HomeMy WebLinkAboutMINUTES - 10172007 - D2 TO: BOARD OF SUPERVISORS Contra
Y. Costa
FROM: William B. Walker, MD, Health Services Director
County
DATE: October 1, 2002
SUBJECT: RECOMMENDATION TO ACCEPT HIV PREVENTION ACTIVITIES REPORT
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATION:
REVIEW AND ACCEPT "The Status of HIV Prevention Activities in Contra Costa Report" as
submitted by the Health Services Director.
FISCAL IMPACT:
Neither Federal nor State funding may be used to support needle exchange activities.
Should additional funding to support needle exchange activities in Contra Costa be authorized,
County funds are required.
CONTINUED ON ATTACHMENT: XX YES NO SIGNATURE:
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RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
APPROVE OTHER
SEE ADDENDIM AMCM.
SIGNATURE(S):
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ACTION OF BOARD ONFEMARY 11.2003 APPROVE AS RECOMMENDED X OTHER
VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT
COPY OF AN ACTION TAKEN AND ENTERED ON THE
UNANIMOUS(ABSENT } MINUTES OF THE BOARD OF SUPERVISORS ON THE DATE
SHOWN.
AYES: ! IL < j NOES:
ABSENT: ABSTAIN:
ATTESTED
JOHN SWEETEN,CLERK OF TRE BOARD OF
SUPERVISORS AND COUNTY ADMINISTRATOR
CONTACT: Christine Leivermann,313-6786
CC' William B.Walker,MD,HSD Director,20 Allen,Mtz
Wendel Brunner,MD,Public Health Director,at
597 Center Avenue,#200,Mtz DEPUTY
BACKGROUND:
In December 1999, the Board of Supervisors declared a state of emergency pertaining to the
increasing/epidemic numbers of HIV/AIDS and Hepatitis C among injection drug users in Contra
Costa. As a condition of the ongoing declaration, the Board of Supervisors has requested a
status update on the state of HIV prevention activities in Contra Costa.
Local epidemiology indicates that injection drug use continues to be a significant mode for
transmission of HIV. Through December 2002, twenty-three percent of those living with AIDS and
thirty-seven percent of those reported with HIV identify heterosexual injection drug use as the
mode of transmission in their diagnosis.
Needle exchange services cannot be funded through State or Federal funds, and exchange sites,
operating under the auspices of Community Health Empowerment/Exchange Works (CHE), have
no contractual ties to the Health Department. CHE reports that it serves approximately 700
individuals through direct and indirect exchanges. The agency estimates between 35,000 to
40,000 needles per month are exchanged at three sites in Contra Costa. The Health Department
provides condoms and other risk reduction materials to CHE as available, and has offered HIV
testing, outreach, and referrals directly and through subcontractors in addition to overseeing a
purchase order in the amount of$25,000 per year for syringes.
In addition to the above resources, CHE has been largely operating on a combination of private
grants and donations. All County funds for the purchase of syringes this fiscal year have been
expended. CHE reports that grant resources have been depleted and that needle exchange
services in Contra Costa are in imminent danger of closing due to lack of resources to continue
operations.
.3
ADDENDUM TO ITEM D.2
FEBRUARY 11, 2003
On this date,the Board of Supervisors reviewed and accepted"The Status
of HIV Prevention Activities in Contra Costa Report"report from the
Health Services Director, Dr. William B. Walker.
The following members of the public presented testimony:
Bobby Bowens, 41 Railroad Avenue, Richmond, regarding HIV
services;
Chris Catchpool, 3870 Patterson Avenue, Oakland, regarding
Exchange Warks/CHE;
Dr. Edwin Hoffman, 6477 North Point Court, Martinez,regarding
needle exchange;
Daryl Gault, 3920 Clarke Street, Oakland, regarding needle
exchange.
The Board members having discussed the matter, it was moved by
Supervisor Uilkema, and seconded by Supervisor Gioia, and the Board:
• ACCEPTED "The Status of HIV Prevention Activities in Contra Costa County"
report;
• DIRECTED Health Services to evaluate different levels of funding with Federal
and State to support needle exchange legally;
• REQUESTED Health Services to work with Alameda County;
• REQUESTED Health Services to ensure discussion on needle exchange occurs at
the HIV Steering Committee level;
• REQUESTED Health Services to identify short term efforts of where the County
can be of assistance, so current scope of operations keeps this operation from
discontinuing;
• and DIRECTED Health Services to provide an analysis of the options discussed.
