Palm Beach County Jurisdictional HIV Prevention Plan

Transcription

1 Palm Beach County Jurisdictional HIV Prevention Plan

2 PALM BEACH COUNTY, AREA 9, JURISDICTIONAL HIV PREVENTION PLAN Plan prepared by: 600 Sandtree Drive, Suite 101 Palm Beach Gardens, FL, Contributing Staff: Andrea Stephenson, MBA, MHS, Executive Director Julie Graham, MPH, CHES, Director of Planning Leah Suarez, BA, Director of Programs Olga Mohyuddin, MS, Health Planner and Program Manager Bertholette Pardieu, MPH, Special Projects Coordinator

3 Table of Contents Table of Tables... v Table of Figures... 2 Acknowledgements... 4 Dedication... 4 Executive Summary... 5 Introduction... 6 Methodology... 6 The Planning Process... 6 Palm Beach County HIV Prevention Planning Timeline... 8 HIV Background / Importance of HIV Prevention... 9 The Community Planning Partnership Community Perspective The National HIV/AIDS Strategy High Impact Prevention Background Palm Beach County Demographic and Epidemiologic Data Palm Beach County Demographic and Socioeconomic Profile Population Race and Ethnicity Gender Palm Beach County HIV/AIDS (Area 9) Epidemiological Profile HIV Incidence HIV Prevalence AIDS Incidence AIDS Prevalence Comorbidities and Other Infections Infectious Syphilis Gonorrhea Tuberculosis HIV Counseling and Testing HIV Death Rates and Counts Provider and Community Perspective... 42

4 Palm Beach County HIV/AIDS Provider Survey Methodology Results Palm Beach County Consumer Survey Methodology Results Palm Beach County (Area 9) HIV/AIDS Priority Populations Methodology Palm Beach County (Area 9) HIV/AIDS Priority Issue Areas Methodology Goals, Objectives and Strategies Palm Beach County Goal 1: Palm Beach County Goal 2: Palm Beach County Goal Monitoring and Evaluation Conclusion Appendix A Provider Survey Tool... 77

5 Table of Tables Table 1: Total Population, Palm Beach County, Florida, Table 2: Population, by Race, Palm Beach County and Florida, Table 3: Population, by Ethnicity, Palm Beach County and Florida, Table 4: Population by Gender, Palm Beach County and Florida, Table 5: Population Age Distribution, Palm Beach County and Florida, Table 6: Population Growth , Palm Beach County and Florida Table 7: Unemployment Rate, by Race and Ethnicity, Palm Beach County and Florida, Table 8: % of Population Living Below Poverty by Race and Ethnicity, Palm Beach County and Florida, 2010, 2011, Table 9: HIV Prevalence by Race and Ethnicity, Palm Beach County, through Table 10: HIV Prevalence, Males, Palm Beach County through Table 11: HIV Prevalence, Females, Palm Beach County, through Table 12: HIV Prevalence, Pediatric, Palm Beach County, through Table 13: HIV Prevalence, Palm Beach County, by Age, Table 14: HIV Prevalence, by Race, Ethnicity and Age, Palm Beach County, through Table 15: AIDS Incidence, Palm Beach County, Florida, Table 16: AIDS Prevalence, by Race, Ethnicity and Age, Palm Beach County, through Table 17: Infectious Syphilis, Palm Beach County, by Gender, 2011, Table 18: Infectious Syphilis, Palm Beach County, by Age, 2011, Table 19: Infectious Syphilis, Palm Beach County, by Race and Ethnicity, 2011, Table 20: Gonorrhea, Palm Beach County, by Gender, 2011, Table 21: Gonorrhea, Palm Beach County, by Age, 2011, Table 22: Gonorrhea, Palm Beach County, by Race and Ethnicity, 2011, Table 23: Tuberculosis, Palm Beach County, by Gender, 2011, Table 24: Tuberculosis, Palm Beach County, by Age, 2011, Table 25: Tuberculosis, Palm Beach County, by Race and Ethnicity, 2011, Table 26: HIV Counseling and Testing, Palm Beach County, by Gender, 2011, Table 27: HIV Counseling and Testing, Palm Beach County, by Race and Ethnicity, 2011, Table 28: Adults <65 who have ever been tested for HIV, Palm Beach County and Florida, 2002, 2007, Table 29: Deaths from HIV/AIDS, Palm Beach County and Florida, by Gender 2010, 2011, Table 30: Deaths from HIV/AIDS, Palm Beach County and Florida, by Race 2010, 2011, Table 31: Deaths from HIV/AIDS, Palm Beach County and Florida, by Ethnicity 2010, 2011, Table 32: Priority Populations Prioritization Results Table 33: Priority Issue Areas Prioritization Results... 70

