1

OPA/OFP HIV Prevention ProjectAnnual Technical Support

Conference Six Years of HIV Supplemental Grants – A National Perspective

Susan B. MoskoskyDirector, Office of Family Planning

Office of Population Affairs

2

Setting the Stage - The Epidemic

June 5, 1981 – CDC published MMWR describing 5 previously healthy males in LA with Pneumocystis carinii pneumonia – later recognized as the first reported cases of AIDS in the US

Since that time, 25 million deaths worldwide and more than 500,000 deaths in US from AIDS

3

The Epidemic

Despite prevention efforts, since the late 1990s, ~ 40,000 new cases of HIV infection each year many under the age of 25

African American men and women hardest hit - AIDS is the leading cause of death for African Americans 25-44 (CDC 2001)

Primary modes of transmission

MSM For women, heterosexual transmission through

contact with high risk sexual partners

4

The Epidemic

Today, estimated 1 million living with HIV in the US

Approximately 25% of those do not know they are infected

Implications Unknowing transmission to sexual partners Delayed entry into medical care Delayed behavior change that maximizes health

5

Title X Response

In December 1987, OPA issued a Program Instruction mandating that HIV prevention education and referral services, at a minimum, be offered as part of Title X family planning services

January 2001 revised Program Guidelines reiterated the information, also stating that when a program does not offer risk assessment, counseling and testing, they MUST provide a list of providers that offer these services

6

Title X Response - Training

late 1980s/early 1990s - training of individuals working in Title X clinics regarding HIV/AIDS

1988 - OPA provides supplemental funds to Regional Training Centers (RTCs) for integration of HIV training activities through MOU with CDC - limited scope

1995 - Cooperative Agreement directly between CDC and RTCs – training on HIV integration in FP one of several training topics

7

Title X Response - Training

2001 - Title X provided supplemental funds to Regional Training Centers (RTC) to assess the need for training related to providing HIV services in Title X clinics

2002-2005 – Supplemental funds provided to implement training to address the needs identified

2006 – HIV training incorporated into general training activities

8

Title X Response - Services

Late 1990s, OFP began attending meetings with other agencies leading prevention efforts

CDC

HRSA

Congressional Black Caucus Steering Committee (later the Minority AIDS Initiative)

9

Title X Response

In 2001, for the first time, OPA/OFP received funds from the Minority AIDS Initiative to support supplemental grants for projects in existing Title X clinics

Proposed to expand the availability of HIV counseling, testing, and referral services on site in Title X Family Planning Clinics

Two categories for funding Supplement or enhance existing HIV services Initiate HIV activities beyond basic HIV prevention

education

10

1st Cycle of Supplemental Grants

Total Funding approximately $5 M (2001-2002-2003)Total Funding approximately $5 M (2001-2002-2003) $3 M from Congressional Black Caucus (now $3 M from Congressional Black Caucus (now

Minority AIDS Initiative Fund)Minority AIDS Initiative Fund) $2 M + from Title X Appropriation$2 M + from Title X Appropriation

34 Projects in 23 Grantee Agencies34 Projects in 23 Grantee Agencies

Projects in 8 of 10 PHS RegionProjects in 8 of 10 PHS Region

11

1st Cycle of Supplemental Grants - Requirements Project activities required to incorporate cultural

competency, age appropriateness, and linguistic and educational appropriateness

Projects required to have linkages with community based agencies providing HIV-related health and social services

Providers trained according to local requirements or the most current CDC counseling and testing guidelines

12

1st Cycle Outcomes

Services provided on-site

# Clients counseled 365,461

# Clients tested 187,702

# Positive tests 693

Change in HIV testing levels in 89%34 project sites from beginning to end of 1st cycle of HIV supplemental projects

13

2nd Cycle of Supplemental Grants

Increase in Funding $6 M Minority AIDS Funds $3 M + Title X Appropriation

63 projects funded – At least one in each PHS Region

62 projects continue

14

2nd Cycle of Supplemental Grants

Requirements similar to 1st round of funding

Intended to contribute to “Advancing HIV/AIDS Prevention: New Strategies for a Changing Epidemic”(CDC 2003)

Increased focus on collaboration and formal linkages with HIV-related community agencies, and

Increased focus on strategies that encourage clients to return for post-test counseling

15

2nd Cycle of Supplemental Grants

All projects required to incorporate the “A-B-C” approach to HIV prevention activities

Care of HIV + individuals receiving Title X services must utilize “CDC Recommendations

to Incorporate HIV Prevention into the Medical Care of Persons Living with HIV”

16

Where We Are Now

Number of HIV TestsTotal = 451,325 Tests

61,253 70,51855,931

132,609 131,014

0

40,000

80,000

120,000

160,000

Cycle 1, Period 1-210/01 – 12/02

Period 3-41/03 – 12/03

Period 51/04 – 8/04

Cycle 2, Period 1-29/04 – 12/05

Period 3-41/06 – 12/06

17

Where We Are Now

Number of Tests by GenderCycle 2

203,569

52,153

0

50,000

100,000

150,000

200,000

250,000

Females Males

Number of Positive Tests by GenderCycle 2

348 342

0

100

200

300

400

Females Males

18

Where We Are Now

Caucasian/White41%

African American/Black

30%

Asian2%

Multi-race/Other10%

American Indian/Alaskan

Native1%

Native Hawaiian/Pacific

Islander0.2%

Unknown/Not Reported

16%

Figure 11a: Percent Distribution of Clients Tested for HIV by Race

19

Where We Are Now

Caucasian/ White33%

Asian1%

African American/

Black51%

Multi-race/Other

7%

Unknown/Not Reported

8%

American Indian/Alaskan Native

0.4%

Native Hawaiian/Pacific Islander

0.1%

Figure 11b: Percent Distribution of Clients Testing Positive for HIV by Race

20

Where Are We Going From Here?

The request for applications for the 3rd cycle of HIV prevention integration projects was published April 24, 2007 – Applications due June 25, 2007

Minority AIDS Initiative funds - $6.5 Million

Title X appropriations approximately $3.3 Million

Plan to fund 70-80 new projects with a range of $100,000 to $160,000 per award

Announcement and application kit available at

www.Grantsolutions.gov

21

3rd Cycle of Supplemental Grants

Highlights

Projects should incorporate the CDC September 2006 “Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health Care Settings”

Focus on testing all clients 13-64 in health care settings (such as Title X clinics)

Testing on-site

De-links counseling from testing

Opt-out approach to consent

ABC approach to prevention education and counseling

22

Title X responded early to the HIV epidemic and has maintained an interest in prevention as the epidemic has evolved

Title X providers have responded, ensuring that those serving our clients have the knowledge and skills necessary to provide quality family planning services, including HIV-related prevention services

You have responded by integrating HIV counseling, testing, and referral services into already busy clinic operations

23

Together we have served hundreds of thousands of Title X clients, and have contributed to the health and well-being of our communities!!