Regional Perspective on HIV Regional Perspective on HIV Integration in Title X ProgramsIntegration in Title X Programs

LCDR Nancy MautoneLCDR Nancy Mautone--Smith, MSW, LCSWSmith, MSW, LCSWRegional Program ConsultantRegional Program Consultant

Office of Family PlanningOffice of Family Planning--Region IXRegion IXSan Francisco, CA 94103San Francisco, CA 94103

Region IXRegion IX

Region IX includes CA, AZ, NV, HI, and the Region IX includes CA, AZ, NV, HI, and the Pacific Islands of Guam, American Samoa, Pacific Islands of Guam, American Samoa, the Commonwealth of the Northern Mariana the Commonwealth of the Northern Mariana Islands, the Republic of Palau, the Islands, the Republic of Palau, the Federated States of Micronesia, and the Federated States of Micronesia, and the Republic of the Marshall IslandsRepublic of the Marshall IslandsApproximately 420 service sites in 2006Approximately 420 service sites in 2006Approximately 970,000 users in 2006Approximately 970,000 users in 2006

Region IXRegion IX-- DiversityDiversity

GeographicGeographicCulturalCulturalLinguisticLinguisticOrganizationalOrganizational

Geographic DiversityGeographic Diversity

Major Metropolitan AreasMajor Metropolitan Areas-- Los Angeles, San Los Angeles, San Francisco, Phoenix, Las Vegas, HonoluluFrancisco, Phoenix, Las Vegas, HonoluluSmall towns and rural areasSmall towns and rural areasIndian Communities (Gila River, Navajo Indian Communities (Gila River, Navajo Nation)Nation)Pacific BasinPacific Basin

Geographic DiversityGeographic Diversity

Pacific BasinPacific Basin-- 3 U.S. Territories, 3 Freely 3 U.S. Territories, 3 Freely Associated StatesAssociated StatesTime zonesTime zones--Communication challengesCommunication challenges-- infrastructure infrastructure Vast distanceVast distance--

Pacific BasinPacific Basin

High maternal and infant mortalityHigh maternal and infant mortalityPovertyPovertyEducational challengesEducational challengesGeographic isolationGeographic isolation-- (supply issues)(supply issues)Cultural and linguistic issues that impact Cultural and linguistic issues that impact service deliveryservice delivery

Dispensary on Pohnpei, FSM

Title X clinicTitle X clinic-- Majuro, RMIMajuro, RMI

Ministry of HealthMinistry of Health-- Majuro, RMIMajuro, RMI

Cultural DiversityCultural Diversity

Diverse populations in Western StatesDiverse populations in Western StatesImmigration IssuesImmigration IssuesCultural beliefs that may impact service Cultural beliefs that may impact service deliverydelivery

Linguistic DiversityLinguistic Diversity

Language on US MainlandLanguage on US Mainland--varies according to varies according to geographic location (similar to other Regions)geographic location (similar to other Regions)Pacific BasinPacific Basin-- English is the official language of English is the official language of business and commerce, but indigenous business and commerce, but indigenous languages spoken within clinic settinglanguages spoken within clinic settingDiversity within Pacific Island cultureDiversity within Pacific Island culture-- FSM has 4 FSM has 4 states (societies) and 9 languagesstates (societies) and 9 languagesImmigration/Migration in the PacificImmigration/Migration in the Pacific-- ““LEPLEP”” with with diverse populations (for example, nondiverse populations (for example, non--resident resident workers)workers)

Organizational DiversityOrganizational Diversity

State/County Health Departments, NonState/County Health Departments, Non--profits, Family Planning Councilsprofits, Family Planning CouncilsFlag Territories and Foreign GovernmentsFlag Territories and Foreign GovernmentsIndian CommunitiesIndian Communities