The vote on the motion was as follows:
(AYES:I, II, IV, V NOES:NONE . ABSTAIN.NONE. ABSENT III)
WILLIAM B.WALKER,M.D. CONTRA COSTA
HEALTH SERVICES DIRECTOR
WENDEL$RUNNER,M.D. PUBLIC HEALTH
PUBLIC HEALTH DIRECTOR 597 Center Avenue,Suite 200
Martinez,California
CONTRA COSTA 945534675
PH 925 313-6712
HEALTH SERVICES FAx 925 313-6721
wbrunner@hsd.co-contra-costa.ca.us
TO: Supervisor Mark DeSaulnier, Chair Date: February 6, 2003
Supervisor Gayle Uilkema
Supervisor Donna Gerber
Supervisor John Gioia Re: HIV Prevention
Supervisor Federal Glover Activities Update
FROM: Wendel Brunner, MD,
Director of Public Health
The attached "Status of HIV Prevention Activities in Contra Costa County" report provides an update
on HIV prevention services provided by Contra Costa Health Services and its contractors. Over the
last several years, there have been significant advances in the treatment of HIV infection, allowing
people to live longer and more productive lives. Nonetheless, a cure for the infection remains elusive,
and prevention of new HIV infections must be the key strategy to control this epidemic in our
communities.
As of December 2002, four thousand nine hundred Contra Costa residents are estimated to have
been infected with HIV. Of this number, nearly half(2,347) have already been diagnosed with AIDS.
Approximately forty percent of the people living with AIDS are from West County, thirty-seven percent
are from Central County, and approximately twenty-three percent are from East County. The majority
of people living with AIDS contracted the infection through gay/bisexual contact, and over a quarter of
the people living with AIDS became infected through IV drug use. Nearly twenty-one percent are
women. The majority of people living with AIDS in Contra Costa are Euro-American; African
Americans in our county are disproportionately impacted by the disease.
These disease trends guide our prevention efforts. Contra Costa Health Services receives
approximately$1.3 million in various state and federal funds to provide HIV prevention and testing
services. Over$1 million of that funding comes from the state general fund, and is presumably highly
vulnerable next fiscal year. In addition, we have directed some county funding to important HIV
prevention efforts.
In December 1999,the Board of Supervisors declared an emergency pertaining to HIV/AIDS among
injection drug users in Contra Costa County, reflecting the continued increase in HIV transmission
among injection drug users. As no state or federal funds can be used for needle exchange, Contra
Costa Health Services began providing support and assistance to a local agency, Community Health
Empowerment/Exchange Works (CHE), providing needle exchange services in Contra Costa. That
assistance includes $25,000 for the procurement of syringes, and a variety of services including the
Health on Wheels van, educational materials, and a county outreach worker to link residents to
treatment and services. CHE reports that private foundation resources have dried up, and they now
lack the resources to continue their operation.
❑Contra Costa Community Substance Abuse Services,--Contra Crista Emergency Madcal Services o Contra Costa EmAronmental Health o Contra Costa Health Plan
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As we confront the issues of bioterrorism and preparations for a possible smallpox outbreak, it is
important that we do not lose focus on a deadly infection, HIV, that continues to spread through
Contra Costa.
cc William Walker, MD, Health Services Director
CONTRA COSTA
HEALTH SERVICES
The Status of HIV Prevention Efforts in
Contra Costa County
February 2003
Contra Costa Health Services
Public Health Divison
Contra Costa Health Services Department
Public Health Division,AIDS Program
February 6,2003
OVERVIEW OF THE HIV EPIDEMIC
Twenty years after the first reported cases of AIDS in the United States, HIV and AIDS has
affected every racial and ethnic population, every age group and every socioeconomic group.
Although the number of new AIDS cases per year has substantially decreased at this point in the
epidemic, disparities in the rate of infection and death among certain racial and ethnic groups
continues to rise. The World Health Organization estimates that 42 million individuals, 19.2 million
of whom are women, are now living with HIV and AIDS in the world. In 2002 alone, it is estimated
that nearly 5 million individuals were newly infected with HIV. Nearly half the new infections were
women.
A larger percentage of the newer cases are now occurring through heterosexual contact, and
greater numbers of women are now infected. In the U.S., Injection Drug Use (IDU) accounts for
14% of all reported diagnoses. Nearly 54% of new HIV infections in 2000 were among African
Americans, who comprise about 13% of total U.S. population. In the 34 areas of the U.S. with
HIV confidential names reporting, the bulk of HIV infections in 13-19 year olds reported July 2000-
June 2001 were among females (560!%), with a disproportionate percentage of them African
American. '
The introduction of antiretroviral therapies, earlier identification of disease, and better clinical
understanding of how to manage the disease have contributed to a dramatically reduced HIV/AIDS
mortality since 1995, although the trend may be leveling off at this time. Longer survival may be
leading to complacency and decreased focus on prevention efforts. Prevention efforts appear to
not be reaching men who have sex with men, as there are increasing rates of Sexually
Transmitted Disease (STDs) being reported. AIDS related illnesses remain the leading cause of
death for African American men aged 25-44 and the third leading cause of death among Hispanic
men in the same age group."
