Broward County HIV Prevention Plan BROWARD COUNTY HIV PREVENTION PLAN Broward County BCHD Broward Community Planning Partnership

Transcription

1 BROWARD COUNTY HIV PREVENTION PLAN Broward County HIV Prevention Plan Broward County BCHD Broward Community Planning Partnership

2 Contents Acknowledgements...5 PART 1: Introduction... 7 Overview of HIV Community Planning...7 Community Planning in Broward County...7 Our History...8 Our Future...9 BCPP Reorganizational Background...10 Reorganizational Goals...10 BCPP Name...10 BCPP Mission...11 BCPP Vision...11 BCPP Role...11 New BCPP Structure...11 Broward County HIV/AIDS Minority Network...12 Diagram of HIV Prevention Entities...13 Eliminated Committees...13 Part 2: Local Research & Surveillance...14 Purpose...14 Overview of this Section...14 Surveillance...15 Research...15 Overview of Our Community...16 Map of Broward County...17 Racial & Ethnic Diversity...18 Age & Gender Diversity...18 Socioeconomic Diversity...19 Sexual Orientation Diversity...19 HIV and AIDS in Broward County: An Overview...19 Demographics and HIV/AIDS Data...20 Gender...20 Race/Ethnicity...21 Age...22 Behavioral Risk Populations...23 Men who have sex with Men (MSM)...23 White MSM Key Data and Observed Trends...24 HISPANIC MSM Key Data and Observed Trends...25 BLACK MSM Key Data and Observed Trends...27 Broward Community Planning Partnership 2

3 Heterosexual Women...29 Black Females Key Data and Observed Trends...29 Hispanic Females Key Data and Observed Trends...31 White Females Key Data and Observed Trends...32 Injecting Drug Users (IDU)...34 White IDU Key Data and Observed Trends...35 Black IDU Key Data and Observed Trends...35 Hispanic IDU Key Data and Observed Trends...36 Part 3: Community Assessment:...37 Local Focus Groups...38 Focus Group Locations...40 Provider Survey...41 Part 4: Priority Setting:...42 Overview of Priority Population Selection Methodology...42 Path 1: HIV Case Data...42 Path 2: Disproportionate Impact...42 Path 3: Resource Disparity...42 Path 4: Community Planning Partnership Deliberation...43 Priority Populations...43 Methodology Data...44 Methodology Summarization...45 Part 5: Strategies & Interventions...46 Overview of HIV Prevention Interventions...46 Providing information is not enough...46 Understanding environmental and contextual factors is critical to enabling people to change behavior...46 A more realistic model of behavior change addressing risk AND vulnerability...46 Effective prevention works at multiple levels...47 Important implications for prevention programs...47 Lessons from the first two decades of HIV prevention...48 Real prevention is COMPLEX; there is no magic bullet Effective prevention takes time...48 Prevention must take a long-term perspective...48 The Science of HIV Prevention...49 Behavioral Change Theories and Effective HIV/AIDS Interventions...50 Behavioral Change Continuum of Theories...51 Diffusion of Effective Behavioral Interventions (DEBI)...51 Adaptation & Tailoring...53 Part 6: Other Significant Issues...55 Broward Community Planning Partnership 3

4 Mental Illness and HIV/AIDS...55 Domestic Violence...55 Drugs and HIV/AIDS...56 Snapshot of Drug Use Epidemiology in Broward...56 Other Infectious Diseases...57 Part 7: Conclusion / Recommendations:...59 Pending the community prevention forum on 12/05/ Appendix 1: Detailed Focus Group Findings...60 Older Driftwood Community Center...60 Substance Abuse Spectrum Programs...61 Black New Birth...61 HIV/AIDS Focus GLCC...62 Substance Use / Mental Archways...62 MDEI...63 Heterosexual Teens...64 HIV/AIDS Focus Broward House...64 References:...66 Broward Community Planning Partnership 4

5 Acknowledgements The production of this document was made possible by contributions from the following: David L. Roach Administrator, Broward County BCHD Lisa Agate Director, HIV/AIDS Program Office, Broward County BCHD Community Based Organizations Including: American Red Cross Armor Correctional Health Broward County BCHD Broward County Public Schools Broward County Sheriff s Office Broward House Body of Christ Church Broward County Government Care Resources Catholic Charities Children s Diagnostic & Treatment Center CISD Community Foundation of Broward Compassionate Hearts & Serving Hands Covenant House Florida Family to Family C.A.R.E.S. Florida International University REACH 2010 Freedom Christian Tabernacle, Inc. Gay and Lesbian Community Center Henderson Mental Health Association Hispanic Unity of South Florida Holy Cross Hospital Minority Development and Empowerment, Inc. Mothers Voices Mount Bethel Human Services Corporation Mount Olive Development Corporation New Direction Institute New Life Alfa & Omega Ministry North Broward Hospital District Nova Southeastern University Planned Parenthood Positive Images of Broward County Urban League of Broward County Broward Representatives of the Florida HIV/AIDS Comprehensive Planning Network: Kim Saiswick - Patient Care Donna Markland - Public Health Juliette Love Prevention Manny Rodriguez Former Statewide Co- Chair Edited by: Lisa Agate Shirley Fortune Aloysius Gigl Juliette Love Nikki Montgomery Jolene Mullins Donna Markland Manny Rodriguez Cover art by: Juan Lopez Authored by: George Castrataro, JD, MPH Assistant Director, Broward County BCHD HIV/AIDS Program Office For a free copy of this document, call the Broward County BCHD HIV/AIDS Program Office at (954) Broward Community Planning Partnership 5

