HIV in the Deep South: Epidemiology* and Prevention Funding Inequities

Transcription

1 HIV in the Deep South: Epidemiology* and Prevention Funding Inequities Carolyn McAllaster, Clinical Professor of Law Director, Southern HIV/AIDS Strategy Initiative (SASI) Duke University School of Law Valerie Mincey President BASIC NWFL, Inc. *Thanks to Susan Reif, Center for Health Policy and Inequalities Research, Duke University

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5 Southern HIV/AIDS Strategy Initiative (SASI) Broad-based Southern Coalition of HIV/AIDS advocates and their supporters Working with to develop research-based policy & strategy recommendations aimed at securing a federal commitment for the Deep South HIV epidemic Focused on the US South, particularly on 9 Deep South states (referred to as the targeted states) that have been disproportionally affected by HIV: AL, FL, GA, LA, MS, SC, NC, TN, TX

6 SASI Geographic Region Targeted States: A group of 9 Deep South states particularly affected by HIV that also shares characteristics such as overall poorer health, high poverty rates, and a cultural climate that likely contributes to the spread of HIV and poor health outcomes for those infected. (AL, FL, GA, LA, MS, NC, SC, TN, TX)

7 Overview HIV Epidemiology including HIV diagnoses, prevalence and death rates in the Deep South ; Analysis of CDC direct prevention funding of community-based organizations pursuant to PS ; Action Steps to address CDC Prevention funding inequities; Impact of Funding Losses to Southern CBOs

8 Number of Dx per 100,000 of Population HIV Diagnosis Rates: Deep South region had the highest HIV diagnosis rates and the highest number of new diagnoses. (n= 109,019* over 6 years) Targeted South Rest of South Northeast West Midwest Total US CDC Atlas database:

9 HIV Diagnoses Demographic Trends A majority of HIV diagnoses in the Deep South were among black/african Americans (56.4% in 2008; 54.4% in 2013) The percentage of newly diagnosed individuals that were Hispanic/Latino increased from 16.8 in 2008 to 19.6 in 2013 in the Deep South. In 2013, over one-third (37%) of the 10,101 Hispanic/Latino individuals diagnosed with HIV resided in the Deep South. CDC Atlas Database:

10 Percentage of HIV diagnosis that were black MSM The percentage of HIV diagnoses that were black MSM increased in the Deep South from 25.9% in 2008 to near one-third (31.4%) in In 2013, nearly half (48%) of black or African American MSM diagnosed with HIV in the US, resided in the targeted states Targeted South 25 Rest of South 20 Northeast West 15 Midwest Total US

11 Death rates among individuals diagnosed with HIV: Deep South had the highest rates of death and highest number of deaths (34,072) among those diagnosed with HIV followed by rest of the South and Northeast ( ). These rates were higher in the Deep South even after controlling for demographic characteristics such as race, age, and rural/urban residence at diagnosis (2010). Death rates among individuals diagnosed with HIV may be due to comorbidities or other causes. CDC Atlas Database:

12 Death rates with HIV as Underlying Cause Although data on death rates among PLWHA provide critical health outcome information, these statistics may not clearly reflect deaths due to HIV rather than other chronic comorbidities/acute illnesses not related to HIV. Data from the CDC Wonder database provide information about underlying cause of death. We examined CDC Wonder data regarding underlying cause of death from HIV for

13 Age Adjusted Rate of Death per 100,000 Deaths due to HIV as underlying cause ( ) Targeted South Other Southern States Northeast West Midwest The Deep South had the highest death rate where HIV was an underlying cause of any US region. The targeted states also had the highest number of individuals dying from HIV in (n=21,308; 43% of overall deaths) Total US CDC Wonder Database, Underlying Cause of Death

14 HIV Surveillance Data: 2014 In comparison to other regions the Deep South had higher: HIV diagnosis rates AIDS diagnosis rates Death rates among individuals diagnosed with HIV Nine of the 10 Metropolitan Statistical Areas (MSA)s with the highest HIV diagnosis rates and 9 of the 10 MSAs with the highest AIDS diagnosis rates were in the Deep South states. HIV Surveillance Report:

15 10 MSAs with the highest AIDS diagnosis rates rates: 2014

16 SASI Analysis of CDC s recent direct prevention funding for Community-based Organizations PS Centers for Disease Control & Prevention (CDC) funding designed to reach areas with greatest need for HIV prevention services. Restricts eligibility for direct funding to community based organizations (CBOs) to those located in designated metropolitan statistical areas CBOs outside those areas are not eligible to apply for funding.

17 SASI Analysis of % of PLWHA Living Outside an MSA eligible for CBO Funding from CDC 27.61% 69.96% 63.01% 57.45% 68.41% 34.20% 21.56% 32.39% 21.25% Percent HIV+ Population Not Living in MSA 0-20% 20-40% 40-60% 60+%

18 For example: North Carolina Living HIV Disease Cases, as of 12/31/2010, by County of Current Residence

19 New MSA requirement reduces federal prevention funding available for CBOs in the Deep South 12 CBOs in Deep South who received funding in 2004 would have been ineligible to apply under 2015 standards. Would have lost $3,838,975. In 2010 CBO application, loss would have been $2,570,302. Loss in direct CBO Prevention Funding is not made up by State Health Departments CDC grant. States not awarded additional dollars to make up for CBO funding losses.

20 SASI Analysis of Funds Distributed to eligible community based organizations in the US under the recent CDC funding opportunity (PS )

21 CDC s Recent Funding Allocation to CBOs Summary Region/State [1] Total PS Funding Amount Received Percentage of Total US PS Funding Received Percentage of new HIV diagnoses in US (2013) Percentage of People Living with HIV in US (year-end 2012) United States $40,615, % 100% 100% South $13,483,383 33% 51% 43% Deep South Region $10,683,383 26% 40% 34% Florida $1,050,000 3% 11% 11% New York & California $14,794,561 36% 19% 27%

22 Conclusions from SASI Analysis Recent CDC funding to CBOs is inconsistent with the geographic distribution of the epidemic both within states and between regions. Additional resources are needed for the South and within the South, for the large urban centers and the rural and smaller urban areas with heavy HIV burden.

23 Requested CDC Action Steps 2 nd tier of HIV prevention grants to directly fund CBOs outside the large urban areas with heavy HIV burden; That in the next funding announcement, the CDC allocate funds by region in proportion to the epidemic s distribution and allow for competitive processes in each of the 4 regions; That CDC allow funded CBOs to serve surrounding less urban counties; That the CDC require State Health Departments to make publically available the details of how CDC State Health Department Prevention funds are distributed within each State.

24 Take Action with the SASI/SAC Toolkit The Campaign: To generate letters to CDC Prevention Director, Dr. Eugene McCray Action Toolkit: Letter introducing the campaign 2-page Fact Sheet: Impact of Recent CDC Funding on Southern CBOs State-based Fact Sheet State-based Slide Presentation You ll also need: Stationery and envelopes

25 Take Action with the SASI/SAC Toolkit (cont d) Send letters by May 1 st to: Southern HIV/AIDS Strategy Initiative Duke Law School Box Durham, NC 27708

26 Impact of Funding Losses to Southern Community-based Organizations Valerie Mincey, President BASIC NWFL, Inc. Panama City, Florida

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28 Raise your Hand, Use the Question Feature to Ask Questions, or questions You may also your questions to

29 Follow SASI and SAC s Work Visit the SASI website to join the SASI/SAC list serves: sasi@law.duke.edu Visit the SAC website