LOCAL EPIDEMIOLOGY
AIDS case data is not a highly accurate reflection of HIV trends in a population. However, HIV has
only been a reportable disease in California since July 2002; consequently the majority of
information presented below pertains to AIDS Case data.
In 2002, the State saw an increase of 6% in new AIDS cases, largely among African Americans
and Latinos. The State attributes this increase to better reporting, and cites similar spikes in other
states during the implementation of HIV reporting. Contra Costa ranks # 11 in terms of
cumulative incidence of AIDS cases in the State of California. However, Contra Costa ranked #9 in
terms of new cases of AIDS reported in California in 2001, the most recent year for which there
are published figures. The overall State incidence rate in 2001 was 12.5 case per 100,000
individuals. The incidence in 2001 among Contra Costa males was 11.6 cases per 100,000
population. While the numbers of women converting to an AIDS diagnosis in 2001 were small, the
incidence among Contra Costa women was 2.5 cases per 100,000 population - the sixth highest
rate in California in 2001. All Contra Costa women reported during this period were women were
women of color. "I
As of December 2002, 4,900 Contra Costa residents are estimated to have been infected with HIV.
Of this number, nearly half (2,347) have already been diagnosed with AIDS. Of those diagnosed
with AIDS, nearly 64% (1,502) have died from AIDS.'"
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ep
Contra Costa Health Services Department
Public Health Division,AIDS Program
February 6,2003
More than half of those ever diagnosed with AIDS in Contra Costa are gay and/or bisexual men.
That number has been decreasing over time and now increasing numbers of individuals are
infected through heterosexual contact and injection drug use. The number of women, particularly
women of color, diagnosed with AIDS continues to grow, with most women attributing injection
drug use and/or partnering with a man who injects drugs as the cause of their infection.
Total Cumulative Adult and Adolescent AIDS Cases Reported by Mode of Infection and
Gender Dreg not include late reporting
MODE of Infection December 31 1997 December 31 2002
Males 7 Females Total Males Females Total
Ga bisexual 71% 0% 61.5% 69.7% 0% 58.8%
Heterosexual IDU 16.8% 50.4% 21.3% 17.7% 49.3% 22.6%
Ga bisexual IDU 6.2% 0% 5.4% 6% 0% 5.1%
Hemophilia 0.9% 0% 0.8% 0.9% 0% 0.7%
Heterosexual 0.5% 38.4% 5.5% 1.1% 40% 7.2%
Transfusion blood 1.7% 6.2% 2.3% 1.4% 4.7% 1.9%
Under investigation 2.9% 5% 3.2% 3.2% 6% 3.6%
'total 1 1668 1 258 1 1926 1 1969 365 2334
Additionally, there were 12 pediatric AIDS cases reported as of 12/31/97. Three were attributed
to receipt of blood/ blood products, and the remainder to having a parent at risk. As of 12/31/02,
one additional pediatric AIDS case was attributed to a parent at risk.v
PEOPLE LIVING WITH AIDS
Regionally, approximately 40% of people living with AIDS are from West County, with another
37% in Central County and the remainder in East County. Nearly 21% are female. Greater
percentages of women identified injection drug use as the mode of transmission, while the
percentage of men identifying injection drug use has decreased. More men are now identifying
heterosexual contact as their mode of transmission, but the majority of individuals living with AIDS
are still attributed to gay/bisexual contact.v1
People Liying with AIDS through the Period by Mode of Infection and Gender
Does not Include late reporting
MODE of Infection December 31 1997 December 31 2002
Males Females Total Males I Females Total
Ga bisexual 69.6% 0% 56.9% 68.8% 0% 54.7%
Heterosexual IDU 19.2% 48.3%_ 24.5% 17.6% 46% 23.4%
Ga bisexual IDU 5.8% 0% 4.7% 5.4% 0% 4.3%
Hemophilia 0.7% 0% 0.6% 0.8% 0% 0.6010
Heterosexual 0.4% 40% 7.7% 1 1.9% 43.1% 10.4%
Transfusion-:blood 0.2% 5.8% 1.2% 0.2% 2.9% 0.7%
Parent at Risk for HN 0.4% 1.7% 0.6% 0.4% 1.1% 0.6%
Under investigation 3.7% 4.2% 3.8% 4.9% 6.9% 5.3%
Total 536 1 120 656 671 174 845
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Contra Costa Health Services Department
Public Health Division,AIDS Program
February 6, 2003
People Living with AID5 through the Period by Ethnicity
Does not Include late reporting
Race / Ethnicity 12/97 12/02 % Of Ethnic Group in Contra Costa
2000 Census Data
White 53.8% 51% 57.90/o""
African American 33.1% 34.1% 9.4%
Latino 10.7% 12.2% 17.7%
Asian Pacific Islander 2.1% 1 2.5% 11.4%
Native American 0.3% 0.2% 0.6%
Total 656 845
HIV REPORTING
In July 2002, HIV became a reportable disease in the State of California, using a non-names
reporting process. As of December 31, 2002, 234 Contra Costa residents with HIV have been
reported to the local Health Department. Of this number, 44% are white, 42% are African
American, and 11% are Hispanic. The vast majority, 67%, is between the ages of 30 and 49.