6 Dedication BROWARD COUNTY HIV PREVENTION PLAN YEARS of hope and despair, discovery and promise, loss and renewal Broward Community Planning Partnership 6

7 PART 1: Introduction Overview of HIV Community Planning HIV community planning is an ongoing and ever evolving process whereby state and local HIV prevention/care organizations share responsibilities for developing a comprehensive HIV prevention/care plan with other state/local agencies, community based organizations and representatives of communities and groups at risk for or affected by HIV. Community Planning in Broward County The Broward Community Planning Partnership (BCPP) is the group that guides HIV prevention in Broward County, along with the Broward County BCHD. Members of the BCPP are from local communities and government, and Broward County s diverse community. The primary task of the Broward Community Planning Partnership (BCPP) is to develop a comprehensive HIV prevention plan that includes prioritized target populations and a set of prevention activities/interventions for each target population. Target populations are prioritized and prevention activities/interventions chosen based on their ability to prevent as many new infections as possible. Key information necessary to develop the comprehensive HIV prevention plan can be found in the epidemiologic profile, community research (surveys, focus group data, etc) and the community services assessment. After developing and/or reviewing these products, the BCPP will then move to the task of setting priorities for target populations using a methodology determined by the Florida Comprehensive HIV/AIDS Planning Network (FCPN). Once target populations have been prioritized, the BCPP must determine what intervention or mix of interventions will best meet the needs of the prioritized target population. The BCPP planning process is ongoing with the core goal of developing an HIV Prevention Plan every three years. This county-wide plan is designed to address all HIV prevention activities and provide a blueprint for how all HIV prevention funds are to be used, including federal, state, local, and, when possible, private resources. The BCHD and BCPP are jointly responsible for establishing the planning process. The BCPP operates under the guidance of the Florida Comprehensive HIV/AIDS Planning Network (FCPN). All involved recognize that the community planning process should be flexible. There is no one way to achieve the goal, however; the BCPP recognizes that a process that is based on shared decision making between the BCHD and the BCPP is more likely to accomplish the ultimate goals and objectives of community planning. The BCHD has worked closely with the BCPP and member agencies to jointly determine the approach for the community planning cycle (i.e., creating a reasonable time frame and the following a step-wise process to accomplish the various products of the process that lead to a comprehensive HIV prevention plan meeting all requirements). Broward Community Planning Partnership 7

8 Our History Broward County was one of the first and hardest hit epicenters of the AIDS pandemic. Sadly, as we enter 2007, Broward County continues to experience one of the most devastating epidemics in the country. Thousands of people men, women, transgendered persons, youth, and even some infants have become infected with HIV, many of those have advanced to a diagnosis of AIDS, and far too many have died. This plan is dedicated to all of them. The staff of the BCHD and members of the BCPP, who developed this Broward HIV Prevention Plan, take very seriously their responsibility to remember the devastation, to build effective and successful strategies to eliminate new HIV infections, and to improve the quality of life for those living with HIV and AIDS. Community planning began Broward County and throughout the nation during the early years of the epidemic. It is a process that was developed to reflect the belief that determining how best to respond to local HIV prevention priorities and needs is best carried out through local decisionmaking. In 1993, the Centers for Disease Control and Prevention (CDC) acknowledged that local communities should be more involved in the HIV planning process. These partnerships are made up of community members and BCHD officials, including representation from the infected and affected communities. From its inception, the BCPP has been a consistent, clear voice of the people of Broward County. The role of community planning has been clear since the early days of this epidemic. Community planning has helped identify who was at the highest risk for HIV infection. It has acted as a bridge, helping many populations (including gay men, injection drug users, youth, the recently incarcerated, and immigrants) who had not had access to safe and appropriate health care communicate with those responsible for the design and delivery of care and prevention services. Although they exist, it was never acceptable to have disparities in health care, and in the era of HIV and AIDS it became a crisis. Community planning made sure that all of these individual voices were heard. The elimination of racial and economic disparities in the delivery of health care is at the top of all public health organizations agendas. In fact, the federal government (e.g., Healthy People 2000 and Healthy People 2010), the American Public Health Association, and others have taken great strides in identifying and strategically attacking identified disparities. It is through community planning that these disparities have the best chance to be identified and eradicated. The principles of parity, inclusion, and representation that guide community planning ensure that all affected communities, including people of different racial/ethnic backgrounds, genders, and life experiences, have a voice at the table. This place is assured during the setting of the agenda, not in the middle of a process designed by others (as had too often been the historical case). In 2005, the State of Florida Department of Health Bureau of HIV/AIDS has recently announced that it could no longer provide funding for the continued existence of local community planning groups. The announcement was made during the August 2005 meeting of the Florida HIV Broward Community Planning Partnership 8

