Getting to Zero San Francisco Consortium. Zero new HIV infections Zero HIV deaths Zero stigma and discrimination

Transcription

1 Getting to Zero San Francisco Consortium Zero new HIV infections Zero HIV deaths Zero stigma and discrimination

2 Agenda 1. Welcome, Acknowledgements & Overview 2. In Memoriam 3. Policy & Legislative Update 4. GTZ-SF looking back to move forward 5. Panel & Community Discussion: Promoting Black/African-American Health Equity: Addressing Racism & Institutional Bias

3 Getting to Zero San Francisco: Multi-sector independent consortium, operating under principles of collective impact: Long-term commitment of groups from different sectors to a common agenda to solve a specific social problem Improve HIV outcomes for persons living with disease and at risk in San Francisco Secure funding and broad city/private sector support for gaps Create innovative programs Exchange best practices with other cities

4 In Memoriam

5

6 Policy Update Courtney Mulhern-Pearson, MPH November 29, 2018 SAN FRANCISCO AIDS FOUNDATION //

7 Agenda 1 Proposition C next steps and implementation 2 California s End the HIV, HCV and STD Epidemics project SAN FRANCISCO AIDS FOUNDATION // 2

8 Update on Proposition C SAN FRANCISCO AIDS FOUNDATION //

9 An overview of proposition C SAN FRANCISCO AIDS FOUNDATION // 4

10 Proposition C results and implementation Proposition C passed in November with 61 percent of the vote This is enough to meet the simple majority requirement but not enough to pass the twothirds threshold In August 2017, the CA Supreme Court ruled (5-2) that ballot measures that raise taxes for a specific purpose only require simple majority to pass when placed on the ballot via citizens initiative June s Prop C and Prop G were the first measures to be passed after this ruling and C is being challenged in court San Francisco City Attorney Dennis Herrera will proactively file a validation lawsuit for November s Proposition C Mayor London Breed introduced an ordinance to allow this to happen The city will begin collecting the tax starting in January but the City Controller has said SF cannot begin spending the funds until the legal issues are resolved In the meantime, the collected money will sit in reserve Advocates are continuing to work on implementation planning, including recommendations for the oversight committee SAN FRANCISCO AIDS FOUNDATION // 5

11 Prop C: Lessons Learned & Next Steps event on Dec 5 Please join us for Prop C: Lessons Learned & Next Steps. When: Wednesday, December 5th. Doors open at 5:30pm and program begins at 6pm. Where: Glide, 330 Ellis St., Freedom Hall What: A presentation and panel discussion about Prop C lessons learned, next steps, and how to stay involved. RSVP and share the event on Facebook SAN FRANCISCO AIDS FOUNDATION // 6

12 End the Epidemics Project SAN FRANCISCO AIDS FOUNDATION //

13 Statewide End the Epidemics project Over the past several months, 85 public health and community leaders from across the state have come together and formed a coalition End the Epidemics: Californians Mobilizing to End HIV, HCV, and STDs The ETE coalition is now ready to release a statement that urges Governor-elect Newsom and the CA Legislature to implement a statewide strategy to end the HIV, HCV, and STD epidemics Governor-elect Newsom endorsed the idea of creating a statewide HIV and HCV strategy during the campaign SAN FRANCISCO AIDS FOUNDATION // 8

14 ETE Goals The ETE coalition has identified six goals for the strategy: 1. Increase the number of people living with HIV, HCV, and STDs who are aware of their status; 2. Increase access to comprehensive HIV, HCV, and STD prevention services; 3. Ensure linkage to and retention in culturally competent, quality health care for everyone living with and vulnerable to HIV, HCV, and STDs; 4. Increase training and capacity building to strengthen and integrate the HIV, HCV and STD provider workforce; 5. Address social determinants of health that impact people living with at increased risk for HIV, HCV, and STDs; 6. Develop and track metrics to assess progress toward ending the HIV, HCV, and STD epidemics. SAN FRANCISCO AIDS FOUNDATION // 9

15 ETE next steps The End the Epidemics coalition has drafted community consensus statement which: Outlines the need for a comprehensive strategy to address the HIV and HCV epidemics as well as the state s alarming epidemic of STDs Calls on Governor-elect Newsom and the California Legislature to launch this effort as soon as possible, by convening a high-level working group of key stakeholders to develop and implement a strategy to end the HIV, HCV, and STD epidemics The statement will be circulated for organizational sign-on next week SFAF will be collecting individual sign-ons text SFAF to to receive updates SAN FRANCISCO AIDS FOUNDATION // 10

