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More Than 45,000 Californians Living With HIV Would Be Impacted by Medicaid Cuts in Senate Health Plan According to a fact sheet from the California HIV/AIDS Policy Research Centers, the cuts would be felt by patients covered by Medi-Cal

Tens of thousands of Californians living with HIV would be impacted by Medicaid cuts under the Better Care Reconciliation Act (BCRA), according to a fact sheet released by the California HIV/AIDS Policy Research Centers in collaboration with the UCLA Luskin School of Public Affairs.

The fact sheet highlights new data from the California Department of Public Health, Office of AIDS, which indicates that 45,033 people living with HIV received health coverage through Medi-Cal in 2014. These data also indicate that approximately 11,500 people living with HIV enrolled in Medi-Cal because of the Affordable Care Act (ACA). Medi-Cal, California’s Medicaid program, covers the cost of medications that help low-income people living with HIV achieve viral suppression, which both improves their health and prevents new infections.

Last week, the U.S. Senate released the BCRA, which would make dramatic cuts to Medicaid. A similar bill passed by the U.S. House of Representatives, the American Health Care Act (AHCA), would have cut Medicaid nationwide by $834 billion over 10 years.

The BCRA would radically restructure the Medicaid program by converting it to a per capita cap or block grant and effectively end the ACA’s Medicaid expansion. Together, these changes would result in a massive fiscal shift from the federal government to the states and add billions in additional costs to the state of California.

“People living with HIV have complex health-care needs that require high-quality, consistent and affordable health care,” said Ian Holloway, director of the Southern California HIV/AIDS Policy Research Center and an assistant professor in the Department of Social Welfare at the UCLA Luskin School of Public Affairs.

The CHPRC fact sheet emphasizes that limits on Medicaid financing and coverage would have a detrimental impact on California’s efforts to provide care and treatment for people living with HIV and to reduce new HIV infections.

“It is important for policymakers to understand the threats the BCRA poses to people living with HIV and other vulnerable communities in California,” Holloway said.

 

Despite Ongoing Meningitis Outbreak, Vaccination Among Gay Men Remains Low Limited 2-dose completion among HIV-positive men puts them at particular risk, new study shows

Despite a yearlong outbreak of invasive meningococcal disease in Southern California primarily affecting gay and bisexual men, less than 27 percent of men who have sex with men (MSM) in Los Angeles County have been vaccinated for meningitis.

The findings released Thursday, March 30, 2017, by the California HIV/AIDS Policy Research Centers in collaboration with the UCLA Luskin School of Public Affairs, the Los Angeles LGBT Center and APLA Health call for more education about the disease and more places offering immunization throughout Southern California at venues where gay and bisexual men socialize.

More than 500 men were interviewed about their knowledge of the meningitis outbreak by UCLA Luskin’s Ian Holloway, an assistant professor in the Department of Social Welfare, and teams of researchers who visited venues throughout Los Angeles County. Most of the canvassers were current UCLA students or recent graduates.

“Our rapid-response research suggests that coordinated efforts to standardize data collection about sexual practices in conjunction with immunization will enable better tracking of meningitis vaccination among gay and bisexual men,” said Holloway, who is also the director of the Southern California HIV/AIDS Policy Research Center.

Meningococcal disease is often characterized with sudden onset of high fever, headache, nausea, vomiting, rash, stiff neck and confusion, which can lead to rapid septic shock and death if not treated quickly. Vaccination is highly effective and can prevent the disease. The current outbreak in Southern California is the second in the area in recent history. A 2014 meningitis outbreak led to the deaths of three gay men in their 20s.

Despite the outbreak and vaccination recommendations from the California Department of Public Health, the majority of respondents interviewed by the UCLA team were not protected against meningitis.

Holloway noted that HIV-positive people are at particular risk for developing serious health issues if infected with meningitis and are recommended to receive a two-dose primary series of meningitis vaccination. Few HIV-positive men surveyed by Holloway’s team had received two doses of the vaccination.

