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Home My WebLink AboutBOARD STANDING COMMITTEES - 12022013 - FHS Cte Agenda Pkt FAMILY & HUMAN SERVICES COMMITTEE December 2, 2013 1:00 P.M. 651 Pine Street, Room 101, Martinez Supervisor Candace Andersen, Chair Supervisor Federal D. Glover, Vice Chair Agenda Items: Items may be taken out of order based on the business of the day and preference of the Committee 1.Introductions 2.Public comment on any item under the jurisdiction of the Committee and not on this agenda (speakers may be limited to three minutes). 3. CONSIDER approving recommendations for the appointment of Ella Jones to the Member at Large Seat #14 and Dina Osakue to the Member at Large Seat #17 on the Advisory Council on Aging, as recommended by the Advisory Council on Aging. 4. ACCEPT the annual HIV Prevention/Needle Exchange update. Denice Dennis, Public Health Department, Presenter 5. ACCEPT staff recommendation to carryover seventeen referrals from the 2013 Family and Human Services Committee to the 2014 Committee. 6.The schedule for the 2014 Family and Human Services Committee meetings has not yet been established. 7.Adjourn The Family & Human Services Committee will provide reasonable accommodations for persons with disabilities planning to attend Family & Human Services Committee meetings. Contact the staff person listed below at least 72 hours before the meeting. Any disclosable public records related to an open session item on a regular meeting agenda and distributed by the County to a majority of members of the Family & Human Services Committee less than 96 hours prior to that meeting are available for public inspection at 651 Pine Street, 10th floor, during normal business hours. Public comment may be submitted via electronic mail on agenda items at least one full work day prior to the published meeting time. For Additional Information Contact: Dorothy Sansoe, Committee Staff Phone (925) 335-1009, Fax (925) 646-1353 dorothy.sansoe@cao.cccounty.us FAMILY AND HUMAN SERVICES COMMITTEE 3. Meeting Date:12/02/2013 Submitted For: FAMILY & HUMAN SERVICES COMMITTEE, Department:County Administrator Referral No.: N/A Referral Name: Appointments to Advisory Bodies Presenter: Dorothy Sansoe Contact: Dorothy Sansoe, 925-335-1009 Referral History: Appointments to at-large seats on the Advisory Council on aging are routinely considered by the Family and Human Services Committee prior to submission to the Board of Supervisors for approval. Referral Update: Please see the attached request memo. Recommendation(s)/Next Step(s): CONSIDER approving recommendations for the appointment of Ella Jones to the Member at Large Seat #14 and Dina Osakue to the Member at Large Seat #17 on the Advisory Council on Aging, as recommended by the Advisory Council on Aging. Fiscal Impact (if any): No fiscal impact. Attachments Appointment Memo and Applications Page 3 1 of 1 Kathy Gallagher, Director 40 Douglas Dr., Martinez, CA 94553 Phone: (925) 313-1579 Fax: (925) 313-1575 www.cccounty.us/ehsd. MEMORANDUM DATE: 11/12/2012 TO: Family and Human Services Committee CC: John Cottrell, Director Aging and Adult Services Lori Larks, Division Manager, Area Agency on Aging FROM: Jaime Ray, Secretary for the Area Agency on Aging SUBJECT: Advisory Council on Aging – Appointment Requested The Contra Costa Area Agency on Aging (AAA) recommends for immediate appointment to the Contra Costa Advisory Council on Aging (ACOA) the following applicants: 1. Ms. Ella Jones for Member at Large Seat #14. MAL #14 is an undesignated seat and has remained vacant since September 30, 2013. 2. Ms. Dina Osakue for Member at Large Seat #17. MAL #17 is an undesignated seat and has remained vacant since October 16, 2012. Recruitment has been handled by both the Area Agency on Aging, the ACOA and the Clerk of the Board using CCTV. AAA staff has encouraged interested individuals including minorities to apply through announcements provided at the East and West County Senior Coalition meetings and at the regular monthly meetings of the ACOA. Efforts to reestablish the Central County Senior Coalition continue with regular meetings scheduled to resume in January of 2014. The Contra Costa County EHSD website contains dedicated web content where interested members of the public are encouraged to apply and are provided an application with instructions on whom to contact for ACOA related inquiries, including application procedure. Ms. Jones and Ms. Osakue were interviewed by members of the ACOA Membership Committee at their June 2013 meeting using the Council’s standard informational interview format. The June minutes of the meeting record that the Committee agreed by consensus to recommend their appointments. Copies of the applications for ACOA membership are provided as a separate attachment. Thank You Page 4 II Print Form , . For Office Use Only Date Received: For Reviewers Use Only: Accepted Rejected BOARDS, COMMIITEES, AND COMMISSIONS APPLICATION MAIL OR DEUVER TO: Cor1Ja CosIa Cany a.ERKa=11-£ BOARD 651 Pre SIreet, Rm. 106 Martinez, Caifooia 94653-1292 PLEASE TYPE OR PRINT IN INK (Each PosIIIon R8cP188 a SepanIIB AppIIraCIon) BOARD, COM MimE OR COMMISSION NAME AND SEAT TInE YOU ARE APPLYING FOR: Contra Costa County ~dviSOry Council on Aging r-------------------, PRINT EXACT NAME OF BOARD, COMMITTEE, OR COMMISSION PRINT EXACT SEAT NAME (If applicable) 1. Narne:~~o_n_e_s________________________~E~I-la__-------------------------c-o-re_n_e__________~ (Last Name) (First Name) (Middle Name) 2. Address: 113728 San Pablo Avenue #1022 San Pablo CA 94806 (No.) (Street) (Apt.) (City) (State) (Zip Code) 3. Phones: ~10-778-8192 N/A 862-576-2740 ~==~~====~~~~======~~~================~ (Home No.) (Wor!