Political activity: a nursing intervention.

For the past 2 years, the Association of Nurses in AIDS Care (ANAC) members in Mississippi have been politically active on behalf of those with HIV disease. Nurses have shown the ability to provide the energy and organization for action, to facilitate a multidisciplinary and coordinated effort, and to generate successful outcomes for their effort. This effort started with a health care crisis and continues as a statement of nursing concern and power. Through the Ryan White AIDS Drug Assistance Program (ADAP), the federal government has for many years provided very expensive HIV medications (at the cost of about $1,000 a month for each patient) for those unable to afford them. In Mississippi, the state department of health has administered ADAP because it has branches throughout the state equipped to dispense medications closer to where each needy individual lives. In May of 1997, a sudden crisis occurred when the Mississippi ADAP program ran out of money. This came as a shock to the health care community, and the crisis worsened as the department of health stated that it would be accepting no more referrals and would be required to cut more than half of the current recipients out of the program. In response to this, ANAC nurses and nurse practitioners at the University of Mississippi Medical Center, where most of the state HIV care occurs, brought together an interdisciplinary group from throughout the state to brainstorm the most reasonable response to this crisis. It was decided at that meeting that this group would form a lobbying organization called the Mississippi HIV/AIDS Assembly and would work to provide adequate HIV care for the uninsured of Mississippi through political action. The assembly included many who were not knowledgeable about political action and a few who were. This group was able to form two branches of action. A grass-roots lobbying body of those personally infected with or affected by HIV disease was formed, as well as a lobby of doctors, nurses, dentists, social workers, and pharmacists. The grass-roots group put pressure on politicians individually, and the professional group was able to mobilize its organizations to support bills important to the assembly’s goals. As a result of this nurse-founded and nurse-led organization, there were immediate changes in the funding at the department of health, so that many individuals who would have been cut off their medicines were able to continue. Also, in 1998, the first state allocation of money was given to the Mississippi ADAP program. In the 1999 legislative session, the assembly worked with a disabilities group to pass a bill giving disabled individuals a chance to work without fearing the loss of their Medicaid coverage; this bill also increased the Medicaid prescription limit from 5 to 10 per month. The partnership also convinced the legislature to increase the Medicaid eligibility limit from 100% of poverty to 135%, allowing those regarded as low income but slightly over the poverty level (usually the recipient of a disability check) to receive Medicaid, which pays for their needed medications. Unfortunately, the governor vetoed this bill at the last minute because of “technical problems,” even though the money was allocated and placed in the budget for this particular purpose. In the 2000 legislative session, the assembly continues as a force to be reckoned with, still nurse led and multidisciplinary in membership. This year, the assembly would like to see the legislature override the Policy and Politics Column