Prevention Programs That Work

HEALTHY STATES POLICY WORKSHOP Prevention Programs That Work How Legislators Make A Difference Bambi W. Gaddist, DrPH Executive Director SC HIV/AIDS Council Columbia, South Carolina www.schivaidscouncil.org July 31, 2009

The South Carolina HIV/AIDS Council Founded in 1994; A social service 501(c)3 organization; Utilizes a global approach to prevent the spread of HIV/AIDS and other sexually transmitted infections; Provide technical assistance and capacity building at the local and state level; Seek to create local solutions to local problems ; Devotes significant time and expertise to advocacy initiatives.

The South Carolina HIV/AIDS Council Scope of Services In-House and Mobile Rapid HIV Testing -Counseling-Outreach Syphilis Elimination Community Intervention HIV/AIDS Case Management and Support Services I-C.A.R.E. HIV/AIDS Faith Training Project F.A.I.T.H Community Services SATIR Celebrate Recovery Mental Health Counseling Group Level Interventions Video Opportunities For Innovative Condom Education and Safer Sex (V.O.I.C.E.S.) Many Men, Many Voices Be Proud, Be Responsible Basic Training D-UP SAFETY COUNTS HIV/AIDS/STI Program Development and Capacity Building Services

WE ARE ALL PRODUCTS OF OUR ENVIRONMENT

WE ARE ALL PRODUCTS OF OUR ENVIRONMENT THERE IN OUR PERCEPTIONS OF WHO WE ARE, HOW WE SEE OTHERS, AND OUR WILLINGNESS TO PROTECT LIES. OR VIOLATE THEIR HUMAN RIGHTS

THE FOUNDATION OF PREVENTION WALKING A MILE IN THEIR SHOES

IT S TIME FOR A REALITY CHECK

DEALING WITH THE DOUBLE STANDARD

SO..WHAT S DRIVING YOUR LEGISLATIVE DECISIONS? SO YOU THINK YOU KNOW HUMAN BEHAVIOR?

Sharing Beliefs.. But for Different Reasons

IF PREVENTION SAVES MONEY. WHY HAVEN T WE FOCUSED ATTENTION ON IT?

HIV/AIDS related Stigma is everywhere!

STIGMA IS EVERYWHERE! Individual Stigma Behaviors, thoughts, and feelings that express prejudices against Persons Living With HIV. IMPACT FEARING OF TELLING. REFUSAL TO GET TESTED FOR HIV! FAILURE TO SEEK MEDICAL TREATMENT OR CARE EVEN AFTER DIAGNOSIS. (Chesney & Smith, 1999). REFUSAL TO SEEK CARE FOR DEPRESSION, ANXIETY, AND EXPERIENCE GREATER SEVERITY OF LONELINESS. (Lee, Kochman & Sikkema, 2002). AFRICAN AMERICANS BECOME PART OF THE PROBLEM INSTEAD OF THE SOLUTION!

STIGMA IS EVERYWHERE! Cultural Stigma Emerges in the form of laws and policies that single out people with HIV in ways well beyond the demands of public health. IMPACT Laws; Policies; Popular Discourse- (Faith); Social Conditions of PWA s; Addressing Issues Related to Persons Higher At-Risk for HIV/STI Infection.

WE MUST CREATE POSITIVE SOLUTIONS AS WE CONFRONT POLITICS

WHILE CONFRONTING OUR PERSONAL FEARS AND LACK OF UNDERSTANDING

An Evolving Case Study SOUTH CAROLINA Ranks 9th in the nation in the rate of AIDS. The capitol, Columbia, ranks 6th in the nation in the rate of AIDS among larger MSA s. 74% of new HIV cases are among African Americans. 1st in the nation in heterosexual (male to female) transmission. 3rd in the nation in the proportion of African Americans that have AIDS.