< No.) (Cell No.) 4. ErnaiiAddress:~~o_n_e_se_lI_aC_@_y_a_h_oo_._co_m______________-=__________________________=-__~ 5. EDUCATION: Check appropriate box if you possess one of the following: High School Diploma [E] G.E.D . Certificate 0 California High School Proficiency Certificate 0 Give Highest Grade or Educational Level Achieved ....p_n_e..;.y_ea_r_o_f_co_I_le.;;g_e_____________---' Names of colleges I universities Degree Degree Date Course of Study I Major Units Completed Degreeattended Awarded Type Awarded Semester Quarter A) Morgan State University B' Ad" . II Yes No L1[E] D 0 0 Incompletel!Baltimore, MD uSlness ministration 8)1 II II Yes No DO D 0 01 I C)I I Yes No DO D 0 01 1 D) Other schools I training Course Studied Hours Completed Certificate Awarded: completed: Iraralegal Studies I Eyears I Yes No IEJD Upsala College ast Orange, NJ THIS FORM IS A PUBLIC DOCUMENT Page 5 , . 6. PLEASE FILL OUT THE FOLLOWING SECTION COMPLETELY. List experience that relates to the qualifications needed to serve on the local appointive body. Begin with your most recent experience. A resume or other supporting documentation may be attached but It may not be used as a substitute for completing this section. A) Dates (Month, Day, Year) From To \10/2009 \ EJ Total : Yrs . Mos. CJCJ Hrs. per week~. Volunteer lEI \ Title rARP VOLUNTEER I !==E=m=p::::;I=OY=le=r='S=N=a=m=e=a=n=d=A=d=d=r=e=ss=::::::!. Duties Performed obbying on behalf of fair government ~ccountability towards older citizens. Participated in community event i.e. ~A state fair, health fairs and food ~anks for AARP. .I~c:enlor advocacy representing and fo\ARP FOUNDATION ISACRAMENTO, CA B) Dates (Month, Day, Year) From To 11012005 I~ DO Hrs . per weeD. Volunteer 0 Title Duties Performed ~etlred ~elocated to home state of New Jersey Employer's Name and Address C) Dates (Month, Day, Year) From To ~110/2005 I Total : Yrs. Mos . geQlunreer 0 Title Duties Performed raxTechnician I petermined eligibility and/or ~rocessed permits for persons seeking Ibusiness tax permits in this state . Employer's Name and Address IState of California Board of Equalization iClay Street pakland , CA D) Dates (Month, Day , Year) From To Title \ I Duties Performed EmQloyer's Name and Address TH~FORMISAPUBUCDOCUMENT Page 6 II • 7. H~w -did you le~m-about this vacancy? OCCC Homepage[] Walk-In []Newspaper Advertisement o District Supervisor [EJother IViSit to ACqA meeting 8. Do you have a Familial or Financial Relationship with a member of the Board of Supervisors? (Please see Board Resolution no. 2011/55, attached): No ~Yes~ If Yes, please identify the nature of the relationship: Ir-----------------~ 9. Do you have any financial relationships with the County such as grants, contracts, or other economic relations? No ~Yes---.CL.. If Yes, please Identify the nature of the relationship: II-_________________.:L. I CERTIFY that the statements made by me in this application are true, complete, and correct to the best of my knowledge and belief, and are made In good faith. I acknowledge and understand that all information In this application is publically accessible. I understand and agree that misstatements 1omissions of material fact may cause forfeiture of my rights to serve on a Board, Committee, or Commission In Contra Costa County. Sign Name: .....:~::::......-=~_...:C:::...::...~~~~~/____Date: ~~<....L.Io<"""~=_=_=_:...__....;;.3_,;'-=d.::..;C>:;;......:...13=--- Important Infonnation 1. This application is a pu~ic doa.rnent em is ~to the California Public Records M (CA GeN. Code §625Q.6270). 2 . Send the completed paper appicaIion to the Office r:J the Clerk r:J the Board at 651 Pine Street, Room 106, Martinez, CA 94553. 3. A resume or oCher releVCllt information may be Slbmitted v.1Ih this application. 4. AI members are requi"ed 10 take the foIIoo.W1g trainilg: 1) The I3roY.n M, 2) The Better GoveIrYnent Ordnance, cn13) Ethics Trairilg. 5. Members r:J beads, commissions, a1d committees may be reqlired 10: 1) file a Statement of Economic Interest Form also knoY..fI as a Form 700, cn12) compete the State Ethics Trainilg Coc..rse as reqlired by M3 1234. 6. AcMsory body meetings may be held n various locations a1d some locations may net be accessi:lIe by pt.bIic transpor1aIion. 7. Meeting dates cn11ines ere subject 10 cha1ge a1d may occur ~to too days per manltl. 8. Some bocivds, COI'TVTIUees, or commissions may assign members to Slix:ommilees or'MX1< g'Ol4JS Wlich may requi"e a'1 additional commiment of tine. THIS FORM IS A PUBLIC DOCUMENT Page 7 APPLICATION FOR MEMBERSHIP . . PAease pnnt c11early. 1 If comp/eting on computer. move rom space to space with Flo NAME: ELLA C. JONES DATE: 1March 11, 2013 HOME ADDRESS: 13728 SAN PABLO AVENUEJ APT #1022 1 CITY SAN PABLO 1ZIP CODE 94806 MAIUNG ADDRESS: SAME AS ABOVE (If different) 1 CITY 1ZIP CODE E-MAIL: jonesellac@yahoo.com PHONE: 510 -778-8192 1CELL (If applicable): 1862-576-2740 Current or former PARALEGAL/RETIRED occupation: Employer (ifapplicable): N/A IWork Phone: I Educational Background: PARALEGAL snJDIES ,UPSALA COLLEGE, EAST ORANGE, NJ - MORGAN STATE UNIVERSIlY, BALTIMOREJ MD Community Involvement I Civic Activities: AARP FOUNDATION, LEGISLATIVE,LOBBYING ADVOCACY Special Interests: HEALTHCAREEDUCATION ND EMPLOYMENT OPPORTUNIES FOR SENIORS Area(s) of Senior Advocacy in Which HOUSING SEARCH EDUCA ION AND I Am Most Interested: IMPLEMENTATION FOR SENIORS Work Group(s) Most Health Housing legislative Mental Health Transportation Interested in X X X D Exploring: Coun dl members mus ,.. serve on at leas one ofour wor/c groups. Under 60 Over 60 U XX How did you learn of the GAIL GARRETT, SENIOR CrnZEN ADVOCATE Advisory Council on Aging? Page 8 Stgnature: . Th a~ ij (1 r k1 I.