an analysis of cdc hiv prevention funding by state aids... · 2009 national hiv prevention...

The AIDS Institute 1

An Analysis of CDC HIV Prevention Funding by State

Carl SchmidJessica Ladd

2009 National HIV Prevention ConferenceAtlanta, GA

August 26, 2009


Purpose

• Analyze how CDC HIV prevention funding (FY2007) is distributed to states, territories, and DC.

• Analyze if this distribution correlates with demographic information such as:

– Population (2007 Census Data)

– Living AIDS Cases (2007 from CDC Surveillance Report)

– Living HIV/AIDS Cases (2007 from CDC Surveillance Report)

– New HIV Diagnoses (2007 from CDC Surveillance Report)

– Living AIDS Rate and Population


CDC FY 2007 HIV/AIDS Prevention Funding

• HIV Prevention Cooperative Agreements (56%)

• HIV/AIDS Surveillance Cooperative Agreements (13%)

• Community-Based Organization (CBO) and Capacity Building Assistance (CBA) Providers (15%)

• Division of Adolescent and School Health (DASH) (3%)

• Miscellaneous Funding (6%)

• Expanded HIV Testing in African American Communities (7%)

• Total: $530 million


Map of CDC Prevention Funding Distribution

Source: Kaiser Family Foundation’s http://www.statehealthfacts.org, data provided by National Alliance of State and Territorial AIDS Directors

(NASTAD)