9 Community Planning Group and was effective on January 1, The difficult decision to no longer mandate and support local community planning was made after careful deliberation and was based upon several factors which include: 1) continued reductions in federal funding for HIV prevention activities coupled with the growing need for State support community based HIV prevention programs; 2) significant costs associated with State support for local community planning; and 3) federal (CDC) mandate that requires only the State to maintain a community planning group. Pursuant to federal (CDC) expectations, the State of Florida will continue to support and maintain the Florida Community Planning Group and further will further develop a local process to ensure that relevant local data and information are effectively communicated to the State. The Broward County BCHD (BCHD) fully supported the State decision and recognized that the difficult decision would afford more funding to directly support prevention activities. The BCHD also recognized the role of community planning in our community and made the decision to support community planning in a more efficient form. It is essential to note that prior to the statewide change in community planning, the BCPP had already begun to address needed structural changes. These changes were addressed by the BCPP Planning and Evaluation Committee and the BCPP Executive Committee during the 2005 calendar year. The statewide announcement coupled with the local needs resulted in the decision to implement a significant reorganization to the structure of the BCPP. The reorganization was carefully planned during the 2006 calendar year. The reorganizational plan was developed in close consultation with our partners in the FCPN, Bureau of HIV/AIDS, and numerous local key stakeholders. Our Future This HIV Prevention Plan is the result of the work and commitment of community planning in Broward County, of the BCHD, of the BCPP, and its committees in 2005 and A broad spectrum of the Broward County community members have debated the principles contained in this plan. Together we developed priorities for HIV prevention services, and together we recommended strategies and interventions to meet the needs of Broward County s community. State and federal governments must strive to meet the needs of the people. The BCPP understands and enthusiastically accepts its role as a partner in the design, delivery, and evaluation of HIV prevention and health promotion activities. In order for government and the medical and the health care communities to be successful in achieving our goals, we must mobilize the people in all of our communities and neighborhoods, in articulating a shared vision. We must recommend services that originate with those at risk for or living with HIV and their families, partners, and friends. It is essential that we each take our responsibility seriously and remain vigilant in our continued commitment to the end of this epidemic, eliminate health care disparities, and promote the health of all in Broward County. As part of this responsibility, we are pleased to implement the proposed reorganization and to release this plan for Broward Community Planning Partnership 9

10 BCPP Reorganizational Background In 1994, the Broward County BCHD established and first convened the Broward Community Planning Partnership (BCPP) in response to the growing need to further involve the community in the planning process used to address local HIV prevention priorities and needs. Since its inception, the BCPP has been composed of community members and BCHD officials, including infected and affected communities. The BCPP has been passionately committed to ensuring that community members involved in the process have reflected the epidemic in Broward County. For over ten years, the BCPP has served as the primary HIV prevention body within the county and has actively led the development and implementation of a comprehensive strategy to address HIV prevention within Broward County. In any organization, a significant change in funding necessitates an obvious reassessment of need, purpose, and direction. Before undertaking reorganization and pursuing any additional funding, the Broward County BCHD sought recommendations from numerous stakeholders within the community. The input collected sought first to examine whether the BCPP should be continued and if so, to assess how it could better serve the HIV prevention needs of our community. Consistent with the statewide elimination of funding to support the community planning process and ever evolving community needs, the following structure has been established to provide ongoing coordination and leadership for HIV prevention services in Broward County. Reorganizational Goals 1. Ensure mutually exclusivity within advisory groups 2. Ensure representation of all priority populations 3. Eliminate static committee structure and implement an advisory group structure which is more responsive approach to epidemiological changes 4. Eliminate procedural activities and focus on HIV community planning activities 5. Reduce the number of committee requirements thereby preventing the overburdening members 6. Promote coordination between advisory groups 7. Promote cross partnership planning tasks including resource inventory, prioritization and intervention selection 8. Promote linkages to other community bodies including South Florida AIDS Network and the HIV Health Planning Council BCPP Name To reflect the importance of HIV prevention planning and to build upon already established community awareness and visibility, the name will remain the Broward Community Planning Partnership. Broward Community Planning Partnership 10

11 BCPP Mission The mission of the BCPP is to develop a comprehensive HIV Prevention Plan for Broward County that will result in programs that are responsive to high priority, community-validated needs within defined populations. BCPP Vision The BCPP will serve as a model for participatory community planning throughout the nation. The BCPP seeks to: Promote community participation and involvement in HIV prevention-related services Support increases in HIV prevention planning funds Support public and private grant application funds Improve the awareness of HIV and HIV early intervention among the public Strive to reduce duplication and improve the coordination of HIV prevention services Build and strengthen community capacity in the fight against HIV disease BCPP Role The following roles represent the key areas of BCPP activity and tasks: Prioritize HIV/AIDS prevention by target population and geographic areas, and propose/adopt recommended high-priority strategies and interventions Assess existing community resources to determine the community s current capability to respond to the HIV/AIDS epidemic Identify unmet HIV/AIDS primary, secondary and tertiary prevention within defined populations. Identify specific high-priority strategies and interventions to meet the priority needs of defined populations. Develop and periodically update the comprehensive HIV/AIDS Prevention Plan and foster technical assistance to meet the needs of the community. New BCPP Structure The new Partnership structure will be composed of the BCPP (full body) which will meet three times per year and advisory groups which will be created based upon the recommendations found within the HIV Prevention Plan and community need. Broward Community Planning Partnership 11

12 The subcommittee structure will be replaced with an advisory structure which is mutually exclusive and representative of the highest ranking priority populations. Since the key functions of the population specific advisory groups will remain similar to that of the committee structure, the transition will be gradual and will be lead by the committee members in collaboration with the BCHD. The advisory groups will meet four times annually (minimum) and will make annual recommendations to the full BCPP. The new structure has been created to more efficiently address community need using a variety of existing infrastructural elements including the Broward County HIV Educator s Alliance and the Broward County Minority HIV/AIDS Network. Broward County HIV/AIDS Minority Network In 1999 the Florida Department of Health Bureau of HIV/AIDS implemented the Florida HIV/AIDS Minority Network. Its functions are carried out by HIV/AIDS Minority Network Liaisons who are affiliated with HIV/AIDS service organizations or interested persons in the community. They work closely with the BCHD s, Regional Minority AIDS Coordinator (RMAC) as well as the Bureau of HIV/AIDS Prevention and Patient Care Section staff in facilitating capacity building and program development and planning services to our minority communities. The Hispanic/Latino Committee presently serves under the HIV/AIDS Minority Network. The committee provides a forum for the community to strategize and develop effect responses to challenges in prevention, early intervention and patient as well. In a short time the committee has created awareness about prevention for Latinos through an open and participatory process. The members of the committee are community leaders, concern citizens and public health officials that have successfully mobilize the Hispanic/Latino community in Broward County. The committee will continue to exist as a committee under the HIV/AIDS Minority Network and will also serve as the advisory body for the BCPP. The following advisory committees have been created and will remain active during the threeyear period of : African American / Caribbean Islander Heterosexual (Includes non-self-identified MSM) Hispanic / Latino Heterosexual (Includes non-self-identified MSM)* Multicultural MSM (will convene culturally-specific forums as needed) *It should be noted that Hispanic Committee of the BCPP elected to continue meeting during the transition period of the reorganization. The committee is an active and vibrant body which has served as a model for the new substance Broward Community Planning Partnership 12

