HUMAN SERVICES COMMISSION JANUARY 8, 2019 UNFINISHED BUSINESS SUBJECT: INITIATED BY: HIV ZERO INITIATIVE END OF YEAR 2 EVALUATION REPORT HUMAN SERVICES AND RENT STABILIZATION DEPARTMENT David Giugni, Social Services Manager Derek Murray, Social Services Program Administrator Corey Roskin, Social Services Specialist STATEMENT ON THE SUBJECT: The Human Services Commission will receive and discuss the HIV Zero Initiative Year Two Evaluation Report. RECOMMENDATION: Receive the presentation and discuss. BACKGROUND ANALYSIS: The HIV Zero Initiative has four broad goals: (1) increase access to healthcare for people living with HIV and people at an elevated risk for acquiring HIV, (2) reduce new HIV infections, (3) reduce HIV-related disparities and health inequalities, and (4) slow disease progression from HIV to AIDS. During the initial two-year period (April 2016- December 2018) of the HIV Zero Initiative, progress has been made toward achieving these four goals. The HIV surveillance data presented in this report is from January 2014 to December 31, 2016 - the first implementation year of the HIV Zero Initiative. End of year 2016 data is the most recently available data per the Centers for Disease Control and Prevention data management guidelines, which requires an 18-month delay on reporting to increase the accuracy of sensitive public health data. Given this reality, results presented indicate that the City is on target to meet its HIV Zero Initiative goals. Yet, we need to monitor progress until 2020 to know how much progress was made. Goal 1: Healthcare coverage has increased for all West Hollywood residents, including men aged 18-44 years. In 2014, these men were the most likely to acquire HIV and, were the least likely to have health insurance. In 2016, we established the goal to Increase primary healthcare coverage enrollment by 6 percent among men aged 18 to 44 years from 77 percent at baseline to 81 percent. West Hollywood is on target to achieve its goal. By 2016, eighty-two percent (82%) of men aged 18-44 years have health insurance. Figure 1 shows health insurance among men aged 18-44 years in West Hollywood and LA. West Hollywood outpaces the of Los Angeles in health insurance coverage for younger men (82% vs. 72%).
Page 2 of 6 85% 80% Figure 1: Health Insurance Coverage Among Males, 18-44 Years Old 75% 70% 65% Goal 2: HIV infections continue to decline among men in West Hollywood. Approximately 99% of all new infections are among gay and bisexual men in West Hollywood. In 2016, the City set a goal to reduce the number of newly diagnosed by 15 percent from 77 per year at baseline to no more than 66 per year. This projection was based on the best available data at the time. Figure 2, shows West Hollywood is on target to surpass this goal. As of 2016, West Hollywood had only 46 new HIV diagnoses. Figure 2: Annual HIV Diagnoses in West Hollywood: 2014-2016 77 61 46 Goal 3: HIV-related disparities and health inequalities are mixed. Although City contracted providers are offering a comprehensive list of services to people living with HIV including medical health services, mental health, substance abuse treatment, housing support, food, transportation and other social services, key health metrics declined or plateaued between 2014 and 2016. These metrics include the HIV continuum of care cascade: linkage to care, retention in care and viral suppression. West Hollywood has experienced a reduction in linking HIV positive community members to medical care. In 2014, ninety-two percent (92%) of people newly diagnosed with HIV in West Hollywood were linked to care. As of 2016, the linkage percentage fell to 80%. Figure 3 shows that West Hollywood outperforms Los Angeles in linkage to care 80% vs. 64% in 2016. However, we expect a much higher linkage rate in West Hollywood, given the advanced level of coordination among service providers, and the increased access to health care for people living with HIV.
Page 3 of 6 95% 90% 85% 80% 75% 70% 65% 55% Figure 3: Linkage to Care Among People Recently Diagnosed with HIV, The most disconcerting figure is the decline in the percentage of people living with HIV who are retained in care. Figure 4 reveals a countywide decline in health care retention among people living with HIV; and, a sharper decline in retention rates for West Hollywood. In 2014, of men in West Hollywood were retained in care. In 2016, the percent dropped to 54% in West Hollywood and 55% in the. 62% Figure 4: Retention in Care Among People Living with HIV, 58% 56% 54% 52% Although West Hollywood has a higher rate of viral suppression than the, the rate dropped between 2014 and 2016. In 2014, 69% of people living with HIV were virally suppressed. In 2016, sixty-seven (67%) were virally suppressed. Figure 5 shows the narrowing gap between viral suppression rates between West Hollywood and the of Los Angeles between 2014 and 2016.