( • ~tt ts_ i. se ~""9 DIlL t~t! Co lIlC.iU OTE: ALL ~ '" ..... s a e. crpe~ a~~ r...l L< ~~(.. attel.l\.~ as ~I.{est tLvv..e. ,etum application to: Ms. Beverly Wallace, Chair, Membership Committee at 3086 Keith Drive. Richmond, CA 94803 PH (510) 223-4528 FX (510) 223-1824 or e-mail Bevwallacel@aol.com Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 FAMILY AND HUMAN SERVICES COMMITTEE 4. Meeting Date:12/02/2013 Submitted For: FAMILY & HUMAN SERVICES COMMITTEE, Department:County Administrator Referral No.: 61 Referral Name: HIV Prevention/Needle Exchange Presenter: Denice Dennis, Health Services Department Contact: Dorothy Sansoe, 925-335-1009 Referral History: The HIV Prevention/Needle Exchange program was referred to the Family and Human Services Committee in October 2002. The issue was discussed four times during 2003 and was subsequently closed. The referral was then re-opened on January 4, 2005. Since that time the Family and Human Services Committee has discussed the surrounding issues eight times. This will be the ninth report. Referral Update: Please see the attached report and PowerPoint presentation for the 2013 annual update on the program and services. Recommendation(s)/Next Step(s): ACCEPT update and recommendations contained in the attached report. Attachments Needle Exchange Report Needle Exchange PowerPoint Presentation Page 15 Contra Costa Health Services Needle Exchange Update Report to Family & Human Services Committee November 2013 - 1 - RECOMMENDATIONS 1) Accept this report on needle exchange as part of the comprehensive HIV Prevention Program. 2) Direct the Health Services Department to continue supporting and monitoring needle exchange services and reporting at least biennially as required by law. SUMMARY This report satisfies State regulatory requirements to maintain needle exchange services in Contra Costa. Last year’s legislative changes allowing pharmacies to dispense up to 30 syringes without a prescription have had no apparent negative effect on Contra Costa. Currently, 1983 individuals are living with HIV or AIDS in Contra Costa. The percentage of new infections attributed to Injection Drug Use has been decreasing over time. While the distribution of combined HIV and AIDS cases remains largely similar to previous years, among People Living with HIV (PLWH) and people newly diagnosed with HIV (not AIDS), the percentages attributed to Injection Drug Use (IDU) are dramatically reduced. Management of needle exchange services has successfully transitioned to HIV Education and Prevention Project of Alameda County (HEPPAC) and services which had been dropping off over time have stabilized. The Health Department continues to provide $54,000 in County general funds annually to support the operation of Needle Exchange services. Services are provided in West and East County on a weekly basis and are reaching those in need. There has been a sharp uptick in referrals for health and supportive services this past fiscal year. There is no evidence that needle exchange services and the increased accessibility of syringes for purchase at pharmacies have negatively impacted law enforcement in terms of exposure to blood borne pathogens. The availability of needle exchange as part of a comprehensive continuum of services for injection drug users is a necessary Public Health measure to continue to reduce transmission of blood borne diseases, and as such should remain available in Contra Costa County. Page 16 Contra Costa Health Services Needle Exchange Update Report to Family & Human Services Committee November 2013 - 2 - BACKGROUND Multiple studies have demonstrated the efficacy of needle exchange in reducing transmission of blood borne pathogens. In a 2008 study in New York, researchers reported that an expenditure of $502 per client produced a gain of 0.01 quality adjusted life years per client. The same study reported that needle exchange reduced HIV treatment costs by $325,000 per case of HIV averted, and averted 4–7 HIV infections per 1000 clients.1 A comprehensive review of international studies on syringe access programs, including both syringe exchange and nonprescription pharmacy syringe sales concluded, “There is compelling evidence that increasing the availability, accessibility, and both the awareness of the imperative to avoid HIV and utilization of sterile injecting equipment by IDUs reduces HIV infection substantially.”2 Needle exchange has been a formal component of Contra Costa’s comprehensive HIV risk reduction strategy to reduce the transmission of HIV attributed to Injection Drug Use (IDU) since 1999. Existing State statutes at that time required a monthly declaration of a State of Emergency to authorize needle exchange services. In 2005 the authorization process was simplified by replacing the continuous declaration of a local state of emergency with a written report. Additional legislation in 2012 reduced reporting