November 23, Dear Members of the Office of National AIDS Policy,

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1 Chairperson W. Harold Tuck, Jr. President and CEO Rudolph A. Johnson, III November 23, 2009 Dear Members of the Office of National AIDS Policy, In response to President Barack Obama s Call to Action: Americans Speak about HIV/AIDS, Neighborhood House Association (NHA) was proud to host an HIV/AIDS Community Forum on November 10, 2009, in our city of San Diego, California. The discussion included topics such as current HIV/AIDS challenges and solutions, and was attended by approximately 70 professionals, government officials, consumers, practitioners, providers, community leaders, NHA staff, and other interested parties from over 20 different organizations. In an effort to support the Office of National AIDS Policy in collecting and analyzing community data, the discussion was focused on the three primary goals for the National HIV/AIDS Strategy. In this report, main recommendations to these three goals are described, supplemented with real comments from our forum participants, as well as suggestions on who should lead the overall effort. In general, the recommendations centered on the following: the need for HIV/AIDS prevention education at early levels in the school systems, the need for culturally sound research and empirical assessment and evaluation regarding HIV/AIDS, and the need for additional and appropriate funding for programs at the community level in order to best coordinate and collaborate accordingly. NHA is San Diego County's largest multi-purpose human services agency. Since 1914, we have helped thousands of individuals and families improve their quality of life by providing vital social services including HIV/AIDS, healthcare, Head Start, teen and senior services. We appreciate the opportunity to contribute to the President s National AIDS Strategy. Should you have any questions, please do not hesitate to contact me at (858) or via at RudyJohnson@neighborhoodhouse.org. Sincerely, Rudolph A. Johnson, III President and Chief Executive Officer 5660 COPLEY DRIVE, SAN DIEGO, CALIFORNIA TELEPHONE: FACSIMILE: info@neighborhoodhouse.org

2 Neighborhood House Association Page 2 of 15 TABLE OF CONTENTS Content Page Recommendations for Reducing HIV Incidence 3 Recommendations for Increasing Access to Care and Optimizing Health Outcomes 5 Recommendations for Reducing HIV-related Health Disparities 7 Appendix A: Power Point Presentation 9 Appendix B: HIV/AIDS Community Discussion Questionnaire 12 Appendix C: List of Organizations and Agency Participants 13 Appendix D: Group Photo 14

3 Neighborhood House Association Page 3 of 15 RECOMMENDATIONS FOR REDUCING HIV INCIDENCE Aggressive marketing and advertising campaigns Free-testing campaigns that are culturally appropriate and communicated in all forms of media Public service announcements that outreach to high risk populations, possibly during prime-time television or to include celebrities (i.e. singers, actors, etc.) in order to attract youth attention Public service announcements that normalize and encourage intimate talk before intimate action. Intimate talk would include partners sharing STD and HIV/AIDS status and selecting safer sex options Education on how to effectively use condoms and plastics for safer sex options, yet emphasizing safer sex options are safer than no protection Marriage license requirements that included lab tests for venereal diseases provided partners that trusted each other enough to want to marry with a cooling period. This is a verifiable way to learn about their own and their partner s status before crossing the threshold. It could reduce the number of people that are unknowingly infecting or being infected by others if this type of trust, but verify process was introduced sooner in relationships (as many, if not most, people no longer wait until they are married to engage sexually). Something that made it a normal part of the culture for people to carry and share a status card prior to engaging in sexual conduct could at least prepare partners to make informed decisions about risks and how they want to engage. Normalize HIV issues by redefining HIV/AIDS prevention and reforming education Make HIV/AIDS and sex education mandatory in middle thru high school Outreach to churches and engage church leaders in the message Create a Peer to Peer Model that will better engage consumers given that providers will mirror the profile of clients Market condoms as a personal hygiene matter Focus on health policy Redo 2010 CDC Prevention Policy based on community input The 2005 CDC HIV Community Planning guidelines were not effective and reinforced negative stigmas, fears, and divisions. Create a task force composed of various agencies (i.e. Positive Women s Network, state and local policy makers, etc.) in order to develop strategic plans and oversee the implementation of these efforts

4 Neighborhood House Association Page 4 of 15 Include ETHA language and provisions to expand and strengthen Medicaid eligibility requirements to include non-disabled persons living with AIDS Support legislation like the Omnibus spending bill Conduct thorough research and evaluation of what works and dedicate resources to these efforts Identify and target areas of the community of high risk and high incidence Coordinate the education and prevention efforts to high risk populations (i.e. women of color, Latinos, African American, youth, drug users, etc.) by developing stronger collaborations Appropriate funding to HIV/AIDS providers and agencies Restore prevention funding Offer free or low cost services Offer free and quick turnaround HIV testing results Who do you think should lead the effort to REDUCE HIV INCIDENCE? 8% 5% 15% Federal Government 23% State & Local Government Non-profits Businesses Other 21% 29% All n=35