16 SAN FRANCISCO AIDS FOUNDATION //

17 Getting to Zero San Francisco Consortium: Looking back to move forward

18 Getting to Zero San Francisco Mission & Vision Mission Zero new HIV infections Zero HIV deaths Zero HIV stigma & discrimination Vision Become the first municipal jurisdiction in the United States to achieve the UNAIDS vision of Getting to Zero

19 Strategic priorities for San Francisco Getting to Zero Consortium City-wide coordinated PrEP program Rapid ART start with treatment hubs Linkageengagementretention in care Reducing HIV stigma Adolescent & Young Adult Committee for each initiative is developing action plan, metrics and milestones. Drug user health Mental health/ Substance use/housing as HIV prevention Linkage to care and partner services (LINCS) Treatment as prevention Primary care HIV screening Syringe access Health ed/risk reduction STD testing & treatment Prevention with positives HIV testing 9

20 PrEP

21 PrEP Uptake Citywide

22 RAPID: Better treatment, better Dissemination prevention of Rapid Protocol Rationale Dissemination Expedited (same day) linkage and ART start: Reduces HIV illness and death Reduces transmission Empowers patient for disclosure Started as pilot at ZSFG hospital, GTZ expanded RAPID citywide

23 RAPID Outcomes & Global Dissemination RAPID citywide outcomes: Time from first medical visit to ART start: 0 days! Time from HIV diagnosis to viral suppression: 66 days (decreased 54% in last 3 years) Rapid protocol taken up by many organizations, locations, including: US CDC New York City, Philadelphia, Atlanta, and others Central America Thailand Netherlands Uganda, Kenya

24 Retention & Re-engagement Expanded LINCS: Linkage Integration, Navigation, Comprehensive Services Other initiatives: Intensive case management Food security Employment services Frontline Organizing Group Cell phone charging stations

25 Improvements in Viral Suppression Percent virally suppressed 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 75% 77% 68% 65%

26 Where we are heading into 2019 Number of New HIV Diagnoses/Deaths ,446 14,654 14,912 15,129 15,345 15,534 15,755 15,888 15,962 15,978 15,975 15, Living HIV cases New HIV diagnoses Number of Living Cases Nearly 16,000 PLWH in SF New diagnoses decreased 52% last 5 years but only 5% between Number of deaths is level Survival is improving; 65% of PLWH >50yrs Late diagnoses declined from 21% in 2012 to 11% in 2016 Number of HIV-related deaths has decreased by 56% from 178 in 2006 to 78 in 2017 Year 16

27 BUT, DISPARITIES REMAIN

28 New diagnoses by race/ethnicity in men 2017 Rates highest in Black MSM and not declining in past year Latino men also higher rates

29 New diagnoses in SF highlight disparities % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 86% Trans women: small % but disproportionate 12% 2% 60% PWID now make up 25% of new diagnoses 11% 14% 6% 8%

30 60 PrEP uptake for eligibles lags behind for African Americans San Francisco City Clinic, Percent of MSM eligible for PrEP African American Latino White Asian

31 Rates of viral suppression lower in cis- and transgender women, people of color, youth, PWID Rates of viral suppression lowest in homeless (32%)

32 Priorities for 2019 for all committees Homeless/marginally housed People who inject drugs Integrating interventions for HIV with STI/HCV prevention and treatment Racial and economic justice

33 African-Americans make up 5.4% of the SF population, 14% of PLWH, and 26% of Homeless PLWH PEOPLE LIVING WITH HIV Asian 10% Other 4% African American 14% HOMELESS LIVING WITH HIV Asian 3% Other 8% African American 26% White 48% Latinx 24% White 43% Latinx 20%

34 Promoting Black/African-American Health Equity: Addressing Racism & Institutional Bias ~ Guest Panelists ~ Vincent Fuqua, San Francisco Department of Public Health James Loyce, San Francisco Health Commissioner Diane Jones, Nurse & GTZ-SF Joe Hawkins, Oakland LGBTQ Center Takija Gardner, YMCA of San Francisco