requirements to a biennial report. On January 10, 2006, the Contra Costa Board of Supervisors: • TERMINATED the local State of Emergency first declared on December 14, 1999; • AUTHORIZED the Health Services Department to administer a clean needle and syringe exchange project pursuant to Health and Safety Code section 121349 et seq; and • DIRECTED the Health Services Director to annually report to the Board on the status of the clean needle and syringe exchange project, with a focus on reducing transmission among women to their unborn children, reducing HIV and Hepatitis C transmission, ensuring access to treatment services, and not increasing risk to law enforcement. In 2012 the Family and Human Services Committee directed the Health Department to continue to provide annual reports on the status of needle exchange activities in Contra Costa County. REDUCING TRANSMISSION OF DISEASE As of December 31, 2012, 1290 individuals were reported living with AIDS (PLWA) and an additional 693 living with HIV (PLWH) in Contra Costa. The number of newly reported AIDS cases has declined over time while the number of newly reported HIV cases has increased by about 45% since the two year period of 2006-2007. HIV reporting by name was instituted in 1 Hrishikesh K. Belani, Peter A. Muennig. Journal of HIV/AIDS & Social Services, Vol. 7(3) 2008. Available online at http://www.haworthpress.com. # 2008 by The Haworth Press. 2 Wodak A, Cooney A. Do needle syringe programs reduce HIV infection among injecting drug users: a comprehensive review of the international evidence. Subst Use Misuse. 2006;41(6-7):777-813. Page 17 Contra Costa Health Services Needle Exchange Update Report to Family & Human Services Committee November 2013 - 3 - 2005. The distribution of major demographics in the total number of people living with HIV and AIDS is largely unchanged over the past several years with some shifts noted in those newly diagnosed and living with HIV. People Living with HIV and AIDS. N= 1983 People Living with AIDS N=1290 People Living with HIV N=693 New HIV infections January 2011 – December 2012 N=116 (subset of PLWH) Male 81.4% 80.2% 83.8% 88.8% African American 30.6% 30.3% 31% 34.5% White 44.5% 44.8% 44% 30.2% Hispanic 20% 19% 21% 25% Similar shifts are seen in transmission risks. While Injection Drug Use (IDU) and Men who have Sex with other Men and also inject drugs (MSM/IDU) together comprise 19.4% of those living with AIDS, they are 10% of those living with HIV and only 4.3% of the new HIV infections occurring in the most recent two year interval. People Living with HIV and AIDS. N= 1983 People Living with AIDS N=1290 People Living with HIV N=693 New HIV infections January 2011 – December 2012 N=116 (subset of PLWH) MSM 61.2% 58.3% 67% 71.6% IDU 11.4% 14.4% 6% 2.6% MSM/IDU 4.5% 5% 4% 1.7% Heterosexual 12.5% 13% 12% 4.3% These figures demonstrate a remarkable change from earlier years, when injection drug users comprised about 25% of all People Living with AIDS in Contra Costa 3. While Contra Costa continues to have a higher percentage of individuals living with HIV or AIDS who attribute their infection to injection drug use than the State, the figures are now more closely aligned than in the past. The most recent published California data (for 2009) shows that statewide about 8 percent of living and 6 percent of newly diagnosed cases report injection drug use as their primary risk. Injection drug users (IDUs) who also report MSM activity account for about 8 percent of living and 5 percent of newly diagnosed cases.4 The City of Richmond continues to report the largest number of indviduals living with HIV or AIDS in Contra Costa. Currently, 36% of all PLWH/PLWA are residents of West County, 40% are residents of Central County, and 24% are residents of East County. Cities with five or more 3 Contra Costa Public Health Division report, July 2006. http://cchealth.org/health-data/pdf/hiv_2006_07.pdf 4 California HIV/AIDS Epidemiological Profile, 2009. August 2012. http://www.cdph.ca.gov/programs/aids/Documents/RSEpiProfileUpdate2009.pdf Page 18 Contra Costa Health Services Needle Exchange Update Report to Family & Human Services Committee November 2013 - 4 - cases are included in the chart below. Because the higher numbers of people attributing their infections to injection drug use remain in the West and East areas of Contra Costa, there are no plans to modify needle exchange site locations at this time. Maternal Transmission There is no comprehensive tracking of maternal transmission since the Stanford project was defunded in 2009. Locally, because of their small numbers, the impact of the epidemic among children is tracked by cumulative (ever diagnosed and reported) numbers: of 3,102 cumulative AIDS cases reported through 12/31/12, 24 are attributed to pediatric transmission (15 male and 9 female). Seventeen were born to women with HIV/AIDS, and six were exposed through blood/blood products. One has no identified risk. Additionally, of 737 cumulative HIV cases reported through 12/31/12, eight are pediatric (5 male and 3 female). Five were born to women Page 19 Contra Costa Health Services Needle Exchange Update Report to Family & Human Services Committee November 2013 - 5 - with HIV/AIDS, and three have no identified risk. The decrease in maternal transmission is attributed to earlier diagnosis and treatment of HIV positive women to interrupt the transmission of HIV to their unborn children. Hepatitis