;

It must be taught by trained certified health educators;

It must be presented for an effective number of hours at every
level;

The state must set instructional guidelines;

The state must set specific goals and student  outcomes related
to HIV prevention for which local school districts are
accountable;

The DOE must provide technical assistance, training, and
materials for local school boards and private schools;

-Parents must be made aware of the results of the Florida Youth
Risk Behavior Survey report and the degree of youth involvement
in at-risk activities. Parents must understand the importance of
prevention strategies and be educated to participate in
prevention.

-The state must require HIV/AIDS education for all educators
licensed by the state of Florida and other school board,
community college, and university personnel who come into regular
contact with students.

-A major initiative should be taken jointly by the government and
private sector to provide adult supervised after school
activities for children.

-The number of supplemental school health services should be
expanded so that all of Florida's children are served. HIV/AIDS
prevention plans should be required as part of participant
applications.

-    HIV/AIDS education should be required in Florida's
universities and community colleges beyond the fliers or
pamphlets currently distributed pursuant to the Omnibus AIDS Act
of 1988.

-    Peer education of all types, including AIDS awareness clubs
on school campuses, must be encouraged.

-    Peer education training should be established throughout the
state.

-    The use of pertinent health indicators as a tool in
targeting HIV/AIDS prevention efforts should be expanded.

-    Efforts to target education/prevention strategies at
populations most at risk for HIV infection, with sensitivity
given to cultural and language differences, should be expanded.

-    Prevention strategies based upon knowledge gained from the
Centers for Disease Control (CDC) AIDS Community Demonstration
Projects and similar efforts should be supported.

-    Prevention efforts to reach out-of-school youth (migrant,
runaway, drop outs, homeless) should be intensified.

-    Prevention outreach programs by community based
organizations should be intensified and given the leeway to use
non-judgmental, culturally sensitive strategies without undue
restrictions based upon prejudice or paranoia.

-    HIV/AIDS education prevention efforts in the work  place
should be promoted to reduce risk prone behavior and promote a
non-hostile work atmosphere for HIV infected employees.

-    The Department of Health and Rehabilitative Services should
pursue state-of-the-art prevention materials and act as a
facilitator for same.

-    The CDC required review panel for HIV/AIDS prevention
materials should include at least one person with HIV disease.

-    Intensify efforts to make male and female condoms more
available in various colors, including skin tone, and in such
places as supermarkets, restaurants, hotels, laundromats,
convenience stores, gas stations, doctors' offices, hospitals,
counseling and testing sites, colleges and universities, drug
abuse treatment centers, community based outreach programs, labor
camps, community health centers, movie theaters, rest stops,
public rest rooms, homeless shelters, bars, lounges, schools
(should be part of a comprehensive health education program and
health services), and prisons (should be part of a comprehensive
HIV/AIDS prevention program  for inmates in the Department of
Corrections) and should be available upon discharge for both male
and female inmates.

-Intensify efforts to promote safer sex and condom skill training
with strategies that promote peer acceptance of usage.   These
efforts should be made whenever possible where condoms are made
available, and, including but not limited to, testing and
counseling sites, physicians' offices, at community outreach
programs, civic clubs, health clubs, drug abuse treatment
programs, colleges and universities, places of employment, labor
camps, community health centers, schools (although controversial,
this should be done as part of age appropriate, comprehensive
health education in the schools where parents are allowed both
participation and an ability to opt out their children), prisons
(as part of comprehensive programs), and to prostitutes.

-Special attention should be given to the education of
gynecologists, obstetricians and other health care providers on
the need to counsel and test women for HIV infection and on the
signs and symptoms of HIV disease in women. Endorsement of this
proposal should be sought from the Black Nurses Association, the
Florida Nurses Association, the Florida Medical Association and
other related professional organizations.

-HIV/AIDS education should be required for attorneys, judges, in-
court personnel and county jail personnel.

-Health care provider education requirements under Florida law
should not be weakened. Health care providers should be better
informed as to the public policy rationale for the AIDS laws to
provide better acceptance by them.

-A panel with representatives from varied professions mandated to
take HIV/AIDS education courses under Florida law should be
formed to coordinate educational efforts and develop a standard
core curriculum.