http://www.statehealthfacts.org/


Funding per Capita


2007 Funding per Capita

Rank State $/Capita

1 District of Columbia $34.42

2 Virgin Islands $15.34

3 New York $4.20

4 Guam $3.90

5 Maryland $3.50

6 Alaska $3.00

7 Delaware $2.95

8 Vermont $2.85

9 New Jersey $2.77

10 Rhode Island $2.67

11 Connecticut $2.48

12 Louisiana $2.47

13 Massachusetts $2.46

14 Wyoming $2.43

15 Hawaii $2.20

16 Florida $2.03

17 Montana $2.00

18 Puerto Rico $1.92

19 South Carolina $1.90

20 California $1.78

21 Colorado $1.77

United States $1.7322 Mississippi $1.65

23 Maine $1.63

24 Georgia $1.62

25 North Dakota $1.52

26 Nevada $1.50

27 Illinois $1.47

Rank State $/Capita

28 New Hampshire $1.46

29 Pennsylvania $1.46

30 New Mexico $1.43

31 Texas $1.36

32 South Dakota $1.18

33 West Virginia $1.17

34 Oregon $1.16

35 Michigan $1.15

36 Tennessee $1.12

37 Missouri $1.09

38 Virginia $1.05

39 North Carolina $1.03

40 Washington $1.01

41 Arizona $0.96

42 Oklahoma $0.94

43 Minnesota $0.90

44 Nebraska $0.88

45 Arkansas $0.83

46 Alabama $0.83

47 Wisconsin $0.80

48 Idaho $0.79

49 Kansas $0.71

50 Iowa $0.69

51 Kentucky $0.66

52 Ohio $0.65

53 Indiana $0.63

54 Utah $0.47



Top 10 States Bottom 10 States

Average: $1.73

Rank State $/Capita

1 District of Columbia $34.42

2 Virgin Islands $15.34

3 New York $4.20

4 Guam $3.90

5 Maryland $3.50

6 Alaska $3.00

7 Delaware $2.95

8 Vermont $2.85

9 New Jersey $2.77

10 Rhode Island $2.67

Rank State $/Capita

54 Utah $0.47

53 Indiana $0.63

52 Ohio $0.65

51 Kentucky $0.66

50 Iowa $0.69

49 Kansas $0.71

48 Idaho $0.79

47 Wisconsin $0.80

46 Alabama $0.83

45 Arkansas $0.83


Regional Funding per Capita

• Northeast: $2.86

• U.S. Average: $1.73

• South: $1.72

• West: $1.54

• Midwest: $0.98


Funding per PLWA


2007 Funding per Estimated Persons Living with AIDS

Rank State $/PLWA

1 Guam $19,311

2 North Dakota $12,147

3 Wyoming $11,992

4 Montana $9,334

5 Vermont $7,398

6 South Dakota $6,369

7 Alaska $5,969

8 Virgin Islands $5,026

9 Maine $3,987

10 Idaho $3,720

11 New Hampshire $3,271

12 West Virginia $2,711

13 District of Columbia $2,277

14 Iowa $2,256

15 Hawaii $2,145

16 New Mexico $2,104

17 Rhode Island $2,094

18 Colorado $2,010

19 Wisconsin $1,945

20 Minnesota $1,912

21 Nebraska $1,871

22 Massachusetts $1,731

23 Michigan $1,635

24 Oklahoma $1,488

25 Oregon $1,470

26 Mississippi $1,445

27 Kansas $1,425

28 Delaware $1,386

Rank State $/PLWA

29 New Jersey $1,361

30 Nevada $1,280

31 Maryland $1,255

32 Connecticut $1,255

33 Louisiana $1,247

34 Arizona $1,190

35 Washington $1,156

United States $1,13336 South Carolina $1,117

37 Missouri $1,114

38 Illinois $1,103

39 New York $1,078

40 Utah $1,035

41 Arkansas $1,027

42 North Carolina $1,018

43 Ohio $1,011

44 Tennessee $1,007

45 Indiana $998

46 California $994

47 Kentucky $989

48 Alabama $947

49 Pennsylvania $944

50 Texas $933

51 Virginia $917

52 Georgia $860

53 Florida $772

54 Puerto Rico $659




Average: $1,133

Rank State $/PLWA

1 Guam $19,311


3 Wyoming $11,992

4 Montana $9,334

5 Vermont $7,398


7 Alaska $5,969


9 Maine $3,987

10 Idaho $3,720

Rank State $/PLWA

54 Puerto Rico $659

53 Florida $772

52 Georgia $860

51 Virginia $917

50 Texas $933

49 Pennsylvania $944

48 Alabama $947

47 Kentucky $989

46 California $994

45 Indiana $998


Regional Funding per PLWA

• Midwest: $1,314

• Northeast: $1,198

• West: $1,180

• U.S. Average: $1,133

• South: $1,032


Funding per PLWHA


2007 Funding per Estimated Persons Living with HIV/AIDS

Excluded from analysis due to lack of data: California, Connecticut, Delaware, District of Columbia, Hawaii, Illinois, Kentucky,Maine, Maryland, Massachusetts, Montana, New Hampshire, Oregon, Pennsylvania, Rhode Island, Vermont, and Washington