C In Contra Costa, the number of chronic Hepatitis C carriers continues to decline from a high of 1,400 cases reported in 1999. However, reporting data for Hepatitis C is generally not considered reliable due to considerable variation in medical provider reporting capacities. New technologies in lab reporting are helping to clarify the picture, and efforts are underway to promote electronic reporting of all communicable diseases. Please note: Fiscal Year 1011 was grossly under-reported due to transitioning to a new database. Data for fiscal year 1213 contains one full year of data from the new database. Exposure Impact on Law Enforcement and First Responders The Public Health Communicable Disease Control Program reviews reported exposures to ensure that law enforcement and first responders have access to the information, care and treatment needed to ensure their health and wellbeing following any exposure. Prepackaged kits containing all necessary paperwork and blood collection tubes are provided to CML, the lab company under contract with the Sherriff’s Department, to ensure the correct process is followed and proper documentation provided. Printed materials are also available on our website at http://cchealth.org/aids/syringe-exchange.php. Page 20 Contra Costa Health Services Needle Exchange Update Report to Family & Human Services Committee November 2013 - 6 - The number of needlestick exposures (occurring outside a medical context) compared to all exposures reported by first responders remains very small, with 3 incidents out of 81 potential exposures reported between July 1, 2012 and June 30, 2013 which were attributed to needle sticks not associated with the provision of medical care 5 . Needle Exchange Services, Fiscal Year 12/13 Needle exchange services in the region rely on a combination of county general funds and other funding secured through foundations and other organizations. An RFP for provision of needle exchange services in Contra Costa was issued this year and the contract was awarded to HIV Education and Prevention Project of Alameda County (HEPPAC). The agency had assumed interim service delivery responsibility following the passing of long time needle exchange provider Bobby Bowens last year, and has gradually increased performance over the last several months. HEPPAC’s mission is to stop the spread of HIV and Hepatitis C among injection drug users and their families and to reduce the impact of drug related harm to the community. The agency adheres to a Harm Reduction model and provides health education as well as condoms and other risk reduction materials to participants. Their services in Alameda include a drop in center, training, access to STD and Hepatitis C testing, health and wellness support as well as other services. The agency is a registered 501(c) 3 and is certified to offer HIV testing. They conduct surveys among their clientele and offer staff education and support. Between August 2012 and June 2013 (the period of transitional exchange services) they provided 97 referrals to health care, substance use treatment and other resources. The county general funds portion of the budget supports an outreach worker, a site supervisor, staff training, and supplies. 5 Contra Costa Health Department Communicable Disease Program Page 21 Contra Costa Health Services Needle Exchange Update Report to Family & Human Services Committee November 2013 - 7 - The following data on FY 12/13 needle exchange services was provided by HEPPAC. The percentage of African Americans and Hispanics served has increased since the previous year. Ethnicity Totals African American 382 34.7% European American 534 48.5% Latino/Hispanic 177 16.1% Native American 1 Asian/Pacific Islander 5 Other 1 Total 1100 Of the 1100 contacts served in the year, 676 (approx. 62%) were male. Detailed data for one quarter was not delineated by region of the county served, but for the quarters which were delineated, 25% of the reported contacts were in East County and 75% in West County. One-for-one syringe exchange continues to be the core operating principle of needle exchange. While the number of individuals attending needle exchange, as well as the number of individuals doing secondary exchange for others, has decreased over the past 5 years, services have stabilized under the management of HEPPAC, and there is a modest increase in the number served over the previous year. Individuals bringing in syringes for others, referred to as a secondary exchange, are the “Reported Number of People Reached by Needle Exchange Services”, below. These figures are duplicated. Page 22 Contra Costa Health Services Needle Exchange Update Report to Family & Human Services Committee November 2013 - 8 - Finally, the total number of syringes distributed over time has also decreased, but as with clients served, the numbers have stabilized and modestly increased over the past year. The agency is performing above expectations for the first contract period and will be continuing to provide the service in both East and West County sites on a weekly basis. Alcohol and Other Drug Services (AODS) Of the 3,829 admissions to AODS services last fiscal year, 765 were injection drug users. A review of data from AODS treatment sites shows a nearly 20% decline in enrollment since fiscal year 0809. Several factors may reflected in this decline: the loss of Proposition 36 funding for Page 23 Contra Costa Health Services