“Primary care doctors who treat gay and bisexual men and HIV-positive people should talk to their patients about the ongoing outbreak and make sure they receive the full recommended dosing,” said Phil Curtis, director of government affairs at APLA Health.

The study praises the efforts of the Los Angeles County Department of Public Health Immunization Program, which distributed free vaccines, and of participating community-based organizations such as AIDS Healthcare Foundation and the LA LGBT Center, but researchers concluded that more needs to be done.

In addition to Holloway, study authors include Elizabeth Wu and Jennifer Gildner from the Southern California HIV/AIDS Policy Research Center, and Vincent Fenimore and Paula Frew from Emory University.

Learn more about Ian Holloway and the meningitis study in this video:

Taking the Fight for LGBT Health Equity to the Streets Late-night canvassing to assess a meningitis outbreak exemplifies the dedication that has earned UCLA Luskin Social Welfare professor Ian Holloway national recognition for his groundbreaking research

By Les Dunseith

It’s the Tuesday night before Christmas as UCLA Luskin professor Ian W. Holloway tucks his 2-year-old daughter Sofía into bed and prepares to leave his home on a tree-lined street of bungalow-style houses in the Larchmont neighborhood of Los Angeles.

It’s time for Holloway, an assistant professor in the Department of Social Welfare, to get back to work.

Along with three UCLA student researchers, Holloway will spend the next several hours in West Hollywood doing legwork for his latest research project. Their task will be to find and interview gay and bisexual men outside popular nightspots and discover how much they know about an ongoing meningitis outbreak and the steps that health officials have taken to battle it.

This type of time-consuming, on-the-ground research is par for the course for Holloway, who serves as the director of the UCLA Luskin-based Southern California HIV/AIDS Policy Research Center and is currently juggling four major research efforts related to his expertise in health disparities among sexual and gender minority populations. Holloway’s dedication and his innovative methods recently led the Society of Social Work Research (SSWR) to select him for its Deborah K. Padgett Early Career Achievement Award, presented in January 2017 during the organization’s national conference in New Orleans.

“This is our primary professional society,” Holloway says about the honor, which recognizes social work research completed during the recipient’s first decade after earning a doctoral degree. “They give just one a year at the society’s big professional meeting.”

UCLA Luskin students Jorge Rojas and Christine Munoz listen as Ian Holloway outlines the agenda as another night of research gets underway. Photo by Les Dunseith

On this night, however, the meningitis study takes precedence. Outside the Urth Caffé, Holloway helps the student researchers establish a “line” — in this case basically a crevice in the sidewalk — at the corner of Melrose Avenue and Westmount Drive. One or more of the students then approaches any man who crosses that line, asking them to participate in the research effort by spending 20 minutes answering survey questions using an iPad.

In the first half-hour, however, only one man who meets the study’s criteria has been successfully interviewed. Holloway and his research team are trying to complete about 500 interviews for the project by February, and foot traffic is just too light to continue at the site. So they move on to the next venue that has been randomly preselected for this night’s canvassing effort — the Motherlode, a tavern with removable walls that proudly shows off its dive-bar atmosphere to passersby along Santa Monica Boulevard.

The thought of an academic research project centered around bar hopping in West Hollywood until 2 a.m. may seem incongruous, but it’s a proven research approach that works particularly well when the target audience is gay and bisexual men in Los Angeles County, including those who are HIV positive. During a meningitis outbreak that has led to two deaths in Southern California since it was first reported last spring, the researchers need to go where those who are most at risk can reliably be found.

UCLA Luskin student researchers Ryan Dougherty and Christine Munoz use digital devices to establish a survey zone. Photo by Les Dunseith

“We use a strategy called venue-based sampling,” Holloway explains. “It’s a systematic sampling strategy that is one of the best ways we know for how to approximate generalizability among gay and bisexual men.”

Holloway’s meningitis study is funded as part of a four-year, $4-million grant from the California HIV/AIDS Research Program to produce “what we call rapid response research,” he says. The idea is to complete research within months, not years, related to timely policy issues that impact people living with HIV or AIDS in California.

