Transcript Marin County Jurisdictional Strategy Presentation

Marin County Jurisdictional HIV
Prevention Plan
Chris Santini, Cicily Emerson
Marin County Division of Public Health
HIV/AIDS Program
January 10, 2013
Looking Back………….
•
In 2009, State budget reductions resulted in the defunding of
the HIV testing and prevention programs that had been
operating in Marin for many years (1995-2009)
•
After 2009, the County continued to offer HIV testing in its
Sexually Transmitted Disease Clinic and in the County jail
•
Marin AIDS Project used private funding to offer rapid HIV
testing one evening a week.
Looking Back……………
•
In 2008, the County Health and Human Services, Clinics were
opened on the Marin Health and Wellness Campus which is a
central hub for some public services including HIV and STD
health services.
•
Marin Community Clinics, is co-located on the Campus. The colocation of these services has increased the capacity of the
County to identify at risk individuals and link them to medical
care and/or provide a referral to on-site medical services.
Why are we here today?
•
In 2011, with San Francisco and San Mateo, Marin
responded to the Centers for Disease Control and
Prevention Request for Proposals CDC-RFA-PS12-1201
Comprehensive HIV Prevention Programs for Health
Departments.
•
Calls for a Jurisdictional and HIV Prevention Plan and
Comprehensive HIV Prevention Plan for 2012-16
HIV Prevention Plan Goals
Find and test the 20% infected but unaware of
their status, link to care, and treat them with
medications
Reduce disparities (racial/ethnic) in new HIV
infections
“Treatment as Prevention”
Marin County Profile
Mostly suburban community located north of San
Francisco.
• Low population density, many different cities and
towns
• Highest risk population, MSM, is isolated and
difficult to reach.
• Few gay-identified social gathering places in the
County.
• Small, insulated Hispanic and African-American
communities that are difficult to reach.
• Unknown number of IV drug users
•
•Gender & Ethnicity PLWHA Marin County (n=570)
Transgender
0.7%
Native
Hawaiian/
Pacific Islander
Asian
0.5% Other/ Multiple/
2.1%
Unknown
Female
11.7%
1.4%
Hispanic/Latino
15.8%
Male
87.2%
Black/African
American
6.5%
Non-Hispanic
White
73.7%
Age, Persons Living with HIV/AIDS
Marin County (n=270)
34.6%
29.7%
21.6%
10.4%
0.0%
1.1%
Under 13
13-19
2.6%
20-29
30-39
40-49
50-59
60+
Transmission Category PLWHA Marin County (n=570)
Unknown
13.0%
IDU
14.5%
Pediatric
5.8%
Medical**
0.4%
Heterosexual*
4.4%
Pediatric
0.4%
MSM & IDU
10.4%
Medical**
0.0%
IDU
5.0%
Heterosexual*
66.7%
Females
MSM
74.5%
Males
Unknown
5.0%
Table 2. Demographics of Marin County Community Residents Newly Diagnosed with
HIV Infection, 2006-2011
Year of HIV Diagnosis 2006-2007 2008-2009 2010-2011
Age at
13-19
0
0%
0
0%
1
3%
Diagnosis
20-24
6
14%
0
0%
8 22%
25-29
5
12%
2
5%
0
0%
30-39
14
33% 15 38% 16 43%
40-49
15
35%
9 23%
6 16%
50-59
1
2%
9 23%
3
8%
60+
2
5%
4 10%
3
8%
Race/Ethnicity Hispanic/Latino
11
26% 12 31% 12 32%
Asian
1
2%
1
3%
1
3%
Black/African American
9
21%
4 10%
3
8%
Native Hawaiian/Pac. Islander
1
2%
0
0%
1
3%
White
20
47% 21 54% 20 54%
Multiple races
1
2%
1
3%
0
0%
Gender
Female
8
19%
8 21%
4 11%
Male
35
81% 31 79% 33 89%
Transmission Male-to-Male sexual contact (MSM) 23
53% 18 46% 25 68%
Category
Injection Drug Use (IDU)
5
12%
1
3%
0
0%
MSM + IDU
3
7%
5 13%
3
8%
Heterosexual contact
9
21%
6 15%
2
5%
No Identified/Reported Risk
3
7%
9 23%
7 19%
Late
No
22
51% 21 54%
Testers*
Yes
21
49% 18 46%
Total
43 100% 39 100% 37 100%
* AIDS diagnosis with one year of HIV diagnosis
Observations and Trends
2010 County tests: 1004 tests, 5 positives
• The number of new diagnoses each year has remained
steady (around 20)
• The HIV/AIDS population is aging; more than 50% are over
50 years of age
• Latinos are 32.5% of new infections, AA 8.1% (yet 15.5%
and 2.6% of County population)
• Number of infections attributed to MSM is increasing
• 50% of people testing progress to AIDS within one year.
Late testers, late to care
•
Review of Marin’s Plan
Targeted Risk Populations
• Men Who Have Sex With Men (MSM)
• Injection Drug Users (IDU)
• MSM/IDU
• Sexually active Latinos and African
Americans who have never had an HIV
test
Current Prevention and Treatment Resources
Service Description
Target
Populations
Service Provider(s)
Geographic
Location
Funding Source(s)
Targeted outreach and
rapid HIV Testing
MSM
MSM/IDU
IDU
AA/Latinos
(not tested)
All
HHS and Marin AIDS
Project, Marin Treatment
Center
Jail Medical Services
Central San Rafael,
Canal, Marin City,
Novato
County Wide
Correctional Facilities
County Wide
CDC prevention
funding
SAMHSA funding
County
Central San Rafael
Ryan White, ADAP,
Public and Private
Insurance, Private
donations
HOPWA
Private donations,
?
Routine HIV Testing
STD Clinics, FQHCs,
Community Clinics,
Reproductive Health
Clinics
Kaiser, Tom Steel Clinic,
MAP, HHS Clinics
HIV Treatment and
Retention in Care
HIV Support Services
PCRS Services1
Transitional Housing
Prevention Education
HIV+ and
Partners
HIV+
All (Primary
Prevention)
MAP, Hamilton
Huckleberry Youth
Programs, MAP
Outpatient and
Residential Drug
Treatment
HIV+
Marin Treatment Center
Centerpoint
Helen Vine
Needle Exchange
MSM/IDU
IDU (Primary
Prevention)
Marin AIDS Project
Provides services
County Wide
Novato
High Schools ,
Teen Clinics in San
Rafael and Novato
Central San Rafael
FPACT, Public and
Private Insurance
Ryan White
SAMHSA funding,
Public and Private
Insurance
Private donations
Strategies for HIV Prevention-CDC
Required activities:
• HIV testing
• Comprehensive Prevention with Positives
(linkage and retention in care, Partner
Services)
• Condom distribution
• Policy initiatives
Strategies for HIV Prevention-CDC
Recommended components:
• Evidence-based interventions for high-risk HIVnegatives
• Social marketing, media, and mobilization
• Pre-Exposure Prophylaxis and non-occupational
Post-Exposure Prophylaxis
Review of Marin’s Plan
Core Program Activities:
• Provide targeted HIV testing
• Encourage routine medical testing
• Ensure engagement and retention in HIV
medical care
Review of Marin’s Plan
Additional Activities
• Syringe access and disposal
• PrEp and nPEP
• Stigma reduction, social marketing, and media
• Policy initiatives (service integration and
infrastructure development)
• Evidence-based interventions for high risk
negatives (HERR)
Q and A