National HIV/AIDS Strategy (NHAS) South Florida Federal Executive Board Meeting September 18, 2014

Region IV Office of the Assistant Secretary for Health Alabama Florida Georgia Kentucky Mississippi North Carolina South Carolina Tennessee . As the senior federal public health official and scientist in the region, the Regional Health Administrator performs essential functions for the Department of Health and Human Services (HHS) in three major areas: prevention, preparedness, and agency-wide coordination.  These functions directly and indirectly support the work of the Department and the individual federal agencies.  Prevention:  The Regional Health Administrators are the regional arm by which the Assistant Secretary for Health (ASH) promotes the Department’s prevention mission and various prevention initiatives, with a special emphasis on women’s health, minority health, family planning and reproductive health as well as HIV/AIDs prevention.  Because of their unique position, as HHS leaders in long term field assignments, the Regional Health Administrators are able to serve as effective high-level departmental liaisons throughout the country with Federal, Tribal, State, and local health officials, as well as community-based organizations and health/medical institutions on matters of public and community health.  Preparedness:  In partnership with the Regional Emergency Coordinators of the Office of the Assistant Secretary for Preparedness and Response (ASPR), the Regional Health Administrators serve a key regional public health leadership role in matters of all-hazards preparedness. Regional Health Administrators foster collaboration among HHS preparedness staff and State and local leadership in the region and among other Federal agents on all-hazards preparedness activities of the Department.  In actual public health emergencies, Regional Health Administrators may assume the role of Senior Health Official, as directed by ASPR and the Assistant Secretary of Health.  They also serve as senior consultants to the Incident Response Coordination Team, as well as to the Regional Directors during any regional emergency response. They also oversee the Medical Reserve Corps in their regions. Facilitating Agency-wide coordination and collaboration across HHS Agencies:  Perhaps the most important role of the RHAs is to assist HHS’ coordination in a fashion that maximizes the effectiveness of the agencies in their overall mission, as well as the effectiveness of the various individual programs.  The Regional Health Administrator’s mission-critical task in this regard is to help ensure that efforts to promote health are well-aligned in the field – catalyzing collaboration where appropriate, minimizing redundancy, and providing feedback to the agencies and the Secretary to maximize programmatic effectiveness and to ensure a well integrated effort for the Department overall.  In each region, the Regional Health Administrator is uniquely situated to provide support to various initiatives of all OPDIV health missions, especially those which cross functional program lines. Regional Resource Network Program

National HIV/AIDS Strategy for the United States 30 years ago, in 1981, doctors reported the first 5 cases of the disease we now know as HIV/AIDS. At that time, neither those doctors or the public, could anticipate the reach and scale of the epidemic to come and the imprint that HIV/AIDS would have on American society. A generation of young adults have now grown up always knowing about the presence of HIV/AIDS. On this 30 year anniversary, we’ll take a brief look at where we are in our fight against this epidemic; review the new National HIV/AIDS Strategy launched last year; and suggest how as a country — working together — we must all refocus our efforts to more effectively combat HIV/AIDS.

NHAS Vision The United States will become a place where new infections are rare and when they do occur, every person, regardless of age, gender identity, or socio-economic circumstance, will have unfettered access to high quality, life-extending care, free from stigma and discrimination. —NHAS July 2010 The United States will become a place where new infections are rare and when they do occur, every person, regardless of age, gender identity, or socio-economic circumstance, will have unfettered access to high quality, life-extending care, free from stigma and discrimination. The National HIV/AIDS Strategy is a plan to make this vision a reality.

National HIV/AIDS Strategy Goals: Reduce HIV incidence Increase access to care and optimize health outcomes Reduce HIV-related health disparities “Our country is at a crossroads. Right now, we are experiencing a domestic epidemic that demands a renewed commitment, increased public attention, and leadership.” President Barack Obama July 13, 2010 In July of 2010 President Obama announced the new national strategy for fighting the HIV/AIDS epidemic that refocuses our existing efforts to deliver better results to the American people. The Strategy has three primary goals: Reduce new HIV infections Increase access to care and optimize health outcomes Reduce HIV-related health disparities To develop this Strategy, the people on the front lines of fighting the epidemic were consulted. They included scientists, health care providers, health officials, community leaders, faith leaders, advocates, and people living with the HIV/AIDS — many from communities that are disproportionately affected by the epidemic. The White House and the Department of Health and Human Services hosted community discussions and heard from thousands of Americans around the country. Success will require the commitment of all parts of society: Including — federal, state, tribal, and local governments, businesses, faith communities, philanthropy, the scientific and medical communities, educational institutions, social and civic organizations.