Women comprise 25.6% of the reported HIV infections during the period, a higher percentage
than that of women living with AIDS in Contra Costa. While the data is preliminary, and it is too
early to draw any substantive conclusions from the data, injection drug use continues to play a
significant role in the transmission of HIV in Contra Costa, and African Americans continue to
experience disproportionate impact."'
People Reported with HIV through December 31, 2002 by Mode of Infection
December 31 1997
MODE of Infection Males f=emales Total
Ga bisexual 45% 0% 33%
Heterosexual IDU 35% 42% 37%
Ga bisexual IDU 4% 0% 3%
Heterosexual 1% 33% 9%
Under investi ation 15% 25% 18%
Total 174 60 234
Forty three percent of those diagnosed with HIV are from West County, 36% from Central County
and 20% from East County. This distribution is roughly similar to that of People Living with AIDS
in Contra Costa, with a slight elevation noted in West County residents.
EDUCATION AND PREVENTION ACTIVITIES IN CONTA COSTA
Community Planning Process Activities
The Center for Disease Control has established criteria to assist in the identification of high priority
prevention needs. These criteria are used to establish local HIV prevention priorities. A State-
mandated Local Implementation Group (LIG), known in Contra Costa as the HIV Steering
Committee, develops the priorities used by the AIDS Program. This group, consisting of providers
and other interested individuals meets on a monthly basis and is also charged with developing
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Contra Costa Health Services department
Public Health Division,AIDS Program
February 6,2003
strategies to meet priority population needs, revising the local HIV Prevention Plan and providing
input to the AIDS Program on other matters pertaining to HIV prevention in Contra Costa.
In addition to the countywide planning body, other regional and ad hoc bodies assist in identifying
issues and providing recommendations for directions. Of these groups, the largest is the West
County AIDS Task Force, established in 1999 by Supervisor John Gioia and Mayor Rosemary
Corbin, to look specifically at the impact of HIV on communities of color in West County. The Task
Force meets monthly to plan events, identify gaps and review strategies. Two subcommittees, the
Faith Committee and the Outreach Committee, meet regularly to plan and develop local responses
to HIV and HIV prevention in West County.
Funding
Contra Costa Health Department receives approximately $1.3 million in various State and Federal
funds to provide HIV Prevention and testing services. In fiscal year 2001, the State Office of AIDS
implemented a 10% reduction in Education and Prevention funds, resulting in a reduction of
services. The most visible evidence of this reduction is the loss of one contracting agency and the
reduction in condoms and health education materials available to various agencies.
Some of the services supported by these funds are provided directly by the Public Health Division's
AIDS program, including street-based outreach workers, community education services,
anonymous and confidential HIV counseling and testing, and the NIGHT (Neighborhood
Interventions Geared to High risk Testing) van serving various community agencies and other
locations. Surveillance and reporting activities are conducted through Public Health Division's
Communicable Disease Control Epidemiology, Surveillance and Health Data Unit. Other services
supported by these funds are provided by Community Based Organizations (CBOs) through
contracts with the AIDS Program. Agencies currently contracted to provide HIV prevention
services in Contra Costa include:
• Catholic Charities of the East Bay (CCSB)
• Center for Human Development (CHD)
• Familias Unidas (FU)
• Filipinos for Affirmative Action (FAA)
• Neighborhood House of North Richmond (NHNR)
• Pittsburg Preschool and Community Council (PPCC)
• Planned Parenthood Shasta Diablo (PP)
• Ujima Family Recovery Services (UFRS)
• Approximately $10,000 in State funds per year is provided to smaller community groups in the
form of mini-grants for specific HIV prevention activities
In addition to the funding granted by the State and Federal governments to the Health
Department, other funds not administered by the Health Department are available to agencies
providing services in Contra Costa. Pittsburg Preschool Community Council receives funding from
the Center for Disease Control to conduct street-based HIV testing in East County. The University
of California at San Francisco receives federal funds to support HIV/AIDS research in Contra Costa,
the East bay Perinatal Council and East Bay Recovery Center receive federal Substance Abuse and
Mental Health Services Administration for HIV prevention services in Contra Costa, and other
federal and private funds are available to agencies providing HIV prevention and outreach
activities in Contra Costa.