13 Diagram of HIV Prevention Entities Eliminated Committees Committee Women s Issues Adolescent Issues Planning & Evaluation Executive Committee Membership By-Laws Rationale The committee was eliminated as the population is not mutually exclusive nor supported by appropriate epidemiological data as a discrete population. The BCPP values the role and impact of this committee and will organize a Woman s Issues Forum to ensure multicultural needs are addressed. Issues pertaining to Black and Hispanic women will be addressed by the respective advisory groups based upon race/ethnicity. The adolescent committee was eliminated supported by sufficient data. The BCPP committee and will organize an Adolescent multicultural needs are addressed. Additionally, the BCPP seeks to work closely with the Connect2Protect initiative. The BCPP will rely on the advisory committee infrastructure to provide key planning and evaluation guidance. Structural changes no longer necessitate this committee. Broward Community Planning Partnership 13

14 Part 2: Local Research & Surveillance Purpose The purpose of this section is to present the epidemiology of the HIV and AIDS epidemic in Broward County. This section paints a picture of HIV and AIDS in Broward County. The HIV and AIDS data is presented for key demographic and risk populations. AIDS data tells the story of HIV transmission several years ago; this data is included because it is the most complete data we have related to the epidemic, and it gives us some information about who is affected by HIV. HIV data, estimates, and indicators tell the story of current patterns in HIV infection. Unlike AIDS data, HIV data is not based on case reporting and is therefore less complete. Both types of data are needed to get a full picture of the epidemic. The information in this section represents the scientific evidence upon which Broward County s HIV prevention priorities are based. Specifically, the funding priorities are based on the estimates of HIV incidence, as well as prevalence, incidence, and behavioral data for specific populations. Additional information on the funding priorities can be found in Part 3: Priority- Setting. For more detailed needs of various populations, as well as additional data on cofactors related to HIV such as drug use or homelessness, see Part 4: Community Assessment. Overview of this Section This section presents an overall picture of the epidemic in Broward County. The section uses a combination of data from surveillance and the KABB survey to lend key insight into the epidemiological issues. To understand the disproportionate effects of HIV/AIDS on various demographic groups and behaviorally defined groups, it is essential to recognize the overlapping nature of demography and behavior. This plan places a greater emphasis upon addressing behavioral risk populations as they can be more effectively targeted with prevention interventions. Remember it is not who you are (demography) but what you do (behavior). 1) Demographic components a. Gender b. Race/ethnicity c. Age 2) Behavioral risk population components a. Men who have sex with men (MSM) b. Heterosexual Women c. Injecting drug users (IDU) The information in this part represents the best and most recent data. However, funding and time have not allowed an investigation of all aspects of the local HIV epidemic. For example, there is less research available regarding HIV and injecting drug users in Broward than with gay men. Therefore, data should be interpreted with caution. Please contact the BCHD to inquire regarding data limitations. Broward Community Planning Partnership 14

15 Surveillance The HIV/AIDS Surveillance unit continues to be a member of the local partnership. The data provided to the BCPP members/agencies is very valuable for planning purpose. All agencies applying for grants contact the HIV/AIDS Surveillance Program of the BCHD for guidance on data information and reporting. As agencies evolve in their proposed projects many do request other health information such as TB, STD, HEP C from various Health Department Programs. As reporting has become important to how funds are awarded, many agencies recognize the need to obtain accurate demographic data and grapple with how to make it as accurate as possible. This is a reoccurring theme and Technical Assistance has been requested. With evaluation being discussed on the local and state level, the accuracy of instrument tools has become a new hot topic. Evaluations have been part of projects for a long time. Many now recognize the need for accountability and bringing it to the next level through measurable outcomes and utilization of surveillance data. Research Prevention Research has been discussed on a statewide as well as a local level. During 2005 and 2006, the BCHD engaged in several significant research initiatives in support of the completion of this plan. Research activities involved the administration of a comprehensive community survey, analysis of surveillance data, and focus groups (see section 4). Over 750 KABB surveys were completed based upon a sample of community members obtained from the following locations: Broward House Urban League Center One Minority Development and Empowerment Care Resource Hispanic Unity Broward County Health Department (pharmacy) Mount Bethel Positive Images World AIDS Day (Ft Lauderdale Public Library) Campaign to End AIDS (BCHD) National Women and Girls HIV/AIDS Awareness Day Latino AIDS Awareness Day (Ft Lauderdale Public Library) Florida Atlantic University Nova Southeastern University Black AIDS Awareness Day (Delevoe Park) BCHD HIV/AIDS Education Department (Bus stops and location in the field) MLK and 6 th Street, Fort Lauderdale Copans Rd and 3 rd, Pompano Beach 27 th Street and Atlantic Blvd, Pompano Powerline Rd and Sample Rd, Pompano 19 th Street and 55 th Ave, Lauderhill Sunset Strip and 64 th Ave, Sunrise Sunland Park Lauderdale Manor Park Main Bus Terminal-Broward and SW 2 nd, Fort Lauderdale 920 NE 11 th Ave, Deerfield Beach. Work Force One, Pompano Beach. BCHD North West Health Center Pridefest The Family Alcoholism and Drug Addiction Recovery Center Salvation Army-1445 W. Brow. Blvd. Ft. L. Broward Comm. College Central Campus Broward Community Planning Partnership 15

