1 MMWR (60), 2011.

Of all with HIV infection, ~850,000 individuals do not have suppressed HIV RNA (72%)

Of all with HIV infection, ~850,000 individuals do not have suppressed HIV RNA (72%)

100%

75%

50%

25%

80%

77%

66%

77%

89%

Gaps that Limit Test and Treat for Gaps that Limit Test and Treat for HIV Prevention in USHIV Prevention in US

2

TO IDENTIFY 95% OF HIV+ RESIDENTS OF THE SECOND DISTRICT WHO ARE NOT IN CARE

Goal

3

1. DETERMINE TOTAL HIV+ POPULATION OF SECOND DISTRICT2. DETERMINE NUMBER NOT AWARE OF STATUS A. HOW DO WE FIND THEM? 1) PHYSICIANS TESTING THEIR PATIENTS 2) FOCUSED INTERVENTION 3) ZIP-CODE COMMUNITY TESTING 4) CHURCHES AND OTHER SUPPORT B. OTHER3. HIV+ BUT NOT IN CARE A. INCENTIVES B. CHURCHES AND OTHER COMMUNITY SUPPORT4. IMPROVE ADHERENCE A. MCC ( MEDICAL CASE COORDINATION) B. DOT ( DIRECT OBSERVATION OF THERAPY)

Objectives

0

20

40

60

80

100

Awareness of HIV Serostatus:Awareness of HIV Serostatus:Estimates of TransmissionEstimates of Transmission

People Living With HIV(1,039,000-1,185,000)

New Sexual infections/Year(~32,000)

Per

cen

t

~25%Unaware

of Infection~54%

of NewInfections

~46%of New

Infections

~75%Aware

of Infection

Marks G. AIDS. 2006;20:1447-1450.

6

Young Men’s Survey (1994-2000):Young Men’s Survey (1994-2000):Perceived Risk and Unrecognized HIV Perceived Risk and Unrecognized HIV InfectionInfection

0

5

10

15

20

25

30

35

MacKellar DA, et al. JAIDS. 2005;38:603-614.

HIV

Po

siti

ve (

%)

White Hispanic Black

10% of 5649 Young MSM Tested Were HIV Positive77% Were Unaware They Were HIV Infected

Unaware of HIV InfectionAware of HIV Infection

75%

Conducted in Baltimore, Dallas, Los Angeles, Miami, New York, and Seattle.

White Hispanic Black

75%

91%

56%

64%

91%

15 to 22 Years of Age 23 to 29 Years of Age

7

1. OASIS DATA : 46% OF ADOLESCENT CLIENTS ARE INFECTED AFTER BEING “KICKED OUT” OF HOME…. MOMS CAN’T HANDLE THEIR SEXUALITY

Keeping the HIV Neg MSM HIV neg

8

1. CHURCHES /SORORITIES 2. LOCAL MSM GROUPS3. WE CAN’T FORGET THE “CLOSETED MEN”4. IF BLACK MOTHERS CAN LOVE THEIR SONS WHO ARE IMPRISONED FOR MURDERING SOMEONE….THEY SHOULD BE ENCOURGAGED TO LOVE THEIR KIDS WHO LIKE SOMEONE OF THE SAME SEX

Programs

9

10

•

•Current Treatment Cascade