As noted on its website, CHPRC.org, the center works closely with community partners from AIDS Project Los Angeles Health and the Los Angeles LGBT Center to tailor research efforts to match urgent needs within the LGBTQ communities.

“We get community input, synthesize that and then set an agenda for policy research,” Holloway explains.

He took over the center’s leadership last April from Arleen Leibowitz, professor emeritus of public policy at UCLA Luskin, and feels fortunate to conduct research efforts that directly arise from community interaction.

“Models of funding like this aren’t widely available, so we are lucky to have a center here at UCLA, and we are lucky to have had it for seven years,” he says. “We want to continue to do this work and be able to conduct research that is driven by the community and that directly benefit the community.”

The meningitis study resulted from a meeting in October at which about 40-50 advocates, health workers and social service providers from across Southern California came to Los Angeles to talk about the needs of people in the local LGBTQ communities.

“These are people who are working with HIV-positive clients, who are doing prevention work,” Holloway says of the attendees. The meeting gave them an opportunity to think about and debate the issues most affecting their communities. The researchers primarily were there to listen and help structure projects that could be completed in a rapid response timeframe to produce data that would actually benefit those communities.

“It is … very much aligned with the mission of Luskin and the mission of the Department of Social Welfare,” Holloway notes.

Ian Holloway discusses where to relocate with his survey team when one of their preselected research sites proves unworkable. Photo by Les Dunseith

Back in West Hollywood, the Motherlode proves unworkable as a survey venue on this night. A private party is booked at the site, but it won’t start for a couple of hours and the survey team can’t afford to simply bide time waiting.

Holloway, ever cheerful no matter the hurdle he faces, quickly gathers his team to discuss their options. Proceed to the next pre-selected venue? Or go just around the corner to the “emergency backup” site, the Abbey, a 25-year-old West Hollywood landmark that has been voted the best gay bar in the world.

Within minutes, the team is in place outside the Abbey, and all three student researchers are actively engaged in recruiting potential survey respondents.

To gather enough surveys to produce statistically valid results by their deadline, Holloway has put together a rotating team of about 10 UCLA student workers, assisted occasionally by a couple of alumni who help out during staffing shortfalls. The majority are current Luskin master of social welfare students, but two are in a Ph.D. program.

“There’s lots of exciting work going on,” Holloway says with a broad smile. “And we have a fantastic team at UCLA supporting it.”

The data being gathered now will be analyzed by March to inform a research brief that should help California produce better outreach and better programs centered around meningitis vaccination for this population. The student workers collecting the information were carefully screened during a selection process led by Holloway’s research manager, Elizabeth Wu.

“We are looking for people who are obviously outgoing and who understand the importance of collecting good quality data,” says Holloway, whose own affable manner permeates the research effort. The canvassers, who refer to Holloway mostly by his first name, also need to be comfortable staying out to the wee hours to chat with strangers they encounter outside bars and clubs.

The iPad-based surveys are completed by the researchers based on respondents’ answers. Photo by Les Dunseith

For researcher Christine Munoz, a first-year MSW student who got her undergraduate degree at UC Riverside, the learning process was frenetic at first, but also rewarding.

“It is very new to me because I wasn’t really involved in the LGBTQ community previously,” she says during a break during the canvassing effort. “I am learning so much from this community. So, it’s broadening my skills, my social work skills. Now I can work with clients who are from the LGBT community. I am learning so much as a future social worker.”

The survey teams have been on the job since November, gathering data that Holloway says will either confirm or refute the notions that helped form the basis of the survey hypothesis.

For example, there is a feeling that the distribution of meningitis vaccine to the targeted community “is pretty haphazard,” Holloway says. “There isn’t always a good refrigeration system for the vaccine at community clinics; health workers aren’t always tracking how many doses have been given.”

