zero new hiv infections zero hiv deaths zero stigma and ......•sb 159 –prep/pep furnished by...
TRANSCRIPT
Getting to Zero San Francisco
Consortium
Zero new HIV infections
Zero HIV deaths
Zero stigma and discrimination
Agenda
1. Welcome
2. Policy Updates, Q&A
3. GTZ @ Pride & AIDS Walk
4. Panel & Community Discussion: Exploring women’s experiences and challenges for HIV prevention & treatment
SAN FRANCISCO AIDS FOUNDATION //
Policy Update
Ande Stone
April 25, 2019
SAN FRANCISCO AIDS FOUNDATION //
Agenda
1 Local Updates
2 State Updates
3 End the Epidemics Campaign
4 Questions
2
SAN FRANCISCO AIDS FOUNDATION //
Local Updates
SAN FRANCISCO AIDS FOUNDATION //
Local Updates
• City Budget Advocacy
– requesting funding to backfill for any and all federal level HIV funding reductions;
– 3% Cost of Doing Business increase for all grant-funded contracts to address and ensure
sustainability for all safety net programs;
– Support new housing subsidies for seniors and adults with disabilities, including people
living with HIV, to address the greatest disparity in health outcomes – housing status;
– Continued funding for enhanced mental health services to benefit long term survivors of
HIV;
– overdose death prevention services;
– Sustain Residential Care Facilities for the Chronically Ill (RCFCI); critical resource for
seriously ill, multiply diagnosed people living with AIDS at risk of program closure.
• Meeting with the Mayor - RCFCI
4
SAN FRANCISCO AIDS FOUNDATION //
State Updates
SAN FRANCISCO AIDS FOUNDATION //
Legislative & Budget Updates
• AB 362 – Supervised Injection Facilities (Overdose Prevention Services)
– Passed out of Public Health Committee & Public Safety Committee
– Next Step is Assembly Floor
• SB 159 – PrEP/PEP furnished by Pharmacies
– Amendments added, only allows pharmacists to furnish 30 days worth of PrEP and then
patient must be referred to provider for follow-up
• $60 million – HIV, HCV & STD Prevention Budget
– Budget Hearings are ongoing, more updates soon!
– Statewide lobby day coming up on April 30 (more info soon)
6
SAN FRANCISCO AIDS FOUNDATION //
#EndTheEpidemics
SAN FRANCISCO AIDS FOUNDATION //
End the Epidemics
• Overview
• Consensus Statement• 150 organizations!
• Is your organization signed on?
• End the Epidemics Day of Action• Tuesday - April 30th
• 28 folks from across the Bay Area & Northern California
• 54 advocates from across the state
• Direct Outreach• We’ve gathered 285 signatures
• Hunky Jesus + Ojos Que No Ven (IFR) + AIDS Survivors Storytelling (Shanti) +
• Please share with your orgs and invite us to do outreach at your events!
• Sign up www.sfaf.org/HANEvents
8
SAN FRANCISCO AIDS FOUNDATION //
Sign the PetitionText RESIST to the number 52886
9
SAN FRANCISCO AIDS FOUNDATION //
Ande Stone
Community Mobilization Manager, San Francisco AIDS Foundation
10
Questions?
SAN FRANCISCO AIDS FOUNDATION //
Volunteer at the GTZ-SF booth! Play spin-the-wheel, give away fun prizes
+ talk with the community about our work!
Opportunities to share Getting to Zero SF in the Community: Sign up at the table
This year we’re printing signs to carry at the Pride parade!Let us know if your organization would like 1-2 for the event.
