Getting to Zero San Francisco Consortium Zero new HIV infections - - PowerPoint PPT Presentation

Getting to Zero San Francisco Consortium

Zero new HIV infections Zero HIV deaths Zero stigma and discrimination

Agenda

• 1. Welcome, Acknowledgements & Overview
• 2. In Memoriam
• 3. Policy & Legislative Update
• 4. GTZ-SF looking back to move forward
• 5. Panel & Community Discussion: Promoting

Black/African-American Health Equity: Addressing Racism & Institutional Bias

Getting to Zero San Francisco: Multi-sector independent consortium, operating under principles of collective impact:

“Long-term commitment of groups from different sectors to a common agenda to solve a specific social problem.”

• Improve HIV outcomes

for persons living with disease and at risk in San Francisco

• Secure funding and

broad city/private sector support for gaps

• Create innovative

programs

• Exchange best

practices with other cities

2014

In Memoriam

SAN FRANCISCO AIDS FOUNDATION //

Policy Update

Courtney Mulhern-Pearson, MPH November 29, 2018

SAN FRANCISCO AIDS FOUNDATION //

Agenda 1 Proposition C – next steps and implementation 2 California’s End the HIV, HCV and STD Epidemics project

2

SAN FRANCISCO AIDS FOUNDATION //

Update on Proposition C

SAN FRANCISCO AIDS FOUNDATION //

An overview of proposition C

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SAN FRANCISCO AIDS FOUNDATION //

Proposition C – results and implementation

• Proposition C passed in November with 61 percent of the vote

– This is enough to meet the simple majority requirement but not enough to pass the two- thirds threshold

– In August 2017, the CA Supreme Court ruled (5-2) that ballot measures that raise taxes for a specific purpose

• nly require simple majority to pass when placed on the ballot via citizens’ initiative

– June’s Prop C and Prop G were the first measures to be passed after this ruling and C is being challenged in court

– San Francisco City Attorney Dennis Herrera will proactively file a validation lawsuit for November’s Proposition C

– Mayor London Breed introduced an ordinance to allow this to happen

– The city will begin collecting the tax starting in January but the City Controller has said SF cannot begin spending the funds until the legal issues are resolved

– In the meantime, the collected money will sit in reserve

– Advocates are continuing to work on implementation planning, including recommendations for the oversight committee

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SAN FRANCISCO AIDS FOUNDATION //

Prop C: Lessons Learned & Next Steps event on Dec 5

6

• Please join us for Prop C: Lessons Learned

& Next Steps.

• When: Wednesday, December 5th. Doors
• pen at 5:30pm and program begins at 6pm.
• Where: Glide, 330 Ellis St., Freedom Hall
• What: A presentation and panel discussion

about Prop C lessons learned, next steps, and how to stay involved.

• RSVP and share the event on Facebook

SAN FRANCISCO AIDS FOUNDATION //

End the Epidemics Project

SAN FRANCISCO AIDS FOUNDATION //

Statewide End the Epidemics project

• Over the past several months, 85 public health and community leaders

from across the state have come together and formed a coalition—End the Epidemics: Californians Mobilizing to End HIV, HCV, and STDs

• The ETE coalition is now ready to release a statement that urges

Governor-elect Newsom and the CA Legislature to implement a statewide strategy to end the HIV, HCV, and STD epidemics

• Governor-elect Newsom endorsed the idea of creating a statewide HIV

and HCV strategy during the campaign

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SAN FRANCISCO AIDS FOUNDATION //

ETE Goals

• The ETE coalition has identified six goals for the strategy:

1. Increase the number of people living with HIV, HCV, and STDs who are aware of their status; 2. Increase access to comprehensive HIV, HCV, and STD prevention services; 3. Ensure linkage to and retention in culturally competent, quality health care for everyone living with and vulnerable to HIV, HCV, and STDs; 4. Increase training and capacity building to strengthen and integrate the HIV, HCV and STD provider workforce; 5. Address social determinants of health that impact people living with at increased risk for HIV, HCV, and STDs; 6. Develop and track metrics to assess progress toward ending the HIV, HCV, and STD epidemics.