16 The KABB survey sample was well-stratified by age and gender. Greater effort was placed upon obtaining Black, Hispanic, MSM and seropositive participants. It is essential to understand the KABB survey is not a scientific study and is not intended to be used for larger generalizations of Broward County. Rather the findings provided key insight into issues and challenges facing our community. When the KABB data is utilized in conjunction with the focus group findings, other local research and surveillance, the combined result is sufficiently valid to support the proposed plan. The Florida Department of Health s behavioral surveillance program focusing on the MSM and injecting drug user community began in September The study was conducted by the University of Miami and funded through the Centers for Disease Control and Prevention. The project collected information related to behaviors placing individuals at risk for HIV in Miami- Dade and Broward Counties. The data collected has been widely disseminated through forums like the Broward MSM Summits and numerous local presentations. The University of Miami is currently conducting a similar behavioral analysis of injecting drug users. When formally released, this data set will aid in filling numerous behavioral gaps within the IDU community. For information from focus groups, please reference Section: 4. Overview of Our Community Broward County is well known for its brilliant sunshine in the winter, and ocean breezes in the summer, but it is also a vibrant, diverse destination for many growing businesses, corporations and others who seek the unique South Florida lifestyle. Currently, the County consists of thirty (30) unique municipalities, from the bustling urban center of the City of Fort Lauderdale, to the tranquil rural lifestyle found in the Town of Southwest Ranches. The diversity of lifestyles and tremendous population growth has positioned Broward County to become the second most populated county in the State of Florida. Broward County is an urbanized county located in southeast Florida. It is bounded by Palm Beach County to the north, Miami-Dade County to the south, Hendry and Collier Counties to the west, and the Atlantic Ocean on the east. The County population has increased steadily from 5,135 in 1920 to more than 1.8 million in This dramatic increase has made Broward County the 15th largest county (in terms of population) in the United States and the second largest in the State of Florida, just behind Miami-Dade. Broward County was created in It was named for Napoleon Bonaparte Broward, Governor of Florida from 1905 to By the 1960s, Broward County was considered a leader in agricultural products and services within the State of Florida. The massive buildup of the South Florida region since the mid 1970s transformed the region, evidenced by the closure of the last major agriculture center within the county (Waldrep Dairy Farm) in Since the 1990 s, Broward County has had an annual population growth rate of 2.9 percent. This translates into 36,000 new residents moving into the County every year. The total population of Broward County is forecast to exceed 2 million people by i The high rate of population growth and economic changes observed within Broward County are highly complex and significantly impact the state and national infrastructure.

17 Map of Broward County Broward Community Planning Partnership 17

18 Racial & Ethnic Diversity As of the census of 2000, the racial makeup of the county was 70.57% White, 20.54% Black or African American, 0.24% Native American, 2.25% Asian, 0.06% Pacific Islander, 3.00% from other races, and 3.35% from two or more races % of the population was Hispanic or Latino of any race. ii The race and ethnicity of Broward County residents is best depicted in the pie chart. The diversity of our community is also reflected in the fact that over 25% of the total population is foreign born. Specifically, 410,387 residents of Broward County, or 25.3 percent of the total population, are foreign-born. 60,241 of these were born in Jamaica, 47,445 in Haiti, 32,572 in Cuba, Figure 1 12,776 in Peru, 10,843 in Mexico, 9,189 in the United Kingdom, and 9,015 in the Dominican Republic. According to a report released by the U.S. Census Bureau on August 4, 2006, the total population of Broward County had risen to 1.8 million people in This number is substantively accounted for by an increase of 442,355 in the black population and an increase of 364,121 in the non-black Hispanic population. A significant portion of the black population has resulted from immigration more black foreigners immigrated to Broward County between 2001 and 2005 than any other county in the United States. The population change is significant in at least one respect: the percentage of population identified as non- Hispanic white has now dropped to less than half, at 49.9%. Non-Hispanic whites are expected to decrease further through 2010, amidst overall population growth. Despite the aforementioned increase in the black community, by 2010, non-black Hispanics will surpass non-hispanic blacks to become the single largest minority within Broward County, representing 24% of the total population. iii The south and southwest areas of Broward are expected to remain areas high in Hispanic concentration. Contributing to these communities are the Hispanics migrating from Miami-Dade who will continue to settle close to county lines. Age & Gender Diversity Age distributions within the county are spread out with 23.6% under the age of 18, 7.2% from 18 to 24, 31.4% from 25 to 44, 21.7% from 45 to 64, and 16.1% who were 65 years of age or older. The median age was 38 years. It should be noted that despite the projected population growth, the overall proportion of the young and the old will remain about the same. Females outnumber males throughout all age groups; however this disparity is most notable in those over 18. For every 100 females (all females) there were Figure 2 Broward Community Planning Partnership 18