Without a systematic infrastructure in place to promote the wellbeing of these men, health officials often find themselves in a defensive posture when dealing with outbreaks of vaccine-preventable illnesses among HIV-positive men or men at high risk for HIV. “It shouldn’t take an outbreak for us to realize this is a priority community,” Holloway says.

His passion to understand and promote better health options for LGBTQ communities is an outgrowth of Holloway’s life experience. He was raised in Northern California during the early years of the HIV crisis in America. His parents’ generation saw an entire community of gay men decimated, almost wiped out by AIDS.

“Growing up and knowing that I was gay, and hearing and seeing what happened close by in San Francisco, I think it was pretty impactful for my young life,” Holloway recalls. “When I decided that I wanted to go back to school for social work, I was pretty clear that this was the community that I wanted to work with, and this was the issue that I wanted to work around.”

Professor Ian W. Holloway has been selected by the Society for Social Work Research as its 2017 Early Career Achievement Award winner. Photo by George Foulsham

That dedication is evident in the meningitis study as well as three other research projects that Holloway is currently shepherding:

  • A two-year study supported by a $1.89-million grant from the U.S. Department of Defense is looking at the experiences of of lesbian, gay, bisexual and transgender active-duty service members since the 2010 repeal of “don’t ask, don’t tell,” the law barring homosexuals from openly serving in the military.
  • A study funded by the NIH through a small research grant mechanism uses predictive technologies to understand how gay and bisexual men use geo-social networking apps and other kinds of social media to find substance use partners and sexual partners. This collaborative effort with UCLA’s departments of engineering and computer science is using predictive algorithms and social media data to try to understand how social media behavior predicts health behavior.
  • And he is involved in the development of a social networking app for HIV-positive black men in L.A. County in the 18-29 age range through a grant from California HIV/AIDS Research Program. It will be a virtual community space where these men can connect with those with similar experiences, focusing not just on health and medication adherence but on housing, job assistance, social services and/or legal needs.

Despite his prolific research output, Holloway doesn’t neglect his classroom responsibilities. If fact, he finds that his research interests often dovetail nicely with teaching opportunities.

“I teach a class on diversity, oppression and social functioning. Each year when we talk about community responses to oppression, I show the ‘Silence = Death’ banner that Act Up used as a call to action in the early days of HIV when nobody was talking about it and the entire community was being wiped out,” he explains. “Each year I show that banner from the early days of the AIDS epidemic, and each year fewer and fewer students recognize it.”

UCLA students working as canvassers approach any men who cross into their survey area. Photo by Les Dunseith

Out on the streets of West Hollywood, student researchers such as Ryan Dougherty are learning first-hand how much knowledge exists among today’s gay and bisexual men about the serious health issues that still impact many of them.

Dougherty joined the survey team as a result of taking Holloway’s research methods class, where he learned “about the process of research, everything from the theoretical foundations of collecting data to the ethics of research. And Ian extended an opportunity for students to get involved and see what that process looks like on the ground.”

As a student in the social welfare Ph.D. program at UCLA Luskin, Dougherty may follow in Holloway’s footsteps someday, pursuing research of his own that will benefit marginalized populations and ameliorate health disparities.

“To be able to do this kind of work, and to work alongside Ian, has helped me to gain more theoretical perspectives and learn about different types of research methods,” Dougherty says. “You can spend all day in the classroom learning about research, but to actually do it and overcome the logistical barriers that come with implementing a really good research project, is a really good learning experience to have.”

At the Abbey, those logistical barriers are in full force as Dougherty attempts to stop men who cross his survey line outside the venue’s patio-style entrance. Some ignore him. A few politely wave him off. One is willing to take the survey but doesn’t qualify because he is not a resident of L.A. County.

Soon, however, a young man in a white hooded sweatshirt approaches. Dougherty catches his attention. The newcomer meets the research criteria. And he is willing to take the survey.

Nearby, Ian Holloway nods his approval. And the research interview begins.

