Geographic Information Systems As a Tool for Community-based Advocacy 1 Morehouse School of Medicine 2 Satcher Health Leadership Institute 3 National Center for Primary Care 4 Dept. of Family Medicine 5 Dept. of Community Health and Preventive Medicine 6 Georgia Equality Khusdeep Malhotra 1,3,5 Harry J Heiman 1,2,4 Megan Douglas 1,3 Jeff Graham 6

Presenter Disclosures (1)The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: Khusdeep Malhotra “No relationships to disclose” (2) My presentation will include discussion of “off-label” use of the following: “No relationships to disclose”

Abstract # Issue- The purpose of this project was to demonstrate the state-wide impact of HIV/AIDS in Georgia using Geographic Information System (GIS), and increase legislative support for sustained ADAP (AIDS Drug Assistance Program) funding. Description- A legislative database of House, Senate and Congressional district representatives was created using data from an advocacy organization and the state government website. HIV/AIDS data was obtained from the Georgia Department of Public Health. Prevalence rates were calculated for , using population estimate from the American Community Survey. These rates were then linked to the legislative database using unique identifiers. Thematic maps exploring yearly trends in HIV/AIDS by Senate and House districts were used to prepare policy briefs for ADAP Citizen Lobby Day. Lessons Learned- A total of 32 maps by senate districts and 17 maps by house districts were created. Twenty-eight citizen advocates used the policy briefs to lobby legislators in the House Appropriations Committee and Senate Health and Human Services Committee, providing to them an accurate and timely picture of the status of HIV/AIDS and communicating the need for targeted state-wide intervention. The maps effectively focused attention on the state-wide nature of HIV/AIDS, aided an effective academic-community partnership and allowed the strategic messaging of a public health problem. Recommendations- Geographic Information Systems (GIS) are a powerful tool for identifying and communicating public health problems to policy makers. Its powerful visualization and analytic tools can be leveraged effectively to promote public health advocacy, empower the users of the information and inform policy decisions.

Demonstrate the use of geospatial methods to support community based advocacy and informing decision making Learning Objectives

Background: The Academic Community Partnership

Mission To develop a diverse group of exceptional health leaders, advance and support comprehensive health system strategies, and actively promote policies and practices that will reduce and ultimately eliminate disparities in health. Background: Satcher Health Leadership Institute

To advance fairness, safety and opportunity for Georgia’s lesbian, gay, bisexual, transgender and allied communities Safe Schools Workplace Fairness Public Safety Parental Rights Marriage & Relationships HIV / AIDS & LGBT Health Background: Georgia Equality Mission Issues

 Georgia HIV Advocacy Network Founded in 2009 Statewide network of providers and citizen advocates Policy analysis, advocacy training and coordinated community activities  Policy Priorities Protecting and expanding funding for HIV services and prevention Strengthening Georgia’s state support for HIV services and prevention Promoting evidence-based interventions Strengthening community capacity for advocacy HIV/AIDS Advocacy in GA

 Federal appropriations  State appropriations for ADAP  Fulton County Human Services funding  Extension of Ryan White Program  Passage of National AIDS Strategy Funding for HIV/AIDS AIDS Drug Assistance Programs  State administered programs  Provide HIV/AIDS medications to low-income individuals  Originally authorized by the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act (1990)  Were authorized under the Ryan White HIV/AIDS Treatment Modernization Act of 2006  Payer of last resort

ADAP Crisis in Georgia  Nationwide, due to the economic recession Increases in ADAP client utilization Costlier drug regimens Minimal increases in federal appropriations Heightened HIV testing Source: NASTAD  Due to increasing unemployment in Georgia, $15 million in additional funding was needed to meet the projected need for fiscal year 2013

Source: NASTAD = 37, 311 (2008, 9 th highest in nation) = 40, 328 (2009, 6 th highest in nation) (2010, 6 th highest in nation) = 41,986

Source: Kaiser Family Foundation 2012

Project Goal  Support GA Equality’s legislative advocacy to address the disproportionate impact of HIV/AIDS in LGBT communities Specific Aim 1  Establish that HIV/AIDS is a statewide issue (not restricted to Metro Atlanta) Create a user friendly, web-based GIS database of HIV/AIDS prevalence rates between at Congressional, House, & Senate district geographies

 Make legislators listen! Identify legislators to speak with Prepare fact sheets using maps for lobbying Participate in lobbying at the state capitol during the ADAP Lobby Day Specific Aim 2 Georgia Legislature in Senate districts and 180 House districts (and 13 Congressional districts) Committees targeted: Senate Health and Human Services House Appropriations

1 Rates per 100,000 calculated using 1 year population totals by house district from American Community Survey Prevalence Rates of People Living With HIV/AIDS (PLWHA) in Georgia by House District ( ) Rates of PLWHA by House District

Prevalence Rates * of People Living With HIV/AIDS (PLWHA) in Georgia by Senate District ( ) 1 1 Rates per 100,000 calculated using 1 year population estimates from the American Community Survey

Targeted Maps

Fact Sheets

Lessons Learned: Effective Communication Maps have communicative power  Maps helped focus attention on a largely ignored crisis  Maps demonstrated local impacts of a statewide crisis  Maps demonstrated HIV/AIDS was an issue across all of Georgia  Legislators responded to information focused on their districts and constituents

Lessons Learned: Coalition Building Maps helped unite stakeholders and aided coalition building This approach helped marginalized groups to participate in state advocacy GIS data & maps helped inform policy decision making

Lessons Learned: Informed Decision Making

Challenges & Conclusion Variables to measure & quantify the impact of advocacy are difficult to define Direct impact is difficult to measure “Policy change is the result of multiple actions and efforts, and it can rarely be attributed to just one project or product” – Kirwan Institute GIS is an important and underutilized tool for public health advocacy