Center for Health Policy Health Inequalities Program Duke University Beth Stringfield

There is an HIV/STD epidemic in Guilford County Number of new HIV/AIDS cases in 2007

HIV/STDs in Guilford County  33,635 cases of reportable STDs Underestimated Rates exceed NC averages Number excludes other STDs

HIV/STDs in Guilford County  1615 cases of HIV/AIDS 3 rd highest in the state Approximately 339 with unknown HIV infection

HIV/STDs in Guilford County  Many more at high risk! Drug use ○ 39% HS students drank alcohol ○ 38% HS students smoked marijuana Sexual risk ○ 48% HS, 17% of MS students sexually active ○ Only 37% of adolescents reported condom use ○ Only 26% of adults reported condom use

HIV/STDs in Guilford County  Racial and ethnic disparities Rates of STDs 10x greater among non-Whites New AIDS cases ○ 69.1% African American ○ 29.1% White Why? ○ Lower income and education levels ○ Poorer access to health care ○ High levels of HIV/STD stigma

HIV/STDs in Guilford County  Economic and Societal Costs Lifetime medical costs range from $266,600 to $385,000, depending on when an individual begins treatment. ARV therapy alone costs around $1,500 per month for a patient with >300 CD4 count. The lifetime costs associated with productivity losses are $742,100.

HIV/STDs in Guilford County  In addition to a worsening epidemic and widening disparities… America has gone silent on HIV/STDs Federal funding has decreased or remained stable Restrictions on federal funding Access to care limitations Economic downturn

What is currently being done in Guilford County?  Community based organizations work together to meet the prevention and treatment needs of Guilford County’s population Outreach, testing, and coordinating services ASOs already implement evidenced based interventions to reach high risk populations ASOs have demonstrated competence

What are the gaps in services?  Needs assessments, personal interviews, and focus groups have highlighted areas of need Prevention services for youth, Hispanics, MSM, and HIV+ individuals Treatment and service capacity

Reducing Transmission in Guilford County  Efforts to prevent disease transmission are critically important  Effective HIV prevention efforts combine behavioral, biomedical, and structural interventions

Reducing Transmission in Guilford County  Behavioral Interventions Designed to reduce HIV/STD risk and are conducted at the individual, group, or community level Evidence of efficacy (25-50% risk reduction) 63 Evidenced-Based Interventions ( EBIs) 21 Diffusion of Evidenced Based Intervention programs (DEBIs)

Reducing Transmission in Guilford County  Biomedical Interventions Based on biological sciences HIV/STD testing ○ Identify to prevent future transmission ○ Facilitate early entry into treatment Antiretroviral treatment ○ Reduce infectiousness ○ Improve quality of life

Reducing Transmission in Guilford County  Structural Interventions Address structures, laws, or policies which may affect transmission risk or access to prevention, treatment, and care services Improve availability, accessibility, and acceptability of HIV/STD services

What can MC-WLCHF do?  Funding is needed to address HIV/STDs Recommendations consider current funding and service availability, forthcoming funding changes, service gaps, and intervention efficacy and cost-effectiveness Build on the strengths of service providers Behavioral, biomedical, and structural strategies

What can MC-WLCHF do?  Behavioral Interventions Implement behavioral interventions to meet prevention needs of youth, Hispanics, MSM, and HIV+ individuals ○ DEBI examples: Focus on imPACT, VOCES, Popular Opinion Leader, CLEAR Continue to support behavioral interventions for high risk populations ○ DEBI examples: SISTA, RAPP, Community Promise

What can MC-WLCHF do?  Biomedical Interventions Support routine HIV testing in medical care settings Increase funding for case management and continue funding for support services  Structural Interventions Support an HIV/STD advocacy group Provide capacity building services including evaluation assistance

What are the consequences of doing nothing?  Many programs which currently provide essential services to high risk populations will not be funded  Additional services that could help prevent future infections will not be available  The number of individuals with unknown infection will remain high and these people may unknowingly infect others  Reductions in support services for HIV+ individuals will likely result in less access and adherence to medications, poorer QOL, and increases in HIV transmission  Disparities by race/ethnicity will continue to widen  Moses Cone remains the only major private funder in Guilford County. Removing this funding will have a significant impact on treatment, care and prevention services in Guilford County

Authors  Sara LeGrand, MS  Matthew Toth, MSW

Beth Stringfield, Program Director North Carolina Community AIDS Fund Duke University Center for Health Policy 2812 Erwin Road, Suite 403 Durham, NC