National HIV/AIDS Strategy (NHAS)

Regional Resource Network Program U.S. Department of Health & Human Services

National HIV/AIDS Strategy (NHAS)

South Florida Federal Executive Board Meeting

September 18, 2014

AlabamaFloridaGeorgiaKentuckyMississippiNorth CarolinaSouth CarolinaTennessee

Region IV Office of the Assistant Secretary for Health

Regional Resource Network Program

Regional Resource Network Program U.S. Department of Health & Human Services

National HIV/AIDS Strategy for the United States

Regional Resource Network Program U.S. Department of Health & Human Services

NHAS Vision

The United States will become a place where new infections are rare and when they do occur, every person, regardless of age, gender identity, or socio-economic circumstance, will have unfettered access to high quality, life-extending care, free from stigma and discrimination. —NHAS July 2010

Regional Resource Network Program U.S. Department of Health & Human Services

National HIV/AIDS Strategy

Goals:• Reduce HIV incidence• Increase access to care and optimize health outcomes• Reduce HIV-related health disparities

“Our country is at a crossroads. Right now, we are experiencing a domestic epidemic that demands a renewed commitment, increased public attention, and leadership.”President Barack ObamaJuly 13, 2010

Regional Resource Network Program U.S. Department of Health & Human Services

A More Coordinated National Response to HIV/AIDS

• Ensure coordinated program administration

• Promote equitable resource allocation• Streamline and standardize data

collection• Provide rigorous evaluation of current

programs and redirect resources to the most effective programs

• Provide regular public reporting• Encourage States to provide regular

progress reports

Regional Resource Network Program U.S. Department of Health & Human Services

Implementing the National HIV/AIDS Strategy

Regional Resource Network Program U.S. Department of Health & Human Services

HIV Care Continuum The HIV Care Continuum Initiative calls for coordinated action in response to data that has been released since the Strategy three years ago, showing only a quarter of people living with HIV in the United States have achieved the treatment goal of controlling the HIV virus.

Regional Resource Network Program U.S. Department of Health & Human Services

Ways to Support the NHAS

• Discuss what your agency or organization can do in new or different ways

• Participate in state and local discussions about HIV

• Engage new partners in HIV prevention, care, treatment, and stigma-reduction to reach more people

Regional Resource Network Program U.S. Department of Health & Human Services

Chiquita F Covington, MPARegional Resource Coordinator

Office of the Assistant Secretary for HealthU.S. Department of Health and Human Services, Region IV

Office: (404) 562-7901Email: [email protected]

Regional Resource Network Program U.S. Department of Health & Human Services

The HIV/AIDS Epidemic in Miami-Dade County

Kira Villamizar, BS, MPH

HIV/AIDS Program Coordinator

Florida Department of Health in Miami Dade

The Epidemic in Miami-DadePopulation in 2013: 2.5 million

(1st in the state)Newly diagnosed HIV infections in 2013: 1,436

(1st in the state in 2013)Newly diagnosed AIDS cases in 2013: 709

(1st in the state in 2013) Cumulative pediatric AIDS cases reported through (1981-2013): 512

(1st in the state through 2013)

Persons diagnosed and living**with HIV disease through 2013: 26,489

HIV prevalence estimate through 2013: 33,725(Including those unaware of their status)

HIV incidence in 2013: 1,436(There was a 25% decrease from 2004-2013)

HIV-related deaths in 2013: 227(Down 1.3% from 2011).

66% Hispanic17% Black15% White2% Other*

*Other = Asian/Pacific Islanders; American Indians/Alaskan Natives; multi-racial. **Living (prevalence) data as of 06/30/2013

45% Black41% Hispanic 12% White 2% Other*

The Epidemic in Miami-Dade (Cont.)

• Nearly 1 in 6 people with HIV don’t know they are infected,

don’t get medical care and can pass the virus on to others

without knowing it

• An estimated 60% of people with HIV are getting the care

they need to manage their virus

Adult AIDS Cases by Race/Ethnicity and Year of Report,

2004-2013, Partnership 11a Factors Affecting Disparities-Late diagnosis of HIV.-Access to/ acceptance of care.-Delayed prevention messages.-Stigma.-Non-HIV STD’s in the community.-Prevalence of injection drug use.-Complex matrix of factors related to socioeconomic status

Note: In 2013, blacks accounted for 48% of adult AIDS cases, but only 16% of the population. From 2004 to 2013, the proportion of adult AIDS cases increased by 10 percentage points among Hispanics. In contrast, the proportion of adult AIDS cases decreased among whites and blacks by 2 and 6 percentage points, respectively, during the same time period. Numerous disparities can affect the increases of HIV disease in a given population. Other races represent less than 3% of the cases and are not included.

2004 2005 2006 2007 2008 2009 2010 2011 2012 20130

10

20

30

40

50

60

Year of Report

Per

cen

t o

f C

ases

Black

Hispanic

White

AIDS N=708

HIV InfectionN=1,432

Note: Partnership 11a’s Adult Population is: 48% Male and 52% Female.