35 Black/African American Health Initiative Health Data and Health Action November Vincent Fuqua Health Program Coordinator Data drawn from SFHIP CHNA, Our Children Our Families Council, SFUSD

36 The Black/African American Health Initiative (BAAHI) 2014 BAAHI Charter: Director Garcia directs all areas of the Department of Health to work together on: 4 health inequity areas 2 staff improvement areas

37 BAAHI: an interdivisional initiative Director of Health Steering Committee PHD PC Sexual Health BHS PHD Behavioral Health = staff from clinics, HR, etc impacted by the work Backbone support 4 staff Guides strategy Supports activities Establishes shared measurement Builds public will Advances policy Mobilizes resources Racial Equity Infrastructure Heart Health PHD PC PC PHD Women s Health Racial Equity Training

38 Black Health Report Black Health Data Social Determinants + Health Status BAAHI Structure and Outcomes Other DPH B/AA Health Services 9 of the 10 top causes of death in SF show B/AA with highest rates Call to action for collaboration to improve Black health

39 Why don t Black/African Americans have equal health? Institutional and Structural Racism Less access to resources (food, safety ) Everyday Racism Discriminatory and disrespectful treatment CHRONIC STRESS Adaptive Behaviors Substance use, family changes, diet changes Allostatic Load Prolonged output of stress hormones wears at the body Epigenetic Changes Genes behave differently and this is passed on children

40 BAAHI: outcomes BAAHI METRICS Hypertension hospitalization Chlamydia incidence Premature Birth Alcohol related deaths Breast Cancer mortality rate Lung Cancer rate Adult Diabetes Hospitalizations Pediatric Asthma hospitalization Adult Asthma hospitalization New HIV infections Hepatitis C incidence Violent injury Incidence Chlamydia screening rates at youth clinics 100% 80% 60% 40% 20% 0% Mar '16 Mar '17 Mar '18 3rd St. Balboa Burton Cole St. Larkin St.

41 Social Determinants of Health

42 CHALLENGES TO LIVING A HEALTHY LIFE

43 Access to healthy, diverse food sources 55% vs. 45% Fast food eaten in the past week: B/AA residents vs all SF 82% vs. 69% B/AA high-school students had a higher rate of soda consumption vs all students

44 Access to recreation/activity spaces

45 HEALTH ENVIRONMENT & STATUS

46 HEALTH STATUS

47 Sexual Health 2.5:1 B/AA vs. citywide gonorrhea rates 6:1 B/AA vs. citywide youth chlamydia rates Black/African Americans have higher rates of chlamydia, gonorrhea, early syphilis and HIV than other San Francisco residents.

48 What does that all lead to? Health Status

49 What can we do to decrease inequities? EVERYBODY Share the data: Upstream and downstream = its unjust not just unfortunate Focus on the cause not just the outcome: Are there INEQUITIES that YOU can do something about? COMMUNITY-BASED ORGANIZATIONS: Create programming to consider the health burdens of B/AA families Create programs that directly address healthy living and support healthy lifestyles Document the health impacts you see build the case for further changes

50 What can we do to decrease inequities? ALL PEOPLE AND FAMILIES Continue to support your own health and the health of your family Seek out services to help you cope with the stress of experiencing racism Advocate for health programming from community and government service providers Advocate for changes to living conditions that contribute to poor community health (eg. the lack of healthy food access points or healthy activities)

51 What you can do to advance health equity Everyone Work to understand the ways in which racism has impacted & continues to impact how B/AA people live in San Francisco Continue to be aware of health disparities Work to eliminate personal bias and help others to identify their own biases Interrupt biased behavior toward B/AA people when you witness it

52 Events Around San Francisco We hope you can attend!! Friday, November 30, 6-9:30pm - Light in the Grove: The National AIDS Memorial Grove Annual Gala. Mike Shriver, activist and outgoing Board Chair, will be honored with the Lifetime of Commitment award. Saturday, December 1, 12pm -1:30pm - National AIDS Memorial Grove 25th Annual World AIDS Day Observance. Golden Gate Park, San Francisco. Tuesday, December 4, 12-1pm - ZSFGH Medical Grand Rounds "Updates in the Fast-Moving World of HIV" with Monica Gandhi, Carr Auditorium, Building 3, Room 100.