Page 4 of 6 Figure 5: Viral Suppression Among People Living with HIV, 75% 70% 65% 55% Survey on Stigma indicates a reduction in HIV related disparity. The City s capacity to reach the goals of the HIV Zero Initiative relies heavily on ensuring HIV positive community members feel included and not discriminated against. Between October 2017 and December 2018, City staff and the consultant conducted three (3) surveys on stigma to track attitudes and experiences community members have when it comes to (1) interacting with healthcare providers, (2) perceptions of HIV treatment and prevention, and (3) discrimination based on sexual identity, gender identity and HIV status all social determinants that may contribute to stigma and compromise an HIV positive person s capacity to adhere to an HIV medication regimen. In the three surveys, HIV positive community members in West Hollywood maintain a 91% comfort rating discussing their sex life with physicians. During the same period, about 1/3 of HIV positive community members report facing discrimination based on their HIV status. In the most recent survey, we asked additional questions about comfort discussing sex with new sex partners and use of condoms. These questions help represent the extent to which HIV related stigma manifests in sexual conversations and practices for HIV positive community members. Figure 6 shows approximately 76% of HIV positive men surveyed in West Hollywood are comfortable disclosing their HIV status to new sex partners compared to 65% who are comfortable asking new sex partners about their HIV status. Fewer than half of HIV positive respondents (41.3%) use condoms with new sex partners; and, 20.7% report concern about transmitting HIV. Given the novelty of these questions and the lack of qualitative supporting data, further assumptions will not be made on what these data may suggest. These questions will be tracked in future waves of the stigma survey to better understand their significance.
Page 5 of 6 Figure 6: Comfort discussing HIV status, Condom use, and Concern about HIV transmission among HIV Positive Men in West Hollywood: 2018 75.9% 65.5% 41.3% 20.7% Comfort disclosing HIV status to new sex partners Comfort asking new sex partners about their HIV status Use of condom with new sex partners Concern about transmitting HIV Goal 4: Stage 3 (AIDS) disease progression appears to be slowing. In 2014, out of the 2,469 people with an HIV diagnosis in West Hollywood, 1,135 had Stage 3, 1,134 did not. HIV surveillance data for Stage 3 is cumulative. As such, once a person living with HIV is diagnosed with Stage 3, the public health data continues to include the total number of people with Stage 3 even if they become virally suppressed and are no longer designated as Stage 3. In 2014, 24 men received Stage 3 diagnoses, which is 24/1,134 or 2.12% among those previously not diagnosed Stage 3. We established the goal to reduce the percentage of persons diagnosed with Stage 3 (AIDS) to no more than 2 percent of the HIV positive population without a Stage 3 diagnoses. In 2015, Stage 3 diagnoses declined slightly to 22 out of 1,240 or 1.77%. This suggests that progress toward Stage 3 diagnosis reduction is being made. These results are pending until the 2016 Stage 3 diagnosis data from the are made available. Next Steps Data collection has presented challenges during the first two years of the HIV Zero Initiative contract. To overcome these barriers, Maroon Society and City staff have (1) simplified and reduced the volume of data requested; (2) minimized the data request schedule from quarterly to bi-annually; (3) held several in-person conferences with social services providers to review the data requests; and (4) worked closely with the Los Angeles s Division of HIV and STD programs to routinize the HIV surveillance data delivery schedule. The results of these efforts are that social services providers will deliver bi-annual data in October and April, and the will provide HIV surveillance data in the month of July/August in 2019 and 2020. Moving forward, annual reports will be provided in September/October to coincide with the data delivered
Page 6 of 6 by the, and mid-year reporting will occur in February/March. Reports will continue to integrate data gathered from social services providers, surveys on stigma, and HIV surveillance data provided by the. OFFICE OF PRIMARY STAFF RESPONSIBILITY: Department of Human Services and Rent Stabilization/Social Services Division