1. P October 26, 2012 Massachusetts Department of Public Health Office of HIV/AIDS 2012 Update P roject ABLE Annual Meeting October 26, 2012

2. General Updates in the Office of HIV/AIDS

3. OHA/BID Activities and Events Massachusetts Integrated Prevention and Care Committee (MIPCC), November 2012 Implementation of Electronic Lab Reporting (ELR) effective January, 2012 4 th Generation HIV assay at State Lab National HIV/AIDS Strategy—State Plan meeting, March 13 th, 2013

4. OHA Changes Prevention and Screening Integrated testing across HIV, STI and HCV Client Health Services HIV/Infectious Disease Correctional Health HIV/Infectious Disease policy efforts Contract Management Capacity Building 27% decline in the number of OHA staff over the past eight years

5. Massachusetts HIV/AIDS Epidemic at a Glance As of September 1, 2012 a cumulative total of 31,153 MA residents have been diagnosed and reported with HIV/AIDS –18,408 MA residents are currently living with HIV/AIDS –An additional 2,393 MA residents living with HIV/AIDS were first diagnosed in another state 649 new diagnoses reported in 2010 669 new diagnoses (preliminary) reported in 2011 Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 9/1/12

6. National Estimates of Unmet Need CDC now estimates that 18% of HIV infected persons nationwide are not aware of their HIV status. OHA is able to estimate that as of January 1st, 2012 approximately 4,692 people living in Massachusetts are infected with HIV and are not aware of their HIV status.

7. Trends in HIV Infection and Death among People Reported with HIV/AIDS by Year: Massachusetts, 2000 – 2011 Diagnosis of HIV Infection Death Note: 2011 Death data are preliminary Data Source: MDPH HIV/AIDS Surveillance Program; Data as of 9/1/12

8. People Diagnosed with HIV Infection Within the Years 2008–2010 by Gender: Massachusetts Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12 N=1,994

9. People Diagnosed with HIV Infection Within the Years 2008–2010 by Race/Ethnicity: Massachusetts Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12 N=1,994

10. People Diagnosed with HIV Infection Within the Years 2008–2010 by Exposure Mode: Massachusetts Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12

11. People Diagnosed with HIV Infection within the Years 2008–2010 by Race/Ethnicity and Place of Birth: Massachusetts Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12

12. Trends in new HIV diagnoses A declining epidemic across populations

13. People Diagnosed with HIV Infection by Race/Ethnicity and Year of Diagnosis 1 : Massachusetts, 2001–2010 1 Reflects year of diagnosis for HIV infection among all individuals reported with HIV infection, with or without an AIDS diagnosis. Data Source: MDPH HIV/AIDS Surveillance Program; NH = Non-Hispanic; Data as of 1/1/12 White NH Other/Unknown Hispanic Black NH

14. Individuals Diagnosed with HIV Infection by Exposure Mode and Year of Diagnosis: Massachusetts, 2001–2010 IDU Pres. HTSX HTSX Data Source: MDPH HIV/AIDS Surveillance Program; Data as of 1/1/12 MSM MSM/IDU NIR Other

15. Men Diagnosed with HIV Infection with Male-to-Male Sex as the Exposure Mode by Race/Ethnicity and Year of Diagnosis 1 : Massachusetts, 2001–2010 1 Reflects year of diagnosis for HIV infection among all individuals reported with HIV infection, with or without an AIDS diagnosis. Data Source: MDPH HIV/AIDS Surveillance Program; NH = Non-Hispanic; Data as of 1/1/12 White NH Black NH Hispanic

16. HIV/AIDS Epidemiology of New Infections—Geographic Analysis

17. Top ten cities in Massachusetts with the greatest number of HIV infection diagnoses within the years 2008–2010 RankCityNo.% of total (N=1,994) 1 Boston53628% 2 Springfield975% 2 Worcester975% 3 Brockton633% 4 Lowell593% 5 Cambridge523% 6 Lawrence513% 7 Lynn422% 8 Waltham372% 9 Fall River362% 9 Provincetown362% Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12

18. Ten cities/towns 1 in Massachusetts with the highest average annual rate of HIV infection diagnoses, 2008–2010 RankCityAverage No.Average Rate per 100,000 1 Provincetown 12.0348.4 2 Boston 178.732.0 3 Holyoke 10.325.1 4 Everett 8.021.6 5 Brockton 21.020.9 6 Lawrence 17.020.8 7 Waltham 12.320.7 8 Springfield 32.320.7 9 Malden 11.320.0 10 Lowell 19.718.6 1 Cities with fewer than 10 total HIV diagnoses from 2008–2010 are excluded Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12

