HIV Overview Presented by: L. William Lyons, HIV/AIDS Director, Office of HIV/AIDS

HIV Surveillance, Georgia HIV/AIDS Epidemiology Section

Persons living with HIV and new diagnoses by race/ethnicity, Georgia 2013 In 2013, an estimated 30% of the Georgia population was Black

HIV prevalence rate by race/ethnicity, Georgia 2013 6 X higher 1.6 X higher

New HIV diagnosis rate by race/ethnicity, Georgia 2013 8.2 X higher

HIV among Atlanta MSM, Involve[MEN]t Study Beginning in early 20's, there is a dramatic racial disparity in HIV prevalence in young MSM in Atlanta. By age 39, up to 60% of black MSM already have HIV. Source: Sullivan PS, Peterson J, Rosenberg ES, Kelley CF, Cooper H, et al. (2014) Understanding Racial HIV/STI Disparities in Black and White Men Who Have Sex with Men: A Multilevel Approach. PLoS ONE 9(3): e90514

New Diagnoses by Age Group among Black MSM, Georgia, 2005 to 2012

New HIV Diagnoses by Age Group among White MSM, Georgia, 2005 to 2012

Adults and adolescents living with HIV, by sex, Georgia, 2012 Adults and adolescents >= age 13, diagnosed by 09/30/2011, living 12/31/2012 Georgia = 46,495 Engaged in care >= 1 CD4 or VL in 2012 Retained in care >= 2 CD4 or VL at least 3 months apart in 2012 Prescribed ART derived from MMP (Medical Monitoring Project) sample Viral suppression (VS) = VL<200 copies/ml Excludes 270 cases for whom sex was not reported

Adults and adolescents living with HIV, by race/ethnicity, Georgia, 2012 This figure shows the number and proportion of adults and adolescents living with HIV infection in Georgia 2012, engaged, and retained in care and virally suppressed, by current age in years Minimal engagement in care is similar across most age groups ranging from 50-58%, with the highest proportion engaged in care in the youngest age group Viral suppression generally increases with increasing age from 30% among those aged 13-24 years to 42% among those aged 45-54 and 40% among those aged 55 years and older Adults and adolescents >= age 13, diagnosed by 09/30/2011, living 12/31/2012, Georgia = 46,495 Engaged in care >= 1 CD4 or VL in 2012 Retained in care >= 2 CD4 or VL at least 3 months apart in 2012 Viral suppression (VS) = VL<200 copies/ml *American Indian/Alaska Native, Asian and Native Hawaiian/Pacific Islander groups together constitute <2% of adults living with HIV in Georgia and are grouped with those of mixed or unknown race/ethnicity

HIV Prevention, Georgia Office of HIV/AIDS

Georgia’s HIV Prevention Goals By increasing the provision of routine-opt screenings for HIV in Georgia where there are high concentrations of HIV infection. By increasing the number of HIV tests conducted at public supported non-clinical sites in areas with high concentrations of HIV in Georgia. By distributing condoms in clinical and non-clinical sites. Reduce new HIV infections By increasing the provision of linkage to care, treatment, and prevention services for HIV-diagnosed individuals in Georgia. By increasing the number of HIV-positive individuals in Georgia’s public health districts who are linked to other HIV-related medical and social services. By increasing the capacity of public health supported entities to refer all newly diagnosed person to partner services (PS). Increase Access to Care and Improving Health Outcomes for people living with HIV By funding a statewide social marketing campaign with tailored messages aimed at reducing HIV infection rates among gay and bisexual men. By re-launching the Georgia Taking Control initiative to increase HIV testing and linkage to care for gay and bi-sexual men. By funding a statewide social marketing campaign with tailored messages aimed at reducing HIV infection rates among black heterosexuals. Reduce HIV-Related Health Disparities In order to meet the goals of the National HIV AIDS Strategy we have aligned our HIV Prevention Goals to match those of the strategy.

2013 HIV Testing Activities in Georgia excluding Fulton and DeKalb # of test events – 86,152 # of rapid tests – 71,623 # of newly diagnosed tested – 278 # of previously diagnosed tested – 77 Positivity rate of 0.4% Source: CT Database (EvaluationWeb) as of 06 Feb 2015 (JEE) Data excludes sites supported by Fulton/DeKalb Jurisdiction.