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Contra Costa Health Services Department
Public Health Division,AIDS Program
February 6,2403
The Health Department encourages internal collaboration to maximize existing resources: the
Division of Alcohol And Other Drugs funds agencies to provide core HIV prevention activities as
part of their AAOD contracts; the Public Health Division's Communicable Disease Control Program,
Community Wellness and Prevention Program, Public Health Clinic services, Family Maternal Child
Health Program, and Homeless Programs all integrate HIV prevention messages as appropriate
into their respective programs. The AIDS Program also provides condoms and health education
materials as available through grant resources to local providers, as well as $20,000 - $25,000 per
year in county general funds for the purchase of clean needles to support the state of emergency
declared by the Board of Supervisors in 1999.
Priority Populations/Risk Behaviors
Based on Epidemiological data and trends as well as State mandates, the HIV Prevention Steering
Committee has established the following priorities for targeted prevention efforts in Contra Costa
County:
■ Men who have sex with men
• Substance users, primarily injection drug users and stimulant users.
■ Women who have sex with men who engage in high risk behaviors
■ Youth engaging in high-risk behaviors.
■ HIV positive individuals
Strategies &Interventions
Contra Costa HIV prevention strategies include the following and are summarized below in a
table:
• General outreach, in which CROs, local businesses, and county staff provide information,
risk reduction materials, and referrals to support services and HIV testing sites located
throughout the county. Outreach occurs at community events, in schools and/or agencies
serving high risk populations, and on the street in areas frequented by individuals at high
risk for HIV
■ Educational presentations to groups interested in learning more about HIV or to individuals
at high risk for HIV. AIDS Program staff coordinate incoming requests for presentations
and provide the presentations directly or access CBO contractors or volunteers to provide
the presentations. Last year presentations were provided to high school and college
students, faith communities, incarcerated individuals, group clinic patients, teachers,
criminal justice system providers, Perinatal service providers, foster care system providers,
Alcohol And Other Drug program providers and clientele, clinicians and other professional
providers.
■ Client-centeredAsk assessment n i I or anonymous HIV--testcounseling,
provided through Department clinics, the Health on Wheels van and the NIGHT van, in
various detention facilities, and at special events. Additionally, the AIDS Program
collaborates with PPCC in East Contra Costa to ensure quality assurance on testing done
through the PPCC program.
■ In-depth risk reduction counseling which involves establishing a relationship between an
outreach worker and a client and includes an assessment of the client's risk for HIV and the
development of a plan to reduce those risks.
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Contra Costa Health Services Department
Public Health Division,AIDS Program
February b,2003
■ On-Aoina risk reduction counseling (also called prevention case management), a more
comprehensive relationship between the outreach worker and the client, which includes
support to the extent possible to reduce risk and to complete an HIV test.
■ Community mobilizations which brings people together to identify an issue/problem,
develop a plan to address this issue/problem and collectively evaluate the process and
outcome. This strategy is used to raise awareness, develop a sense of community
responsibility for HIV prevention, and reinforce individual risk reduction efforts.
Priority Service Description Location(s)
Population and Providers
Men who ■ Venue-based outreach offering education, risk reduction counseling,and referrals. Countywide,
have sex with ■ Community mobilization through social events,workshops, support groups and linkages to primarily in cities
men outreach,counseling and testing services. of Richmond,
(MSMs) ■ Teams conduct outreach and education to local merchants and social service personnel Concord,and
and other health care professionals. Information is provided regarding local HIV testing Pittsburg.
sites. Some of the sites have been established as a mobile testing site to increase access F. U.
to HIV testing. P. P.
■ Internet outreach in chat rooms of known MSM sites P.P.C.C.
■ Door-to-door education and community events related to prevention in low-income N.H.N.R.
housing developments AIDS Program
■ Distribution of risk reduction packets at mini-markets, barber shops, beauty salons and
liquor stores
Substance ■ Community and street outreach offering education, risk reduction counseling, and Countywide
Users, referrals, including alcohol and drug service programs and social/community service U.F.R.S.
including centers. Coordination with the homeless outreach van for outreach and testing. P.P.C.C.
Injection Drug ■ Group workshops for building skills for safer sex and drug use as part of a series of P.P.
Users workshops for women entering substance abuse treatment programs. F.U.
