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Home My WebLink AboutMINUTES - 07192005 - C49 FHS ## 61Contra r • TO. BOARD OF SUPERVISORS '4 Costa FROM: FAMILY AND HUMAN SERVICES COMMITTEE "__ •�° �w srA'couK i''� DATE: JULY 1912005 County SUBJECT: HIV PREVENTION SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION Recommendation: ACCEPT the attached report and recommendations presented by the Public Health Director dated June 20, 2005 on HIV prevention. Fiscal Impact: None Background: This issue was originally referred to the Family and Human Services Committee for monitoring in 2002. Since that time the Health Services Department has been reporting on the needle exchange . program, funding, health care needs and referral services. This report presents current data on the correlation of AIDS diagnosis and injection drug use, and progress made by Community Health Empowerment with the needle exchange program, including discussions with the Greater Richmond Interfaith Program on possible collaboration. CONTINUED ON ATTACHMENT: X YES SIGTURF: RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER SIGNATURE(S): F ERAL D. GLOVER ARK DESAUflTlElk ACTION OF BOARD ON f APPROVE AS RECOMMENDED OT VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE UNANIMOUSABSENT ( } AND CORRECT COPY OF AN ACTION TAKEN AND ENTERED ON THE MINUTES OF THE BOARD AYES: NOES: OF SUPERVISORS ON THE DATE SHOWN. ABSENT: ABSTAIN: ATTESTED S �la-lel JOHN SWErRS N,CLERK OF THE BOARD OF SUPERVISANDCOUNTY ADMINISTRATOR Contact Person: Dorothy Sansoe(5-1009) CC: CAO HSD BY: DEPUTY County of Contra costa .: ICE OF THE COUNTY ADMINISTRATOR MEMORANDUM DATE: June 20, 2005 TO: Family and Human Services Committee Supervisor Federal Glover, Chair Supervisor Mark DeSaulnier,Member FROM: Dorothy Sansoe, Staff Sr. Deputy County Administrator SUBJECT: REFERRAL#61 —HIV PREVENTION RECOMMENDATION: 1) Accept this report on needle exchange as part of a comprehensive HN Prevention Program. 2) Maintain the State of Emergency Declaration in Contra Costa to allow the continuation of the needle exchange program. 3) Direct the Health Services Department to continue evaluating the needle exchange program and report periodically to the Family and Human Services Committee on needle exchange and other issues relating to the HN epidemic in Contra Costa. BACKGROUND: This issue was originally referred to the Family and Human Services Committee in October 2002 for monitoring. Since that time the Health Services Department has been providing periodic reports on the progress made by the Department including,but not limited to, needle exchange sites, funding,health care needs, and referral services. The referral to Family and Human Services was closed in December 2003. In January 2005,the Committee requested the referral be re-opened so that an update could be provided. The attached report from the Health Services Department provides the requested update on the HIV Prevention Program and needle exchange services. Attachment Contra Costa Health Services Needle Exchange Update Report to Family&Human Services Committee June 20, 2005 RECOMMENDATIONS 1) Accept this report on needle exchange as part of a comprehensive HIV Prevention Program. 2) Maintain the State of Emergency Declaration in Contra Costa to allow the continuation of the needle exchange program. 3) Direct the Health Services Department to continue evaluating the needle exchange program and report periodically to the Family and Human Services Committee on needle exchange and other issues relating to the HIV epidemic in Contra Costa. SUMMARY Community Health Empowerment (CHE) has implemented the needle exchange services it is contracted to provide, identified additional needs, and is requesting additional support to meet those needs. General discussions with some community members who support the concept of needle exchange have not yet identified additional financial support to maintain or expand services. Trends analysis indicates that while transmission of HIV via injection drug use (IDU) in Contra Costa seems to be stable and showing a downward trend, the proportion of HIV/AIDS cases attributable to injection drug use in Contra Costa remains higher than that reported across the State of California as a whole. While it cannot be stated that needle exchange is totally responsible for the stabilization, the availability of the service may in part contribute to this positive trend. The declaration of a State of Emergency in Contra Costa should remain in effect and the contract for exchange services should remain in effect so long as the service is provided. Focusing needle exchange efforts at existing sites and working with existing infrastructure and service providers will help to maximize resources at those sites. - 1- Contra Costa Health Services Needle Exchange Update Report to Family&Human Services Committee June 20, 2005 In December 1999, the Board of Supervisors declared a State of Emergency pertaining to the transmission of HIV and Hepatitis C, clearing the way for the provision of needle exchange in Contra Costa. The declaration is reviewed and reissued every two weeks as stipulated by the legislation. Community Health Empowerment/ Exchange Works (CHE) is the designated needle exchange agent in Contra Costa County. DATA REVIEW A statewide telephone survey conducted in 2000 found that approximately 0.8% of adults in California (roughly 200,000 individuals) injected non-prescription drugs during a one-year period.1,2State data also shows: • Approximately 19% of the 135,,218 reported cases of AIDS are attributed to IDU.3 • Reports of needle sharing among IDUs dropped from 76% in 1994 to 70% in 2002. As of January 2005, nearly 28% of all people ever diagnosed with AIDS in Contra Costa are attributed to injection drug use. Currently there are approximately 950 people living with AIDS (PLWA) in Contra Costa. 