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Public Health

Click to edit Master title style Positively Hennepin: The County s Strategy to End HIV Positively Hennepin Strategy Coordinator Hennepin County Public Health Department

Key Points HIV Strategy Landscape in Minnesota Why Positively Hennepin is needed Positively Hennepin overview Positively Hennepin s development Modeling HIV-service Integration for the State HIV Strategy Positively Hennepin Progress Report Discussion

Vision We envision a Hennepin County where: All people living with HIV/AIDS have healthy, vibrant lives There are no new HIV infections All people have equitable access to HIV prevention and health care services.

HIV Strategy Landscape in Minnesota

HIV Strategy Landscape in Minnesota Three major, local HIV strategies Minnesota and Minneapolis-St. Paul Transitional Grant Area Integrated HIV and Prevention and Care Plan 2017-2021 Positively Hennepin Minnesota HIV Strategy

Minnesota and Minneapolis-St. Paul Transitional Grant Area Integrated HIV Prevention and Care Plan 2017-2021 Feb. 2016: Development begins Sept. 2016: Integrated plan publically released Fulfils federal requirements for Ryan White funding First effort to integrate prevention, care, community planning activities across Minnesota and the Transitional Grant Area

Positively Hennepin Jan. 2015: Development begins Dec. 2016: Strategy publically released Created with energy from the community, HIV non-profits, and other advocates Mandate from the county s elected leadership Hennepin County Board of Commissioners

State HIV Strategy Aug. 2016: Development begins with Minnesota s Department of Humans Services and Dept. of Health (DHS and MDH) May 2017: Governor Dayton mandates statewide response to end the epidemic Feb. 2018: First phase of state strategy publicly released Development continues throughout 2018 Specific recommendations on how to end the epidemic Implementation plan Evaluation plan Minnesota HIV Strategy Advisory Board Advice, guidance, and recommendations Positively Hennepin is a member Minnesota Department of Health. (2018, February 9). Minnesota HIV Strategy: A Comprehensive Plan to End HIV/AIDS (Rep.). Retrieved March, 2018.

Timeline of Local HIV Strategies Jan. 15 Positively Hennepin Development Begins Aug. 16 State Strategy Development Begins Dec. 16 Positively Hennepin Released Feb. 16 Integrated Plan Development Begins Sept. 16 Integrated Plan Released Feb. 18 State HIV Strategy Phase 1 Released Development Continues

Why Positively Hennepin in Needed

Why Positively Hennepin in Needed Hennepin County is the center of Minnesota s HIV epidemic. Decrease the stubborn number of new diagnoses o 2016: 149 new diagnoses o Since 1994: between roughly 200 and 150 new diagnoses per year Prevent the epidemic from growing Injection drug use, esp. among men who have sex with men HIV hits historically marginalized communities the hardest. We have the tools to end the epidemic for the first time.

The Center of Minnesota s Epidemic 2016: Percent of Minnesota s New HIV Diagnoses by Geography 49% 51% Hennepin County All other MN Counties No. of New HIV Diagnoses 350 300 250 200 150 100 50 0 2016: Number of New HIV Diagnoses by Geography Hennepin County Geography Minnesota Hennepin County Annual HIV/AIDS Surveillance Report for 2016 Minnesota Department of Health. (n.d.). Table 4. Number of Cases and Rates (per 100,000 persons) of HIV Diagnosis by County of ResidenceI--Minnesota, 2016 (Rep.). Retrieved March 23, 2018, from http://www.health.state.mn.us/divs/idepc/diseases/hiv/stats/2016/index.html

The Center of Minnesota s Epidemic No. of People Living with HIV 10000 8000 6000 4000 2000 2016: Number of People Living with HIV by Geography 0 Hennepin County Geography Minnesota 2016: Percent of Minnesotans Living with HIV by Geography 47% 53% Hennepin County All other MN Counties Hennepin County Annual HIV/AIDS Surveillance Report for 2016 Minnesota Department of Health. (n.d.). Table 4. Number of Cases and Rates (per 100,000 persons) of HIV Diagnosis by County of ResidenceI--Minnesota, 2016 (Rep.). Retrieved March 23, 2018, from http://www.health.state.mn.us/divs/idepc/diseases/hiv/stats/2016/index.html