■ Needle exchange and education sites (not under contract to Health Department): N.H.N.R.
promoting safer drug use techniques and safer sex. Condoms and other materials are AIDS Program
provided. Information and referrals to HIV testing sites, drug abuse treatment and
recove services and other health and social services.
Women ■ Venue-based outreach offering education, risk reduction counseling,and referrals. F.U.
■ Community and street outreach through social events, workshops, support groups and P.P.
linkages to outreach,counseling and testing services. P.P.C.C.
■ Teams conduct outreach and education to local merchants and social service personnel N.H.N.R.
and other health care professionals. Information is provided regarding local HIV testing AIDS Program
sites. Some of the sites have been established as a mobile testing site to increase access
of HIV testing immediatei
At-Risk Youth ■ Venue-based outreach offering education, risk reduction counseling,and referrals. C.C.E.B. , F.U.
■ School-based HIV-positive speakers bureau. F.A.A., P.P.
■ Social Marketing geared toward advocacy of policies that support HIV prevention in P.P.C.C.
schools. Community mobilization and communication strategies that involve youth as peer N.H.N.R.,C.H.D.
educators in the design, Implementation and evaluation. AIDS Pr ram
Incarcerated Enhanced risk reduction classes and HIV testing and counseling. Primarily In
Men,Women Outreach and education for providers who service incarcerated individuals. Richmond and
and Youth Martinez
AIDS Program
People Living Enhances risk reduction counseling offered through private and group services for women Primarily East
with HIV who are HIV positive. County; UFRS,
AIDS Program
Last year, more than 33,000 HIV prevention contacts (Needle Exchange noted separately below)
were made by the AIDS Program and CBOs providing the full array of services. Forty-five percent
of those contacts occurred in West County, 29% in Central County, and 26% in East County.
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Contra Costa Health Services Department
Public Health Division,AIDS program
February 6, 2003
Thirty-three percent of the service contacts went to African Americans, 25% to Latinos, 27.5% to
Whites, and the remainder to other people of color.
HIV Counseling and Testing
The AIDS Program offers anonymous and confidential HIV counseling and testing services to those
seeking HIV testing. Partner Counseling and Referral Services are also available through the
Epidemiology, Surveillance and Health Data Unit for individuals testing positive for HIV and
needing assistance in notifying their partners.
An in-depth risk assessment is performed, goals are developed, and individuals are tested either
via blood sample (at 3 Public Health clinics and the Say Point Family Clinic) or via Orasure (an oral
fluids collection device) if tested through the NIGHT or HOW vans. Last year, more than 3,200
individuals were tested through this program. Approximately 56% were male. Thirty eight
percent of those tested were White, 30% were Hispanic, and 24% were African American. Twelve
percent were 19 years of age or younger. Most individuals (64%) identified multiple partners as
their primary risk factor for seeking testing, and approximately 23% identified injection drug use
as a risk factor. Data breakouts by region are not useful as many individuals seek testing outside
the area in which they live. Twenty of those who tested during the year tested positive for HIV
antibodies.
Community Awareness Services
Several strategies are being used to raise community awareness around risk for HIV and
community skills to manage that risk:
■ The Center for Human Development is implementing a community organizing program in
schools that allows youth to not only discuss and develop skills for safe sex but also to
become primary social change agents by advocating for the implementation of policies that
will reduce homophobia in schools and ultimately help reduce risk for HIV.
■ The WomenTest campaign promotes HIV counseling and testing in women of childbearing
age by providing technical assistance to the Healthy Start Programs and Hospitals and
Clinics.
■ The mini-grant program provides small amounts of funds to communities for developing
and organizing events to raise awareness and skills for HIV prevention and promoting the
message"You have the power to stop AIDS". Program promotion is focused on non-
governmental agencies serving underserved populations in Contra Costa. Grant recipients
receive technical assistance from the AIDS Program to develop and carry out events
successfully.
Through a combination of these different types of community mobilization activities, skills are
developed and shared more broadly within the community than could be possible through the
AIDS Program or contractors alone.
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Contra Costa Health Services Department
Public Health Division,AIDS Program
February 6,2003
Needle Exchange Services
Research shows that the HIV / AIDS epidemic has impacted African Americans more harshly than
whites who inject drugs. According to recent publications, "`In 2000, AIDS was still among the top
3 leading causes of death for African Americans aged 25-54 years. More than half of those deaths
were caused by contaminated needles."'