2013 Newly Diagnosed Positive Test Events # of test results returned – 270 (97%) # tested who attended their first medical appointment – 126 (45%) # referred to and received partner services – 175 (63%) # referred to and received prevention services – 153 (55%) # of newly-diagnosed, confirmed HIV-positive test results returned # of newly diagnosed attending their first medical appointment – we believe this number is higher but have had more to do with agencies sending in Part 2 of their form rather than waiting to confirm that the client attended their medical appointment. We have seen a 8% increase in our linkage numbers with the recent changes. Source: CT Database (EvaluationWeb) as of 06 Feb 2015 (JEE) Data excludes sites supported by Fulton/DeKalb Jurisdictions

2013 Newly Diagnosed Positive Test Events Jan 1, 2013 – Dec 30, 2013 *278 newly diagnosed test events Descriptive distribution among newly diagnosed positives tests were largely Male (78%), MSM (56%) and heterosexual contact (largely amongst black women (38%)) and 80% Black or African American. Other risk category includes MTFSM (Male-to-female sex with male) @ about 4%

2013 Newly Diagnosed Positives Test Events Jan 1, 2013 – Dec 30, 2013 *278 newly diagnosed test events

Georgia CAPUS Demonstration Project CAPUS (Care and Prevention in the United States) Demonstration Project https://dph.georgia.gov/CAPUSProject Multi-agency federal partnership: CDC, HRSA, SAMHSA, HHS Georgia awarded $2.5 million per year for 3 years Funded 9/20/12 – 9/29/15 GA one of 8 states to receive award LA, MS, NC, TN, VA, IL, MO Reduce HIV/AIDS-related morbidity / mortality among racial and ethnic minorities Georgia CAPUS Goals: Create more efficient and more effective systems to improve: HIV testing Linkage to and retention in care ART adherence Specifically targeting highest risk minority populations

Georgia CAPUS Project Components Metro Atlanta Testing and Linkage Consortium (MATLC) Corrections testing / linkage Corrections Linkage Coordinator GA DOC Meetings Trainings Testing / linkage DeKalb County Jail Anti-Stigma Initiative Re-establish Antiretroviral Treatment Access Study (ARTAS) at Grady Infectious Disease Program (IDP) Funding for community based organizations (CBOs) through RFPs Anti-Stigma Group Safe Space Healthy Steps App MSM Symposium Resource Hub Kaiser Speak Out Campaign Grant in Aid (GIA) More than half of CAPUS RFP funds were awarded to minority organizations.

Resource Hub Overview Georgia CAPUS Care Portal www.gacapus.com Purpose –statewide online resource Primary resource in Georgia for assisting statewide testing, prevention and care for HIV/AIDS, and related psychosocial and social determinants of health Collaborative development Department of Public Health Health districts Fulton/DeKalb HIV agencies / Community Based Organizations (CBOs) AID Atlanta Hotline

The Georgia FIMR/HIV Initiative An action-oriented community process that helps identify and address missed opportunities associated with perinatal HIV exposure and transmission.

Missed Opportunities for Prevention The factors involved with preventing mother-to child transmission of HIV are multi-faceted. Each transmission represents a missed opportunity for prevention. How and Why these opportunities are missed is unknown; they are likely dependent on local systems issues.

FIMR Process FIMR/HIV Goal Improve HIV care systems for pregnant women, thus leading to prevention of perinatal transmission of HIV. Identify gaps in care for not just HIV infected women but Maternal and Prenatal care and service throughout Georgia. Actively involve key partners and stakeholders to engage in discussions and plan for improvement. FIMR is an action-oriented community process that continually assesses, monitors, and works to improve service systems and community resources for women, infants and their families. It's a continuous cycle of improvement. The data collection is comprehensive, it collects data on pregnancy experience of women with HIV infection and provides an in-deph look at the systems that result in a perinatal exposure or transmission. FIMR/HIV is not a new concept and Georgia is not the only site implementing FIMR/HIV. Others have done so successfully, such as Baton Rouge, Louisiana, Philadelphia, etc. Fetal and Infant Mortality Review methodology applied to the issue of HIV perinatal transmission Steps: Case Identification (HIV-exposed infant/fetus more than 24 weeks gestation and less than 2 years old at time of review Collect the information – about maternal HIV care, prenatal care, labor and delivery Maternal interview to get her perspective Review by a Case Review Team – purpose is to identify those systems issues and make recommendations to the Community Action Team Community Action Team - make community change happen! FIMR/HIV Prevention Methodology National Resource Center HIV/FIMR 101 (June 2012)