6 Table of Figures Figure 1: HIV Incidence, Palm Beach, Florida, Figure 2: HIV Incidence Rates, by Gender, Palm Beach County and Florida Figure 3: HIV Incidence Rates, by Ethnicity, Palm Beach County and Florida Figure 4: HIV Incidence Rates, by Race, Palm Beach County and Florida Figure 5: AIDS Incidence Rates, Palm Beach, Florida Figure 6: AIDS Incidence Rates, by Gender, Palm Beach County and Florida Figure 7: AIDS Incidence Rates, by Race, Palm Beach County and Florida Figure 8: AIDS Incidence Rates, by Ethnicity, Palm Beach County and Florida Figure 9: Adults <65 who have ever been tested for HIV, Palm Beach County and Florida, Figure 10: HIV/AIDS Crude Death Rates and Count, Palm Beach County and Florida, Figure 11: Provider Survey - Which of the following best describes your agency? Figure 12: Provider Survey - Please indicate which population(s) your agency serves Figure 13: Provider Survey - "Which age and gender group(s) best describe the population(s) your agency serves? Figure 14: Provider Survey - Please indicate the HIV/AIDS prevention services your agency provides Figure 15: Provider Survey - Case Management Referrals Figure 16: Provider Survey - HIV/AIDS Education Referrals Figure 17: Provider Survey - Legal Services Referrals Figure 18: Provider Survey - Mental Health Services Referrals Figure 19: Provider Survey STD Counseling and Testing Figure 20: Provider Survey- Substance Abuse Services Referrals Figure 21: Provider Survey - What barriers does your ORGANIZATION face when providing services to individuals living with or who are at risk of acquiring HIV/AIDS? Figure 22: Provider Survey - What barriers do your CLIENTS living with HIV/AIDS face when accessing services? Figure 23: Provider Survey - What do you think are the barriers to reaching people with HIV/AIDS who are unaware of their status? Figure 24: Provider Survey - What strategies have you/your agency used or do you believe would assist identifying people with HIV/AIDS who are unaware of their status? Figure 25: Provider Survey - Which of these services, in your opinion, are MOST important to get, AND keep people with HIV/AIDS in HIV medical care? Figure 26: Provider Survey -Technical Assistance and Training Figure 27: Provider Survey - Which of the following trainings would help you to better serve clients/patients living with or at risk of acquiring HIV/AIDS? Figure 28: Consumer Survey - What services would help you get HIV/AIDS medical care? Figure 29: Consumer Survey What would be some of the reasons why you would go to the doctor for HIV/AIDS medical care? Figure 30: Consumer Survey - Where did you regularly receive your HIV/AIDS medical care during the past 12 months? Figure 31: Consumer Survey - Which five (5) services do you think are most important for people with HIV/AIDS? Figure 32: Consumer Survey - What were some barriers to you getting the services you needed during the past 12 months? P a g e

7 Figure 33: Consumer Survey - Have you had any of the following problems while trying to get needed services? Figure 34: Consumer Survey - Which five services do you think are most important for people living with HIV/AIDS to be able to access throughout the state? P a g e

8 Acknowledgements The is the product of input and perspective from a broad spectrum of stakeholders in the community including the Community Prevention Planning Group, Florida Health Palm Beach County, providers and health care consumers. Their participation brought tremendous value to the HIV prevention planning process. The Health Council of Southeast Florida wishes to extend their appreciation and thanks to all of the individuals and organizations that participated and contributed to this process. The commitment and collective efforts of these individuals, agencies and organizations will help move Palm Beach County forward in its HIV prevention efforts. Special recognition is due to the dedicated members of the Palm Beach County (Area 9) Community Planning Partnership (CPP), whose input and participation assisted the development of a thorough and executable Jurisdictional HIV Prevention Plan for the county. Dedication This Plan is dedicated to individuals infected and affected by HIV/AIDS as well as the many devoted individuals who work to improve the circumstances for those with the disease. 4 P a g e

