HIV/AIDS: Keeping San Antonio from becoming part of the International Crisis

1. HIV/AIDS: Keeping San Antonio from becoming part of the International Crisis PTDBW

2. Globally

3. Globally • Sub-Saharan African and Asia share a disproportionate burden of the disease. • In parts of Sub-Saharan Africa 50% of women of child-bearing age are HIV infected. • Worldwide, less than one in five people at risk of becoming infected with HIV has access to basic prevention services. Across the world, only one in eight people who want to be tested are currently able to do so.

4. Globally • A total of 39.5 million people now live with HIV/AIDS. More than 25 million people have died of AIDS since 1981. One child dies per minute from HIV/AIDS. • 15 million children around the world have been orphaned by AIDS, losing one or both parents to the disease. • Every day 12,000 people contract HIV – 500 every hour. • At the end of 2006, women accounted for 48% of all adults living with HIV worldwide, and for 59% in sub-Saharan Africa. • Young people (under 25 years old) account for 1/2 of all new HIV infections worldwide - around 6,000 become infected with HIV every day. • 11% of HIV infections are among babies who acquire the virus from their mothers • 10% result from injecting drug use • 5-10% are due to sex between men; and around 5% occur in healthcare settings. • Sex between men and women accounts for the remaining proportion – at least 2/3s of new infections.

5. Global distribution of HIV

6. What’s needed to turn the tide • People need to challenge the myths and misconceptions about human sexuality that translate into dangerous sexual practices. • Work and legislation is needed to reduce prejudice felt by HIV+ people around the world and the discrimination that prevents people from "coming out" as being HIV positive. • HIV prevention initiatives need to be increased, people across the world need to be made aware of the dangers, the risks, and the ways they can protect themselves. • Condom promotion and supply needs to be increased, and the appropriate sexual health education needs to be provided to young people before they reach an age where they become sexually active. • Medication and support needs to be provided to people who are already HIV+, so that they can live longer and more productive lives, support their families, and avoid transmitting the virus onwards. • Support and care needs to be provided for those children who have already been orphaned by AIDS, so that they can grow up safely, without experiencing poverty, exploitation, and themselves falling prey to HIV.

7. HIV/AIDS: A United States Perspective PTDBW

11. Minorities have an unfair burden • As of December 2003, African Americans and Hispanics represented 64% of males and 83% of females living with AIDS . • African-American children represent almost 71% of all pediatric AIDS cases. • AIDS is the leading cause of death among African-American men 25- 44 yrs. AIDS is the leading cause of death among African American women 25-34 yrs. • African Americans make up just over 12% of the population in the USAand account for 50% of all new HIV diagnoses.

12. Getting people testedand into care • It is estimated that a quarter of the 1.2 million people currently living with HIV/AIDS in the United States don’t know they have it.

14. Prevention that works • Primary Prevention: • Varied program formats that promote abstinence/delay of sexual initiation and condom use for those sexually active: • school-based programs, • peer-to-peer interventions, • strategies that use parent-to-child communication, • client-centered counseling, and personalized risk-reduction strategies • Strategies that limit needle sharing, • Secondary Prevention of getting people tested

15. HIV/AIDS: A Texas & San Antonio Perspective PTDBW

16. In Texas ... • 56,012 people living with HIV/AIDS through 2005 • In 2005, 3,917 new HIV cases/3,224 new AIDS cases • 55% of those with AIDS from 1981 – 2005 have died. • Texas is the state with the 4th largest number of reported AIDS cases in the nation • AIDS is the fourth leading cause of death in Texas among individuals age 25-34 • San Antonio/Bexar County ranks 3rd in TX for HIV/AIDS cases

17. Bexar County San Antonio Metropolitan Health District

18. Unusual HIV/AIDS attributes of San Antonio/Bexar County • San Antonio has been designated as a “Late to Care” Community. (by diagnosis—it’s often too late) • Many learn of their HIV infection at the same time they receive a diagnosis of advanced AIDS. • As a result, SA continues to maintain and can fill a dedicated HIV/AIDS inpatient unit at University Hospital and a 36 bed HIV/AIDS dedicated residential skilled nursing/hospice facility. • 1/3 of admissions to SAAF over the past 2 years were newly diagnosed concurrently with HIV and advanced AIDS.

19. San Antonio AIDS Foundation • Founded in 1986 volunteer-run hospice • First community response to HIV/AIDS epidemic • The largest HIV/AIDS special care facility in Texas. • SAAF’s residential nursing care serves all of S. Texas • Services Currently Offered: • Medical Services (24 hour skilled nursing/hospice in 37 bed facility, w/ handicapped accessible transportation to medical/social service appointments) • Dental Care private community based dentist • Case Management (Rental assistance, emergency financial assistance for meds and utilities, referrals and linkages with medical, dental and social services) • Hot Meal Program (Serve over 42,000 meals/yr; 365 days/yr.—breakfast, lunch, dinner) • Education (UW funded program targeted at at-risk youth and young adults. PLWH/A speakers at each session on myriad impact of disease on their lives) • HIV Testing (Fast and free, mouth swab, 15 minute results, anonymous/confidential. Over 1,600 tests per year. Hits high risk community) • Staff of 40+ with lengthy tenure. Family-like, caring setting • All services are free

20. SAAF’s Funding • $2.6 million annual budget • All funding streams annually renewable • In 2006 in response to federal funding cuts, SAAF has gone from 71% government funding to 53%. • Governmental – 53% • United Way – 7% • Contracts (UHS) – 11% • Private grants – 16% • Fundraising – 9% • Contributions (business, community, individuals) – 4%

21. Funding Gaps/Unmet Needs • As governmental funding decreases, and HIV incidence increases, and people live longer with HIV/AIDS, there is need for increased and new funding resources. • Government is no longer funding support services, such as housing assistance, transportation and meals, which may be as fundamental to health of low income persons with HIV/AIDS as is medical treatment and medications. • A new 2-tier system of care, based on social class

22. For the Future:New Initiatives/ Opportunities • We need to break the stereotypes of who is HIV infected and to de-stigmatize both HIV infection and testing • Encourage community physicians to incorporate HIV testing as routine medical care • Get local leaders to test for HIV to set examples for the community

23. Are we losing the battle? “For every one person that you put on therapy, 6 new people get infected. So we’re losing that game, the numbers game.” • Dr. Anthony Fauci, July 2007 • Director National Institute of Allergy and Infectious Diseases, NIH

24. Yet, prevention remains our only major weapon Unlike other deadly diseases, HIV/AIDS is 100% preventable through education and behavior!!!