Rank State $/PLWHA

1 Guam $7,041

2 Wyoming $6,231


4 Alaska $3,240



7 Idaho $1,627


9 Iowa $1,325


11 Nebraska $1,012

12 Wisconsin $945

13 Michigan $853

14 Colorado $832

15 Minnesota $801

16 Oklahoma $750

17 Kansas $717

18 New Jersey $682

19 New York $667

Rank State $/PLWHA

20 Louisiana $652

21 Mississippi $626

22 South Carolina $593

23 Missouri $587

24 Nevada $585

Average $58325 Utah $578

26 Arizona $537

27 Texas $530

28 Indiana $504

29 Arkansas $499

30 Tennessee $492

31 Georgia $486

32 Ohio $470

33 Florida $423

34 Virginia $418

35 North Carolina $418

36 Puerto Rico $404

37 Alabama $391




Average: $583

Rank State $/PLWHA

1 Guam $7,041

2 Wyoming $6,231


4 Alaska $3,240



7 Idaho $1,627


9 Iowa $1,325


Rank State $/PLWHA

37 Alabama $391

36 Puerto Rico $404

35 North Carolina $418

34 Virginia $418

33 Florida $423

32 Ohio $470

31 Georgia $486

30 Tennessee $492

29 Arkansas $499

28 Indiana $504


Funding per New HIV Diagnosis


2007 Funding per New HIV Diagnosis

Excluded from analysis due to lack of data: Vermont, Maryland, and Hawaii

Rank State $/HIV diagnosis

1 Guam $675,897

2 Montana $382,712


4 Wyoming $105,927


6 Alaska $97,500


8 Idaho $69,580


10 Maine $59,478



13 Rhode Island $42,202

14 District of Columbia $41,928


16 New Jersey $34,717

17 Connecticut $33,580

18 Oregon $32,380

19 Colorado $31,447

20 Nebraska $30,037

21 Delaware $29,034

22 New York $28,610

23 Iowa $25,230

24 Kansas $25,067

25 Wisconsin $24,672

26 California $24,257


27 Michigan $23,264

28 Minnesota $20,814

29 Illinois $20,128

30 Oklahoma $19,669

Average $18,75631 South Carolina $18,602

32 Missouri $18,071

33 Pennsylvania $18,036

34 Utah $17,119

35 Washington $16,853

36 Louisiana $16,488

37 Georgia $14,628

38 Virginia $14,522

39 Puerto Rico $13,067

40 Arkansas $13,049

41 Texas $13,004

42 Nevada $12,827

43 Indiana $12,817

44 Kentucky $12,815

45 Ohio $12,517

46 Arizona $12,466


48 Tennessee $9,724

49 Florida $9,321

50 Alabama $8,568





Average: $18,756


1 Guam $675,897

2 Montana $382,712


4 Wyoming $105,927


6 Alaska $97,500


8 Idaho $69,580


10 Maine $59,478



50 Alabama $8,568

49 Florida $9,321

48 Tennessee $9,724


46 Arizona $12,466

45 Ohio $12,517

44 Kentucky $12,815

43 Indiana $12,817

42 Nevada $12,827



Northeast: $30,275

West: $23,468

Midwest: $19,471

U.S. Average: $18,756

South: $12,603

Excluded from analysis due to lack of data: Vermont, Maryland, and Hawaii


Hypothetical Model:Living AIDS Rates and

Funding per Capita


Living AIDS Rate and Funding per CapitaRank AIDS

Rate

Rank $ per

CapitaState

Funding per

Capita

AIDS Rate

per 1,000

1 1 District of Columbia $34.42 15.12

2 3 New York $4.20 3.90

3 2 Virgin Islands $15.34 3.05

4 18 Puerto Rico $1.92 2.92

5 5 Maryland $3.50 2.79

6 16 Florida $2.03 2.63

7 7 Delaware $2.95 2.13

8 9 New Jersey $2.77 2.03

9 11 Connecticut $2.48 1.98

10 12 Louisiana $2.47 1.98

11 24 Georgia $1.62 1.89

12 20 California $1.78 1.79

13 19 South Carolina $1.90 1.70

14 29 Pennsylvania $1.46 1.55

United States $1.73 1.53

15 31 Texas $1.36 1.46

16 13 Massachusetts $2.46 1.42

17 27 Illinois $1.47 1.33

18 10 Rhode Island $2.67 1.28

19 26 Nevada $1.50 1.17

20 38 Virginia $1.05 1.15

21 22 Mississippi $1.65 1.14

22 36 Tennessee $1.12 1.11

23 15 Hawaii $2.20 1.03

24 39 North Carolina $1.03 1.01

25 37 Missouri $1.09 0.97

26 21 Colorado $1.77 0.88

27 46 Alabama $0.83 0.87


Living AIDS Rate and Funding per Capita

Rank AIDS

Rate

Rank $ per

CapitaState

Funding per

Capita

AIDS Rate

per 1,000

28 40 Washington $1.01 0.87

29 45 Arkansas $0.83 0.81

30 41 Arizona $0.96 0.81

31 34 Oregon $1.16 0.79

32 35 Michigan $1.15 0.70

33 30 New Mexico $1.43 0.68

34 51 Kentucky $0.66 0.67

35 52 Ohio $0.65 0.65

36 53 Indiana $0.63 0.63

37 42 Oklahoma $0.94 0.63

38 6 Alaska $3.00 0.50

39 49 Kansas $0.71 0.50

40 44 Nebraska $0.88 0.47

41 43 Minnesota $0.90 0.47

42 54 Utah $0.47 0.46

43 28 New Hampshire $1.46 0.45

44 33 West Virginia $1.17 0.43

45 47 Wisconsin $0.80 0.41

46 23 Maine $1.63 0.41

47 8 Vermont $2.85 0.38

48 50 Iowa $0.69 0.31

49 17 Montana $2.00 0.21

50 48 Idaho $0.79 0.21

51 14 Wyoming $2.43 0.20

52 4 Guam $3.90 0.20

53 32 South Dakota $1.18 0.18

54 25 North Dakota $1.52 0.13


Hypothetical Model

• If: prevention $ / capita was weighted by the average risk of acquiring HIV in that state (assuming equal behavior)