9 Executive Summary The is the culmination of insight and perspective of stakeholders in the community. The goal of the Jurisdictional HIV Prevention Plan for Palm Beach County is to have a workable, relevant, appropriate and actionable document that will help guide the expansion and improvement of HIV prevention efforts in the county and thus, the overall health and wellbeing of the community. The Plan identifies and outlines steps to help the county achieve the goals set forth in National HIV/AIDS Strategy (NHAS) which are: to reduce HIV incidence, to increase access to care and optimize health outcomes and to reduce HIV-related health disparities. In 2012 there were 332 new cases of HIV diagnosed in the Palm Beach County, representing just over 6% of the new HIV cases in the state (5,388). 1 The rate of new HIV cases, HIV incidence, has decreased considerably in both the county and state however, with a rate of 24.9 new cases per 100,000 persons in the county, HIV prevention activities are as important as ever to continue reducing the rate of new HIV infections. Considerable racial, ethnic and gender disparity related to HIV/AIDS incidence, prevalence and deaths from HIV/AIDS is present in the county. In 2012, the rate of new HIV cases in black non- Hispanic individuals was over six times the rate in non-hispanic white individuals in the county and the rate in non-hispanic individuals was considerably higher than Hispanic individuals. Males accounted for 60% of new HIV cases and data shows that specifically the MSM (men who have sex with men) population is high-risk. It is necessary for the county to consider and target these populations in its HIV prevention planning efforts. High Impact Prevention which employs scientifically proven, cost-effective and scalable interventions to targeted populations most affected by the epidemic is the approach employed by the CDC to maximize the impact of HIV prevention efforts and informed the development of the goals set forth in this Plan. County-specific priority populations and priority issue areas were identified and serve as the basis for the goals, objectives and strategies in the Plan. Men who have sex with men (MSM), Hispanic individuals, black and African American individuals and the migrant population were ranked as the priority populations. The top three priority issues areas identified and ranked by stakeholders were: mental health substance abuse, socio-economic determinants of health and access to testing. Goals related to these issues areas are outlined in the Plan. The implementation of this Jurisdictional HIV Prevention Plan will help strengthen the public health infrastructure, specifically related to HIV/AIDS, aid and guide planning, foster collaboration and capacity-building and ultimately promote the well-being and quality of life for Palm Beach County residents. 1 FloridaCHARTS, Florida Department of Health, Bureau of HIV/AIDS 5 P a g e

10 Introduction Florida Health Palm Beach County contracted with the Health Council of Southeast Florida (HCSEF) to develop the Jurisdictional HIV Prevention Plan for Palm Beach County (Area 9) herein referred to as the Prevention Plan or the Plan. Local health departments are tasked with facilitating the development of a Jurisdictional HIV Prevention Plan in an effort to achieve the goals set forth in the National HIV/AIDS strategy at the local level. The development of the Plan for Palm Beach County was a collaborative effort among various stakeholders in the community, with an interest in the prevention of HIV, to gather and analyze data related to HIV/AIDS in the community; to identify priorities; and to develop goals, objectives and strategies related to the priorities in an effort to further improve HIV prevention efforts in county. The goal of the Jurisdictional HIV Prevention Plan for Palm Beach County is to have a workable, relevant, appropriate and actionable document that will help guide the expansion and improvement of HIV prevention efforts in the county and thus, the overall health and wellbeing of the community. Methodology At the request of the Florida Health Palm Beach County, HCSEF worked to gather secondary data related to demographic, socioeconomics, and epidemiology related to HIV/AIDS in Palm Beach County. Data was gathered from several sources including: the US Census Bureau, the Florida Department of Health HIV/AIDS & Hepatitis Program, the Florida Department of Health Bureau of HIV/AIDS, and the Bureau of Vital Statistics. In many cases, the data for the county is compared to that of state as a whole. In some instances data for multiple years is shown to allow trends over time to be observed. Primary data was also collected via surveys of both HIV/AIDS services providers and consumers of HIV/AIDS services in the community. The primary and secondary data was compiled by the health council and presented to a group of HIV/AIDS stakeholders in the community, namely the Community Planning Partnership (CPP). The CPP members and meeting guests worked to review the data, identify issue areas and gaps in services and identify high-risk and underserved populations. These priority areas were prioritized by the stakeholders and goals, objectives and strategies were developed related to these priority populations and issues areas in an effort to set forth a local-level plan for the prevention of HIV in community. The Planning Process The Centers for Disease Control and Prevention (CDC), Division HIV/AIDS Prevention set forth updated guidance for HIV Planning in July 2012 in which the HIV planning process, and specifically the framework for the Jurisdictional HIV Prevention Plan is outlined. 6 P a g e

