HIV and STDs IN Guilford County: a comprehensive guide for a way forward

1. Center for Health Policy Health Inequalities Program Duke University Beth Stringfield HIV and STDs IN Guilford County: a comprehensive guide for a way forward

2. There is an HIV/STD epidemic in Guilford County

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

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

5. 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

6. 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

7. 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.

8. 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

9. 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

10. 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

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

12. 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)

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. Authors • Sara LeGrand, MS • Matthew Toth, MSW

20. Beth Stringfield, Program Director North Carolina Community AIDS Fund Duke University Center for Health Policy 2812 Erwin Road, Suite 403 Durham, NC 27705 919.613.5431