Center for Health PolicyHealth Inequalities Program

Duke University

Beth Stringfield

There is an HIV/STD epidemic in Guilford County

HIV/STDs in Guilford County

33,635 cases of reportable STDsUnderestimatedRates exceed NC averagesNumber excludes other STDs

HIV/STDs in Guilford County 1615 cases of

HIV/AIDS3rd highest in

the stateApproximately

339 with unknown HIV infection

HIV/STDs in Guilford County Many more at high risk!

Drug use○ 39% HS students drank alcohol○ 38% HS students smoked marijuana

Sexual risk○ 48% HS, 17% of MS students sexually active○ Only 37% of adolescents reported condom use○ Only 26% of adults reported condom use

HIV/STDs in Guilford County Racial and ethnic disparities

Rates of STDs 10x greater among non-Whites

New AIDS cases ○ 69.1% African American○ 29.1% White

Why?○ Lower income and education levels○ Poorer access to health care○ High levels of HIV/STD stigma

HIV/STDs in Guilford County Economic and Societal Costs

Lifetime medical costs range from $266,600 to $385,000, depending on when an individual begins treatment.

ARV therapy alone costs around $1,500 per month for a patient with >300 CD4 count.

The lifetime costs associated with productivity losses are $742,100.

HIV/STDs in Guilford County In addition to a worsening epidemic and

widening disparities…America has gone silent on HIV/STDsFederal funding has decreased or remained stableRestrictions on federal fundingAccess to care limitationsEconomic downturn

What is currently being done in Guilford County?

Community based organizations work together to meet the prevention and treatment needs of Guilford County’s populationOutreach, testing, and coordinating servicesASOs already implement evidenced based

interventions to reach high risk populationsASOs have demonstrated competence

What are the gaps in services? Needs assessments, personal interviews,

and focus groups have highlighted areas of needPrevention services for youth, Hispanics, MSM,

and HIV+ individuals

Treatment and service capacity

Reducing Transmission in Guilford County

Efforts to prevent disease transmission are critically important

Effective HIV prevention efforts combine behavioral, biomedical, and structural interventions

Reducing Transmission in Guilford County

Behavioral InterventionsDesigned to reduce HIV/STD risk and are

conducted at the individual, group, or community level

Evidence of efficacy (25-50% risk reduction)63 Evidenced-Based Interventions ( EBIs) 21 Diffusion of Evidenced Based Intervention

programs (DEBIs)

Reducing Transmission in Guilford County

Biomedical InterventionsBased on biological sciences HIV/STD testing○ Identify to prevent future transmission○ Facilitate early entry into treatment

Antiretroviral treatment○ Reduce infectiousness○ Improve quality of life

Reducing Transmission in Guilford County

Structural InterventionsAddress structures, laws, or policies which may

affect transmission risk or access to prevention, treatment, and care services

Improve availability, accessibility, and acceptability of HIV/STD services

What can MC-WLCHF do? Funding is needed to address HIV/STDs

Recommendations consider current funding and service availability, forthcoming funding changes, service gaps, and intervention efficacy and cost-effectiveness

Build on the strengths of service providers

Behavioral, biomedical, and structural strategies

What can MC-WLCHF do? Behavioral Interventions

Implement behavioral interventions to meet prevention needs of youth, Hispanics, MSM, and HIV+ individuals○ DEBI examples: Focus on imPACT, VOCES,

Popular Opinion Leader, CLEARContinue to support behavioral interventions

for high risk populations○ DEBI examples: SISTA, RAPP, Community Promise

What can MC-WLCHF do? Biomedical Interventions

Support routine HIV testing in medical care settings

Increase funding for case management and continue funding for support services

Structural InterventionsSupport an HIV/STD advocacy group Provide capacity building services including

evaluation assistance

What are the consequences of doing nothing?

Many programs which currently provide essential services to high risk populations will not be funded

Additional services that could help prevent future infections will not be available

The number of individuals with unknown infection will remain high and these people may unknowingly infect others

Reductions in support services for HIV+ individuals will likely result in less access and adherence to medications, poorer QOL, and increases in HIV transmission

Disparities by race/ethnicity will continue to widen Moses Cone remains the only major private funder in

Guilford County. Removing this funding will have a significant impact on treatment, care and prevention services in Guilford County

Authors Sara LeGrand, MS Matthew Toth, MSW

Beth Stringfield, Program DirectorNorth Carolina Community AIDS Fund

Duke University Center for Health Policy2812 Erwin Road, Suite 403

Durham, NC 27705919.613.5431