SIGNIFICANT HEALTH DISPARITIES AND CONCERNS About 882 persons are newly diagnosed with HIV every year in South Carolina with over 22,000 individuals living with HIV/AIDS. Gender 70% Male and 30% Female Risk MSM (49%), Heterosexual (42%), IVDU (8%) Race/Ethnicity African American (72%), White (23%), Hispanic (4%) Age 40+ (47%), 30-39 (20%), 20-29 (28%) and 0-19 (5%). (SCDHEC 2007) Approximately 44% of Persons Living with HIV/AIDS are out of medical care in South Carolina.

South Carolina HIV/AIDS Council: HIV Testing Data, 2005 2007 Youth/Young Adults (17 25 years) Total Number Tested: 1,026 Number of Females Tested: 524 Number of Males Tested: 502 Number HIV Positive: 20 Percent HIV Positive: 1.9% 49% 51% Female Male

South Carolina HIV/AIDS Council: HIV Testing Data, 2005 2007 Youth/Young Adults (17 25 years) Total Number Tested: 1,026 Number of Females Tested: 524 Number of Males Tested: 502 Number HIV Positive: 20 Percent HIV Positive: 1.9% 49% 51% Female Male 80 70 60 50 40 30 20 10 0 79.4 17.5 1.7 0.5 0.2 0.1 0.5 Race/Ethnicity Black White Hispanic Asian Native American African Unknown

Males (n=502): Number (and Percent) of Males who Tested HIV Positive: 19 (3.8%) Risk Factors Males n % Unprotected sex 363 72.3 Multiple sex partners 192 38.2 Men who have sex with men (MSM) 143 28.5 Crack cocaine user 16 3.2 Sex partner of an HIV positive person 14 2.8 Sex worker 8 1.6 Gave money for sex 7 1.4 Injection drug user 3 0.6 Sex partner of injection drug user 3 0.6

Females (n=524): Number (and Percent) of Females who Tested HIV Positive: 1 (0.2%) Risk Factors Females n % Unprotected sex 373 71.2 Multiple sex partners 93 17.7 Women who have sex with women 30 5.7 Sex worker 12 2.3 Female sex partner of MSM 8 1.5 Sex partner of injection drug user 7 1.3 Injection drug user 5 1.0 Sex partner of HIV positive person 5 1.0

Number of STD/HIV Cases (17-25 year olds) by Race/Ethnicity (2005-2007) 2007) SCDHEC Data 25000 23953 20000 15000 10000 7081 10554 Blacks Whites Hispanics 5000 0 1684 70 13 383 63 36 166 35 13 Chlamydia Gonorrhea HIV Syphilis

SC Department of Health & Environmental Control: SC HIV/STD Data, 2005-20072007 Youth/Young Adults (17 25 years) 25000 24797 20000 20278 15000 17-20 year olds 10000 8100 8078 21-25 year olds 5000 0 144 340 82 141 Chlamydia Gonorrhea HIV Syphilis

Number of STD/HIV Cases (17 by Sex (2005-2007) 2007) SCDHEC Data (17-25 year olds) 40000 35000 38122 30000 25000 20000 15000 10000 5000 0 10032 6845 6112 363 121 158 65 Chlamydia Gonorrhea HIV Syphilis Males Females

WHAT IS THE IMPACT OF APATHY?

SOUTH CAROLINA S WAIT LIST CRISIS LEGISLATORS MADE A DIFFERENCE

WHAT IS THE IMPACT OF OUR APATHY? LOSS OF LIFE A Cost of Illness Index suggests the economic impact of the HIV/AIDS epidemic in our state is astronomic, exceeding $6.5 billion in 2002.