5 Neighborhood House Association Page 5 of 15 RECOMMENDATIONS FOR INCREASING ACCESS TO CARE AND OPTIMIZING HEALTH OUTCOMES Create a program via the internet allowing people to register to receive HIV/AIDS information, home-testing kits, and condoms in the privacy of their homes Have HIV testing be apart of annual check-ups Open access to care to all HIV/AIDS education should not just be for one kind of minority, but for all. I couldn t get a case manager because I was told I made too much money and that I had private insurance, yet my private healthcare provider had no information available, so discrimination happens everywhere. Advocacy and legislation Federal, state, and local governments should focus on policy work and take congressional action to foster systemic change and ultimately health insurance for all Americans Make legislators accountable for the HIV/AIDS incidence rates in their areas Engage clients to become advocates by educating and preparing clients and the community to be on local councils and advisory boards Better qualified/equipped providers and doctors Recruit and train younger people of color to serve as the next future level of providers Provide proper education and up to date information to student nurses and medical students, stressing culturally competency Conduct research, community surveys/assessments, and analysis regarding HIVrelated health disparities Focus on people of color and high risk areas Better collaboration among health clinics and community organizations Create a One Stop Shop, where clients can receive the following: Culturally appropriate treatment, including non-traditional practices Mental health services and substance abuse counseling Good nutritional education and services in order to support the effectiveness of anti-retroviral treatment and overall better health Emergency housing Access to medications (national drug assistance, i.e. Medicaid coverage) Open centers that represent all or most known cultures and languages

6 Neighborhood House Association Page 6 of 15 Mandate drug companies to provide fair prices for medications and free medications to those who cannot pay Establish programs that help patients pay for dietary needs just like they help pay for medications. Helping patients gain access to recommended foods could prove to lead to healthier outcomes for less cost than assisting with medication only Ensure pay-for-performance standards proposed to be placed on medical providers and develop systems that do not further discourage providers from wanting to care for low income patients that have multiple health issues and medical treatment compliance challenges Profiting businesses need to build community awareness by supporting prevention and invention efforts via funding. Who do you think should lead the effort to INCREASE ACCESS TO CARE AND OPTIMIZE HEALTH OUTCOMES? 10% 2% 14% 24% Federal Government State & Local Government Non-profits Businesses Other 26% 24% All n=34

7 Neighborhood House Association Page 7 of 15 RECOMMENDATIONS FOR REDUCING HIV-RELATED HEALTH DISPARITIES Make HIV/AIDS education mandatory in schools in order to diminish the negative stigma associated with this disease Develop economic opportunities for the HIV/AIDS workforce by promoting the development of jobs Research has found that SES is related to better healthcare outcomes in individuals with HIV/AIDS. Conduct and support effective research studies evaluating the differences and similarities in treatment amongst various ethnicities in order to best develop impactful and sound legislation Continue prevention, education and testing, specifically related to the types of treatments available Focus on existing HIV/AIDS programs and on growing these agencies of service Create a system to receive feedback from HIV/AIDS programs in order to continuously improve prevention and intervention efforts Dedicate additional and appropriate funding to these programs The Congressional Black Caucus (CBC) cut out a portion of the funds from the Ryan White Care Act and ear-marked those funds toward People of Color. In San Diego, those funds are now called Minority AIDS Initiative (MAI) Funds. In the past, these funds were awarded to community organizations that served people of color (predominately African Americans and Hispanic) and whose Board of Directors were made up of that ethnic group. Today, those funds go through a Request for Proposal (RFP), and they are not reaching the community that they were intended for. It is recommended that CBC or MAI funds be directed back to the community that they were intended for, African Americans and Hispanic. Those MAI dollars should be given to the community organizations servicing people of color.

8 Neighborhood House Association Page 8 of 15 Who do you think should lead the effort to REDUCE HIV-RELATED HEALTH DISPARITIES? 13% Federal Government 18% 9% State & Local Government Non-profits 7% Businesses Other 31% All 22% n=34

9 Neighborhood House Association Page 9 of 15 APPENDIX A

10 Neighborhood House Association Page 10 of 15 APPENDIX A CONT.

11 Neighborhood House Association Page 11 of 15 APPENDIX A CONT.

12 Neighborhood House Association Page 12 of 15 APPENDIX B HIV/AIDS COMMUNITY DISCUSSION QUESTIONNAIRE 1. What recommendations do you have to reduce HIV incidence? Who do you think should lead the recommendation? Federal Government Non-Profits State and Local Businesses Government Other What action steps would the entity take to accomplish this recommendation? 2. What recommendations do you have to increase access to care and optimize health outcomes? Who do you think should lead the recommendation? Federal Government State and Local Government Non-Profits Businesses Other What action steps would the entity take to accomplish this recommendation? 3. What recommendations do you have to reduce HIV-related health disparities? Who do you think should lead the recommendation? Federal Government State and Local Government Non-Profits Businesses Other What action steps would the entity take to accomplish this recommendation? Additional Comments

13 Neighborhood House Association Page 13 of 15 APPENDIX C List of Organizations and Agency Participants 18 HIV/AIDS consumers Being Alive County of San Diego, HIV, STD, and Hepatitis Branch Family Health Centers of San Diego Friendship Clubhouse Jewish Family Services Kemet Coalition, Faith Based Working Group Mama s Kitchen Mom s Pharmacy Neighborhood Healthcare Neighborhood House Association Planned Parenthood Positive Women s Network San Diego Youth Services San Ysidro Health Center Stepping Stones The Center Townspeople UEI College University of California San Diego, HIV Neurobehavioral Research Center Walgreens/Community

14 Neighborhood House Association HIV/AIDS Community Forum Report Page 14 of 15 November 23, 2009 APPENDIX D Group Photo

15 Neighborhood House Association HIV/AIDS Community Forum Report Page 15 of 15 November 23, 2009 APPENDIX D CONT.

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