Community Health Empowerment/Exchange Works (CHE) has provided needle exchange services
in Contra Costa since 1995. The program, not yet certified by the internal Revenue Service as a
non-profit agency, reports that it now serves approximately 700 individuals through direct and
indirect (someone exchanging needles for someone else) one-for-one exchanges. During the first
quarter of 2002, CHE reported 38 exchanges serving an average of 180 direct clients and 454
indirect clients at the Richmond sites, 13 exchanges serving 152 direct and 232 indirect clients at
the Pittsburg/Bay Point site. The agency estimates between 35,000 - 40,000 needles per month
are exchanged at the 3 sites in Contra Costa - approximately 25,000 per month in the Richmond
area and approximately 7,000 in the Pittsburg/Bay Point area. Information in the following
information is provided by CHE:
Richmond clients San Pablo clients Pittsburg clients Bay Point clients
Race Ethnici
African American 51% 20% 16% 8.5%
White 40% 70% 55% 76%
Latino 9% 10% 27% 9.5%
Cather 2% 6%
Gender - male 72% 80% 68% 62%
Gender- female 28% 20% 32% 38%
In a 2001 survey funded by CDC, the 23 needle exchange programs in operation in California in
2001 were surveyed." Twenty-one individuals using the exchange services in Richmond
participated in the survey. In addition to the demographics, the researchers found that the
population served was largely older (50+), frequently homeless, and had injected drugs for 20 or
more years. When compared to other syringe exchange sites, participants at the Richmond site
reported far fewer instances of shared syringes and fewer instances of syringe reuse and supply
sharing. Richmond participants were also more likely to clean their skin prior to injecting drugs
and were more likely to be tested for hepatitis B and C. When health issues were surveyed,
Richmond participants reported fewer instances of HIV infection, fewer abscesses and overdoses
in the past year, and a lower incidence of Hepatitis C than participants in other programs. A
greater percentage of Richmond participants reported being screened for hepatitis, HIV, and
Sexually Transmitted Diseases, and although the HIV seroprevalence among the Richmond
participants was higher than 4 of the 5 other Bay Area sites surveyed, researchers reported that
this was likely due to some site bias in terms of the number of HIV positive participants in the
survey in Richmond.
Although the Needle Exchange sites have no formal ties to the AIDS Program, we do know that
outreach services and direct client care services provided by the AIDS Program or funded through
subcontracts with the AIDS Program do reach individuals who also participate in the needle
exchange program. Additionally, the County Health on Wheels van reports a total of 39 clinics
provided to participants of the needle exchange services in Richmond last year. A total of 117
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Contra Costa Health Services Department
Public Health Division,AIDS Program
February 6,2003
patients were seen over the course of 156 visits. Four of these patients were so seriously ill that
they were sent to the emergency room. One person was admitted to the hospital. The rest were
cared for on site and provided referrals to other services.
Neither State nor Federal funds may be used to support needle exchange services. The exchange
has been operating on a mix of private grants, donations and about $25,000 per year in county
general funds. All general funds for this fiscal year have been expended, grant resources have
dried up, and needle exchange services in Contra Costa are in imminent danger of closing due to
lack of resources to continue operations. This occurs at a time when the CHE reports they have
been asked to expand services to 4 other sites in Contra Costa.
The Center for Disease Control has indicated that the use of sterile needles continues to be the
most effective method available to reduce HIV transmission in injection drug users who continue
to inject drugs. As a significant number of women living with AIDS identify injection drug use as
their mode of transmission, it is critical to make clean needles available to decrease the risk of
transmission of HIV to unborn children. Additionally, the preliminary data indicating injection drug
continues to be a major factor in transmission of HTV supports the need for continued funding for
this service.
Next Steps
The HIV Steering Committee is currently revising and updating the HIV Prevention plan, and
expects to complete the task in the next several months. While injection drug users will remain on
the priority population list, the HIV Steering Committee has not finalized their prioritizations for the
next year. Recent budget discussions will impact the State Office of AIDS HIV Prevention budget
and it is expected that additional modest funding cuts will be forthcoming in the next fiscal year.
No specific plan has been put forth at this time by the State. The increased focus on provision of
prevention services for HIV positive individuals will further impact the capacity to provide outreach
and referrals to high risk negatives, including those who receive needle exchange services. The
State is now requiring that 25% of State Education and Prevention funds target those who are HIV
positive. The HIV Prevention for Positives program initiated earlier this year by County staff may
be ready to expand further into the community in the next year, but we have determined that the
utilization of a local prevention CBO for this aspect of HIV Prevention work will require additional
time to pilot and work out the differences in both philosophy and service delivery. The AIDS
Program has offered technical assistance to CHE when it is ready to begin its program to serve
HIV positive individuals.
Additional alignment of HIV testing funding is expected in the coming fiscal year with fewer sites
(as yet unnamed) being funded. It is anticipated that those sites being funded may actually
receive a slight increase in reimbursement rates to help offset the cost of providing testing
services. Neither the federal nor the state government is expected to relax legislation and allow
the use of those funds for needle exchange services.
