The San Francisco HIV Prevention Strategy, 2012-2016: An Integrated, Citywide Approach HIV Prevention Planning Council November 8, 2012.

The San Francisco HIV Prevention Strategy, 2012-2016:

An Integrated, Citywide Approach

HIV Prevention Planning CouncilNovember 8, 2012

HPPC Work Group

Richard Bargetto Chadwick Campbell David Gonzalez Paul Harkin Aja Monet (co-chair) Jessie Murphy Kyriell Noon Frank Strona Laura Thomas Channing Wayne (co-

chair)

SFDPH Staff Laurel Bristow, HPS Dara Geckeler, HPS Emalie Huriaux, HPS Kevin Hutchcroft,

HHS Eileen Loughran, HPS Oscar Macias, HPS Jenna Rapues, HPS

Timeline for Engagement & Review

August 9th HPPC Meeting: HPS provided overview of Jurisdictional Plan, identified need for work group, and timeline. HPPC executive committee established the Work Group (WG).

August 20th HHSPC Meeting: HPS provided overview of the process for developing the Strategy and invited participation of HHSPC members on the WG.

August 27th Meeting with Marin & San Mateo Counties: HPS met with the counties to provide an overview and determine how the counties will include their strategies.

September 4th HPPC WG Meeting: The WG provided feedback about what should be included in the Strategy.

September 14th HIV Testing Coordinators Meeting: HPS provided an overview of the process.

September 20th Joint HPS & HHS Meeting: HPS provided an overview of the process and garnered feedback about how to include care & treatment info.

October 1st HPPC WG Meeting: The WG provided feedback on the initial draft

October 5th HIV/AIDS Providers Network Meeting: HPS provided an overview of the process.

October 10th HPPC WG Meeting: The WG provided feedback on the draft.

October 16th Transgender Advisory Group Meeting: HPS provided an overview of the process.

October 22nd HPPC WG Meeting: The WG voted to approve the draft.

October 25th HPPC Executive Committee Meeting: The Committee reviewed the draft and approved the presentation.

November 8th HPPC Meeting: HPPC votes on concurrence

5-year plan (2012-2016) required by CDC

The Strategy outlines “the vision”

Due December 30, 2012

Will update annually, as needed

The SF HIV Prevention Strategy

Steps in the planning process

Stakeholder identification

Results-oriented engagement

process

SF HIV Prevention Strategy

development, implementation, and monitoring

Shared Roles/Responsibilities of SFDPH & HPPC

Ensure collaboration and coordination of HIV prevention, care, and treatment services.

Ensure that the SF Strategy aligns with the goals of the National HIV/AIDS Strategy.

Ensure services and resources are directed and disseminated to the areas with the greatest HIV burden.

Roles/Responsibilities

SFDPH

Submit the SF Strategy to CDC.

HPPC

Inform the development of the SF Strategy.

Five components of “high-impact prevention”:

1. Effectiveness and cost;

2. Feasibility of full-scale implementation;

3. Coverage in the target population;

4. Interaction and targeting of interventions; and

5. Emphasis on interventions that will have the greatest overall potential to reduce HIV infections.

The SF Strategy is guided by…

Letter to CDC from HPPC, including:

Documentation that HPPC was informed regarding the development of the Strategy;

Description of the process used to review it;

Concurrence, concurrence w/ reservations, or non-concurrence.

“The Letter”

Programmatic activities and resources are being allocated to the most disproportionately affected populations and geographical areas that bear the

greatest burden of HIV disease, including populations at greatest risk of HIV transmission and

acquisition. (definition from CDC’s community planning guidance)

or

The Strategy matches the information (e.g., epidemiology, community knowledge/experience).

Concurrence

Concurrence

Information

(epidemiology, community knowledge/ experience)

Resources

Review of Strategy Narrative

Local Epidemiology The San Francisco HIV Prevention Strategy Goals and Objectives Underlying Principles Summary

Introduction(pp. 11-14)

The HIV Prevention, Care & Treatment Cascade(pp. 15-18)

Viral suppression, achieved through secondary

and tertiary prevention efforts, is ultimately a

primary prevention strategy for HIV-negative

individuals. Thus, secondary and tertiary

prevention activities for PLWHA are primary

prevention for HIV-negative people, even those

HIV negative individuals who never come into

direct contact with any HIV prevention effort.

Gaps Along the Cascade: A Quantitative Perspective

Community Needs: A Qualitative Perspective

Populations with Significant Barriers to HIV Testing, Care, and Treatment

Structural Change Needs

Gaps and Needs in HIV Prevention, Care & Treatment(pp. 19-25)

HIV Prevention Allocation Consolidating & Coordinating Resources Health Care Reform Leveraging Private Resources to Support the

Strategy

Resources for HIV Prevention, Care & Treatment Services(pp. 26-31)

MSM IDU TFSM TOTAL “At-risk” population, 20101 72% 18% 2% 92% Incidence estimate, 20112 88% 5% 4% 97% New diagnoses, 20113 82% 6% 2% 90% PLWHA, 20114 88% 7% 2% 97%                                                           1 Special data report from H. Fisher Raymond, October 9, 2012 2 Presentation to HPPC, 1/13/2011, H. Fisher Raymond 3 2011 HIV Epi Annual Report 4 2011 HIV Epi Annual Report

90%

10%

New Diagnoses*

MSM, IDU, TFSMOther

88%

12%

HIV Prevention Resource Allocation

MSM, IDU, TFSM Other

*Data from 2011 HIV/AIDS Epidemiology Annual Report

Background

Core Activities Syringe Access & Disposal HIV Testing & Other Status Awareness Efforts Comprehensive Prevention with HIV-Positive Individuals Condom Distribution Evidence-based Interventions for HIV-negative People at

Highest Risk of Acquiring HIV (i.e., HERR) Programs to Address HIV-Related Health Disparities PrEP & PEP

Addressing Stigma, Discrimination & Criminalization

Strategies to Address HIV Prevention, Care & Treatment(pp. 32-59)

The HIV Prevention Planning Council The HIV Health Services Planning Council Integrated Prevention and Health Services

Planning

Community Planning for HIV Prevention, Care & Treatment(pp. 60-62)

Research Conducted by the HIV Prevention Section

Research Conducted by Bridge HIV Research Conducted by the HIV

Epidemiology Section

HIV-Related Research within SFDPH (pp. 63-66)

Major implementation milestones for the Strategy have already been achieved.

We are looking forward to measuring outcomes and understanding the successes and challenges created by our approach.

The Comprehensive HIV Prevention Plan outlines in detail the objectives of the Strategy and how we will measure the outcomes.

Timeline for Implementation & Conclusion(p. 67)

Part 1: SF HIV Strategy Part 2: Jurisdictional Strategy for Marin Part 3: Jurisdictional Strategy for San Mateo

Appendices HPS RFP CDC Required & Recommended Activities Table Summary of Funded Programs HIV Testing Policy

Additional Sections & Appendices

Resources allocated to most disproportionately affected populations

Special projects to reach MSM, Latino MSM, African American MSM, TFSM

MSM, IDU, TFSM combined

Resource allocation for MSM, IDU,

TFSM specifically*

“At-risk” population, 2010 92% 88% Incidence estimate, 2011 97%

New diagnoses, 2011 90% PLWHA, 2011 97%     

HIV prevention programmatic activities and resources are being allocated to the most disproportionately affected populations that bear the greatest burden of HIV, including populations at greatest risk of HIV transmission and acquisition, in San Francisco.

“The resources match the information (e.g., epidemiology, community knowledge/experience).”

Concurrence

Q & A