Needle Exchange Update Report to Family & Human Services Committee November 2013 - 9 - services for nonviolent drug offenses, the loss of a major substance abuse provider agency in FY 1112, and transitioning of BASN case management funding all may contribute to a reduction in services. While the drop in enrollment is reflected across all demographics, African Americans and women show the greatest decline (37.2% and nearly 30% respectively) in service utilization since 0809. Additionally, the ratio of injection drug users as a percentage of overall population served, while increasing marginally over the previous year, has decreased by approximately 9% over the last 5 years. Page 24 Contra Costa Health Services Needle Exchange Update Report to Family & Human Services Committee November 2013 - 10 - More than 32% of all AODS enrollees indicated that they were homeless at entry into the AODS program. Most participants identify as having a “dependent” living condition (reliant on someone else or some other institution for their housing), with only about 4.5% of all enrollees indicating that they were independently housed at time of entry into AODS services. While 23% of all enrollees have had three or more prior AODS treatment admissions, more than 38% claim no prior enrollment in AIDS treatment services. The Public Health HIV/AIDS and STD Program continues to provide Education, HIV rapid testing, HCV testing, and STD testing at selected AODS residential and detox centers in Contra Costa. We serve both adult and youth facilities. In FY 1213, 819 adults and 203 youth received comprehensive HIV and STD health education services. Of these, 143 adults elected to receive HIV testing and 355 youth were tested for a range of STDs including HIV. One HIV positive adult was linked to care and treatment. The Program also continues to offer limited Hepatitis C testing to approximately 35-50 of the highest risk individuals per year. Pharmacy Syringe Sales Adults anywhere in California may now purchase and possess up to 30 syringes for personal use without a prescription when acquired from an authorized source.6 http://cchealth.org/aids/syringe- sales.php The pharmacy must ensure that syringes are stored in a manner that makes them inaccessible to unauthorized persons and providers must offer consumers information on options for disposal. While the Health Department no longer provides registration or oversight of this program, Health Education resources for consumers are available on our website at and additional resources are located on the state website: 6 CA State Senate Bill 41, in effect January 2012 – January 2015. Page 25 Contra Costa Health Services Needle Exchange Update Report to Family & Human Services Committee November 2013 - 11 - http://www.cdph.ca.gov/programs/aids/Pages/OASyringeAccess.aspx. We have received no complaints from law enforcement, business, pharmacies, or community members regarding discarded syringes this year. Disposal Contra Costa Environmental Health (CCEH) is responsible for administering the State's Medical Waste Management Program for Contra Costa County, and is the local enforcement and regulatory agency for Medical Waste Generators. CCEH issues permits and registers generators of medical waste, responds to complaints of abandoned medical waste on public property, and implements the Medical Waste Management Act (Part 14, C. 1-11 of the California Health and Safety Code). CCEH maintains a list of frequently asked questions on syringe and needle disposal, a list of disposal sites in Contra Costa, and links to syringe disposal mail back services. More information on disposal is located at http://www.cchealth.org/eh/medical_waste/. A number of locations for safe disposal of syringes are now available in Contra Costa, including: • Alamo Sheriff’s Substation – 150 Alamo Plaza, Suite C. • Lafayette Fire Station – 3338 Mt. Diablo Blvd. • Moraga Fire Station – 1280 Moraga Way • Orinda Police Department – 22 Orinda Way • San Ramon Fire District – 1500 Bollinger Canyon Road • Walnut Creek Fire Station - 1050 Walnut Avenue • Walnut Creek City Hall - 1666 N. Main Street • Rossmoor - Gateway Building, 1001 Golden Rain Road • Danville Police Department - 510 La Gonda Way • Household hazardous waste facility- 101 Pittsburg Ave., Richmond, • Delta Household Hazardous Waste Collection Facility- 2550 Pittsburg/Antioch Highway • Sutter Regional Medical Foundation- 4053 Lone Tree Way, Antioch, Several companies also are listed as State-sanctioned mail in systems. More information on medical waste mail-back services can be found at: http://www.cdph.ca.gov/certlic/medicalwaste/Documents/MedicalWaste/SharpsMailBackList.pdf. OTHER PREVENTION ACTIVITIES FOR INJECTION DRUG USE The Contra Costa HIV Prevention plan, aligned with the State HIV Prevention strategy, targets highest risk populations including men who have sex with other men and injection drug users, for HIV prevention services. We anticipate continuing County General Funds for needle exchange services to support the downward trend in HIV infections attributed to injection drug use. The full plan can be found on the Public Health website at: http://cchealth.org/aids/pdf/HIV-Prevention-Plan-Update-2012-2015.pdf Page 26 Contra Costa Health Services Needle Exchange Update Report to Family & Human Services Committee November 2013 - 12 - While the Prevention program has received numerous budget reductions over the years, we continue to offer specialty services including:  HIV testing services at community sites and in Alcohol and Other Drugs Services programs, reaching approximately 2000 people per year. More than 99% of Public Health HIV testing uses a rapid test, providing preliminary results in 20 minutes.  