• If: PLWA is currently our best measure for all states

• Then:

• Relative risk = (state PLWA per capita)

(mean PLWA per capita)

• For each state,

$/capita = (mean $ / capita) * (relative risk)

• State $ = (state population) * (mean $/capita) * relative risk


Example

• Georgia:Georgia 2007 Funding = $15,491,149

Georgia 2007 Population = 9,544,750

Georgia 2007 Living AIDS Cases = 18,011

U.S. Funding per Capita = $1.73

U.S. AIDS Rate per 1,000 = 1.53

• $/capita = (mean $ / capita) * (relative risk)Georgia Model Funding per Capita = ($1.73) * (1.89/1.53)

Georgia Model Funding per Capita = $2.14

Georgia Model Funding = ($2.14) * Population

Georgia Model Funding = ($2.14) * 9,544,750

Georgia Model Funding = $20,405,671

If funding were based on model, Georgia would see an increase of $4.9 m

Funding per Capita = $1.62

AIDS Rate per 1,000 = 1.89


Redistribution of Funding Based on Model

Order StateWhat Model

PredictsActual

Amount increase /

decrease

% increase /

decrease1 Florida $54,448,735 $37,114,999 $17,333,736 46.7%

2 California $74,301,524 $65,179,685 $9,121,839 14.0%

3 Texas $39,585,485 $32,599,845 $6,985,640 21.4%

4 Puerto Rico $13,032,393 $7,579,007 $5,453,386 72.0%

5 Georgia $20,405,671 $15,491,149 $4,914,522 31.7%

6 New York $85,258,342 $81,138,356 $4,119,986 5.1%

7 Pennsylvania $21,793,543 $18,162,227 $3,631,316 20.0%

8 Virginia $10,051,586 $8,132,331 $1,919,255 23.6%

9 North Carolina $10,342,756 $9,294,097 $1,048,659 11.3%

10 Ohio $8,413,332 $7,510,248 $903,084 12.0%

11 Tennessee $7,742,622 $6,884,508 $858,114 12.5%

12 Alabama $4,583,940 $3,829,903 $754,037 19.7%

13 Indiana $4,553,350 $4,011,737 $541,613 13.5%

14 Illinois $19,345,225 $18,840,058 $505,167 2.7%

15 Kentucky $3,201,734 $2,793,682 $408,052 14.6%

16 Arkansas $2,589,938 $2,348,826 $241,112 10.3%

17 South Carolina $8,508,500 $8,389,512 $118,988 1.4%

18 Utah $1,367,478 $1,249,671 $117,807 9.4%

19 Missouri $6,486,173 $6,378,946 $107,227 1.7%




PredictsActual

Amount increase /

decrease

% increase /

decrease20 Washington $6,377,410 $6,505,354 -$127,944 -2.0%

21 Arizona $5,789,405 $6,083,430 -$294,025 -4.8%

22 Kansas $1,574,809 $1,980,268 -$405,459 -20.5%

23 Nevada $3,395,469 $3,835,348 -$439,879 -11.5%

24 Delaware $2,089,171 $2,555,017 -$465,846 -18.2%

25 Nebraska $946,018 $1,561,912 -$615,894 -39.4%

26 Guam $39,653 $675,897 -$636,244 -94.1%

27 South Dakota $166,545 $936,292 -$769,747 -82.2%

28 Oklahoma $2,576,342 $3,383,118 -$806,776 -23.8%

29 Idaho $360,280 $1,182,866 -$822,586 -69.5%

30 Connecticut $7,851,385 $8,697,330 -$845,945 -9.7%

31 North Dakota $90,636 $971,758 -$881,122 -90.7%

32 Louisiana $9,619,930 $10,585,000 -$965,070 -9.1%

33 Oregon $3,343,353 $4,338,899 -$995,546 -22.9%

34 Iowa $1,038,921 $2,068,821 -$1,029,900 -49.8%

35 Mississippi $3,785,206 $4,829,196 -$1,043,990 -21.6%

36 Wyoming $120,093 $1,271,127 -$1,151,034 -90.6%

37 West Virginia $889,371 $2,128,062 -$1,238,691 -58.2%




PredictsActual

Amount increase /

decrease

% increase /