11 The guidance states that In order to achieve the goals of the NHAS, the HIV planning process remains essential. The process involves the identification of the appropriate stakeholders to engage in a process that is results-oriented, in order to ensure that the goals of the NHAS are achieved and that a Jurisdictional HIV Prevention Plan is developed, implemented, and monitored. 2 The Guidance outlines the expectation that improving HIV prevention programs can be improved by strengthening the: 1. Scientific basis; 2. Community relevance; 3. Key stakeholder involvement; 4. Population or risk-based focus of HIV prevention interventions in each jurisdiction; and 5. Communication and coordination of services across the continuum of HIV prevention, care, and treatment, including social determinants of health associated with but not limited to HIV/AIDS and sexually transmitted diseases, infectious diseases, substance abuse, and mental health. 3 The Guidance outlines the planning process steps as follows: 1. Stakeholder identification. The objective aims to identify community members, key stakeholders, and other HIV service providers involved in HIV prevention, care, and treatment services to participate in a comprehensive engagement process. 2. Results-oriented engagement process. The objective aims to promote collaborative, coordinated, and seamless access to HIV prevention, care, and treatment services, including mental health and substance abuse, to achieve the greatest impact on reducing incidence and HIV-related health disparities. 3. Jurisdictional HIV Plan development, implementation, and monitoring. The objective aims to inform and monitor the development and implementation of the Jurisdictional HIV Prevention Plan, ensure that the engagement process supports the jurisdictional plan, and ensure that the plan is progressing toward reducing HIV incidence and HIV-related health disparities in the jurisdiction. The Plan set forth below, and the data gathering and planning work that preceded the Plan development is specific to the third step of the HIV planning process. 4 2 HIV Planning Guidance, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, July HIV Planning Guidance, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, July HIV Planning Guidance, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, July P a g e

12 Palm Beach County HIV Prevention Planning Timeline April 2013 Florida Health Palm Beach County engaged HCSEF to update Palm Beach County s Jurisdictional HIV Prevention Plan. April 2013 January 2014 HCSEF began to gather demographic, socioeconomic and epidemiologic data related to HIV/AIDS in the community. The provider survey tool was drafted. October 2013 HCSEF presented at the October Community Planning Partnership (CPP) meeting to introduce the Jurisdictional HIV Prevention Plan, the role of the health council, and the anticipated role of the CPP. HCSEF facilitated a discussion with the group to review and revise the list of providers in the community to whom the provider survey would be disseminated. November - December 2013 The provider survey tool was finalized and the Palm Beach County HIV/AIDS Provider Survey was disseminated via to providers. January 2014 The demographic, socioeconomic and epidemiologic data as well as data from the provider and consumer surveys was compiled, analyzed and sent to the CPP. HCSEF provided a data recap for the CPP and facilitated a collaborative brainstorming exercise to identify priority populations and priority issue areas. A multi-voting technique was utilized to prioritize both the populations and issues areas. February 2014 HCSEF facilitated a half-day meeting of the CPP to review prioritized populations and issues areas from previous meeting to determine root causes of the issues in the community, to identify available resources and ongoing efforts in the community and to begin to develop goals, objectives and strategies related to the top three priority issue areas. March 2014 The Jurisdictional HIV Prevention Plan was completed. March 2014 and ongoing (anticipated) The Plan is implemented, monitored and evaluated. 8 P a g e

