The State of the State: Texas

1. The State of the State: Texas Susan M. Gallego, MSSW, LCSW DSHS MHSA HIV Programs Specialist 9/15/10

2. The Big Picture • In 2006, SAMHSA estimated that there are 23.6 million people who were in need of treatment for an illicit drug or alcohol use problems. • In 2008, NASTAD estimated there are approximately 1 million IDUs in the US

3. Texas DSHS MHSA – HEI Programs • Approximately $3,735,000 • 14 SAMHSA Block Grant funded programs in the state of Texas • Programs in all Regions Region 2 and 9.

4. WHO? • Persons with HIV/AIDS who have been identified as having a problem with or history of substance abuse. • Significant others and/or family members of those described in #1

5. Case Management • Programs must use multiple strategies to address the complex needs of our underserved target population who are at risk for poor retention in case across the HIV, substance use, and mental health arenas. “Case Management is the cornerstone of coordinating services and its success is well documented in the literature.”

6. Co-occurring Illnesses • A 2006 study of health care expenditures for HIV positive patients found that approximately 25% of HIV patients had SA and MH problems warranting outpatient visits for therapy.

7. Sept. 1 – May 31, 2010 HEI • Number of adults attending presentations: 12, 995 • Number of client referrals resulting in initial contact of service provider by client within 1 – 14 days. 3,331

8. Persons Living with HIV, Texas 1987

9. Persons Living with HIV, Texas 2007

10. Texas: The Big Picture • HAART is here, but in 2008… • 4,293 Texans were newly-diagnosed with HIV • 2,758 Texans living with HIV progressed to AIDS • 1,280 Texans living with HIV died

11. Texas: The Big Picture • Since 1980: • >107,000 Texans have been diagnosed with HIV • >41,000 Texans with HIV have died • As of year end 2008, 62,772 Texans were known to be living with HIV

12. Over 4,000 persons are diagnosed with HIV in Texas annually • A quarter of newly diagnosed HIV cases are late diagnoses • African Americans are disproportionately affected by HIV, with rates of diagnosis nearly 7 times and 5 times greater than whites and Hispanics, respectively

13. White 48% Black 11% 36% Hispanic 5% Other/Unknown Newly-diagnosed HIV Cases by Race/Ethnicity: Texas, 2008 Texas Population n=24,383,647 New HIV Cases n=4,293 29% 43% 26% 2%

14. MSM continue to represent the largest proportion of newly diagnosed HIV cases • Number of persons known to be living with HIV continues to increase annually

15. HIV/AIDS by Mode of ExposureTexas 2007

16. Estimated Persons Living with HIV – Diagnosed and Undiagnosed: Texas, 2008

17. Newly Diagnosed HIV Cases, Deaths, and Persons Livingwith HIV, Texas, 1980-2008 Living with HIV New HIV Cases Deaths among HIV Cases

18. Late Diagnosis • Nearly 25% of Texans diagnosed with HIV are diagnosed with AIDS within one month of their HIV diagnosis • Everyday in Texas, an average of 3 people first learn they are HIV positive when they have already developed AIDS

19. STDs: The Connection • In 2009, reportable STD rates among Blacks for Chlamydia, gonorrhea and P&S syphilis were 2 to 9 times greater than case rates among Hispanics and 6 to 13 times greater than rates among Whites • In 2009, 68% of all reportable STDs were reported among 15-24 year-olds • 1 in 39 young people • 1 in 14 young Blacks

20. FOCUS 2011 • Integration – Prevention, Intervention, Treatment/Care and RW Medical Case Management Referrals • Science-Evidenced Based Risk/Harm Reduction • Hepatitis and STDs • Higher standards for utilization of MI • Client Recruitment and Retention • Rapid Testing • CMBHS and caseload information

21. and Remember . . . If you think you’re too small to make a difference . . . you’ve never been in bed with a mosquito!