Ryan Dougherty, a Luskin Ph.D. student, conducts a survey interview. Photo by Les Dunseith

Shining New Light on a ‘Red Light’ Profession Oxford handbook co-edited by UCLA Luskin researcher compiles latest economic research on prostitution

By Stan Paul

Although prostitution has been examined by various social scientists, the “world’s oldest profession” has received less attention from an economic standpoint. But that’s changing.

Thanks to the increasing availability of existing data sets on the internet, as well as new surveys that are being implemented, researchers have been able to gather valuable economic data that could help government officials in setting policy guidelines concerning prostitution.

A number of factors, including the proliferation of sexually transmitted infections (STI) and HIV/AIDS, especially in developing nations, have created the need to look at prostitution through an economic lens.

These subjects and other topics dealing with the sex trade are part of the newly published “Oxford Handbook of the Economics of Prostitution,” co-edited by UCLA Luskin School of Public Affairs researcher Manisha Shah and Scott Cunningham, associate professor of economics at Baylor University. A development economist and associate professor in the Department of Public Policy, Shah’s teaching and research interests focus on the intersection of applied microeconomics, health and development.

Researchers in fields from anthropology to sociology have looked at various facets of prostitution both qualitatively and quantitatively. The book’s co-editors cite the nature of economics as looking at problems in mostly quantitative terms, and the new data is yielding a wealth of useful — and often counterintuitive — information on this resilient underground economy.

“I think one of the things that always surprises me is how often the sex market looks like any other market that economists study,” said Shah, who has written on the topic in order to learn how more-effective policies and programs can be deployed to slow the spread of HIV/AIDS and other STIs.

“Most of the time, the predictions of economic theory play out in the sex market as well,” Shah said. “There are so many chapters that highlight this and illustrate that sex workers respond to incentives and prices in the same way that other market participants do.”

More than 40 researchers from around the world contributed to the book, divided into six parts: Supply and Demand, Sex Workers in Developing Countries, Men Who Have Sex With Men, Law and Policy, History of Prostitution Law, and Externalities: Sexually Transmitted Infections and Sexual Exploitation. Chapters include Economics of Sex Work in Bangladesh, Violence and Entry in Prostitution Markets and A Method for Determining the Size of the Underground Economy in in Seven U.S. Cities.

“We know that prostitution has important policy implications because of the effect that prostitution has on STI rates, risky behaviors, as well as its responsiveness to poverty,” Shah said. “But we don’t know as much about optimal policy design.” In addition, she said, most governments have not experimented with different strategies, so prohibition has been the most common policy.

The book also contains chapters that explain and use information collected directly from the web because prostitution continues to shift from the street to indoor sex work. Shah points out that the internet facilitates the functioning of illicit markets through free classified advertising, lower search costs and even client reviews of sex workers.

“Reviews create reputations for sex workers, much like eBay and Airbnb reviews create reputations for vendors,” said Shah, explaining that these “reputation mechanisms” are allowing illegal markets to function more like legal businesses. Shah said this is an important point because, in the illegal sector, providers and clients cannot access legal courts to enforce contracts.

“Reputation, in other words, is the mechanism by which contracts are enforced in illegal sex markets,” Shah said.

Policy makers need to understand the distinction between voluntary prostitution and sex trafficking, Shah said. “Too often these two get conflated. The social costs of sex trafficking are very high, whereas arguably the social costs of voluntary prostitution are lower.”

Pointing to recent government experiments in Sweden and New Zealand, for example, Shah said that policy makers should have a working understanding of how these markets function, as well as understanding theories of policies that can regulate these markets optimally.

“Policy makers can use this information to better design policies that can reduce sex trafficking as well as accompanying externalities,” Shah said, citing a detailed analysis of the Nevada brothel system, which, she said, “can help policy makers understand if there are elements of the Nevada policy that could be applied elsewhere.”

Shah said that with a better understanding of how these markets operate, optimal policies can be designed to reduce the harm associated with prostitution markets and lower the overall social costs.

“The book has explicit models to guide the design of prostitution laws,” Shah said. “We think these are one of the highlights of the handbook in general.”