~ Co-Moderators ~
Tracey Packer, San Francisco Department of Public Health
Cecilia Chung, SF Health Commission & Transgender Law Center
~ Guest Presenters & Panelists ~
Erin Wilson, San Francisco Department of Public Health
Elise Riley, University of California San Francisco
Clarissa Ospina-Norvell, UCSF/SFGH Ward 86
DK Haas, Community Member & Alliance Health Project
Breonna Mccree, Community Member & UCSF
Women & HIV: Addressing challenges experienced by cis &
transgender women in prevention & treatment
HIV and getting to zero new
infections among trans women in
San FranciscoERIN WILSON
SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH
HIV Annual report -
2017
N = 384 trans women in the HIV core surveillance data living with HIV
Trans women made up 3% of all persons diagnosed with HIV from 2016-2017, while they comprise <1% of the San Francisco population6 trans women diagnosed with HIV in 2016
Only 50% were virally suppressed within a year
Disparities in Viral Suppression
68% 69% 69%67%
32%
68% 70% 70%67%66%
68%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Pe
rce
nta
ge
Vira
lly S
up
pre
sse
d
74%
All Population Viral Suppression
Rate
Courtesy of Susan Scheer
HIV prevalence among trans women in SF –data from behavioral surveillance
35.00%
38.80%
33.70%
31.60%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
TRANS
COMMUNITY
HEALTH STUDY,
1997
TEACH 2010 TEACH 2013 TEACH 2016
HIV PREVALENCE
77%
90%85%
65%
81% 81%
44%
69% 64%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
HIV care continuum among trans women in SF2010, 2013, 2016
Raymond et al, 2019
Race/ethnicity of trans population
in San Francisco
32%
3%
18%1%
1%
17%
28%
Hispanic/Latinx
Asian
Black/African American
Native American
Native Hawaiian or
Pacific Islander
Other/Multiple
White
Intersectionality & HIV risk
Race/
Ethnicity
Youth
Transwomen & youth
Gender Identity
Youth & young adults
accounted for 21% of
all new HIV infections in
2017
African Americans
accounted for
43% of all HIV
infections as of
2017 and 13% of
US population
Transwomen in the
US have a 21.7%
pooled HIV
prevalence in the
US and <1% of the
population
Racial/ethnic
disparities in
HIV among
trans women
in San
Francisco
15%
8%
19%
12%
41%
29%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Hispanic/Latino African American
SF in 2010 (census) Living HIV cases in 2016 Transwomen living with HIV 2016
Disparities in the PrEP Continuum and social determinants for trans women (Trans*National) compared to MSM (NHBS) in SF (2016-2018)
79%
36%
15%10%
97%
55%
40%35%
0%
20%
40%
60%
80%
100%
PrEP awareness Talked with a
provider
PrEP use On PrEP and
adherent
Transwomen MSM
PR 0.77 (0.73-0.81)
PR 0.87 (0.83-0.91)
PR 0.80 (0.76-0.84)
PR 0.78 (0.74-0.82)
• Significant differences in social determinants were also found.
• Compared to MSM, trans women had significantly: lower education lower income Less employment More homelessness More engagement with
providers More health insurance
Liu, Wilson et al, HIVR4P 2018
Stay Trans PrEP
demonstration
project
enrollment by site 38 37
29
2022
Tom Waddell
Urban Health
Center
Tri City Health
Center
Castro Mission
Health Center
San Francisco
Community
Health Center
**25 Van Ness
146 trans
people on PrEP
What will it take to get to Zero new HIV
infections among trans women?
Anti-
trans
stigma
Research links anti-trans stigma to
Family rejection
Limitations in educational opportunities
Unemployment
Lack of health care access
Targeted violence from law enforcement and
others
Affects access to medical care (mistrust) Violence
Housing instability
(Santis et al., 2009; Khan et al., 2008; Wilson et al., 2011)
TEACH 2016 – trans women
living with HIV
• Unstable Housing
significantly associated with
detectable viral load
Stay 2018 - PrEP participants
• 38.7% were unstably housed
• 8.5% were homeless
Current housing situation
Couch surfs with…
Homeless/shelter
SRO
Residential treatment facility
Transitional/supportive…
Owns house
Rents house or apartment
Other
17 (2.7%)
278 (44.2%)
47 (7.5%)
106 (16.9%)
122 (19.4%)
17 (2.7%)
20 (3.2%)
22 (3.5%)
Unstably
housed:
313
(49.8%)
Interventions - What’s working
and what to consider Biomedical HIV prevention-
Continue expansion of access to PrEP in trans-specific and PrEP only clinics
Increase access to new biomedical HIV prevention modalities
2-1-1 for trans women
Injectable PrEP and other intervention trials
Radical new approaches that address upstream factors to increase HIV prevention use and HIV care outcomes
Interventions to reduce mental health stress, substance use and sexual risk behavior by reducing
Stigma against trans and racial minority identity people
Violence against trans women
Housing
Trauma
Fund and Partner
with Trans-led City
& Non-profit
Initiatives Compton’s Transgender Cultural District
Kween Culture Initiative
TranshomeSF
El/La Para TransLatinas
Transgender Law center
Thank You!