The Center of Minnesota s Epidemic In 2016, the Ryan White Program served 4,290 individuals living with HIV Just over half of all Minnesotans living with HIV Hennepin County administers a large part of Ryan White Services Ryan White newsletter spring 2017. (2017, May 1). Ryan White Provider News. Retrieved March 23, 2018, from https://content.govdelivery.com/accounts/mnhenne/bulletins/1965155

NUMBER OF HIV CASES OR AIDS DEATHS 250 200 150 100 50 HIV and AIDS in Hennepin County 1993 2016 New HIV Cases AIDS Deaths PLWH 5000 4500 4000 3500 3000 2500 2000 1500 1000 500 NUMBER OF PLWH 0 0 1993 Hennepin 1995 County 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015 Name and date of presentation here, (include slide # if needed) YEAR Hennepin County Annual HIV/AIDS Surveillance Report for 2016

Preventing Future Outbreaks Opioid epidemic Feb. 2018: County Opioid Strategy released 2017 Opioid-related deaths in the county: 162 Fueling increases in viral hepatitis infections through injection drug use Increases risk for HIV infections Foreseeable outbreak among Minnesota injection drug users Chanan, D. (2018, February 9). Hennepin County embarks on its most ambitious opioid prevention strategy. Star Tribune. Retrieved March 23, 2018, from http://www.startribune.com/hennepin-county-embarks-on-its-most-ambitious-opioid-prevention-strategy/473489673/ Minnesota Department of Health. (2018, February 9). Minnesota HIV Strategy: A Comprehensive Plan to End HIV/AIDS (Rep.). Retrieved March, 2018. Obama White House. (2016, December). National HIV/AIDS Strategy: Updated to 2020 2016 Progress Report (Rep.).

Preventing Future Outbreaks No. of HIV Diagnoses 30 25 20 15 10 5 0 New Minnesota HIV Infections by Mode of Exposure 2014 2015 2016 Injection Drug Use (IDU) IDU among Men who have sex with men (IDU/MSM) Minnesota Department of Health. (n.d.). HIV/AIDS Surveillance Reports - 2014(Rep.). Retrieved March 23, 2018, from http://www.health.state.mn.us/divs/idepc/diseases/hiv/stats/index.html Minnesota Department of Health. (n.d.). HIV/AIDS Surveillance Reports - 2015 (Rep.). Retrieved March 23, 2018, from http://www.health.state.mn.us/divs/idepc/diseases/hiv/stats/index.html Minnesota Department of Health. (n.d.). Table 3. Number of Cases and Rates (per 100,000 persons) of HIV Diagnosis by Race/Ethnicity & Mode of ExposureI Minnesota, 2016 (Rep.). Retrieved March 23, 2018, from http://www.health.state.mn.us/divs/idepc/diseases/hiv/stats/2016/index.html

Historically Marginalized Communities 2016: 149 new HIV diagnoses in Hennepin County Among all new diagnoses 44% were MSM 43% were black 9% were MSM/IDU 8% were Latino Among all men newly diagnosed 55% were MSM 21% were African American 16% were African born 12% were MSM/IDU 12% were Latino Among all women newly diagnosed 57% were African born 13% were African American 3% were IDU

Tools to End the Epidemic Affordable Care Act Medicaid expansion No discrimination based on preexisting conditions, i.e. HIV status No cost sharing for preventative services, i.e. HIV testing PrEP and PEP Undetectable HIV is untransmittable

Positively Hennepin Overview

Goals A. Decrease new infections B. Ensure access to and retention in care for people living with HIV (PLWH) C. Engage and Facilitate the empowerment of communities that HIV hits hardest

Operating Principles 1. Reduce health disparities and promote health equity 2. Achieve a fully integrated public and private response to the HIV epidemic

Health Equity Certain communities are disproportionately affected by new HIV infections The communities experiencing the largest number of new HIV infections Hard-hit Communities Young gay, bisexual and other men under 30 years of age who have sex with men Men of Color in particular African-born and gay/bi-sexual/msm who are African-American or Latino Women of Color (cisgender and transgender) in particular African-American, African-Born, and Latina

