Baton Rouge Strategy Meeting

March 1, 2011Baton Rouge Area Foundation

Afternoon Goals

• Present information on HIV/AIDS data for the Baton Rouge MSA

• Identify an HIV prevention strategy or set of strategies that are community defined and driven

• Devise an action plan for community mobilization around the identified prevention strategy or strategies

Understanding Baton Rouge’s AIDS Case Rate

• What is the Baton Rouge MSA?– Baton Rouge Metropolitan Statistical Area (MSA) is 9

parishes• Ascension• East Baton Rouge• East Feliciana• Iberville• Livingston• Pointe Coupee• St. Helena• West Baton Rouge• West Feliciana

Baton Rouge MSA

• Population and Demographics– 2009 Total Population is 786,947

• 11.5% increase since 2000– 49% Female, 51% Male– 60% White – 36.5% Black – 2.3% Hispanic – 1.7% Asian– Median Age 33.7 years (national is 36.3)– Almost 85% of people age 25+ are high school graduates

Quick Definitions

• Incidence: The number of newly diagnosed cases of a disease (New HIV cases, New AIDS cases)

• Prevalence: The total number of cases of disease existing in a population (Persons living with HIV/AIDS)

Incidence

Prevalence

Death

Incidence – Baton Rouge MSA2009

• 2009: 331 persons newly diagnosed with HIV• 2009: 216 persons newly diagnosed with AIDS

NEW HIV CASES NEW AIDS CASES

SexFemalesMales

37%63%

38%62%

RaceBlackWhiteHispanic

86%12%1%

86%13%1%

Age at DiagnosisUnder 2525-4445 and Older

27%47%26%

11%53%36%

HIV Case Rate by Louisiana MSA2000-2009

2000 2001 2002 2003 2004 2005 2006 2007 2008 20090

5

10

15

20

25

30

35

40

45

50

Baton Rouge MSA New Orleans MSA

Year of HIV Diagnosis

HIV

Case

Rat

e pe

r 100

,000

AIDS Case Rate by Louisiana MSA2000-2009

2000 2001 2002 2003 2004 2005 2006 2007 2008 20090

5

10

15

20

25

30

35

40

Baton Rouge MSA New Orleans MSA

Year of AIDS Diagnosis

AIDS

Cas

e Ra

te p

er 1

00,0

00

2008 Estimated AIDS Case RatesUS Metropolitan Areas

Miam

i, FL

Baton Rouge

, LA

New O

rlean

s, LA

Balti

more, M

DJac

ksonvil

le, FL

Was

hington, D

CCo

lumbia,

SCAtla

nta, G

ANew

York

, NY

Jacks

on, MS

San Fr

ansis

coOrla

ndo, FL

Tampa,

FLLa

kelan

d, FL

Philadelp

hia, P

ALo

s Ange

les, C

ARale

igh, N

CHousto

n, TX

Char

lesto

n, SC

Baker

sfield

, CA

0

5

10

15

20

25

30

35

40

45 42.840.0

32.4 32.3

26.9 25.9 25.6 25.3 24.623.0

20.9 20.5 19.5 19.1 18.8 18.1 17.3 17.1 16.5 16.1

Case

Rat

e (p

er 1

00,0

00)

Southern MSA’s

CDC 2008 HIV Surveillance Report, Vol 20

Persons Living in the Baton Rouge MSA2000-2009

2000 2001 2002 2003 2004 2005 2006 2007 2008 20090

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

2,8162,978

3,157 3,2583,428

3,6283,770

3,9194,078

4,352

Year

Num

ber o

f Per

sons

LIvi

ng

Is Baton Rouge at a disadvantage statistically because of the number of prisons in the MSA?

• 2009 the BR MSA had a HIV Prevalence rate of 553 per 100,000. If you take out the prisoners (in state correctional facilities only) this only drops to 506 per 100,000.

• Removing prisons does not account for high prevalence rates in the BR MSA

Persons Unaware of Status

• The CDC estimates that 21% of all people infected with HIV are unaware of their HIV status.

• If you apply this percentage to the Baton Rouge MSA:– 1,208 persons living with HIV in the Baton Rouge

MSA who have not been diagnosed and are unaware they are infected.

What C&T sites identify the most new positives?

Identification of new infections between 10/1/09-9/30/10

• OPH Region 2 STD clinic – 30 (1.0% positivity)• EKL ER – 24 (1.3% positivity)• Metro - Main office – 17 (2.0% positivity)• Metro - Mobile unit – 12 (2.1% positivity)• Capital City – 12 (2.0% positivity)• Hunt Correctional – 8 (.2% positivity)• East Baton Rouge PHU – 6 (.5% positivity)• Metro - EBR Parish prison – 5 (1.6% positivity)

***Example- for Hunt to identify 8 new infections, they tested over 4000 individuals***

What are the sub-populations and risk categories we should be concerned about?