decrease38 New Hampshire $666,178 $1,923,207 -$1,257,029 -65.4%

39 Virgin Islands $375,008 $1,663,671 -$1,288,663 -77.5%

40 Rhode Island $1,529,491 $2,827,517 -$1,298,026 -45.9%

41 New Mexico $1,517,028 $2,817,480 -$1,300,452 -46.2%

42 Hawaii $1,490,970 $2,822,553 -$1,331,583 -47.2%

43 Vermont $270,776 $1,768,196 -$1,497,420 -84.7%

44 Maine $608,397 $2,141,203 -$1,532,806 -71.6%

45 Alaska $388,604 $2,047,499 -$1,658,895 -81.0%

46 Montana $232,256 $1,913,559 -$1,681,303 -87.9%

47 Wisconsin $2,601,267 $4,465,692 -$1,864,425 -41.7%

48 Minnesota $2,763,280 $4,662,265 -$1,898,985 -40.7%

49 Maryland $17,767,017 $19,682,376 -$1,915,359 -9.7%

50 Michigan $8,030,393 $11,585,453 -$3,555,060 -30.7%

51 Colorado $4,855,850 $8,616,437 -$3,760,587 -43.6%

52 New Jersey $20,020,466 $24,058,962 -$4,038,496 -16.8%

53 Massachusetts $10,401,670 $15,896,805 -$5,495,135 -34.6%

54 District of Columbia $10,077,644 $20,251,263 -$10,173,619 -50.2%


If the Model Was Applied…

• South +$18.4 m (+9.3%)

• Territories +$3.5 m (+35.6%)

• West -$4.3 m (-4.0%)

• Northeast -$8.7 m (-5.4%)

• Midwest -$9.0 m (-13.8%)


Limitations• Other explanations for distribution of funding:

– Differences in risk behavior

– Population demographics

– How each state utilizes its prevention funding

– Supplemental state or local resources

– Difficulty in reaching people, density of regions

– Who applies for prevention money, quality of application

– Change in funding or transmission over time

– Prevention is working

– Other possible explanatory variables

• Results of distribution of funding:– We did not analyze correlation between lack of federal prevention

funding and rise in HIV transmission


Findings

When analyzing funding based on selected variables:

• Large disparities

• Certain states receive less funding compared to others (Puerto Rico, Florida, Georgia, Virginia, and Alabama).

• Certain states receive more funding compared to others (Guam, Alaska, North Dakota, the Virgin Islands, and Wyoming).

• The South receives less funding compared to other regions.


Findings

When analyzing funding based on the hypothetical model:

• Some of the states with the highest numbers of living AIDS cases also receive the least funding per capita (FL, CA, TX, PR, GA, NY)

• If the model was applied, the South would see the largest increase, and the Midwest the largest decrease


Conclusion

• We hope these data and findings will help inform future funding allocation decisions at the CDC in order to improve HIV/AIDS prevention efforts.

• The AIDS Institute will continue to advocate for additional federal HIV/AIDS prevention funding.

• This presentation should not be interpreted to mean that The AIDS Institute is advocating for specific funding increases or decreases to any state, territory, or region.


Thank You

Carl Schmid - [email protected]

Jessica Ladd - [email protected]

Offices - Washington, DC and Tampa, FL

www.theaidsinstitute.org

an analysis of cdc hiv prevention funding by state aids... · 2009 national hiv prevention...

Documents