Targeted prevention funds & materials in 2014 Over 1.2 million condoms were distributed throughout Georgia. Over 70% of Prevention funds awarded to CBOs were minority organizations. Health Districts and CBOs received more than 60,000 items (condoms, promotional materials, etc.) for dissemination during community events, including health fairs, pride festivals, and conferences. $225,000 was spent on minority focused media campaigns. CBO Prevention Funds - $372,380 ($272,355/73.1% of funds awarded to minority CBOs) - AID Gwinnett $100,025 - Comprehensive AIDS Resource Encounter (CARE) $97,355 - Someone Cares, Inc. $175,000 CBO CAPUS Funds – $1,132,514 ($628,000/ 55.5% awarded to minority CBOs) Sisterlove, Inc $118,000 Empowerment Resource Center $235,000 Someone Cares, Inc. $125,000 Columbus Wellness Center $150,000 AID Gwinnett $77,453 New Horizons Community Service Board $335,561 Union Mission $91,500 * Per CAPUS grant requirements, 25% of the total award is expected to go to CBOs. Of the 1,237,500 condoms provided to support outreach efforts, 7% were provided to minority CBOs.

Greater Than AIDS 11.8 million digital impressions 137,000 video views In partnership with Kaiser Family Foundation, we develop targeted media messages to increase knowledge, reduce stigma and promote action. 11.8 million digital impressions 137,000 video views 358 indoor PSA in targeted LGBT-friendly businesses Launched a localized campaign targeting YAAMSM 18-24 #SpeakOutHIV Greater Than AIDS is a leading public information response to the U.S. domestic epidemic, overseen by the Kaiser Family Foundation and supported by a broad array of public and private sector partners. GDPH has partnered with GTA/Kaiser since 2009. Prevention ($180K) and CAPUS ($225K) funds are used to develop targeted media messages, (often featuring GA residents) and community outreach aim to increase knowledge and understanding about HIV, reduce stigma and promote actions to stop its spread. In 2014, digital placements received more than 11.8 million impressions and nearly 137,000 video views. Ads were targeted to gay/bi-sexual men ages 18-50 years old, across the state. An additional 358 indoor PSAs were placed in bar restrooms in targeted LGBT-friendly businesses. Health Districts and CBOs received more than 60,000 items for dissemination during community events, including health fairs, pride festivals, and conferences. In 2014, the large majority of CBOs receiving GTA outreach materials were are minority-based – 60% (8 of 13). 3 Young MSM from Georgia were selected to attend the National Speak Out conference in Washington, DC (September 2014).  They received training as campaign ambassadors and are now featured in the national campaign, targeting gay and bi-sexual men ages 18-34. In a concentrated effort to target Georgia’s MSM, we have leveraged our prevention funds to activate the “Speak Out” campaign in Georgia. In January, #SpeakOutHIV identified 20 young, gay and bi-sexual men from across the state of Georgia - both HIV positive and negative - to share their personal stories about HIV. #SpeakOutHIV is an LGBTQ youth-driven social media campaign from Greater Than AIDS to challenge the silence and stigma around HIV. Greater Than AIDS is a leading public information response to the U.S. domestic HIV/AIDS epidemic.

MSM Symposium Collaborative effort with STD Program drawing over 300 participants to address health issues, community concerns, stigma, social determinants of health, and listening sessions relevant to the MSM community. In it’s 4th year, the MSM Symposium has expanded to 3 days and will be held September 24-26, 2015. Face to face forum for healthcare providers and MSM to discuss health issues related to this population particularly HIV and other STDs During last year’s Symposium, over 300 attendees participated. This year, the conference has expanded to three days. An listening session will also take place in South Georgia to ensure that all of Georgia is represented. The HIV Prevention Program recognizes the need to target prevention efforts to address the HIV epidemic among the MSM community. A MSM Coordinator position has been established and will be dedicated to working closely with state and community partners to address barriers and integrate best practices critical to improving the health of gay and bi-sexual men in Georgia.

Ryan White Patient Care, Georgia Office of HIV/AIDS

Georgia Ryan White Part B MAI Purpose: To coordinate linkage efforts in order to maximize education and outreach strategies to link racial and ethnic minorities, specifically African-American and Hispanics, to ADAP. Focus: To target those minorities that have known of their HIV status and have not accessed care within 6-12 months, and effectively link these clients to medical care (with an emphasis on ADAP) within 90 days utilizing the Antiretroviral Treatment Access Study (ARTAS) Linkage Case Management model. Funded Districts and Linkage Coordinators: Albany, 1 Linkage Coordinator Augusta, 1 Linkage Coordinator Clayton, 1 Linkage Coordinator Columbus, 1 Linkage Coordinator Fulton, 1 Linkage Coordinator Coastal, 2 Linkage Coordinators (1 in Chatham County, 1 in Brunswick County)

ADAP Clients Served by Race CY 2014 $53 Million spent in ADAP n=8,984

Ryan White Part B Clients Served by Race CY 2014