19. Massachusetts—City of Boston Among 2008–2010 HIV diagnoses in Massachusetts the city of Boston accounts for: –28% of all diagnoses (N=536, ranked 1 st ) –31% of diagnoses among MSM (N=244, ranked 1 st) –19% of diagnoses among IDU (N=35, ranked 1 st) –34% of diagnoses among Black NH individuals (N=227, ranked 1 st) –22% of diagnoses among Hispanic/Latino individuals (N=109, ranked 1 st) Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12

20. People diagnosed with HIV Infection within the years 2008 – 2010 in the city of Boston by neighborhood Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12 N=536

21. Massachusetts—City of Worcester Worcester is tied with Springfield as the 2 nd highest number of 2008–2010 HIV diagnoses among cities in Massachusetts and accounts for: –5% of all diagnoses (N=97, ranked 2 nd ) –2% of diagnoses among MSM (N=16, ranked 5 th, tied with Somerville) –11% of diagnoses among IDU (N=15, ranked 2 nd ) –7% of diagnoses among Black NH individuals (N=44, ranked 3 rd ) –6% of diagnoses among Hispanic/Latino individuals (N=30, ranked 4 th ) Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12

22. Massachusetts—City of Springfield Springfield is tied with Worcester as the 2 nd highest number of 2008–2010 HIV diagnoses among cities in Massachusetts and accounts for: –5% of all diagnoses (N=97, ranked 2 nd ) –4% of diagnoses among MSM (N=29, ranked 3 rd ) –10% of diagnoses among IDU (N=19, ranked 2 nd ) –5% of diagnoses among Black NH individuals (N=31, ranked 4 th ) –10% of diagnoses among Hispanic/Latino individuals (N=52, ranked 2 nd ) Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12

23. Top ten cities in Massachusetts with the greatest number of people living with HIV/AIDS on 12/31/11 RankCityNo.% of total (N=18,170) 1 Boston5,29629% 2 Springfield1,0316% 3 Worcester9405% 4 Lowell5103% 5 New Bedford4573% 6 Brockton4342% 7 Cambridge4142% 8 Lawrence4132% 9 Lynn3912% 10 Provincetown3292% Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12

24. Hepatitis C Overview Massachusetts

25. HIV and Hepatitis C in Massachusetts Of all Massachusetts residents diagnosed and reported with HIV/AIDS –4,215 (14%) are co-infected with hepatitis C –26,015 (86%) are infected with HIV only 649 new HIV diagnoses reported in 2010 –77 (12%) are co-infected with hepatitis C (same for males and females) –572 (88%) are infected with HIV only Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12

26. Proportion of People Diagnosed with HIV Infection in 2010 Co-Infected with Hepatitis C by Race/Ethnicity: Massachusetts Note: Patients diagnosed with HIV infection first outside of MA are NOT excluded because Hepatitis C diagnosis was made in MA Data Source: MDPH HIV/AIDS Surveillance Program, data as of 9/1/12

27. Proportion of People Diagnosed with HIV Infection in 2010 Co-Infected with Hepatitis C by Health Service Region: Massachusetts Note: Patients diagnosed with HIV infection first outside of MA are NOT excluded because Hepatitis C diagnosis was made in MA Data Source: MDPH HIV/AIDS Surveillance Program, data as of 9/1/12

28. HIV/AIDS Epidemiology of Emerging Populations — MSM and Women

29. MSM Diagnosed with HIV Infection Within the Years 2008–2010 by Race/Ethnicity: Massachusetts Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12 N=789

30. Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12 MSM and Non-MSM Males Diagnosed with HIV Infection Within the Years 2008–2010 by Age at Diagnosis: Massachusetts MSM, N=789 All Other Males, N=1,453

31. MSM Diagnosed with HIV Infection within the Years 2008–2010 by Age at Diagnosis and Race/Ethnicity: Mass. Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12

32. Women Diagnosed with HIV Infection Within the Years 2008–2010 by Race/Ethnicity: Massachusetts Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12 N=541

33. Women Living with HIV/AIDS by Race/Ethnicity: Massachusetts Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12 N=5,253

34. Women Diagnosed with HIV Infection within the Years 2008–2010 by Age at Diagnosis and Race/Ethnicity: Mass. Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12