• African American Men• MSM • IDU • Prisoners • Youth • Pregnant Women, Exposed babies• Transgender individuals

Agency HIV C&T

Evidence Based Interventions

Social Marketing

Case Management

Medical Care

HIV Treatment

(Medications)

Other supportive services for PLWH/A

FSGBR VOA YWCA Metro Health BRASS YMCA

Overview of Programs already provided by CBOs in the Baton Rouge MSA

Agency HIV C&T

Evidence Based Interventions

Social Marketing

Case Management

Medical Care

HIV Treatment

Other supportive services for PLWH/A

Capitol Area Phoenix Initiative EKL-Early Intervention Clinic Capitol Area Reentry Program HAART, Inc. Planned Parenthood Our Lady of the Lake

Overview of Programs already provided by CBOs in the Baton Rouge MSA- continued…

Agency HIV C&T

Evidence Based Interventions

Social Marketing

Case Management

Medical Care

HIV Treatment

Other supportive services for PLWH/A

Women’s Hospital Baton Rouge Area Alcohol and Drug Center AIDSLaw Capitol City Family Health Center Face to Face

Overview of Programs already provided by CBOs in the Baton Rouge MSA- continued…

Map of Services- Whole MSA

Map of Services- City of Baton Rouge

How much investment is going into program categories

Program Category and Funding Source Estimated Amount Designated for the Baton Rouge MSA

ServicesRyan White Part A $3,117,985Ryan White MAI $292,595ADAP (25% of state total) $5,151,350

PreventionC&T $961,122Condoms $56,306Behavioral Interventions & Outreach $296,042DIS and other staff $548,905

Capacity Building and other gap fundingPennington and LCAP* ~$285,000

*LCAP- Includes funding from AIDS United (National AIDS Fund) Baton Rouge Area Foundation, Wilson Foundation, Pennington Foundation, Keller Family Foundation, OPH-SHP and others

Overview of the State’s HIV/AIDS Prevention Funding Categories

From the OPH STD/HIV Solicitation of Offers- $1,100,000 (25% likely to go to Region 2):

• HIV Counseling, Testing and Referral/Linkage;• HIV Screening and Referral/Linkage; • HIV Testing through Social Networks; • STD Screening; • Prevention Materials Availability; • Programs Targeting Men Who Have Sex with Men; • Outreach, Referral and Linkage; • Prevention With Positives

From the Baton Rouge Part A Application- $3,825,000: • Ambulatory Outpatient Medical Care; • AIDS Pharmaceutical Assistance (Local); • Oral Health; • Early Intervention Services; • Medical Case Management; • Mental Health Services; • Substance Abuse Outpatient Services; • Non-Medical Case Management; • Food Bank; • Legal Services; • Psychosocial Support Services; • Emergency Financial Assistance; • Medical Transportation; • Outreach.

Overview of the City’s Ryan White Funding Categories

Our Collective Community-Level Goal

Decreasing/preventing the number of people who test positive for HIV and other STDs in

Baton Rouge MSA

If this is the goal- where are the gaps?

Exercise: Group Discussion and identification of programming gaps

Suggested menu of most promising Community Based HIV Prevention Practices

• Information, education, and communication (IEC) – HIV/AIDS Awareness Social Marketing Campaign– HIV/AIDS & STD 101; awareness raising – School-based sex education – Condom promotion & distribution

• Expanded HIV Counseling & Testing– MSA-wide testing campaign: Example DC or Oakland– Opt-out testing in Emergency Rooms– Social Network Testing – School Based Clinic Testing– Community Health Center Testing

• Evidence based interventions– SISTA; Many Men Many Voices; Mpowerment; Project Respect; Willow; SIHLE

• Expanded Services– Access to care– Housing– Access to medication– Transportation

Criteria for choosing strategies• Reach- The strategy is likely to affect a large percentage of

the target population. • Mutability- The strategy is in the realm of the community’s

control. • Transferability- The strategy can be implemented in

communities that differ in size, resources, and demographics.

• Effect size- The potential magnitude of the health effect for the strategy is meaningful.

• Sustainability of health impact- The health effect of the strategy will endure over time.

Community Mobilization Framework- What is your role?

Working on getting a better version of this graphic!!!

Group Exercise to Devise a Community Mobilization Plan

• Group 1- Information, Education, Communication– What type of media vehicle?– Targeted at whom?– What resources are needed?– How does it match up against the criteria?

• Group 2 – Expanded HIV Counseling & Testing– What type of sites?– Targeted at whom?– What resources are needed?– How does it match up against the criteria?

• Group 3- Evidence Based Interventions– Who should be targeted? (Community level, group, individual?)– What intervention(s) are best suited to fit the need?– What resources are needed?– How does it match up against the criteria

• Group 4- Expanded Services– What service gaps exist?– What is achievable through community mobilization?– What resources are needed?– How does it match up against the criteria?

Group Exercise• Break up into your 4 groups• Answer questions on the previous slide…then• What action steps can you take to endorse?• What action steps can you take to support?• What action steps can you take to participate?• What action steps can you take to build action

coalitions? Remember: You and your organization are change

agents!

Deliverables

• How intervention rates again criteria• List of action steps that can realistically be

done• Schedule next group meeting time and

location• Make sure your call to action is completed-

submit top part to us and keep the bottom for yourself

Group Reports: Action Steps for Mobilizing the Community Around our Goals

• Action steps from afternoon group reports• Feedback and critique from morning training

participants

Next steps after today

• Build a community mobilization action plan document

• Disseminate amongst today’s participants and other Baton Rouge MSA stakeholders

• Others?

Questions about today?

Please contact:

Susan BergsonLouisiana Public Health Institute/Louisiana Community

AIDS Partnershipsbergson@lphi.org; 504-908-1904

Michael Robinsonmrobinson@lphi.org; 504-301-9800