0 22% are IDU 0 Among women,, approximately 41% are IDU Trends analysis of Contra Costa data done by Urban Health Studies shows a steady decline in reported cases attributed to injection drug: from about 23% in the early nineties to 15% in more recent years.' In their assessment of participants at the Richmond needle exchange site Urban Health Studies also found:6 • More than 40% receive 20-49 syringes at one visit • Approximately 60% indicated that they did not reuse syringes • Approximately 65% attend syringe exchange at least 4 times per month • Nearly 50% indicated that they injected 90 or more times in a 30-day period • Heroin is the most frequently injected drug • Nearly 70% of those who tested for Hepatitis C reported they were positive for Hepatitis C 1 Moskowitz,JM et al. California 2000 HIVIAIDS Knowledge,Attitudes, Beliefs, and Behaviors Survey: Methods and Results. UC Berkeley,2002 2 Facer,M.,et al,Social Light Consulting Group, 2001. Consensus Meeting on HIVIAIDS.-Incidence and Prevalence in Californian. Office of AIDS, California Department of Health Services. 3 AIDS Case Surveillance website,December 2004 4 University of California and the California Department of Health Services. California HIV Prevention Indicators: Brief Report#L June,2004 $Contra Costa County Epidemiology,Surveillance and Health Data Unit,June 2003 6 Ricky Bluthenal,RAND;Rachel Anderson&Neil Flynn,UC Davis;Alex Kral&James Kahn,UCSF:Exchange Works: CaISEP Results, 2001-03. The study was conducted in 25 needle exchange sites across California,including the Richmond syringe exchange. Findings are subject to self-selection and other biases. -2 - Contra Costa Health Services Needle Exchange Update Report to Family&Human Services Committee June 20, 2005 A review of West County treatment data from the Alcohol and Other Drugs Services Division shows that approximately 13% of the treatment episodes in calendar year 2004 were for injection drug users. While the data is incomplete, the majority of IDUs reported were white (49%) or African American (40%), male (780/o), and self-referred into care (44%). Half were homeless at the time of intake and 60% experienced an unsuccessful discharge.' NEEDLE EXCHANGE The Health Department provides $60,000 per year for needle exchange services through a contract with Community Health Empowerment (CHE). CHE's scope of work with the AIDS Program requires that exchange services operate one night per week in West County and one night per week in East County. CHE operates a total of 4 exchanges (Richmond, North Richmond, Pittsburg, and Bay Point) and reports on two of them (Richmond and Bay Point). Exchange services run from 6:00 pm to 8:00 pm at all sites. The annual budget is approximately $110,000, including $50,000 in Foundation funds. The budget supports the Director, a part-time outreach coordinator and a part-time support staff person. The fiscal agent, Greater Richmond Interfaith Program (GRIP), manages CHE funds and charges a 5% fee for the Contra Costa portion of the budget. Pittsburg Preschool Community Council provides staff support to the exchange operating at the Pittsburg site. Needle exchange programs in the Bay Area vary widely in their total annual budgets and methods of operation. San Francisco uses a mix of public and private funds to exchange more .than 2.5 million needles per year. Throughout the rest of the Bay Area, most services are much smaller and provided by community-based agencies (CBOs), although San Mateo does provide some needle exchange services through the County Health Services Department. County Type of Service County Funds Alameda 2 CBOs (Tri-City Health Center and HEPPAC Approximately $640,000 San Mateo 2 CBOs under AODS Division Approximately $180,,000 Marin 1 CBO No coun funds LOCAL PROGRESS REPORT Community Health Empowerment participates in the West County AIDS Task Force, has been a presenter and participant in the Contra Costa HIV Service Providers' Network, has attended two AIDS Program contractors' meetings this fiscal year, and participates in statewide meetings. Following a one-day training meeting in San Francisco, CHE decided that it would not pursue a non-profit status application, preferring to remain a small, non-bureaucratic entity unencumbered by organizational structure and politics. 7 Data Run,March 2,20055 Contra Costa Health Department,Alcohol and Other Drugs Services Division,Contra Costa County Epidemiology, Surveillance and Health Data Unit,June 2003 -3 - Contra Costa Health Services Needle Exchange Update Report to Family&Human Services Committee June 20, 2005 Needle exchange services were provided regularly over the course of the year. "Contacts" refers to the number of individuals accessing the sites. While these figures are not unduplicated individuals, previous estimates by CHE indicated that approximately 700 individuals were served at the two exchange sites. Richmond participants are predominantly African American and Bay Point participants are predominantly white. The reporting period is July 1,, 2004-- February 28,, 2005. Site Contacts # Syringes Gender Central Richmond 911 66 68368% M Bay Point 928 571830 -57% M Jotal 1 1839 124r513 Central Richmond exchanges an average of 22,824 syringes per quarter and Bay Point exchanges 18,,520 syringes. In the most recent progress report, CHE reported more apparent homelessness, noting that 38% of the Central Richmond clients and 21% of the Bay Point clients were homeless. CHE reports that many of the clients they see at the exchange sites want to talk about the experiences that led them to substance abuse. While CHE tries to provide each individual with the time they need to discuss whatever issues they feel important, the nature of the constraints at the exchange sites often preclude CHE from providing as much quality time to clients as they would like. CHE also feels unable to provide sufficient support via the exchange venue to the increasing number of younger users they are seeing. They are exploring with their fiscal agent the development of a drop-in center where an appropriate level of support and services could be offered. Recent discussions between CHE and the Board of Directors at Greater Richmond Interfaith