-Funding for the AIDS Hotline should continue and services
expanded for Haitian-Creole users.

-Funding for prevention and education efforts must be increased.



CARE AND TREATMENT AND LIVING WITH AIDS ISSUES

SUMMARY AND RATIONALE

The federal, state and local governments, community based
organizations, and others have made major efforts to deal with
the care and treatment of persons with HIV infection. Much more,
however, needs to be done. Good programs should be expanded.
Prejudices in the health care field need to be eliminated. In
hearing after hearing, the Panel heard testimony about writing
lists for treatment and housing. We heard about doctors, dentists
and nursing homes that refused patient care.

We also heard about successful efforts that should be expanded.
The state Medicaid Waiver Program allows Medicaid dollars to be
send in cost effective manners which keep AIDS patients at home
instead of in hospitals. Florida's AIDS Insurance Project, in
which the state pays insurance premiums for some HIV patients,
was praised as far more cost effective than having the state pay
the full cost of a patient's care through Medicaid. Case
management and coordinated client services were touted as more
effective and less costly care for AIDS patients. We heard
encouraging testimony concerning the use of nutrition programs in
treating AIDS patients. We also heard about the potential for new
drug therapies that were not being offered through the state
Medicaid program.

There was testimony about new medical issues related to HIV/AIDS.
This included great concern about the spread of tuberculosis (TB)
due to its link to HIV. People with HIV infection are especially
vulnerable to TB; they acquire TB infection more readily and TB
often makes them sicker more quickly than persons with normal
immune systems. In outbreaks of multidrug resistant (MDR-TB),
many people with HIV infection have died only a short time after
becoming ill. There was also increasing concern for children with
AIDS. There was agreement by all that access to quality health
care services for all Floridians would be a giant step in our
fight against HIV infection.


RECOMMENDATIONS FOR CARE AND TREATMENT AND LIVING WITH AIDS
ISSUES

-    Universal health care coverage should be provided for all
persons living in Florida to ensure access to quality health care
services.

-    Patient care funding must be increased.

-    Intensify efforts to broaden the number of medical and
dental health care providers willing to care for HIV-infected
patients.

-    Increase efforts to make nursing homes comply with state and
federal laws which require that they accept HIV/AIDS patients.

-    The state should facilitate greater access to drug therapies
for treatment as well as preventive therapy. This should include
access to marijuana when medically indicated.

-    The state must continue and expand its Medicaid Waiver
Program.

-    The state must confront the issue of health care  for
illegal aliens.

-    Nutrition counseling should be encouraged as part of post-
test counseling and part of treatment for those who test HIV
positive.

-    A task force should be created to determine the best course
for establishing pediatric and adolescent AIDS care statewide.

-    The increased spread of tuberculosis among HIV-infected
persons must be confronted. There should be efforts to educate
persons providing services for HIV patients about TB and efforts
to resume direct observation of medication intake by TB patients.

-    Case management of patients and coordination of client
services should be encouraged as less costly and more effective
care for AIDS patients.

-    The state should expand the AIDS Insurance Project statewide
as it has proven to be cost effective.

-    Develop alternative housing arrangements for PWAs and
coordinate those efforts already in place.



COUNSELING, TESTING AND PARTNER NOTIFICATION

SUMMARY AND RATIONALE

Counseling and testing is an important tool in preventing the
spread of HIV infection. With rare exception, testing should be
voluntary, by informed consent, involve pre- and post-test
counseling, and be confidential or anonymous.

Testing by itself is not an effective prevention tool because
behavior change requires education. That is why pre- and post-
test counseling are so important. The pre- and post-test
counseling requirements by Florida law are often the only time a
person receives individual, one-on-one, counseling concerning the
transmission of HIV infection. Although counseling lengthens a
patient's visit to a physician's office, this is a lifesaving
strategy which should not be eliminated.

Counseling effectiveness is increased when it is done in a
person's primary language and by a peer. Establishing a bond of
trust is oft n a pre-condition of opening the ears and mind of
the listener, making the messenger sometimes as important as the
message. The availability of male and female condoms, as well as
condom skill training by trained counselors, should be part of
the counseling.