A More Coordinated National Response to HIV/AIDS Ensure coordinated program administration Promote equitable resource allocation Streamline and standardize data collection Provide rigorous evaluation of current programs and redirect resources to the most effective programs Provide regular public reporting Encourage States to provide regular progress reports A fourth NHAS priority area is to create a more coordinated national response to the HIV/AIDS epidemic to ensure that resources effectively target the populations and communities most in need and that programs achieve their prevention, treatment and care goals. Since the release of the NHAS, HHS has held meetings to discuss: Developing a common set of indicators to measure progress in HIV prevention, treatment and care Streamlining and standardizing HIV/AIDS data collection Revising funding formulas and methods to promote better targeting of HIV resources HHS and the other lead agencies are fostering more effective collaborations across federal programs and with state and local governments through working groups to coordinate where missions overlap, i.e., A working group comprised of the 6 Federal Lead Departments and other key government partners An HHS-specific cross-agency working group to monitor the HHS Operational Plan (CDC, HRSA, SAMHSA, NIH, IHS, CMS, & OS) A cross-Departmental Centers for Faith-Based and Neighborhood Partnerships working group HHS has hosted consultations with key stakeholders, i.e., LGBT and PLWHA leaders, to obtain feedback and promote their participation in the NHAS implementation.

Implementing the National HIV/AIDS Strategy Federal agencies with primary responsibilities and competencies in the areas related to HIV/AIDS are central to the NHAS, and working groups have been created to ensure that staff within Departments and across Departments are sharing information and coordinating their efforts to maximize their impact. Department of Health and Human Services Responsibilities include prevention, research, healthcare, mental health, substance abuse, health insurance, etc. Key agencies involved: CDC, CMS, HRSA, IHS, NIH, SAMHSA, OASH, and others Housing and Urban Development Program for Housing Opportunities for People with HIV/AIDS Department of Justice Responsibility for HIV/AIDS in federal prisons, enforcement of the Americans with Disability Act. Department of Labor Along with EEOC, Labor enforces civil rights laws that outlaw HIV/AIDS-related discrimination in employment Provides educational materials and resources to employers and employees on their rights and responsibilities Veterans Affairs Largest single provider of medical care to people with HIV in the United States supporting over 24,000 Veterans living with HIV/AIDS in 2009, or 1 of every 250 veterans in healthcare at VA. (Department of Veterans Affairs National HIV/AIDS Strategy Operational Plan 2011, p. 4 ) Social Security Administration People with HIV/AIDS who cannot work may qualify for disability benefits

HIV Care Continuum The HIV Care Continuum Initiative calls for coordinated action in response to data that has been released since the Strategy three years ago, showing only a quarter of people living with HIV in the United States have achieved the treatment goal of controlling the HIV virus.

Ways to Support the NHAS Discuss what your agency or organization can do in new or different ways Participate in state and local discussions about HIV Engage new partners in HIV prevention, care, treatment, and stigma-reduction to reach more people Other Ways to Support the NHAS Discuss and Determine what your agency or organization can do in new or different ways to align efforts with the strategy. Participate in state and local discussions - about how HIV prevention, care, and treatment efforts can be fine-tuned to better serve vulnerable populations. Engage new partners in HIV prevention, care, treatment, and stigma-reduction efforts to strengthen our collective and reach more people.

Chiquita F Covington, MPA Regional Resource Coordinator Office of the Assistant Secretary for Health U.S. Department of Health and Human Services, Region IV Office: (404) 562-7901 Email: Chiquita.Covington@hhs.gov

The HIV/AIDS Epidemic in Miami-Dade County Kira Villamizar, BS, MPH HIV/AIDS Program Coordinator Florida Department of Health in Miami Dade