Program (GRIP) have been encouraging, with the GRIP Social Justice Committee asking for additional information about needle exchange while considering the possibility of providing space at a church site for drop-in services to be available on exchange nights. Health Department participation in these discussions has been offered to CHE. In the latest progress report CHE indicated concerns that the model they discussed with GRIP would not serve East County clients who wouldn't be able to access supportive services at a drop-in site located in West County. CHE proposed developing a team of behavioral change experts to provide services one full day per week at each of the existing 4 sites in the county. These teams would work with clients prior to needle exchange and provide them with the referral and interventions needed to develop behavior change. This past year, the HOW van provided 34 clinics at the exchange sites in West County,, serving 136 individuals. These services reduce overall health care costs by addressing serious health issues in a more timely fashion. • Forty individuals are regular recipients of care through the HOW van. • Three were sent directly to the emergency room for treatment of high blood pressure, possible pneumonia., and possible endocarditis. -4- Contra Costa Health Services Needle Exchange Update Report to Family&Human Services Committee June 20, 2005 • The remaining clients received care for abscesses, asthma, bronchitis and other infections unrelated to drug use. • A few individuals (8 or 9) were placed in ongoing substance use care. OTHER ISSUES 1. Working with existing infrastructure. A representative from Neighborhood House of North Richmond (NHNR) began offering behavior change support during Richmond exchange hours effective the end of April. NHNR has a contract with the AIDS Program to provide HIV prevention services in West County. 2. Law Enforcement involvement. Clients report to CHE that officers have taken needles from them and either discarded them or, in some cases, issued citations for individuals to appear in court. In these circumstances, CHE is providing clean syringes to individuals arriving at the exchanges without their used syringes. They have provided exchange participants with a letter to show law enforcement if they are stopped. The AIDS Task Force has indicated an interest in providing a presentation to law enforcement on needle exchange. 3. Insufficient health care resources. CHE reports seeing a number of soft tissue injuries in East County. Most individuals do not access health care except on a crisis basis and there is no HOW van equivalent in the area. There seems to be more poverty in evidence and the population appears to be more "underground" than in the West County area. There are more women and more Hispanics served in the East County exchange. 4. Methadone treatment and services. AIDS Program staff met with the Alcohol and Other Drugs Services Division (ADDS) and discussed providing additional information to CHE about Methadone resources. ACIDS has expressed a willingness to provide an in-service training update on changes to their system of care and how to access services. Community co-chairs of the HIV Service Providers' Network have been asked to place this training update on the Network calendar as soon as possible. 5. Community support for needle exchange. AIDS Program staff have resumed exploratory discussions to assess community concerns and interest. East County has expressed an interest in having staff explore directing the exchange through the local church system to determine the feasibility of a drop-in center for youth and women on exchange days. The interest is for CHE. to propose something small and concrete that builds on existing resources and services under the auspices of a local community group or agency. West County community leaders feel local law enforcement concerns must be addressed before trying to expand service sites, and staff have been advised to frame arguments in terms of crime reduction and related issues. The AIDS Program is exploring data and information that might support that type of dialogue. - 5 - Contra Costa Health Services • Needle Exchange Update Report to Family&Human Services Committee June 20, 2005 CONCLUSIONS: 1. The declaration of a State of Emergency should remain in effect. Trends analysis indicates that transmission of HIV via injection drug use in Contra Costa seems to be stable and showing a downward trend, but the proportion of HIV/AIDS cases attributable to injection drug use in Contra Costa remains higher than that reported across the State of California as a whole. While it cannot be stated that needle exchange is totally responsible for the stabilization, the availability of the service may in part contribute to this positive trend. 2. The contract for exchange services should remain in effect so long as the service is provided. Although fiscal constraints will likely occur in the coming year, the Health Department should continue to set aside general funds to support needle exchange activities. 3. The level of health care needs reported in the East County exchange site should be assessed. Pending budget resolution, Public Health nurses may be able to provide some assessment and propose a process to provide a level of care. 4. CHE should increase efforts to provide drug referral services to participants at the exchange sites. The population is difficult to engage with the limited time available for exchange services. Efforts should be documented and reported with other data. 5. Other providers should be encouraged to participate at exchange slates. Alcohol and Other Drugs Services should encourage contractors to provide outreach services at exchange sites, 6. CHE and the Greater Richmond Interfaith Program should continue discussions that focus needle exchange efforts at existing sites and work with existing infrastructure and services providers to maximize resources at those sites,, rather than spreading themselves to additional locations and activities. -6-