13 HIV Background / Importance of HIV Prevention The Centers for Disease Control and Prevention (CDC) outlines the impact of the HIV epidemic on the national level highlighting the disparities that are present with the disease. More than over thirty years into the HIV epidemic, HIV infection remains a major public health issue in the United States. More than 50,000 new HIV infections occur annually in the country. More than 1.1 million adults and adolescents are living with HIV and 18% of persons living with HIV are not aware of their status. The epidemic continues to have a disproportionate impact on racial and ethnic minority populations particularly African Americans and Hispanics and on men who have sex with men (MSM) and injection drug users (IDUs), regardless of race or ethnicity. 5 Florida has been, and continues to be, among the states hardest hit by the HIV/AIDS epidemic. At the end of 2010, over 95,000 Florida residents were known to be living with HIV/AIDS and in 2009 the state represented 13% of newly diagnosed AIDS cases in the nation, second to only New York. 6 In 2012, there were 332 new cases of HIV diagnosed in the Palm Beach County, representing just over 6% of the new HIV cases in the state (5,388). 7 The rate of new HIV cases, HIV incidence, has improved considerably in both the county and state however, with a rate of 24.9 new cases per 100,000 persons in the county, HIV prevention activities are as important as ever to continue reducing the rate of new HIV infections. 5 Centers for Disease Control and Prevention. HIV Surveillance Report, 2010; vol Florida Jurisdictional HIV Prevention Plan 7 FloridaCHARTS, Florida Department of Health, Bureau of HIV/AIDS 9 P a g e

14 The Community Planning Partnership The Area 9 (Palm Beach County) Community Planning Partnership served as an integral part of the HIV Planning Group (HPG) that helped inform the development of this Plan. The mission of the Palm Beach County HIV Community Planning Partnership is to promote community participation and involvement in HIV prevention services and activities, and provide required planning documents as requested by the Florida Department of Health, Bureau of HIV/AIDS (BHA). 8 CPP membership may include individuals from: the county s health department, community-based organizations (CBOs), AIDS service organizations, the faith-based community, the school district, community health centers, state and local government, mental health and substance abuse providers, businesses, as well as representation from minority and ethnic groups, youth, persons living with HIV/AIDS and underserved populations. 9 The Community Planning Partnership: Strives to reduce the duplication of prevention services and improve coordination within the county for service implementation. Strengthens local collaborative efforts between public and private partnerships in the fight against HIV disease. Collaborates with the Palm Beach County HIV Care Council to promote community planning for HIV prevention/education, early intervention and patient care. Promotes community mobilization. 10 Moving forward and toward the implementation, monitoring and evaluation phases, the CPP members, specifically those identified as Plan liaisons will play a critical role in ensuring that the Jurisdictional HIV Plan is utilized to effectively address gaps in HIV prevention and to further improve HIV prevention efforts throughout the community. 8 Bylaws of the Palm Beach County HIV Community Prevention Partnership; 4/11/12 revision 9 Bylaws of the Palm Beach County HIV Community Prevention Partnership; 4/11/12 revision 10 Bylaws of the Palm Beach County HIV Community Prevention Partnership; 4/11/12 revision 10 P a g e

15 Community Perspective To help frame the need for the Plan and in an effort to gain perspective on the impact HIV/AIDS has had on the community, the health council facilitated a discussion with stakeholders and individuals involved with HIV/AIDS in the community, centering on the question, How has HIV/AIDS impacted Palm Beach County? Many of the individuals who participated in the discussion have been involved with work related to HIV/AIDS for many years and were able to offer a perspective as to how the disease and its impact has changed the community and how the perception and response to the disease has changed over time. The following statements are excerpts from the discussion: Positive Impacts: o Health services are better and there are additional services available o Has brought some agencies together; collaboration o Test Palm Beach Initiative was developed - counseling and testing increased o Parents want kids to be more educated; increased awareness o Increased sense of accountability for providers and populations o Increased conversation and discussion about the disease Other Impacts: o Stigma in certain areas of the county (Western) o Misconception that Palm Beach County is the AIDS capital o Separation and discrimination of populations and geographic locations within county o Stigma experience by MSM prevents care o No longer sense of urgency because the situation has improved 11 P a g e