The Epidemic in Miami-Dade HIV/AIDS in Florida, 1981-2005 Population in 2013: 2.5 million  (1st in the state) Newly diagnosed HIV infections in 2013: 1,436 (1st in the state in 2013) Newly diagnosed AIDS cases in 2013: 709 (1st in the state in 2013) Cumulative pediatric AIDS cases reported through (1981-2013): 512 (1st in the state through 2013) Persons diagnosed and living** with HIV disease through 2013: 26,489  HIV prevalence estimate through 2013: 33,725 (Including those unaware of their status) HIV incidence in 2013: 1,436 (There was a 25% decrease from 2004-2013) HIV-related deaths in 2013: 227 (Down 1.3% from 2011). 66% Hispanic 17% Black 15% White 2% Other* 45% Black 41% Hispanic 12% White 2% Other* Cummulative 1981-2013 The Epidemic in Florida Population in 2013: 19.2 million  (4th in the nation) Newly diagnosed** HIV infections in 2013: 4,864 (2nd in the nation in 2011) Newly diagnosed** AIDS cases in 2013: 2,532 (3rd in the nation in 2011) Cumulative pediatric AIDS cases reported through 2013: 1,547 (2nd in the nation in 2011) Persons diagnosed and living*** with HIV disease through 2012: 105,627 (3rd in the nation in 2010) HIV prevalence estimate through 2012: 125,000 (11.4% of the U.S. estimate for 2010) HIV Incidence Estimates 2010: 3,454 (There was a 30% decrease from 2007-2010) HIV-related deaths in 2012: 923 (Down 8.2% from 2011. The first time to ever be under 1,000 deaths in a given year.) *Other = Asian/Pacific Islanders; American Indians/Alaskan Natives; multi-racial. **Data by year of diagnosis for 2013 are incomplete and should be interpreted with care *** Living (prevalence) data as of 06/30/2013 *Other = Asian/Pacific Islanders; American Indians/Alaskan Natives; multi-racial. **Living (prevalence) data as of 06/30/2013 12 12 12

The Epidemic in Miami-Dade (Cont.) Nearly 1 in 6 people with HIV don’t know they are infected, don’t get medical care and can pass the virus on to others without knowing it An estimated 60% of people with HIV are getting the care they need to manage their virus

Adult AIDS Cases by Race/Ethnicity and Year of Report, 2004-2013, Partnership 11a Black Factors Affecting Disparities Late diagnosis of HIV. Access to/ acceptance of care. Delayed prevention messages. Stigma. Non-HIV STD’s in the community. Prevalence of injection drug use. Complex matrix of factors related to socioeconomic status Hispanic White Adult AIDS Cases by Race/Ethnicity and Year of Report 2004-2013, Partnership 11a Note: In 2013, blacks accounted for 48% of adult AIDS cases, but only 16% of the population. From 2004 to 2013, the proportion of adult AIDS cases increased by 10 percentage points among Hispanics. In contrast, the proportion of adult AIDS cases decreased among whites and blacks by 2 and 6 percentage points, respectively, during the same time period. Numerous disparities can affect the increases of HIV disease in a given population. Other races represent less than 3% of the cases and are not included. Year 04 05 06 07 08 09 10 11 12 13 White 9 9 10 7 9 9 6 7 7 7 Black 54 55 52 57 52 50 51 52 45 48 Hispanic 34 34 36 33 37 38 40 40 45 44 Note: In 2013, blacks accounted for 48% of adult AIDS cases, but only 16% of the population. From 2004 to 2013, the proportion of adult AIDS cases increased by 10 percentage points among Hispanics. In contrast, the proportion of adult AIDS cases decreased among whites and blacks by 2 and 6 percentage points, respectively, during the same time period. Numerous disparities can affect the increases of HIV disease in a given population. Other races represent less than 3% of the cases and are not included.

Adult HIV Infection and AIDS Cases by Sex, Reported in 2013, Partnership 11a HIV Infection N=1,432 AIDS N=708 Adult HIV Infection and AIDS Cases by Sex, Reported in 2013, Partnership 11a Note: Partnership 11a’s Adult Population is: 48% Male and 52% Female. Adult HIV Infection Cases by Sex, 2013 (N=1,432) Males 1,115 Females 317 Adult AIDS Cases by Sex, 2013 (N=708) Males 511 Females 197 Note: Partnership 11a’s Adult Population is: 48% Male and 52% Female.