THE COST OF HIV/AIDS IN SOUTH CAROLINA South Carolina HAD one of the largest wait lists for the AIDS Drug Assistance Program (ADAP) in the country (600) HIV care and support services have been cut over $1 million in 2006, yet the number of persons served increased by 25% from 2002-2006. S.C. HIV/AIDS Care Crisis Task Force, 2006

THE COST OF HIV/AIDS IN SOUTH CAROLINA According to a recent analysis* of South Carolina HIV and economic data for 2002: $151 million was spent for direct medical care for HIV patients. Nearly half (48%) was spent on hospitalizations, and Medicaid paid the largest percent of hospitalization charges (43%). The estimated foregone earnings of persons living with HIV in 2002 who were too ill to work exceeded $5.7 billion. The estimated Source: Kent Sock, MD. The Economic Impact of HIV/AIDS in South Carolina,, 2004

S.C. Economic Impact of HIV Epidemic by Public Health Regions, 2002 Region Region 1 Region 2 Region 3 Region 4 Region 5 Region 6 Region 7 Region 8 Abbeville, Anderson, Edgefield, Greenwood, Laurens, McCormick, Oconee, Saluda Cherokee, Greenville, Pickens, Spartanburg, Union Chester, Fairfield, Lancaster, Lexington, Newberry, Richland, York Chesterfield, Clarendon, Darlington, Dillion, Florence, Kershaw, Lee, Marion, Marlboro, Sumter Aiken, Allendale, Bamberg, Barnwell, Calhoun, Orangeburg Georgetown, Horry, Williamsburg Berkeley, Charleston, Dorchester Beaufort, Colleton, Hampton, Jasper

S.C. Economic Impact of HIV Epidemic by Public Health Regions, 2002 Region Persons Living With HIV/AIDS (2005) ER Visit Charges Hospitalization Charges Cost of Illness (S.C. Rank) Region 1 880 $138,066 $3,760,810 $883,222,337 (4) Region 2 1669 $444,720 $7,896,380 $350,647,896 (8) Region 3 3973 $1,157,040 $22,304,760 $903,698,511 (3) Region 4 2248 $662,260 $13,740,700 $1,725,810,861 (1) Region 5 1098 $230,860 $5,091,990 $1,114,217,860 (2) Region 6 1040 $310,200 $5,658,920 $500,805,617 (6) Region 7 2007 $398,380 $12,149,460 $379,942,414 (7) Region 8 640 $108,680 $2,313,440 $651,989,578 (5) TOTAL 13,605 $3,575,800 $72,907,460 $6,510,333,076

RICHLAND COUNTY Number of South Carolina Discharges and Emergency Department Visits and Charges With Any Diagnosis of HIV-(ICD-9-CM code 042.XX) Number and Percent with a Mental Health/Alcohol/Drug Diagnosis During the Year 2000-2004 YEAR (N) PERSONS W/DIAGNOSIS OF MH/AD PERCENT W/DIAGNOSIS OF MH/AD DIS CHARGES TOTAL CHARGES RATE PER CLIENT 2000 226 104 46% 429 5,689,387 $25,174 per patient 2001 234 117 50% 473 9,001,510 $38,467.99 per patient 2002 251 120 48% 503 12,040,586 $47,970.46 per patient 2003 244 133 55% 462 12,949,857 $53,073.18 per patient 2004 237 117 49% 532 15,909,104 $67,127*** per patient TOTAL 1,192 591 50% 2,399 55,590,444 $46,636 per patient *** Rate per client in FY 2004 is nearly 3 times the client rate during FY 2000

Community and Legislative Advocacy Made A Difference Investing in ADAP and HIV care will: Ø Save money - for Medicaid, hospitals, HIV care system, patients and families. Ø Help get people back to work - and off of public assistance programs, Medicaid. Ø Help prevent new infections - treatment lowers amount of virus. Ø Lengthen and improve lives - more years of earning potential. Ø Garner more federal funds - if S.C. gets more Ryan White funds, we ll need more state funds to meet the 50% state match requirement.