19 93.3 males. For every 100 females age 18 and over, there were 89.8 males. The difference reflects an increasing number of males. Socioeconomic Diversity There were 68,468 households out of which 19.6% had children under the age of 18 living with them, 32.2% were married couples living together, 11.5% had a female householder with no husband present, and 51.8% were non-families. 40.3% of all households were made up of individuals and 11.7% had someone living alone who was 65 years of age or older. The average household size was 2.14 and the average family size was The median income for a household in the county was $41,691, and the median income for a family was $50,531. Males had a median income of $36,741 versus $28,529 for females. The per capita income for the county was $23,170. About 8.7% of families and 11.5% of the population were below the poverty line, including 15.3% of those under age 18 and 10.0% of those ages 65 or over. Sexual Orientation Diversity Broward County has more than 100 gay-owned establishments including hotels/guesthouses, bars, clubs and restaurants, the second largest Metropolitan Community Church congregation in the United States, a gay synagogue, and several gay and lesbian publications. According to the 2000 census, Broward County had nearly 6,000 reported same-sex couples. iv Fort Lauderdale is a popular location for gay and lesbian residents and visitors. In the last decade many gays and lesbians have moved to the city in rather large numbers. Fort Lauderdale is also home to the International Gay and Lesbian Travel Association. HIV and AIDS in Broward County: An Overview Broward County has had over 22,000 people diagnosed with HIV/AIDS since the beginning of the epidemic. Unfortunately, Broward County now leads the nation with AIDS cases, with 58.4 new AIDS cases per 100,000 people. Figure 3 provides an overview of general HIV/AIDS data Compared with national trends; Broward County s epidemic affects a smaller proportion of heterosexuals, injection drug users (IDUs), and people of color, although these groups are still significantly affected. Historically, Broward s HIV epidemic has been largely among men who have sex with men and in the early years prior to needle exchange, among Cumulative AIDS Cases (through 12/05) HIV Prevalence Total Alive # Alive % Estimates 15,888 7,382 46% 16,236 Cumulative HIV Cases (not AIDS Total Alive # Alive % 6,288 6,117 97% Grand Total Total Alive # Alive % HIV/AIDS Cases 22,176 13,499 61% ADULTS Males Females Total M:F Ratio Cumulative AIDS Cases 11,743 3,885 15, : 1 Cumulative HIV Cases 4,067 2,167 6, : 1 Figure 3 Broward Community Planning Partnership 19

20 IDUs as well. Figure 4 provides an overview of HIV cases by year. Between the early 1980s (when the first peak in infections occurred) and the late 1990s, new HIV infections declined dramatically, due to mobilization and prevention efforts among the black community. In the late 1990s, the epidemic began to change. New infections among gay men began to increase, and a high HIV prevalence was documented among MTF transgendered persons. The causes of these increases in new infections are numerous and complex. Highly active antiretroviral therapy (HAART) has led to individuals living longer, feeling healthier, and as a result, being more sexually active. Increases in recreational drug use have been associated with increases in high-risk sexual behavior, particularly among men who have sex with men (MSM). Increases in sexually transmitted disease (STD) rates have affected HIV incidence because some STDs can facilitate HIV transmission. Unmet mental health and substance use treatment needs and economic insecurity are also contributing factors, especially among MSM and MTF transgendered persons. In summary, there continues to be an epidemic among MSM (particularly gay men) and MTF transgendered persons in 2004 in Broward. Demographics and HIV/AIDS Data Gender In Broward, men (mostly MSM) and MTF transgendered persons are disproportionately affected by HIV/AIDS. Specifically, although men make up less than half of Broward s population, they represent 70% of the people living with AIDS. Similarly, women represent approximately 30% of the new HIV infections nationally. v For every 1 female with AIDS in Broward, there are 2.3 men with AIDS. (AIDS cases tend to represent HIV transmission that occurred many years ago. Figure 4 Broward Community Planning Partnership 20

21 For every 1 female with HIV in Broward, there are 2.9 men with HIV. Since 2003 there has been an increase in male cases vs. female HIV and AIDS cases in Broward. The relative increases in male cases reflect the changing face of the epidemic over time and are likely related to significant increases within men who have sex with men. Disparities are even more evident among black women: Annually, more than 80% of female AIDS cases have been reported among black women since HIV case reporting, implemented in mid-1997, has shown a very similar distribution of cases by race/ethnicity and sex. Race/Ethnicity Although whites are the single largest racial group in Broward, more than half of the county s residents are people of color. All racial/ethnic groups in Broward are affected by HIV and AIDS, and African Americans and whites are disproportionately affected. In 2005, blacks accounted for 84% of reported AIDS cases, but only 21% of the population. Hispanic cases remained fairly stable at 6% in 1996 to Disparities are even more evident among women: Annually, more than 80% of female AIDS cases have been reported among black women since HIV case reporting has shown a very similar distribution of cases by race/ethnicity and sex. The good news is that HIV cases are decreasing among all behavioral exposure categories, most substantially among heterosexuals. This decrease is evident in HIV case data and in gonorrhea case rates. Figure 5 provides a graphical representation of HIV case rates per 100,000 population. The racial/ethnic gaps are closing because rates among blacks are decreasing (desirable) while rates among whites (+79%) and Hispanics (+60%) are increasing. Gonorrhea cases are a timely indicator of unprotected sex. From , gonorrhea case rates among blacks decreased 23%. It may be tempting to misinterpret the strides in decreasing HIV case rates among blacks in Broward County as meaning the problem is resolving and needs no further attention. There continues to be a large Figure 5 disproportionate impact within the black community of Broward. The disproportionate impact of HIV and AIDS by race and ethnicity is most evident by the following: Broward Community Planning Partnership 21