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Contra Costa Health Services Department
Public Health Division,AIDS Program
February 6,2003
`AIDS Epidemic Update,UNAIDS/WHO-2002
CDC Report,2002
"'California and the HIV/AIDS Epidemic,State of the State Report,2001. Released December 2002.
Contra Costa HIV/AIDS Epidemiology Report,January 2003. Not yet released.
Ibid and Contra Costa Epidemiology Report,January, 1998
A Ibid
""2000 Census Report www.census.gov. Number does not total 100%as some other race/ethnic groups are not included
in this table.
""'Contra Costa HIV/AIDS Epidemiology Report,January 2003. Not yet released.
Health Emergency 2003,the Spread of Drug-Related AIDS and Hepatitis C among African Americans and Latinos.
Dawn Day,2002. Also at wwvv.harmreduction.org
'Exchange Works. CalSEP Results,2001.R.Bluthenthal and K.Anderson,RAND,R.Anderson et al,UC Davis,A.
Kral et al,UCSF.
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Contra Costa Health Services Department
Public Health Division,AIDS Program
February 6,2003
SUMMARY STATEMENT ON NEEDLE EXCHANGE
The Center for Disease Control has indicated that the use of sterile needles continues to be the
most effective method available to reduce HIV transmission in injection drug users who continue
to inject drugs. Local epidemiology indicates that Injection Drug Use continues to be a significant
mode for transmission of HIV. Twenty three percent of those living with AIDS and 37% of those
reported with HIV through December 2002 identify heterosexual injection drug use as the mode of
transmission in their diagnosis. AIDS is still a leading cause of death for African Americans aged
25-54 years. The use of contaminated needles plays a significant role in those deaths.
Community Health Empowerment/Exchange Works (CHE) reports that it serves approximately 700
individuals through direct and indirect exchanges. The agency estimates between 35,000 - 40,000
needles per month are exchanged at the 3 sites in Contra Costa. When compared to other syringe
exchange sites in California, participants at the Richmond site report far fewer instances of shared
syringes and fewer instances of syringe reuse and supply sharing. Richmond participants reported
fewer instances of HIV infection, fewer abscesses and overdoses in the past year, and a lower
incidence of Hepatitis C than participants in other California programs. A greater percentage of
Richmond participants reported being screened for hepatitis, HIV, and Sexually Transmitted
Diseases
Because Needle Exchange services cannot be funded through State or Federal funds, exchange
sites have no formal ties to the Health Department. The Health Department does provide
condoms and other risk reduction materials to CHE as available, and has offered HIV testing as
well as outreach and referrals directly and through subcontractors in addition to $25,000 per year
through a purchase order for syringes.
In addition to the above resources, the exchange has been largely operating on a mix of private
grants and donations. All county general funds for the purchase of syringes this fiscal year have
been expended. The agency reports that grant resources have dried up and that needle exchange
services in Contra Costa are in imminent danger of closing due to lack of resources to continue
operations. CHE indicates that they require $160,000 immediately to ensure on-going operations,
and have presented a line item budget for $262,000, which includes expansion of services to 4
other sites in Contra Costa. CHE is not a registered non-profit, and a fiscal agent would be
required for any additional contractual funding authorized by the Board of Supervisors.
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Contra Costa Health Services Department
Public Health Division,AIDS Program
February 6,2003
Community Health Empowerment/Exchange Works
Budget
Estimated for January 2003-January 2004
ANNUAL EXPENSES
Salaries and Wages
Executive Director 40,000
Benefits @ 7% 2,800
Outreach Worker 32,000
Benefits @ 7% 2,240
Exchange Site Operation Stipends 46,800
*Antioch $ 100 x 52 wks
Bay Point $ 100 x 52 wks
*Concord $ 100 x 52 wks
Pittsburg $ 100 x 52 wks
Richmond $100 x 52 wks x 3
*Rodeo $ 100 x 52 wks
* San Pablo$ 100 x 52 wks
*We have request for Needle exchange sites from the community in these cities.
Office Admin/Bookkeeper�7a 50% 15,000
Fund development Consultant 10,000
Annual Audit 3,000
Harm Reduction Supplies 40,000
Syringes
Bier-Buckets
Cookers
Tourniquets
Alcohol Wipes
Cotton
Rubber Bands
Condoms
Lubricant
Paper Bags
Travel 2,000
Telephone 1,500
Storage 4,000
Office Rent @$600/mo 7,200
Office supplies/Equipment 5,000
PO Box 600
TO'T'AL EXPENSES $262,140
Budget copied(for purposes of email)as submitted by fax from CHE 1/16/03 to Health Department AIRS Program.
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