Prepared for: HIV Prevention Planning Council January 2013

1. Prepared for: HIV Prevention Planning Council January 2013 Breaking Down Barriers:Access to HIV Testing and Treatment for San Franciscans Affected by Mental Health and Substance Use

2. Introduction • Prioritized by the HPPC in 2010 • To assess how mental health and substance use affect access to HIV testing and care • Today, presenting a brief overview of background, methods, and recommendations based on findings from needs assessment

3. National and Local Trends • National data indicate many people living with HIV/AIDS (PLWHA) are affected by mental health and/or substance use issues • In San Francisco, 30 percent of unduplicated clients living with HIV/AIDS used mental health services, 11 percent used substance use treatment (HIV Prevention Plan 2010) • Mental health & substance use impact HIV transmission and treatment adherence

4. National and Local Strategies Underway • National HIV/AIDS Prevention Strategy • San Francisco Service Integration • MAI-TCE • Integrated guidelines for screening • LINCS

5. How does this report fit in? • Provides in-depth look at how to strengthenexisting efforts underway • Offers recommendations to ensure high-quality, coordinated services for PLWHA and high-risk HIV negative people with mental health and substance use issues • Aligns with the priorities of the National HIV/AIDS Strategy to create a comprehensive system to improve health outcomes for PLWHA

6. Methods • Advisory Committee • Literature Review • Focus Groups with individuals affected by mental health • HIV-negative or status unknown, high-risk BRP (MSM, TFSM, or IDU) (n=2) • HIV-positive MSM and/or IDUs (n=8) • HIV-positive women (n=11) • Interviews with service providers (n=18)

7. Methods • Interview topics covered: Providers’ experiences with barriers, clients’ priority needs, best practices, and ways to improve service coordination • Focus Group topics covered: Barriers to testing and treatment, and ways to improve access to testing and treatment • Analysis: Content analysis using Atlas.ti

8. Recommendations

9. Integrate HIV prevention and care efforts with social services

10. Increase service coordination and communication between providers • Facilitate linkages to HIV testing and care through service coordination and better communication • Establish relationships and partnerships between different agencies and service providers • Data-sharing, case consultations and conferences “It’s about collaboration and making it seamless for clients through partnerships with other agencies. We are a small city rich with services. There’s a lot out there and it’s about helping people get to it.”

11. Increase provider capacity to address co-occurring health conditions • HIV providers should understand how different mental health disorders are manifested in client behavior • Mental health and substance use providers should understand how and when to raise the topic of HIV, risk, and sexual health with clients “If I have a client who I know is HIV-positive and I work at a mental health clinic, I have as much responsibility as an HIV [provider] to get them connected [to HIV care].”

12. Ensure that resources and referrals are in place for successful linkage to HIV testing and treatment • Navigation support • Warm hand-off referrals • Inclusive organization policies that support access • Expanded location and service hours • Transportation support • HIV screening during mental health intake & assessment

13. Develop a community-based approach to improving health outcomes

14. Link people to HIV testing and care through outreach and community engagement • Outreach and community engagement activities can bring people into testing and care “Engage folks on a social level…We got people in the door…That meant the use of food, potlucks, games, and peer facilitators.” • Peer outreach emphasized as useful tool for getting individuals into the door – peers “can act as a magnet” “People need to be able to talk with [others] who have gone through similar situations and can provide that kind of lived-in experience.”

15. Link people to HIV testing and care through outreach and community engagement (continued) • Community engagement activities are important in addressing stigma related to HIV, mental health and substance use by encouraging information-sharing “These efforts are successful because they lead to positive sense of community…These events increase the positive feeling that people have towards [our] agency, which increase trust and leads to higher levels of testing being followed up on.”

16. Address basic needs as part of comprehensive approach to improving health outcomes

17. Increase stable housing opportunities • Stable housing is essential for people affected by mental illness and/or substance use • Consider both sober living situations as well as harm reduction approaches to help people stay in housing “People need access to affordable housing…It is hard to stay connected to medical care, mental health, and other kinds of treatment when living [on the streets], bouncing in and out of shelters.”

18. Contact Kym Dorman Vice President kdorman@harderco.com 415.522.5400 http:www.harderco.com