Clinical risk reduction services targeting high risk men through incremental behavior change plans is available county wide through a subcontracted mental health provider serving HIV positive individuals.  Partner Counseling services providing support for notification to partners of potential exposure and testing available to HIV positive individuals and their providers.  Tighter linkages for making follow up medical appointments for new positives to reduce the number of individuals falling out of care and increase adherence to HIV medications is offered county wide.  Training to increase community capacity to provide prevention services in Contra Costa is provided annually.  Of the three Evidenced Based Interventions prevention subcontracts initiated in the previous fiscal year, two remain in operation, promoting HIV testing among highest risk communities.  Hepatitis C testing is offered to the highest risk individuals in conjunction with HIV testing of injection drug users and has been expanded in the new fiscal year.  Cross training between HIV, STD and HIV Surveillance staff is done to increase the pool of individuals available to meet community demand for education services CONCLUSIONS: 1. Access to clean needles is making a difference in Contra Costa and remains an important component of the overall strategy to reduce transmission of blood borne diseases. The number of infections attributed to injection drug use has declined dramatically over time and the availability of needle exchange and pharmacy syringe sales has played a role in this trend. 2. Reported local law enforcement exposure to potential blood borne pathogens via needle stick injury has not increased with the implementation of needle exchange and pharmacy sales. Materials for Law Enforcement to document potential exposure and request assistance remain available on the website. 3. There is no evidence of increased maternal transmission of HIV to unborn children. 4. The change in the Needle Exchange service provider has not adversely affected the service. The number of referrals to health and support services has increased under the new provider. Page 27 November 2013 Prepared for the Contra Costa Board of Supervisors by Contra Costa Health Department Needle Exchange Update Page 28 NEEDLE EXCHANGE •In 1999, the Contra Costa Board of Supervisors endorsed a State of Emergency with respect to HIV and AIDS to allow for the provision of needle exchange services. •Subsequent legislation replaced the State of Emergency with a written report. •This report satisfies the legislative requirement to maintain needle exchange services in Contra Costa County. Page 29 HIV/AIDS in Contra Costa County As of December 31, 2012, 1983 individuals were reported living with AIDS or HIV in Contra Costa. Approximately 81% are male and 19% are female. African Americans are 30.6% of those living with HIV or AIDS, Whites 44.5% and Hispanics 20%. Predominant transmission among those living with HIV or AIDS remains men who have sex with other men (MSM). Injection Drug Use (IDU) (only) is 11.4% and IDU/MSM is 4.5%, totaling about 16% of the caseload attributed to injection drug use. Page 30 All People Currently Living with HIV and AIDS Compared to Newly Reported HIV (Two year block: Jan 2011 – December 2012) 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00% 100.00% Male African American White Hispanic MSM IDU MSM/IDU Heterosexual PLWA / H New HIV Page 31 Children with HIV and AIDS Infant Exposure has not been tracked by Stanford University since 2009. Of the 3,102 AIDS cases ever reported in Contra Costa, 24 have been pediatric cases (1-12 years of age). Seventeen of those pediatric cases were born to women with HIV/AIDS, and six were infected through blood/blood products. Of 737 HIV cases ever reported in Contra Costa, there were eight pediatric cases. Five were born to women with HIV/AIDS, and three have undetermined transmission. Page 32 Reported Chronic Hepatitis C Cases Over Time Page 33 Law Enforcement and First Responder Exposures Page 34 Needle Exchange Services Services are provided by HIV Education Prevention Project of Alameda County (HEPPAC) One-for-one exchange offered in East and West County: services which had been declining over time are now increasing. Approximately 48% of participants are White, 35% African American, and 16% Latino. This past fiscal year 97 referrals were provided to health care, substance abuse treatment, and other services. Page 35 Reported Contacts (Individuals) at Needle Exchange Sites Over Time Page 36 Number of Syringes Distributed Over Time Page 37 Secondary Exchanges Reported By HEPPAC Over Time Page 38 AODS Service Enrollment FY 12-13 n=3829 (765 IDUs and 3064 non IDU) Page 39 AODS IDU Service Enrollment IDU/Non IDU Page 40 AODS Service Enrollment By Gender Page 41 Other Prevention Strategies to Reduce Transmission of HIV in IDUs HIV and STD testing services in community and in Alcohol and Other Drugs Services programs; Clinical Risk Reduction services which include Partner counseling and Anonymous Partner notification and counseling services; Hepatitis C testing for highest risk IDUs; Evidence-based interventions