Population GrowthPopulation Growth

Elk Grove, CAElk Grove, CA-- fastest growth rate followed fastest growth rate followed by North Las Vegasby North Las VegasPhoenix leads in numeric growthPhoenix leads in numeric growthArizona is the fastest growing state Arizona is the fastest growing state (followed closely by Nevada)(followed closely by Nevada)California is the most populous state at 36.5 California is the most populous state at 36.5 million residentsmillion residentsLos Angeles is the second largest city in the Los Angeles is the second largest city in the US (3.8 million people)US (3.8 million people)

PopulationPopulation

Population Population

Grantee ProfilesGrantee Profiles

15 Title X Service Grantees15 Title X Service GranteesHIV ProjectsHIV Projects-- Started with 17, ending with Started with 17, ending with 15*15*CaliforniaCalifornia-- 88ArizonaArizona-- 7 7 *two projects dropped out due to *two projects dropped out due to administrative issuesadministrative issues

Project Performance Project Performance

RegionallyRegionally-- over 35,000 tests performedover 35,000 tests performed66 confirmed positives identified66 confirmed positives identifiedReturn rateReturn rate-- 66.2% 66.2% Linkages to care developed for clients Linkages to care developed for clients testing positivetesting positiveProjects continue to deliver prevention Projects continue to deliver prevention messagesmessages-- to individuals and communitiesto individuals and communities

““ABCABC”” Prevention Message Prevention Message EvaluationEvaluation

Region IXRegion IX-- Collaborative ABC evaluation Collaborative ABC evaluation coordinated by California Family Health coordinated by California Family Health CouncilCouncil7 Projects in CA, 4 in AZ7 Projects in CA, 4 in AZ1223 baseline surveys, and 445 follow1223 baseline surveys, and 445 follow--up up surveyssurveys

““ABCABC”” Prevention Message Prevention Message EvaluationEvaluation

Collaborative evaluationCollaborative evaluation-- designed to designed to assess:assess:

1.1. Risk at baseline and followRisk at baseline and follow--upup2.2. Acceptability of ABC messageAcceptability of ABC message3.3. Client intentions to reduce riskClient intentions to reduce riskPreliminary results at baseline indicate thatPreliminary results at baseline indicate thatmonogamy ranks first, condom use second monogamy ranks first, condom use second

Region IX Success StoriesRegion IX Success Stories

ASU ASU ““Breaking the CycleBreaking the Cycle”” clinicclinic-- Title X Title X clinic in Phoenix at Grace Lutheran Church. clinic in Phoenix at Grace Lutheran Church. Provides ASU nursing students rotationProvides ASU nursing students rotation--often the only often the only ““hands onhands on”” HIV HIV counseling/testing experience these nursing counseling/testing experience these nursing students have (100 students per year)students have (100 students per year)

Success StoriesSuccess Stories

Gila River Health Care Corporation’s Title X HIV Integration Project- uses a Mobile Medical Unit to serve hard to reach individuals in their community.

Success StoriesSuccess Stories

BienvenidosBienvenidos-- Title X clinic in East Los Title X clinic in East Los AngelesAngelesEstablished a curriculum for couplesEstablished a curriculum for couplesTeen Clinic expanded to include workshops Teen Clinic expanded to include workshops that incorporated the ABC message of that incorporated the ABC message of preventionpreventionApprox 54% of clients served are malesApprox 54% of clients served are males

Looking ForwardLooking Forward……

Next funding cycleNext funding cycle-- focus on implementing CDC focus on implementing CDC 2006 Revised Recommendations for HIV Testing2006 Revised Recommendations for HIV TestingEnhanced staff and patient comfort with HIV Enhanced staff and patient comfort with HIV testing as testing as ““routineroutine”” part of family planning visitpart of family planning visitCreated or enhanced organizational processes Created or enhanced organizational processes needed to implement more routine testing needed to implement more routine testing Projects worked to deProjects worked to de--stigmatize testingstigmatize testing-- the the individual, community, and organizational levelsindividual, community, and organizational levels

ReferencesReferences--

www.cia.govwww.cia.govwww.census.govwww.census.govhttp://www.yokwe.net/ydownloads/EbeyeParhttp://www.yokwe.net/ydownloads/EbeyePart1.pdft1.pdfwww.unaids.orgwww.unaids.org