Confidentiality is also important. One only has to e reminded of
the shameful burning of the home of the Ray family when the
disclosed that their three sons were HIV infected. Our Panel
heard repeated testimony about the fears of discrimination as
well as actual discrimination against persons with HIV. Fear of
discrimination may be an obstacle preventing a person fro  coming
forward to be tested. Confidentiality or anonymity in testing
removes that obstacle.

Florida's anti-discrimination laws are also important prevention
tools in the fight to stop the spread of HIV infection. Despite
political rhetoric to the contrary, protecting civil rights and
stopping the spread of HIV/AIDS are compatible. In fact, this was
recognized by President Reagan's Presidential Commission on the
Human Immunodeficiency Virus Epidemic in 1988. That commission
recommended strong laws protecting persons with HIV from
discrimination in all aspects of life including employment,
housing, and public accommodations.

The reason for this is two-fold. First, anti-discrimination laws
(along with confidentiality) allow people to feel secure about
being tested without losing an important part of their life, such
as their job or their insurance, should they test positive.
Second, if persons with HIV are taken out of the mainstream of
society due to discrimination while they are still productive,
the tragedy of HIV infection is compounded both for the
individual and for the community.

Mandatory testing policies, although often thought of as a good
idea on the surface, are not cost effective and are contrary to
public health efforts, as well as to a democratic society. For
example, mandatory testing of a11 health care workers, while not
only ineffective in terms of cost, could lead to health care
workers refusing to treat HIV infected persons, and could cause a
relaxation of their use of universal precautions. Instead,
routine, voluntary counseling and testing programs may be
effective in a variety of circumstances. These efforts should be
intensified in all prisons. Physicians should be encouraged to
counsel and test women of childbearing age, their newborns,
persons who are sexually active, and drug users. HIV counseling
and voluntary testing, where appropriate, should be offered with
all primary care visits and entry into health care facilities.

Public health officials testified that voluntary partner
notification efforts have been relatively successful in Florida.
Currently in Florida, all persons who are tested in the public
sector and found to be HIV positive are offered assistance with
contacting their partners. This is a voluntary service that is
done confidentially and without naming partner source. Increased
efforts are appropriate to ensure that Florida physicians are
fully aware of the legal requirements to notify their patients of
this service and to encourage the use of it.

The issue of mandatory name reporting of HIV infected persons is
controversial. Those who favor reporting want to collect
epidemiological data and to expand partner notification
activities for private patients of physicians. The opponents of
HIV reporting are concerned that name reporting would deter
persons from being tested and that this would have the effect of
the disease going underground. Other opponents argue that
mandatory reporting is too great an intrusion by government into
individual privacy without substantial benefit to the public. The
Panel unanimously rejected mandatory name reporting, finding that
both epidemiological analysis as well as expansion of voluntary
partner notification services were possible without name
reporting.



RECOMMENDATIONS FOR COUNSELING, TESTING AND PARTNER NOTIFICATION

-    Increase and advertise the availability of confidential and
particularly anonymous testing.

-    Testing should continue to be by informed consent,
voluntary, confidential or anonymous, with pre- and post-test
counseling.

-    Mandatory testing policies are rejected as non cost
effective, contrary to public health efforts, and adverse to a
democratic society. This includes, but is not limited to,
mandatory testing of all health care workers, marriage
applicants, prisoners, and patients admitted to health care
facilities.

-    Routine, voluntary counseling and testing programs should be
continued and intensified in all prisons.

-    Intensify efforts to promote counseling and voluntary HIV
testing where appropriate as part of primary health care and
entry into health care facilities.

-    Intensify efforts to promote voluntary counseling and
testing for childbearing age women and newborns.

-    Offer routine, voluntary testing of pregnant women giving
birth in Florida. Routine and voluntary HIV screening of heel-
stick blood from newborns should be studied expediently by an
appropriate panel of experts. Such a program should be funded and
initiated if so advised by the panel.

-    Partner notification efforts should remain voluntary,
confidential, and without identification of the named source.

-    The private sector should be encouraged to participate in
voluntary partner notification activities with assistance by
public health personnel. HRS should step up efforts to work with
private physicians and their patients, taking advantage of CDC
funding.