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SAN FRANCISCO AIDS FOUNDATION //

ETE – next steps

• The End the Epidemics coalition has drafted community consensus

statement which:

– Outlines the need for a comprehensive strategy to address the HIV and HCV epidemics as well as the state’s alarming epidemic of STDs – Calls on Governor-elect Newsom and the California Legislature to launch this effort as soon as possible, by convening a high-level working group of key stakeholders to develop and implement a strategy to end the HIV, HCV, and STD epidemics

• The statement will be circulated for organizational sign-on next week
• SFAF will be collecting individual sign-ons – text SFAF to 52886 to

receive updates

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SAN FRANCISCO AIDS FOUNDATION //

Getting to Zero San Francisco Consortium: Looking back to move forward

Getting to Zero San Francisco Mission & Vision

Mission Zero new HIV infections Zero HIV deaths Zero HIV stigma & discrimination Vision Become the first municipal jurisdiction in the United States to achieve the UNAIDS vision of “Getting to Zero”

City-wide coordinated PrEP program Rapid ART start with treatment hubs Linkage- engagement- retention in care Reducing HIV stigma

Committee for each initiative is developing action plan, metrics and milestones.

Treatment as prevention Syringe access Prevention with positives HIV testing STD testing & treatment Primary care HIV screening Mental health/ Substance use/Housing as HIV prevention Health ed/risk reduction Drug user health Linkage to care and partner services (LINCS)

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Adolescent & Young Adult

Strategic priorities for San Francisco Getting to Zero Consortium

PrEP

PrEP Uptake Citywide

Dissemination of Rapid Protocol

Expedited (same day) linkage and ART start:

• Reduces HIV illness and

death

• Reduces transmission
• Empowers patient for

disclosure Started as pilot at ZSFG hospital, GTZ expanded RAPID citywide

RAPID: Better treatment, better prevention

Rationale Dissemination

RAPID Outcomes & Global Dissemination

• RAPID citywide
• utcomes:

– Time from first medical visit to ART start: 0 days! – Time from HIV diagnosis to viral suppression: 66 days (decreased 54% in last 3 years)

• Rapid protocol taken up

by many organizations, locations, including:

– US CDC – New York City, Philadelphia, Atlanta, and

• thers

– Central America – Thailand – Netherlands – Uganda, Kenya

Retention & Re-engagement

Expanded LINCS: Linkage Integration, Navigation, Comprehensive Services

Other initiatives:

• Intensive case

management

• Food security
• Employment services
• Frontline Organizing Group
• Cell phone charging

stations

68% 65% 75% 77%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

2012 2013 2014 2015 Percent virally suppressed

Improvements in Viral Suppression

14,446 14,654 14,912 15,129 15,345 15,534 15,755 15,888 15,962 15,978 15,975 15,952 532 533 523 471 462 424 458 394 315 272 233 221

327 325 265 254 246 235 237 261 241 256 236 244 178 159 133 125 104 101 84 103 106 99 77 78

5000 10000 15000 20000 100 200 300 400 500 600 700 800

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Number of Living Cases Number of New HIV Diagnoses/Deaths Year Living HIV cases New HIV diagnoses

16

• Nearly 16,000 PLWH in

SF

• New diagnoses

decreased 52% last 5 years but only 5% between 2016-2017

• Number of deaths is

level

• Survival is improving;

65% of PLWH >50yrs

• Late diagnoses declined

from 21% in 2012 to 11% in 2016

• Number of HIV-related

deaths has decreased by 56% from 178 in 2006 to 78 in 2017

Where we are heading into 2019

BUT, DISPARITIES REMAIN

New diagnoses by race/ethnicity in men 2017

• Rates

highest in Black MSM and not declining in past year

• Latino men

also higher rates

86% 12% 2% 60% 11% 14% 6% 8% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

PWID now make up 25%

• f new

diagnoses

New diagnoses in SF highlight disparities 2017

Trans women: small % but dis- proportionate

PrEP uptake for eligibles lags behind for African Americans

San Francisco City Clinic, 2014-2017

8.4 11.4 11.8 9.2 21.2 22.6 27.9 24.5 31 36 43.2 37.4

34.2 47.5 50 49.2

10 20 30 40 50 60 African American Latino White Asian Percent of MSM eligible for PrEP 2014 2015 2016 2017

Rates of viral suppression lowest in homeless (32%) Rates of viral suppression lower in cis- and transgender women, people of color, youth, PWID

Priorities for 2019 for all committees

• Homeless/marginally housed
• People who inject drugs
• Integrating interventions for HIV with STI/HCV

prevention and treatment

• Racial and economic justice

African American 14%

Latinx 24% White 48% Asian 10% Other 4%

PEOPLE LIVING WITH HIV

African American 26% Latinx 20% White 43% Asian 3% Other 8%

HOMELESS LIVING WITH HIV

African-Americans make up 5.4% of the SF population, 14% of PLWH, and 26% of Homeless PLWH

~ Guest Panelists ~ Vincent Fuqua, San Francisco Department of Public Health James Loyce, San Francisco Health Commissioner Diane Jones, Nurse & GTZ-SF Joe Hawkins, Oakland LGBTQ Center Takija Gardner, YMCA of San Francisco