Adult HIV and AIDS Cases Reported in 2013 and Population Data, by Race/Ethnicity, Partnership 11a 2013 Partnership 11a Population Estimates* N=2,184,346 HIV Infection N=1,432 AIDS N=708 Adult HIV and AIDS Cases Reported in 2013 and Population Data, by Race/Ethnicity, Partnership 11a Note: In this snapshot for 2013, blacks are over-represented among the HIV and AIDS cases, accounting for 37% of adult HIV cases and 44% of adult AIDS cases and, but only 16% of the adult population. A group is disproportionately impacted to the extent that the percentage of cases exceeds the percentage of the population. *Source: Population estimates are provided by Florida CHARTS as of 06/03/2014. **Other includes Asian/Pacific Islanders, Native Alaskans/American Indians and mixed races. HIV (N=1,432) Race/Ethnicity White Black Hispanic Other # of Cases 161 533 719 19 2013 Partnership 11a Population Estimates* (N=2,184,346) Pop. # 321,277 352,372 1,460,057 50,640 AIDS (N=708) # of Cases 51 341 310 6 White Black Hispanic Other** Note: In this snapshot for 2013, blacks are over-represented among the HIV and AIDS cases, accounting for 37% of adult HIV cases and 44% of adult AIDS cases and, but only 16% of the adult population. A group is disproportionately impacted to the extent that the percentage of cases exceeds the percentage of the population. *Source: Population estimates are provided by Florida CHARTS as of 06/03/2014. **Other includes Asian/Pacific Islanders, Native Alaskans/American Indians and mixed races.

Number and Percentage of HIV-Infected Persons Engaged in Selected Stages of The Continuum of HIV Care — Partnership 11a, 2013 Definitions HIV-infected=HIV diagnosed cases divided by 84.2% (to account for 15.8% national estimated unaware of their status in Florida). The 2011 indicator report (http://www.cdc.gov/hiv/pdf/2011_Monitoring_HIV_Indicators_HSSR_FINAL.pdf ) estimates that 15.8% are undiagnosed (Table 9a) – this report uses 2010 data and was published in October 2013. HIV Diagnosed=Number of cases known to be alive and living in Florida through 2013, regardless where diagnosed, as of 06/30/2014 (used for unmet need calculations). Linked to Care (Ever in Care) =86% of those cases were linked to care, based on persons living with HIV disease in Florida (regardless of where diagnosed) who ever had a CD4 or Viral load (VL) test in the electronic HIV/AIDS Reporting System (eHARS) (2010 National estimates are 79%*). In Care this Year=55% of cases were in care this year, based on Health Resources and Services Administration (HRSA) unmet need definition, for persons living with HIV in Florida (regardless of where diagnosed) and having at least 1 HIV-related care service involving either a Viral Load or CD4 test or a refill of HIV-related prescription (2010 National estimates for in care are 56%*). On ART=Estimated 90.6% of In care this year in Florida per 2011 Medical Monitoring Project (MMP) data (2010 National estimates are 80%*). Suppressed VL=Estimated 78.0% on ART & a suppressed VL (<200 copies /mL) this year in Florida per 2011 MMP data (2010 National estimates are 70%*). *Continuum of HIV care among Ryan White HIV/AIDS Program clients, U.S., 2010 (http://hab.hrsa.gov/data/reports/continuumofcare/index.html) (1) Number of cases known to be alive and living in Florida through 2013, regardless where diagnosed, as of 06/30/2014 (used for unmet need calculations). (2) Ever in Care = 86% of those cases were linked to care, based on persons living with HIV disease in Florida (regardless of where diagnosed) who ever had a CD4 or Viral load (VL) test in the electronic HIV/AIDS Reporting System (eHARS). (2010 National estimates are 79%*). (3) 55% of cases were in care this year, based on HRSA unmet need definition, for persons living with HIV in Florida (regardless of where diagnosed) and having at least 1 HIV-related care service involving either a VL or CD4 test or a refill of HIV-related RX. (2010 National estimates for in care are 56%*). (4) Estimated 90.6% of In care and on ART this year in Florida per 2011 MMP data (2010 National estimates are 80%*). (5) Estimated 78.0% on ART & the viral load is <200 this year in Florida per 2011 MMP data (2010 National estimates are 70%*). *Continuum of HIV care among Ryan White HIV/AIDS Program clients, U.S., 2010 (http://hab.hrsa.gov/data/reports/continuumofcare/index.html) For additional information please refer to the Florida Continuum of Care slide set accessible at http://www.floridahealth.gov/diseases-and-conditions/aids/surveillance/index.html