in prevention agencies; Outreach services to link new positives to care; Cross training of staff and agencies. Page 42 Syringe Disposal Options Adults anywhere in California may now purchase up to 30 syringes without a prescription. A number of locations for safe disposal of syringes are now available in Contra Costa. A link to the full list is maintained by the Contra Costa Environmental Health Program, as is a list of frequently asked questions on syringe and needle disposal and links to syringe disposal mail back services. More information on disposal is located at http://www.cchealth.org/eh/medical_waste/ Page 43 CONCLUSIONS 1. Access to clean needles is making a difference in Contra Costa and remains an important component of the strategy to reduce transmission of blood borne diseases. The number of infections attributed to injection drug use has declined dramatically over time and the availability of needle exchange and pharmacy syringe sales has played a role in this trend. 2. Reported local law enforcement exposure to potential blood borne pathogens via needle stick injury remains at the same level as prior to implementation of needle exchange and pharmacy sales. Materials for Law Enforcement to document potential exposure and request assistance remain available on the website. 3. There is no evidence of increased maternal transmission of HIV to unborn children. 4. Change in Needle Exchange service provider has not adversely affected the service. The number of referrals to health and support services has increased under the new provider. Page 44 FAMILY AND HUMAN SERVICES COMMITTEE 5. Meeting Date:12/02/2013 Submitted For: FAMILY & HUMAN SERVICES COMMITTEE, Department:County Administrator Referral No.: N/A Referral Name: Year-End Report Presenter: Dorothy Sansoe Contact: Dorothy Sansoe, 925-335-1009 Referral History: At the end of each calendar year, the staff person to the Family and Human Services Committee reports to the Committee on the activities during the year and makes recommendations regarding the closure of referrals and the carryover of other referrals to the next year. Referral Update: Please see the attached Recommendation(s)/Next Step(s): I. ACKNOWLEDGE that the Board of Supervisors referred one new item to the Family and Human Services Committee (FHS) for their review and consideration during the 2013 calendar year in addition to the referrals carried over from the prior year. II. ACCEPT the recommendation to carry forward the following seventeen referrals from the 2013 Family and Human Services Committee to the 2014 Committee: Referral #1 – Child Care Affordability Funda. Referral #2 – Oversight of the Service Integration Teamb. Referral #5 – Continuum of Care Plan for the Homeless/Healthcare for the Homelessc. Referral #20 – Public Service Portion of the CDBGd. Referral #25 – Child Care Planning/Development Council Membershipe. Referral #44 – Challenges for EHSDf. Referral #45 – Elder Abuseg. Referral #56 – East Bay Stand Down for Homeless Veterans (Bi-annual)h. Referral #61 – HIV Prevention/Needle Exchange Programi. Referral #78 – Community Services Bureau/Head Start Oversightj. Referral #81 – Local Child Care & Development Planning Council Activitiesk. Referral #82 – Secondhand Smoke Ordinancel. Referral #92 – Local Planning Council – Child Care Needs Assessmentm. Referral #93 – Independent Living Skills Programn. Page 45 Referral #101 – FACT Committee At-Large Appointmentso. Referral #103 – SNAP (Food Stamp Program)p. Referral #107 – Laura’s Lawq. III. No referrals are being recommended for closure at this time. BACKGROUND/REASONS FOR RECOMMENDATION(S): Between January and December 2013, the Board of Supervisors referred one new item to the Family and Human Services Committee (FHS) in addition to sixteen referrals carried forward from the 2012 year. The FHS Committee heard thirteen separate reports during the calendar year in addition to making recommendations for appointments to various County boards and commissions. Several referrals were not heard during the year. They include the following: Referral #1 – Child Care Affordability Fund: In 2012 the Family and Human Services Committee recommended, and the Board of Supervisors approved, a two year funding cycle for allocation of funds to support child care for low income children. Because 2013 was the second year in the two year cycle, no report was necessary. A report will be provided to the Committee in 2013 for allocation of additional funds. 1. Referral #92 – Local Child Care & Development Planning Council – Countywide Child Care Plan: The Contra Costa Office of Education requested a delay in their report to the Committee. Staff is in the process of collecting input from the Community that will inform the development of the Comprehensive Countywide Child Care Plan. They requested a delay so that the information collected from the community could be included in the report to the Committee once completed. 2. Referral #103 – SNAP (Food Stamp) Program: Due to the reorganization of several functions within the Employment and Human Services this program was transferred from the Department Aging and Adult Services Bureau to the Workforce Services Bureau. Due to this transfer, the Department requested that the item be delayed until early 2014 so a comprehensive update could be provided by the new Bureau Director. 3. Fiscal Impact (if any): No fiscal impact. Attachments No file(s) attached. Page 46