DR. LAURIE DILL , M.D.MEDICAL DIRECTOR,

MEDICAL AIDS OUTREACH OF ALABAMAThe Pres ident ’ s Adv i so ry Counc i l on HIV /A IDS

February 28 , 2012

Access to Care for Women and Girls with HIV/AIDS: Voices

from the South

Overview: HIV/AIDS in the United States

600,000 deaths

1.2 million living with HIV

20 % not diagnosed

Average 50,000 new cases per year*

Estimated HIV incidence in the US, 2006-2009, CDC, August 2011

Overview: HIV/AIDS in the United States

A Disproportionate Burden: HIV/AIDS in the Southeastern United States

A Disproportionate Burden: HIV/AIDS in the Southeastern United States for African-Americans

A Disproportionate Burden: HIV/AIDS in the Southeastern United States for Women and Girls

Rates of Females Living with an HIV Diagnosis by County, Southeastern U.S., 2008

A Disproportionate Burden: HIV/AIDS in the Southeastern United States

The following 2009 data from the CDC provide evidence of the disproportionate burden of new HIV infections (which include all new infections reported regardless of stage of HIV disease) and of new AIDS diagnoses in the South4:

The rate of new HIV infections per 100,000 population was the highest in the Southern US, indicating that this region had the greatest proportion of residents testing positive for HIV in 2009.2

Half of newly reported HIV infections were in the South although the South accounted for only 37% of the US population.2, 3

The South accounted for nearly half (46%) of new AIDS diagnoses and the AIDS diagnosis rate in the Southern region was only second to the AIDS diagnosis rate in the Northeast region.1

1 Centers for Disease Control and Prevention. HIV Surveillance Report, 2009. 2011; http://www.cdc.gov/hiv/surveillance/resources/reports/2009report2 Centers for Disease Control and Prevention. HIV Surveillance Report, 2009, Table 19. 2011; http://www.cdc.gov/hiv/surveillance/resources/reports/2009report3 U.S. Census Bureau PD. Table 1, Annual Estimates of the Resident Population for the United States, Regions, States, and Puerto Rico: April 1, 2000 to July 1 2009. 2009; http://www.census.gov/popest/states/NST--‐ann--‐est.html.

Auburn University Montgomery Center for Demographic Research: 2011 Alabama HIV/AIDS & STD Data Sheet

HIV/AIDS in Alabama

Auburn University Montgomery Center for Demographic Research: 2011 HIV/AIDS & STD Data Sheet

HIV/AIDS estimates for 2010

Prevalence: Incidence: U.S. 370.12 11.33 Alabama 362.51 13.58 Dallas County 513.46 18.66 Lowndes County 646.07 47.45 Macon County 717.88 40.38 Montgomery County 896.88 36.03

Medical AIDS Outreach of Alabama

Serves 26 counties of South Central Alabama

Is currently serving 1,242 patients whom otherwise would be without treatment for HIV, and has reached 22,000 people through community education and outreach in the last year

provides free HIV testing provides compassionate,

comprehensive, and confidential care to those infected and/or affected by HIV

Has a 99%success rate with newborn initiative, treating over 100 HIV positive women ensuring their babies are born free of HIV

accesses medications for 100% of uninsured and underinsured patients

Women with HIV

In 2009, CDC surveillance data indicated that nearly one-quarter of new HIV infections (24%) were among women.1

The regions with the highest proportion of new HIV infections among women were the South (25%) and Northeast regions (27%).2

Our patient population is 37% women

1. CDC HIV Surveillance Report, 2009; 2. Southern HIV/AIDS Strategy Initiative Report 2011

Minority Women with HIV

African American women are particularly affected by HIV in the South, as the majority of new HIV diagnoses (71%) among women in the South between 2005-2008 were among African-American women.

Half of the new HIV diagnoses among Hispanics/Latinos occurred in the Southern US

79% of our female patients at MAO are African-American

CDC. Disparities in Diagnoses of HIV Infection Between Blacks/African Americans and Other Racial/Ethnic Populations-37 States, 2005-2008.

Understanding the HIV/AIDs Epidemic

Structural violence, defined as the physical and psychological harm that results from exploitive and unjust social, political, and economic systems, is the dynamic in which the AIDS virus lurks.”

Women, Poverty and AIDS: Sex, Drugs and Structural Violence (2nd edition, 2011): Paul Farmer et. al

*Paul Farmer, "Women, Poverty and AIDS"

Barriers to Care for Women in the South

A Synergy of Plagues *PovertyRaceStigmaDomestic ViolenceRural ChallengesHealth Funding and Infrastructure

Challenges

AIDS United: Access to Care Initiative

Alabama eHealth is a matching grant initiative through AIDS United and the Social Innovation Fund for telemedicine sites

Grant matching at 100% ($300,000/year) for three years will enable satellite clinics to open

Goal is to use telemedicine to provide primary and HIV-specific medical care initially to three rural sites and then to expand to further rural areas

Telemedicine as a Tool for Rural Access

Using technology as an opportunity to address the profound need for expert care throughout rural Alabama communities

High-speed video/diagnostic tools to link rural patients with skilled physicians

Allows providers to be “in two places at once,” enabling immediate access to high-quality care

Decreases problem of medical availability and cost of transportation for rural residents

First Year Project Progress

March 2011- MAO and two collaborating partner agencies, AIDS Action Coalition (Huntsville) and Whatley Health Services (Tuscaloosa) received the Access to Care Grant from AIDS United/ SIF

Together the agencies serve 47 of Alabama’s 67 counties, including all of the “Black Belt” counties

“Spoke” telemedicine clinics in Selma, Sipsey, and Florence, AL, connect with corresponding “hubs" in Montgomery; Tuscaloosa; and Huntsville, AL have been set up and are being implemented

Seeing Solutions: Telemedicine for Rural Access to Care

Seeing Solutions: Telemedicine for Rural Access to Care

Seeing Solutions: Telemedicine for Rural Access to Care

THANK YOU

Thank you to all of the staff of Medical AIDS Outreach of AlabamaAnd to our patients

DR. LAURIE DILL , M.D.MEDICAL DIRECTOR,

MEDICAL AIDS OUTREACH OF ALABAMATELEPHONE: 334-280-3349

EMAIL: ld i l l@maoi .org

Access to Care for Women and Girls with HIV/AIDS: Voices from the South