16 The National HIV/AIDS Strategy A primary function and purpose of the Palm Beach County Jurisdictional HIV Prevention Plan is to identify strategies to achieve the National HIV/AIDS Strategy s (NHAS) goals at the local level. There are three primary goals for the NHAS: The steps identified to achieve these on a national level are outlined below each goal. Reduce HIV incidence o Step 1: Intensify HIV prevention efforts in the communities where HIV is most heavily concentrated. o o Step 2: Expand targeted efforts to prevent HIV infection using a combination of effective, evidence-based approaches. Step 3: Educate all Americans about the threat of HIV and how to prevent it. Increase access to care and optimizing health outcomes o Step 1: Establish a seamless system to immediately link people to continuous and coordinated quality care when they learn they are infected with HIV. o o Step 2: Take deliberate steps to increase the number and diversity of available providers of clinical care and related services for people living with HIV. Step 3: Support people living with HIV with co-occurring health conditions and those who have challenges meeting their basic needs, such as housing Reduce HIV-related health disparities o Step 1: Reduce HIV-related mortality in communities at high risk for HIV infection. o o Step 2: Adopt community-level approaches to reduce HIV infection in high-risk communities. Step 3: Reduce stigma and discrimination against people living with HIV The vision of the National HIV/AIDS Strategy is a vision that Palm Beach County strives for on the local level and hopes to take make progress toward with the implementation of the Palm Beach County Jurisdictional HIV Prevention Plan. The United States will become a place where new HIV infections are rare and when they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, gender identity or socio-economic circumstance will have unfettered access to high quality, life-extending care free from and stigma and discrimination Accessed 3/8/ P a g e

17 High Impact Prevention The Centers for Disease Control and Prevention (CDC) believes that utilizing High Impact Prevention approach to HIV prevention offers promise in addressing the HIV epidemic in the United States. Specifically, the CDC is using High Impact prevention to advance the goals of the National HIV/AIDS strategy and to ensure that ensure that HIV prevention efforts are impactful and effective. 12 The High Impact Prevention approach uses combinations of scientifically proven, cost-effective, and scalable interventions targeted to populations and geographic areas most affected by the epidemic, and promises to greatly increase the impact of HIV prevention efforts. HIP is also designed to maximize the impact of prevention efforts for all Americans at risk for HIV infection, including gay and bisexual men, communities of color, women, injection drug users, transgender women and men, and youth. 13 Through the High-Impact Prevention approach, HIV prevention efforts are guided by five major considerations: Effectiveness and cost. While all proven interventions may have a place in HIV prevention programs, High-Impact Prevention prioritizes those that are most costeffective at reducing overall HIV infections. Available cost-effectiveness data strongly supports interventions such as HIV testing and condom distribution, as well as many others. Programs to help people living with HIV avoid transmitting HIV to others are also cost-effective, since this group can be more efficiently served than the much larger population of people at risk for becoming infected. Feasibility of full-scale implementation: To make a substantial difference in new infections, priority should be placed on interventions that are practical to implement on a large scale, at reasonable cost. More time- and resource-intensive interventions, such as one-on-one or group counseling, should be reserved for people at the very highest risk of transmitting or becoming infected with HIV. Coverage in the target populations: Prevention planners should select interventions based in part on how many people can be reached once the intervention is fully implemented. For example, CDC recommends routine, opt-out HIV testing in health care settings for people regardless of risk, as research has shown that this approach can identify many people with undiagnosed HIV infection. Additionally, CDC supports targeted HIV testing in non-health care settings among people at higher risk, as this is a cost-effective tool for helping those individuals learn their HIV status. Interaction and targeting: It is also important to consider how different interventions interact, and how they can most effectively be combined to reach the most-affected populations in a given area. For example, expanding HIV testing can amplify the impact of efforts to increase adherence to treatment, particularly in areas where large numbers of people remain undiagnosed ; Accessed 3/9/14 13 HIV Planning Guidance, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, July P a g e

18 Prioritization: To put the above considerations into practice, prevention planners need to rigorously assess the potential impact on HIV infections of combining different interventions for specific populations. This will allow for prioritizing the interventions that will have the greatest overall potential to reduce infections Accessed 3/13/14 14 P a g e

19 Background Palm Beach County Demographic and Epidemiologic Data Palm Beach County Demographic and Socioeconomic Profile Palm Beach County is located in southeast Florida and is one of three counties that comprise the South Florida metropolitan area. Formed in 1909, it is the largest county in the state in area and the third largest in population. The county has a total area 2, square miles, of which 1, square miles (82.73%) is land and square miles (17.27%) is water. The county was named for the palm trees and beaches in the area. The county seat is located in the county s largest city, West Palm Beach. Palm Beach County borders Martin County to the North, the Atlantic Ocean to the East, Broward County to the South, Hendry County to the West, and extends into Lake Okeechobee in the Northwest, where it borders Okeechobee County and Glades County at one point in the center of the lake. For HIV/AIDS planning, the state of Florida is divided into seventeen distinct geographical areas and fourteen planning partnerships that cover those areas to conduct patient care and prevention planning. The Area 9 planning partnership is comprised of Palm Beach County. 15 Population The population of Palm Beach County in 2012 was 1,356,545 which accounted for just over 7% of the state s population. Table 1: Total Population, Palm Beach County, Florida, 2012 Total Population Palm Beach County 1,356,545 Florida 19,317,568 Source: U.S. Census Bureau, 2012 Estimates Compiled by: Health Council of Southeast Florida, Florida Jurisdictional HIV Prevention Plan 15 P a g e