Trans*National Study team - Karen Aguilar * Jade Deva * Corey
Drew * Marla Fisher * Rafael Gonzalez * Catherine Kazbour * Victory
Le * Jacqueline Lewis * William McFarland * Andres Pomart * Henry
Fisher Raymond * Sofia Sicro* Orianna Saportas* Theo Beltran
Stay Study team – Sean Arayasirikul, Christina Sanz Rodriguez, Albert
Liu, Corey Drew, Jayne Gagliano, Viktor Belmont, Jasmine Infiniti
Community Health Equity and Promotion, San Francisco
Department of Public Health
National Institute on Minority Health and Health Disparities (R01-
MD010678)
California HIV/AIDS Research Program- UC Office of the President
Elise D. Riley, PhD, MPH
Professor
UCSF Department of Medicine
Division of HIV, Infectious Disease and Global Health
Zuckerberg San Francisco General Hospital
Women Living with HIV in San Francisco
Women Living with HIVin the United States
• Fewer women receive antiretroviral (ART) therapy than men
• Among individuals who do receive ART, women are twice as likely to discontinue therapy compared to men
HIV Epidemiology, Annual Report, SFDPH, 2017
HIV Epidemiology, Annual Report, SFDPH, 2017
HIV Epidemiology, Annual Report, SFDPH, 2017
Survival of Persons Diagnosed with Stage 3 HIV (AIDS) in San Francisco
Shelter, Health and Drug Outcomes among Women (SHADOW) Study
● 47=mean age
● 49% African-American
● 17% incarcerated (past 6 months)
● 46% used cocaine
● 18% used heroin
● 50% used cannabis
● 60% had an outpatient health care visit in the past 6 months
● 71% had an HIV case manager
Baseline Characteristics (n=129)
Socioeconomic factors ● age, race, education, income, insurance, housing
Health care ● primary care, case management, ART use
Social support ● close friends, instrumental support
Drug use ● cocaine, heroin, meth, opioid analgesics, alcohol
Predictors of Mental Health Status
Main Effect of Adjusted Adjusted 95% Adjusted tVIMPopulation Confidence p-value RankEffect Interval
Unmet subsistence needs -5.37 (-7.34, -2.35) <.0001 1
>90% ART adherence 5.07 (2.12, 7.76) .0006 2
Has a close friend/confidant 3.20 (1.05, 4.98) .0014 3
Crack cocaine use -4.55 (-7.20, -1.69) .0018 4
Slept on the street -2.92 (-4.47, -0.49) .0036 6
Cocaine withdrawal -3.02 (-4.95, -0.34) .011 7
At-risk alcohol use (>1d/day) -2.78 (-5.44, -0.38) .032 8No reported sources of instrumental Support -2.26 (-4.49, -0.15) .040 9
Ranked Influence of Study Factors on Mental Health (n=129)
(Riley et al., PLoS One. 2012; 7 (4): e35207, 1-7)
Factors Associated with Unsuppressed Viral Load
Study Characteristics
Demographics(age, race income)
Housing(# nights homeless or in an SRO)
Social supportFood insecurityIncarcerationViolenceDrug use (cocaine, meth, heroin, alcohol, pain killers)
Clinical characteristics (recent primary care, case management, insurance)
● 60% >1 unsuppressed viral load over 3 years
● 19% unsuppressed at every visit
Unsuppressed Viral Load (n=129)
Factors Associated with Unsuppressed Viral Load (N=129)
Study Characteristics (past 6 months)
Adjusted Odds Ratio (95% CI)
# nights slept on the street 1.10 (1.01-1.19)*
# nights slept in a shelter 1.15 (1.05-1.26) *
# nights slept in an SRO 1.04 (1.02-1.07)*
Any incarceration 3.17 (1.61-6.23)*Heroin use 1.91 (0.98-3.74)Cannabis use 1.55 (1.01-2.36)*
“I discovered that my environment had a lot to do with my mental state. So, when I had my own place, I was in control of the environment. You know, there was no drama, everything was nice and mellow, and so I was able to function... It was when other people and situations were introduced into my environment that I couldn’t get away from, that would send me over the edge.”
(Knight et al., Int J Drug Policy 2014)
The Social Context of Housing
“WLWH continue to experience poor outcomes across the HIV care cascade and overall health, an appreciable proportion of which may not be disease-related but due to socio-structural barriers that impact health.”
(Shokoohi et al., PLoS One, 2019)
Acknowledgements
The women who participate in our studies
The SHADOW and PULSE study teams
The National Institute on Drug Abuse (R01 DA037012 and K24 DA039780)
The research presented here was made possible by
Thank you!