Adult HIV Infection and AIDS Cases by Sex,Reported in 2013, Partnership 11a

78%

22%

MaleFemale

72%

28%

White Black Hispanic Other**

Note: In this snapshot for 2013, blacks are over-represented among the HIV and AIDS cases, accounting for 37% of adult HIV cases and 44% of adult AIDS cases and, but only 16% of the adult population. A group is disproportionately impacted to the extent that the percentage of cases exceeds the percentage of the population. *Source: Population estimates are provided by Florida CHARTS as of 06/03/2014.**Other includes Asian/Pacific Islanders, Native Alaskans/American Indians and mixed races.

Adult HIV and AIDS Cases Reported in 2013 and Population Data, by Race/Ethnicity, Partnership 11a

7%

48%

44%

1%

15%

16%

67%2%

11%

37%

50%

1%

AIDSN=708

2013 Partnership 11a Population Estimates*

N=2,184,346

HIV InfectionN=1,432

Number and Percentage of HIV-Infected PersonsEngaged in Selected Stages of

The Continuum of HIV Care — Partnership 11a, 2013

Series10%

10%20%30%40%50%60%70%80%90%

100%100%

77%

45%41%

32%

(1) HIV Diagnosed

(2) Linked to Care

(3) In Care this Year

(4) On ART

(5) Suppressed Viral Load (<200 copies/mL on ART)

Continuum of HIV Care

Perc

ent o

f Cas

es

HIV-infected = 30,42625,619

19,737

11,51410,432

8,137

77% of those di-agnosed with HIV were linked to care. 58% of those

linked to care were in care this year.

91% of those in care this year were on ART.

78% of those on ART have a suppressed VL.

(1) Number of cases known to be alive and living in Florida through 2013, regardless where diagnosed, as of 06/30/2014 (used for unmet need calculations). (2) Ever in Care = 86% of those cases were linked to care, based on persons living with HIV disease in Florida (regardless of where diagnosed) who ever had a CD4 or Viral load (VL) test in the electronic HIV/AIDS Reporting System (eHARS). (2010 National estimates are 79%*). (3) 55% of cases were in care this year, based on HRSA unmet need definition, for persons living with HIV in Florida (regardless of where diagnosed) and having at least 1 HIV-related care service involving either a VL or CD4 test or a refill of HIV-related RX. (2010 National estimates for in care are 56%*). (4) Estimated 90.6% of In care and on ART this year in Florida per 2011 MMP data (2010 National estimates are 80%*).(5) Estimated 78.0% on ART & the viral load is <200 this year in Florida per 2011 MMP data (2010 National estimates are 70%*). *Continuum of HIV care among Ryan White HIV/AIDS Program clients, U.S., 2010 (http://hab.hrsa.gov/data/reports/continuumofcare/index.html) For additional information please refer to the Florida Continuum of Care slide set accessible at http://www.floridahealth.gov/diseases-and-conditions/aids/surveillance/index.html

95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 130

200

400

600

800

1000

1200

1400

1,182

886

545444

516

840

466

411 424 442 407 443397

352282 268 230 218 227

Year

Nu

mb

er o

f D

eath

sResident Deaths due to HIV Disease

By Year of Death, 1995-2013, Partnership 11aRace/Ethnicity

No. rate

White Male 12 6.1White Female 2 1.1Black Male 75 36.2Black Female 59 25.8Hispanic Male 51 6.2Hispanic Female 11 1.2Other* 17 27.9TOTAL 227 8.8

2013

These data represent a 81% decline in HIV resident deaths due to HIV disease from the peak year of 1995 to 2013. This is slightly higher than the 78% decline observed by the state. Source: Florida Department of Health, Bureau of Vital Statistics, Death Certificates (as of 05/16/2014). Population data are provided by Florida CHARTS. *Other includes Asian/Pacific Islanders, Native Alaskans/American Indians and mixed races.

NHAS Goals for Reducing HIV Incidence

• Reducing the number of people who become infected with HIV

• Increasing access to care and optimizing health outcomes for people living with HIV; and

• Reducing HIV-related disparities

GoalAchieving a More Coordinated National Response to the HIV Epidemic

• Increase the coordination of HIV programs across the Federal Government and between Federal agencies and State, territorial, local, and tribal governments.

• Develop improved mechanisms to monitor and report on progress toward achieving national goals.

GoalAchieving a More Coordinated National Response to the HIV Epidemic

• Increased Collaboration with Ryan White Part A to maximize use of resources in the community (data sharing, linkage to care, prevention plan and comprehensive plan)

• Partnership with Miami Dade County Board of County Commissioners (Days of observance, county resolution)

• Partnership with Metro Transit (Take the Train-Take the Test)

Activities

Achieving a More Coordinated National Response to the HIV

Epidemic

How Can We Collaborate?• Linking newly released HIV positive inmates to

medical care and services• Providing housing assistance to HIV positive

persons • Providing substance abuse and mental health

treatments• Engaging more faith leaders to promote

nonjudgmental support for people living with HIV • Ensuring equal employment opportunities

Thank You

Questions?

Kira Villamizar B.S., M.P.H.Florida Department of Health in Miami-Dade County

Health ManagerEmail: [email protected]

Phone: (305) 643-7425Mailing Address: 2515 West Flagler Street Floor: 02

MIAMI, FL 33135