and Death Rates by Race/Ethnicity and Sex Resident Deaths due to HIV Disease By Year of Death, 1995-2013, Partnership 11a Resident Deaths due to HIV Disease By Year, 1995-2013, Partnership 11a, and Death Rates by Race/Ethnicity and Sex These data represent a 81% decline in HIV resident deaths due to HIV disease from the peak year of 1995 to 2013. This is slightly higher than the 78% decline observed by the state. Source: Florida Department of Health, Bureau of Vital Statistics, Death Certificates (as of 05/16/2014). Population data are provided by Florida CHARTS. *Other includes Asian/Pacific Islanders, Native Alaskans/American Indians and mixed races. Year # of Deaths 1995 1,182 1996 886 1997 545 1998 444 1999 516 2000 840 2001 466 2002 411 2003 424 2004 442 2005 407 2006 443 2007 397 2008 352 2009 282 2010 268 2011 230 2012 218 2013 227 These data represent a 81% decline in HIV resident deaths due to HIV disease from the peak year of 1995 to 2013. This is slightly higher than the 78% decline observed by the state. Source: Florida Department of Health, Bureau of Vital Statistics, Death Certificates (as of 05/16/2014). Population data are provided by Florida CHARTS. *Other includes Asian/Pacific Islanders, Native Alaskans/American Indians and mixed races.

NHAS Goals for Reducing HIV Incidence Reducing the number of people who become infected with HIV Increasing access to care and optimizing health outcomes for people living with HIV; and Reducing HIV-related disparities

Goal Achieving a More Coordinated National Response to the HIV Epidemic Increase the coordination of HIV programs across the Federal Government and between Federal agencies and State, territorial, local, and tribal governments. Develop improved mechanisms to monitor and report on progress toward achieving national goals. Linkage to care Protocol Aims to increase linkage to care rates within Miami Dade county C/T sites. Enhances collaboration and coordination between C/T sites and Ryan White outreach workers with the purpose of facilitating linkage to care for both newly identified and previous positives. This protocol also maximize use of resources in the community and avoids duplication of services.

Partnership with Metro Transit (Take the Train-Take the Test) Goal Activities Achieving a More Coordinated National Response to the HIV Epidemic Increased Collaboration with Ryan White Part A to maximize use of resources in the community (data sharing, linkage to care, prevention plan and comprehensive plan) Partnership with Miami Dade County Board of County Commissioners (Days of observance, county resolution) Partnership with Metro Transit (Take the Train-Take the Test) Linkage to care Protocol Aims to increase linkage to care rates within Miami Dade county C/T sites. Enhances collaboration and coordination between C/T sites and Ryan White outreach workers with the purpose of facilitating linkage to care for both newly identified and previous positives. This protocol also maximize use of resources in the community and avoids duplication of services. Miami Dade Comprehensive Plan includes some of the activities listed on the Miami Dade HIV Prevention Plan. Miami Dade county Board of County Commissioners passed a resolution naming the fist week of December as AIDS Awareness week in Miami Dade County, Conducted activities in collaboration with Miami Dade County to promote National Days of Observance Met with commissioner’s chief of staff to present the epidemic at their districts and elicit their support to address the epidemic within their district. Attended the 2013 September meeting of the South Florida Federal Executive Board to seek their collaboration and support in order to achieve a more coordinate response to the HIV epidemic in Miami Dade. Schedule to present to the board on September 17th on the local efforts to address NHAS

Achieving a More Coordinated National Response to the HIV Epidemic How Can We Collaborate? Linking newly released HIV positive inmates to medical care and services Providing housing assistance to HIV positive persons Providing substance abuse and mental health treatments Engaging more faith leaders to promote nonjudgmental support for people living with HIV Ensuring equal employment opportunities If they have established relationships in the community they could work closer to promote HIV/AIDS VA- promote education, awareness and routinizing HIV testing in the clinics SS- information on same sex marriage and changes made as it relates to this issue

Thank You Questions?

Kira Villamizar B.S., M.P.H. Florida Department of Health in Miami-Dade County Health Manager Email: Kira.Villamizar@flhealth.gov Phone: (305) 643-7425 Mailing Address: 2515 West Flagler Street Floor: 02 MIAMI, FL 33135