CAMPAIGN RESULTS $4,000,000 $3,500,000 $3,000,000 $2,500,000 $2,000,000 $1,500,000 $1,000,000 $500,000 $0 FY07 FY08 S.C. State Funds for ADAP

Demographic Trends of HIV-infected Inpatients, South Carolina, 1996-2007 Kent J. Stock, DO, MBA, FACP, FAAP Lowcountry Infectious Diseases, P.A. Charleston, SC Presented to South Carolina HIV/AIDS Care Crisis Task Force March 17, 2009

HIV-infected Inpatients by Age Group, South Carolina, 1996-2007 2,400 2,200 2,000 1,800 1,600 1,400 1,200 1,000 800 600 400 200 0 96 97 98 99 00 01 02 03 04 05 06 07 0-19 20-29 30-39 40-49 50-59 60-69 70+

Prevention Programs That Work LEGISLATORS CAN MAKE A DIFFERENCE

Project F.A.I.T.H. Model SC General Assembly SCDHEC Pastors SCHAC Technical Assistance Providers 39 African American Churches or/alliances Care Teams Congregations USC Evaluation Team AIDS Service Organizations & Consultants Communities

FOSTERING MALE COMMITMENT

PROJECT F.A.I.T.H. Project F.A.I.T.H. churches/fbos: Conducted a variety of programs and services: Focus primarily on HIV/AIDS/STI education, skills-building, and awareness; Targeted a variety of populations; Increased collaborations with local HIV/AIDS service organizations, health departments, other churches in their area; Piloted Celebrate Recovery Addictions Ministry and SATIR Family Support Model in selected faith sites; Featured on CNN Heroes segment during FY 2008

LOOKING INTO THE FUTURE RESTRUCTURING DURING FY 2009-2010 Project F.A.I.T.H priorities include: Modifications in RFP process with enhanced emphasis on product development and evaluation of program outcomes; Creation of Faith Leader Academy in collaboration with Metropolitan Interdenominational Church Technical Assistance Network (MICTAN); Provision of I-CARE Training of Trainers Program; Provision of Grant Sustainability Training; Provision of Project Life Line Outreach and Recruitment Training of Facilitators;

SO.LEGISLATORS CAN MAKE A DIFFERENCE Keep abreast of current sexual health issues. Have your staff seek out service organizations in your district for up-dates and current issues; Assign your staff to set up an appointment to conduct an assessment and bring information back to you. Inquire about controversial concerns before they arrive at the legislature.

SO.LEGISLATORS CAN MAKE A DIFFERENCE Examples: SC State HIV/AIDS Curriculum Standards STD-Prevention education is now MANDATORY for students in grades 6, 7 AND 8!.. They were amended to: Permit the instruction of pregnancy prevention in middle schools (at the discretion of the local school boards) and REQUIRE STD-prevention instruction in grades 6, 7 and 8! This mandates that all middle school students in South Carolina receive 3 separate courses in STD- prevention BEFORE they enter high school. For more go to www.tellthemsc.org..

Examples: LEGISLATORS MAKE A DIFFERENCE SC State HIV/AIDS Curriculum Standards STD-Prevention education is now MANDATORY for students in grades 6, 7 AND 8!. They were amended to: Permit the instruction of pregnancy prevention in middle schools (at the discretion of the local school boards) and REQUIRE STD-prevention instruction in grades 6, 7 and 8! This mandates that all middle school students in South Carolina receive 3 separate courses in STD-prevention BEFORE they enter high school. For more go to For more go to www.tellthemsc.org. Teen Relationship Violence Bill (Joan Bradey) Failed to pass due to disagreements in philosophy about whether gay/bisexual youth should be specifically included in the bill. Partner with Local Service Organizations and Host a Town Hall in Your District

Bambi W. Gaddist, DrPH Executive Director South Carolina HIV/AIDS Council BAMEWAME@AOL.COM P.O. Box 2531 1115 Calhoun St Columbia, S.C. 29201 (803) 254-6644 www.schivaidscouncil.org