22 1) Black Males: 1 in 58 2) Black Females: 1 in 83 3) Hispanic Males: 1 in 148 4) White Males: 1 in 310 5) Hispanic Females: 1 in 553 6) White Females: 1 in 1,625 Finally, it should be noted that Race/ethnicity is a substitute indicator for factors that tend to increase HIV/AIDS cases. It is not a root cause of HIV/AIDS. The following underlying factors are essential in addressing the disparities: Amount of HIV already in the community Late diagnosis of HIV or AIDS Access to/acceptance of care Stigma, denial, a shameful, deadly secret Discrimination, homophobia Poverty, income inequality, unemployment Delayed prevention messages (considered a gay, white male disease for a long time) Non-HIV sexually transmitted diseases in a community HIV/AIDS conspiracy beliefs, reflecting mistrust of the health care system Unprotected sex & needle-sharing behaviors; condom usage, other risk reduction behaviors Incarceration Complex set of factors related to socioeconomic status Language barriers Age In general Broward County has observed relatively stable HIV/AIDS case by age with the exception of 40 to 49 year olds. This age group has nearly doubled in the number of new HIV and new AIDS cases. Anecdotal evidence indicates a large portion of these cases are men who sex with men. Additionally a favorable decline has been observed in AIDS cases within the 50 and older category. Figure 6

23 Behavioral Risk Populations Three core category of behavioral risk will be addressed extensively within this section. The categories are determined based upon the mode of transmission as follows: a. Men who have sex with men (MSM) b. Heterosexual Women c. Injecting drug users (IDU) Men who have sex with Men (MSM) At the conclusion of 2006, Broward County represents one of the most highly impacted Eligible Metropolitan Areas (EMAs) in Florida with regard to HIV/AIDS and the at-risk population of Men Who Have Sex with Men (MSM). In terms of incidence for both HIV and AIDS cases among MSMs, Broward County has exhibited large-percentage increases during the period of 1999 to 2006 often in excess of corresponding trends observed statewide. In 2005, 74% of adult males diagnosed with HIV infection in Broward County indicated MSM as the mode of transmission. Similarly, for new cases of AIDS in 2005, 59% of adult males indicated MSM. These figures are significantly higher than those at the state level. Presently, Broward County ranks first among Florida s counties in the incidence of new HIV and AIDS cases within the MSM population. When the local MSM population is considered overall, the magnitude of growth in HIV infection, as well as for AIDS cases, appears to portray a sustained expansion of the epidemic. This interpretation appears valid since reported HIV cases tend to represent more recent infections and a prevalence of risky behaviors which promote transmission. For example, during the recent period 2002 to 2004, MSM-related HIV and AIDS cases increased by 40% and 33%, respectively. Between 1999 and 2004, new cases of HIV infection in the MSM population increased by 94%. During this same period, it should be noted that local HIV infection attributed to heterosexual males decreased by 43% and among heterosexual male IDUs (Intravenous Drug Users) by 27%. HIV infection risk-factor data for 2004 demonstrates that among male Persons Living with HIV and AIDS (PLWHAs) in Broward County -- 87% of Whites, 73% of Hispanics, and 28% of Blacks are classifiable as MSMs. Concurrent with this risk-factor data, a highly adverse trend in the co-infection rate of syphilis and HIV among MSMs, is of particular concern. For example, the co-infection rate more than doubled among HIV-infected MSMs diagnosed with syphilis, from 30% in 2001 to 76% in In Broward County, the ongoing transmission of HIV within the MSM population is being exacerbated by the pervasive use of substances during sex or in close association with general Broward Community Planning Partnership 23

24 sexual/social activity. According to the results of the Broward County Health Department s (BCHD s) 2005 HIV/AIDS Community Health Survey, 48% of all MSM respondents indicated using one or more of the following substances in the past three months: cocaine (16%), crack (10%), crystal meth (7%), ecstasy (10%), and GHB (5%). Perhaps of even more concern, 44% of respondents indicated never using a condom, and 31% confirmed engaging in at least one episode of unprotected sex within the past three months. In addition, 22% indicated that they had exchanged sex for drugs within the same time frame. White MSM Key Data and Observed Trends 1. Current HIV/AIDS Prevalence Data: a. In Broward County, Whites comprise 53% of the population of 1,746,603 and consist of 34% of reported PLWHAs. vi b. In Broward County, for the period of calendar year in 310 White (non- Hispanic) adult males are classifiable as PLWHAs. c. In Broward County, for the period of calendar year % of White PLWHAs are classifiable as MSMs. 2. Near-Term HIV/AIDS Incidence Data: a. In Broward County, during period of calendar year 2005, the rate of HIV cases per 100,000 for adult White males (93.6) was almost half than that for adult Black males (160.8) and approximately equal to that of adult Hispanic males (89.3) vii b. In Broward County, during period of calendar year 2005, the rate of AIDS cases per 100,000 for adult White males (57.8) was three times less than for adult Black males (173.8) and approximately equal to that of adult Hispanic males (52.3) viii 3. Intermediate/Long-Term HIV/AIDS Incidence Data: a. In Broward County, during period of , newly diagnosed cases of HIV infection among White adult males increased 120.6%. This represented the second largest known increase of HIV cases among the three target ethnic/racial groups. In all of the remaining three risk categories, incidence of new HIV infection decreased. 4. HIV Infection Knowledge and Testing Behavior Data (BCHD KABB SURVEY) WHITE MSM (AREA 10) 2005 KABB Survey Key HIV Infection Knowledge and Testing Behaviors Data All Ages YRS YRS >50 YRS A/ Aware of HIV Infection 66.40% 44.40% 79.70% 41.40% B/ Un-Aware of HIV Infection 7.10% 22.20% 5.40% 6.90% Broward Community Planning Partnership 24