-    Voluntary partner notification efforts should be based upon
physician diagnosis and done after consultation with a patient's
doctor.

-    Mandatory name reporting of HIV infected persons should not
be required by law. The state should collect non-identifying data
on seroprevalence testing in the private sector and should
implement stronger measures to encourage private physicians to
make use of voluntary partner notification services provided by
public health personnel. This could be done, for example, by
allowing doctors to put patients in touch with health officials
on a voluntary basis during the post-test counseling.

-    Counseling should be offered whenever possible in the
person's primary language and by a peer. Establishing a bond of
trust is often a pre-condition of opening the ears and mind of
the listener, making the messenger sometimes as important as the
message.

-    Condoms and condom skill training should be made available
during pre- and post-test counseling by trained counselors.

-    Amend s. 381.0O4(3)(f)11., F.S., to include in the list of
persons with a "need to know," those residential programs and day
programs licensed or funded pursuant to ch. 393 F.S.

-    Conform the Omnibus AIDS Act to the provisions of the
Florida Civil Rights Act as it relates to damages.

-    Policy information provided to insureds by an insurer should
be required to be revised not less often than every two years to
take into account differences between Florida and other
jurisdictions.

-    Require confidentiality by insurers as to a person having
taken or having refused to take an HIV test or having refused to
authorize release of the results.



SUBSTANCE ABUSE AND PREVENTION

SUMMARY AND RATIONALE

The transmission of HIV among intravenous drug users has been
well documented. Regretfully, funding for drug abuse treatment
programs has been dismal. However, even with the availability of
a rehabilitative program, drug users often stay involved with
drugs for many years before seeking or completing treatment.

There is a definite link between dirty needles and  HIV
transmission. The panel heard the testimony of many persons
involved with drug rehabilitation programs. With rare exception,
none believed that distributing clean needles would promote drug-
use. All were in agreement that clean needle programs should not
be considered substitutes for drug rehabilitation programs.
However, clean needle exchange as part of a comprehensive drug
abuse treatment program would be a way to reduce the harm of drug
use until the drug user could be rehabilitated.

It is important that persons working with drug users be fully
educated in a variety of HIV/AIDS education issues. HIV/AIDS
education is an important part of their counseling and outreach
efforts to drug users.

RECOMMENDATIONS FOR SUBSTANCE ABUSE AND PREVENTION

-    More drug abuse treatment programs must be made available.

-    Break the link between dirty needles and HIV infection by
implementing clean needle programs in conjunction with drug abuse
treatment programs. This requires removing certain legal
barriers.

-    Strengthen educational efforts for drug abuse and mental
health counselors.



GOVERNMENTAL ACTION

SUMMARY AND RATIONALE

Although there are many HIV/AIDS prevention and care activities
ongoing in the state of Florida, there does not seem to be a
comprehensive, coordinated effort. A permanent AIDS advisory
council and AIDS policy advisor to the Governor would have the
dual effect of elevating the importance of our fight against
HIV/AIDS infection, as well as effecting a statewide
comprehensive plan.

Due to the changing face of AIDS and to the disproportionate
amount of infection in the ethnic minority communities, it is
important that ethnic minorities be included in both policy
making and advisory positions at all levels in the fight against
HIV/AIDS infection.

The cost of caring for AIDS patients combined with the
epidemiological predictions are dismal. Increased funding now
both for prevention and care will save dollars later. Florida's
leaders have a need to know and understand the seriousness of the
HIV/AIDS epidemic so that they will support increased funding
efforts.

RECOMMENDATIONS FOR GOVERNMENTAL ACTION

-    A permanent HIV/AIDS Advisory Panel should be established
with the potential for sub panel task committees. The panel
should be diverse with special sensitivity to infected
populations.

-    The Governor should appoint an HIV/AIDS Policy Advisor.

-    Increase ethnic minority participation in the HRS AIDS
program at the state level.

-    The Governor should call a leadership conference on HIV/AIDS
to educate Florida's leaders on the seriousness of HIV
prevention.

-    Increase funding at all levels of HIV/AIDS prevention,
education, and care.

-    Don't put these recommendations on the shelf. Face the truth
or suffer the consequences!