35. Fiscal Projections State Fiscal Year 2014

36. Proportion of FY ’13 Contract Allocations by Service Type (all sources )

37. FY13 Office of HIV/AIDS Funding by Service Category State FundsRetained Revenue FederalTotalPercentage Direct Services Client Health Services 13,677,750.64 - 5,264,751.69 18,942,502.3327% Minority AIDS Initiative - - 164,048.00 0% Corrections to Community Reintegration 861,762.93 - 100,000.00 961,762.931% Prevention and Screening 12,082,740.00 -$3,711,838.72 15,794,578.7223% Rapid Test, Risk Reduction Supplies & Syringe Disposal Kiosks 1,033,512.00 - 301,319.00 1,334,831.002% HDAP 1,893,375.48 7,500,000.00$14,154,750.71 23,548,126.1934% Training and Public Information 700,681.47 - 516,493.28 1,217,174.752% Evaluation 357,735.00 - 873,176.28 1,230,911.282% Quality Management - - 245,000.00 0% Total Direct Services 30,607,557.52 7,500,000.00 25,331,377.68 63,438,935.2091% Administrative Services 0% Personnel 329,990.59 - 4,037,603.06 4,367,593.656% Operations 279,361.89 -$589,539.27 868,901.161% Consultant Services including SWCAB 479,083.00 - - 1% Other Department Support 405,030.00 - - 1% Total Administrative Services 1,493,465.48 - 4,627,142.33 6,120,607.819% Total Funding 32,101,023.00 7,500,000.00 29,958,520.00 69,559,543.00100%

38. FY2012-FY2016 CDC Calendar Year Funding Loss Ranges PART A Award RangesFunding Loss Range% Loss Range FY2012 6,551,478.00 FY2013- LowFY2013- HighFY2013-minFY2013 Max% loss- min% loss Max 5,231,100.00 5,781,700.00 (769,778.00) (1,320,378.00)12%20% FY2014- LowFY2014- High 4,732,700.00 5,230,900.00 (498,400.00) (550,800.00)10% FY2015- LowFY2015- High 4,483,600.00 4,955,500.00 (249,100.00) (275,400.00)5% FY2016- LowFY2016- High 4,234,400.00 4,680,100.00 (249,200.00) (275,400.00)6%

39. CDC Losses Across State Fiscal Years SFY13SFY14SFY15SFY16SFY17 Award Rangesminmaxminmaxminmaxminmaxminmax FY2012 6,551,478.00 FY2013- LowFY2013- High 5,231,100.00 5,781,700.00 (384,889) (660,189) (384,889) (660,189) FY2014- LowFY2014- High 4,732,700.00 5,230,900.00 (249,200) (275,400) (249,200) (275,400) FY2015- LowFY2015- High 4,483,600.00 4,955,500.00 (124,550) (137,700) (124,550) (137,700) FY2016- LowFY2016- High 4,234,400.00 4,680,100.00 (124,600) (137,700) (124,600) (137,700) (384,889) (660,189) (634,089) (935,589) (373,750) (413,100) (249,150) (275,400) (124,600) (137,700)

40. FY13 Update HDAP Costs by Program Category –Full-Pay- $5,166,048 –Co-Pay- $4,098,203 –CHII -$9,994,102 HDAP is stable in FY13

41. Fiscal “Big” Picture SFY14 Projections Projected CDC losses in 12-1201, Year 2 of the Cooperative Agreement 1/2013-12/2013 Projected HRSA losses in upcoming grant year, 4/2013-3/2014 due to allocation methodology Projected losses due to sequestration in CDC and HRSA, effective early CY 2013 State FY14 budget, current funding $32.1 million

42. CDC Projected Reductions CY2012 reductions were absorbed in SFY12 (Jan - June 2012) and SFY13 (July – Dec 2012) investments CY2013 losses will be absorbed in SFY14 investments (July – Dec 2013) Projected loss in CDC CY2013 is up to $1.3 million. –$634,000 – 935,500 will be absorbed in SFY14 –Sequestration might add another $500K reduction Total CDC loss in SFY14 as high as ~$1.4 million, including projected impacts of sequestration

43. Projected HRSA Reductions Funding methodology based on name-based HIV case reports only is applied in 2013 award Historically we received partial credit for code-based HIV cases ~10% of Massachusetts cases (HIV only) do not have a name- based report Projected up to $2 million reduction in the Massachusetts HRSA Part B award to the state –$1.5 million to HDAP –$500,000 to services (base) –Sequestration might add another $2 million reduction Potential HRSA losses of ~$4 million, including projected impacts of sequestration

44. Time frame January 2013, CDC award April 2013, HRSA award Jan-March sequestration impacts June 2013, state FY14 budget Impact of reductions may be substantial Losses will effect OHA administration Both Prevention and Care investments will be impacted

45. Thank you H. Dawn Fukuda Office of HIV/AIDS Dawn.Fukuda@state.ma.us (617) 624-5303