25 5. Behavioral Factor Data (BCHD KABB SURVEY) WHITE MSM (AREA 10) 2005 KABB Survey Key HIV Infection Behavioral Risk Factors Data All Ages YRS YRS >50 YRS A/ Never Use Condoms 48.20% 44.40% 45.80% 53.60% B/ Condom Non Usage 47.50% 55.50% 56.00% 24.00% C/ Exchange of Sex for Drugs 15.60% 0% 19.70% 10.70% D/ Drug Usage: CRACK 5.40% 0% 6.80% 3.60% E/ Drug Usage: CRYSTAL METH 15.50% 12.50% 21.90% 0% F/ Drug Usage: COCAINE 16.20% 11.10% 21.80% 3.60% G/ Drug Usage: ECSTACY 9.10% 22.20% 11.10% 0% H/ Drug Usage: GHB 6.30% 11.10% 8.40% 0% I/ Drug Usage: HEROIN 3.60% 0% 5.40% 0% J/ Drug Usage: MARIJUANA 38.70% 44.40% 46.60% 17.90% K/ Drug Usage: ALCOHOL 77.10% 77.70% 77.50% 75.00% 6. Environmental Factors Data (BCHD KABB SURVEY) WHITE MSM (AREA 10) 2005 KABB Survey Environmental, Income and Educational Factors Data All Ages YRS YRS >50 YRS A) Past Incarceration 15.60% 0% 22.20% 3.60% B) Past)Current Homelessness 15.00% 25.00% 18.60% 3.60% C) No income or <$10, % 11.10% 40.00% 41.40% D) Income $10,000 to $19, % 22.20% 24.00% 17.20% E) Income $20,000 to $29, % 22.20% 10.70% 10.30% F) Income $30,000 to $74, % 33.30% 24.00% 31.00% G) Education: High School Grad 16.70% 22.20% 20.00% 6.90% H) Education: 2-Year College 9.60% 0% 13.30% 3.40% Degree I) Education: 4-Year College 22.80% 22.20% 20.00% 31.00% Degree J) Education: College Masters Degree 15.80% 11.10% 14.70% 20.70% HISPANIC MSM Key Data and Observed Trends 1. Current HIV/AIDS Prevalence Data a. Hispanics are 20% of Broward County population of 1,746,603 and consist of 11% of PLWHAs. ix b. In Broward County, for the period of calendar year in 148 Hispanic adult males are classifiable as PLWHAs c. In Broward County, for the period of calendar year % of Hispanic PLWHAs are classifiable as MSMs. 2. Near-Term HIV/AIDS Incidence Data a. In Broward County, during period of calendar year 2005, the rate of HIV cases per 100,000 for adult Hispanic males (89.3) was almost half than that for adult Black males (160.8) and approximately equal to that of adult White males (93.6) Broward Community Planning Partnership 25

26 b. In Broward County, during period of calendar year 2005, the rate of AIDS cases per 100,000 for adult Hispanic males (52.3) was three times less than for adult Black males (173.8) and approximately equal to that of adult White males (57.8) c. In Broward County, during period of , newly diagnosed cases of HIV infection were observed to remain stable for Hispanic adult male MSMs. 3. Intermediate/Long-Term HIV/AIDS Incidence Data a. In Broward County, during period of , newly diagnosed cases of HIV infection among Hispanic adult males increased 184.8%. This represented the largest known increase of new HIV cases among the three target ethnic/racial groups. Of the remaining three risk categories, incidence of new HIV infection increased by 73.7% for Heterosexuals, and declined for MSM/IDU (-100%) and IDU (-20%). b. In Broward County, of MSMs with syphilis, the HIV co-infection rate was 30% (2001), 51% (2002), 61% (2003) and 76% (2004). Syphilis among HIV-infected MSMs is an indicator of unsafe sex among those most likely to transmit or acquire HIV. (CHART: Infectious (P&S) Syphilis, Broward County, ). 4. HIV Infection Knowledge and Testing Behavior Data (BCHD KABB SURVEY) HISPANIC MSM (AREA 10) 2005 KABB Survey Key HIV Infection Knowledge and Testing Behaviors Data All Ages YRS YRS >50 YRS A) Aware of HIV Infection 68.90% 40.00% 78.60% 100% B) Un-Aware of HIV Infection 4.90% 20.00% 0% 0% 5. Behavioral Factor Data (BCHD KABB SURVEY) HISPANIC MSM (AREA 10) 2005 KABB Survey Key HIV Infection Behavioral Risk Factors Data All Ages YRS YRS >50 YRS A) Never Use Condoms 55.80% 46.70% 60.00% 0% B) Condom Non Usage 47.20% 64.30% 44.40% 0% C) Exchange of Sex for Drugs 14.30% 23.30% 13.90% 0% D) Drug Usage: CRACK 5.60% 14.20% 2.70% 0% E) Drug Usage: CRYSTAL METH 15.10% 15.40% 13.50% 0% F) Drug Usage: COCAINE 22.30% 15.40% 26.30% 0% G) Drug Usage: ECSTACY 14.90% 14.20% 16.20% 0% H) Drug Usage: GHB 9.80% 15.40% 8.60% 0% I) Drug Usage: HEROIN 0% 0% 0% 0% J) Drug Usage: MARIJUANA 37.10% 35.70% 40.50% 0% K) Drug Usage: ALCOHOL 70.40% 71.40% 69.40% 100% Broward Community Planning Partnership 26