Marin County Jurisdictional HIV Prevention Plan

1. Marin County Jurisdictional HIV Prevention Plan Chris Santini, Cicily Emerson Marin County Division of Public Health HIV/AIDS Program January 10, 2013

2. Looking Back…………. In 2009, State budget reductions resulted in the defunding of the HIV testing and prevention programs that had been operating in Marin for many years (1995-2009) After 2009, the County continued to offer HIV testing in its Sexually Transmitted Disease Clinic and in the County jail Marin AIDS Project used private funding to offer rapid HIV testing one evening a week.

3. Looking Back…………… In 2008, the County Health and Human Services, Clinics were opened on the Marin Health and Wellness Campus which is a central hub for some public services including HIV and STD health services. Marin Community Clinics, is co-located on the Campus. The co-location of these services has increased the capacity of the County to identify at risk individuals and link them to medical care and/or provide a referral to on-site medical services.

4. Why are we here today? In 2011, with San Francisco and San Mateo, Marin responded to the Centers for Disease Control and Prevention Request for Proposals CDC-RFA-PS12-1201 Comprehensive HIV Prevention Programs for Health Departments. Calls for a Jurisdictional and HIV Prevention Plan and Comprehensive HIV Prevention Plan for 2012-16

5. HIV Prevention Plan Goals Find and test the 20% infected but unaware of their status, link to care, and treat them with medications Reduce disparities (racial/ethnic) in new HIV infections “Treatment as Prevention”

6. Marin County Profile Mostly suburban community located north of San Francisco. Low population density, many different cities and towns Highest risk population, MSM, is isolated and difficult to reach. Few gay-identified social gathering places in the County. Small, insulated Hispanic and African-American communities that are difficult to reach. Unknown number of IV drug users

7. Gender & Ethnicity PLWHA Marin County (n=570)

8. Age, Persons Living with HIV/AIDS Marin County (n=270)

9. Transmission Category PLWHA Marin County (n=570)

11. Observations and Trends 2010 County tests: 1004 tests, 5 positives The number of new diagnoses each year has remained steady (around 20) The HIV/AIDS population is aging; more than 50% are over 50 years of age Latinos are 32.5% of new infections, AA 8.1% (yet 15.5% and 2.6% of County population) Number of infections attributed to MSM is increasing 50% of people testing progress to AIDS within one year. Late testers, late to care

12. Review of Marin’s Plan Targeted Risk Populations Men Who Have Sex With Men (MSM) Injection Drug Users (IDU) MSM/IDU Sexually active Latinos and African Americans who have never had an HIV test

13. Current Prevention and Treatment Resources

14. Strategies for HIV Prevention-CDC Required activities: HIV testing Comprehensive Prevention with Positives (linkage and retention in care, Partner Services) Condom distribution Policy initiatives

15. Strategies for HIV Prevention-CDC Recommended components: Evidence-based interventions for high-risk HIV-negatives Social marketing, media, and mobilization Pre-Exposure Prophylaxis and non-occupational Post-Exposure Prophylaxis

16. Review of Marin’s Plan Core Program Activities: Provide targeted HIV testing Encourage routine medical testing Ensure engagement and retention in HIV medical care

17. Review of Marin’s Plan Additional Activities Syringe access and disposal PrEp and nPEP Stigma reduction, social marketing, and media Policy initiatives (service integration and infrastructure development) Evidence-based interventions for high risk negatives (HERR)

18. Q and A