Milestones 60% of HCMC and NorthPoint clients will have had an HIV test 90% of people living with HIV will know their status There will be a 5% decline in the number of new HIV infections 100% increase in the number of people on PrEP 80% of people living with HIV will be retained in care 70% of people living with HIV have suppressed virus 75% of people living with HIV will not experience housing barriers to retention in care 90% of people from these communities living with HIV will be aware of their status 80% of people from these communities living with HIV will be retained in care 70% of people from these communities living with HIV have suppressed virus To be achieved by 2019 The milestones measure HIV testing Status awareness Number of new infections Retention in care Viral suppression Housing stability PrEP use

Actions to Achieve Strategy Vision and Goals A: Decrease new HIV infections B: Ensure access to and retention in care for PLWH C: Engage and facilitate the empowerment of communities that HIV hits hardest Increase routine HIV testing Expand PrEP and PEP programming Testing for people who are at high-risk Ensure All Doors Open Eliminate barriers to care Engage and retain in care Partner with communities Develop education and marketing campaigns to reduce HIV related stigma in disproportionately affected communities Provide community access

Positively Hennepin s Development

The First National HIV Strategy Foundation: President Obama s National HIV/AIDS Strategy National HIV/AIDS Strategy: Updated to 2020 (NHAS 2020) President Barack Obama 2010: First national plan to fight HIV Foundation of Minnesota s strategic responses to HIV NHAS 2020 Goals Reducing new infections Improving access to care and health outcomes Reducing HIV-related disparities Achieving a more coordinated national response Former Office of National AIDS Policy Director Jeffrey Crawley interviewed during Positively Hennepin's development

Community Partnership and Engagement Ten listening sessions Over 90 PLWH Over half were people of color Gay, bi, other men who have sex with men Government, non-profit, and hospital leaders MDH, DHS, NorthPoint Health and Wellness, Hennepin County Medical Center, Minnesota AIDS Project, Clare Housing, Rainbow Health, and many more

Positively Hennepin: Modeling HIV-service Integration for the State HIV Strategy

Click to edit Master title style NHAS: An integrated federal response to the national HIV epidemic

An Integrated County Response to HIV How can HIV and STI programs be integrated into every service that Hennepin County provides to its residents? Training staff across county services on this strategy, HIV, and referring residents to existing HIV-related services Minneapolis Central Library Red Door pamphlets and condom distribution, HIV book displays, education events Safety-net programs, e.g. WIC, SNAP, MFIP HIV pamphlet distribution, awareness-building at county human service centers Emergency mental health Screening questions to assess clients need for HIV/STI services Integrating HIV policy throughout state agencies and policies will be key to the state strategy

Positively Hennepin Progress Report April 23 at the state capitol Milestone baseline data Projects completed within the strategy s framework Areas of focus and change throughout 2018

Discussion

Discussion How well does Positively Hennepin s list of hard-hit communities match your knowledge of the epidemic? Hard-hit Communities Young gay, bisexual and other men under 30 years of age who have sex with men Men of Color in particular African-born and gay/bi-sexual/msm who are African-American or Latino Women of Color (cisgender and transgender) in particular African-American, African-Born, and Latina

Discussion Hard-hit Communities Young gay, bisexual and other men under 30 years of age who have sex with men Men of Color in particular African-born and gay/bi-sexual/msm who are African-American or Latino Women of Color (cisgender and transgender) in particular African-American, African-Born, and Latina Who are the community leaders among young gay men?

Discussion What partnerships do you already have with the county that fit within the strategy? What opportunities exist to build partnerships that serve both the state and county HIV strategies? A: Decrease new HIV infections B: Ensure access to and retention in care for PLWH C: Engage and facilitate the empowerment of communities that HIV hits hardest Increase routine HIV testing Expand PrEP and PEP programming Testing for people who are at highrisk Ensure All Doors Open Eliminate barriers to care Engage and retain in care Partner with communities Develop education and marketing campaigns to reduce HIV related stigma in disproportionately affected communities Provide community access Hennepin County Name and date of presentation here, (include slide # if needed)

Positively Hennepin Progress Report April 23 at the state capitol Milestone baseline data Projects completed within the strategy s framework Areas of focus and change throughout 2018

jake.maxon@hennepin.us Health Services Building 525 Portland Ave Minneapolis, MN 55415