Promoting Black/African-American Health Equity: Addressing Racism & Institutional Bias

Black/African American Health Initiative Health Data and Health Action

November 28 2018 Vincent Fuqua – Health Program Coordinator Data drawn from SFHIP CHNA, Our Children Our Families Council, SFUSD

The Black/African American Health Initiative (BAAHI)

2014 BAAHI Charter: Director Garcia directs all areas of the Department of Health to work together on:

• 4 health inequity areas
• 2 staff improvement areas

BAAHI: an interdivisional initiative

= staff from clinics, HR, etc impacted by the work

Steering Committee

Racial Equity Training Heart Health Racial Equity Infrastructure

Women’s Health

Backbone support

4 staff

Guides strategy Supports activities Establishes shared measurement Builds public will Advances policy Mobilizes resources Behavioral Health

Sexual Health Director of Health PC

PHD

PC PC

PHD PHD BHS PHD

PHD

PC

• 9 of the 10 top causes of death in SF show B/AA with highest rates
• Call to action for collaboration to improve Black health

Black Health Report

BAAHI

Structure and Outcomes

Other DPH

B/AA Health Services

Black Health Data

Social Determinants + Health Status

Why don’t Black/African Americans have equal health?

Institutional and Structural Racism

Less access to resources (food, safety…)

Everyday Racism

Discriminatory and disrespectful treatment

CHRONIC STRESS

Adaptive Behaviors Substance use, family changes, diet changes Allostatic Load Prolonged output of stress hormones “wears” at the body Epigenetic Changes Genes behave differently and this is passed on children

BAAHI: outcomes

0% 20% 40% 60% 80% 100% Mar '16 Mar '17 Mar '18 Chlamydia screening rates at youth clinics 3rd St. Balboa Burton Cole St. Larkin St. BAAH AHI I METRIC RICS

Hypertension hospitalization Chlamydia incidence Premature Birth Alcohol related deaths Breast Cancer mortality rate Lung Cancer rate Adult Diabetes Hospitalizations Pediatric Asthma hospitalization Adult Asthma hospitalization New HIV infections Hepatitis C incidence Violent injury Incidence

Social Determinants of Health

CHALLENGES TO LIVING A HEALTHY LIFE

Access to healthy, diverse food sources

• 55% vs. 45%
• Fast food eaten in the past week: B/AA

residents vs all SF

• 82% vs. 69%
• B/AA high-school students had a higher

rate of soda consumption vs all students

Access to recreation/activity spaces

HEALTH ENVIRONMENT & STATUS

HEALTH STATUS

Sexual Health 2.5:1

B/AA vs. citywide gonorrhea rates

6:1

B/AA vs. citywide youth chlamydia rates Black/African Americans have higher rates of chlamydia, gonorrhea, early syphilis and HIV than other San Francisco residents.

What does that all lead to? Health Status

What can we do to decrease inequities?

EVERYBODY

• Share the data: Upstream and downstream = its unjust not just unfortunate
• Focus on the cause not just the outcome: Are there INEQUITIES that YOU can do

something about? COMMUNITY-BASED ORGANIZATIONS:

• Create programming to consider the health burdens of B/AA families
• Create programs that directly address healthy living and support healthy lifestyles
• Document the health impacts you see build the case for further changes

What can we do to decrease inequities?

ALL PEOPLE AND FAMILIES

• Continue to support your own health and the health of your family
• Seek out services to help you cope with the stress of experiencing racism
• Advocate for health programming from community and government service

providers

• Advocate for changes to living conditions that contribute to poor

community health (eg. the lack of healthy food access points or healthy activities)

What you can do to advance health equity

Everyone

• Work to understand the ways in which racism has impacted & continues to

impact how B/AA people live in San Francisco

• Continue to be aware of health disparities
• Work to eliminate personal bias and help others to identify their own biases
• Interrupt biased behavior toward B/AA people when you witness it

Events Around San Francisco

• Friday, November 30, 6-9:30pm - Light in the Grove: The National AIDS

Memorial Grove Annual Gala. Mike Shriver, activist and outgoing Board Chair, will be honored with the “Lifetime of Commitment” award.

• Saturday, December 1, 12pm -1:30pm - National AIDS Memorial Grove 25th

Annual World AIDS Day Observance. Golden Gate Park, San Francisco.

• Tuesday, December 4, 12-1pm - ZSFGH Medical Grand Rounds "Updates

in the Fast-Moving World of HIV" with Monica Gandhi, Carr Auditorium, Building 3, Room 100.

We hope you can attend!!