20 Race and Ethnicity Table 2 shows the racial distribution of individuals in Palm Beach County and in Florida. In 2012, just over three- quarters of Palm Beach County residents identified as white, and 17.6% as black or African American. The remaining 6.7% of the county s population was comprised of individuals who identified as American Indian or Alaska Native, Asian, Native Hawaiian and other Pacific Islander, some other race or two or more races. Table 2: Population, by Race, Palm Beach County and Florida, 2012 Palm Beach County Florida Number Percent Percent White 1,026, % 76.3% Black or African American 238, % 16.1% American Indian and Alaska Native 1, % 0.3% Asian 34, % 2.5% Native Hawaiian and Other Pacific Islander 1, % 0.1% Some other race 24, % 2.4% Two or more races 29, % 2.4% Source: American Community Survey, 2012 Compiled by: Health Council of Southeast Florida, 2014 Table 3 shows the ethnic distribution of individuals in Palm Beach County and in Florida. In 2012, just over 20% of individuals in Palm Beach County identified as Hispanic or Latino. Table 3: Population, by Ethnicity, Palm Beach County and Florida, 2012 Palm Beach County Florida Number Percent Percent Hispanic or Latino (of any race) 272, % 23.2% Not Hispanic or Latino 1,084, % 76.8% Source: American Community Survey, 2012 Compiled by: Health Council of Southeast Florida, 2014 Gender Table 4 shows the gender distribution in Palm Beach County and in Florida. In 2012, females represented slightly more than half of the population in both Palm Beach County and in Florida. Table 4: Population by Gender, Palm Beach County and Florida, 2012 Palm Beach County Florida Number Percent Percent Female 700, % 51.1% Male 656, % 48.9% Source: American Community Survey, 2012 Compiled by: Health Council of Southeast Florida, P a g e

21 Table 5 shows the age distribution of the populations in Palm Beach County and in Florida. Representing 25.9% of the population, the year age group represented the largest segment of the population, of any ten-year age bracket. Table 5: Population Age Distribution, Palm Beach County and Florida, 2012 Palm Beach County Florida Number Percent Percent Under 5 years 70, % 5.5% 5 to 9 years 74, % 5.8% 10 to 14 years 77, % 5.8% 15 to 19 years 81, % 6.2% 20 to 24 years 79, % 6.8% 25 to 34 years 153, % 12.3% 35 to 44 years 161, % 12.5% 45 to 54 years 189, % 14.2% 55 to 59 years 84, % 6.6% 60 to 64 years 83, % 6.1% 65 to 74 years 141, % 9.8% 75 to 84 years 102, % 5.8% 85 years and over 56, % 2.5% 18 years and over 1,083, % 79.3% 21 years and over 1,035, % 75.3% 62 years and over 348, % 21.8% 65 years and over 299, % 18.2% Source: American Community Survey, 2012 Compiled by: Health Council of Southeast Florida, 2014 Table 6 shows the population growth in Palm Beach County and in Florida between 2000 and During the time period shown, the population in Palm Beach County increased by 188,950 persons or 16.7%. Table 6: Population Growth , Palm Beach County and Florida 2000 Population 2010 Population Net Change Percent Change Palm Beach County 1,131,184 1,320, , % Florida 16,074,896 18,788,795 2,713, % Source: American Community Survey, 2012 Compiled by: Health Council of Southeast Florida, P a g e

22 Table 7 shows the unemployment in Palm Beach County and in Florida by race and ethnicity. In 2012 in Palm Beach County, the unemployment rate in Palm Beach County among black individual was 18.1%, over double the rate of the white population. This disparity was also seen at the state level. Table 7: Unemployment Rate, by Race and Ethnicity, Palm Beach County and Florida, 2012 Palm Beach County Florida White Black Asian Hispanic Total White Black Asian Hispanic Total % 18.1% 7.5% 11.2% 10.6% 10.1% 18.9% 6.9% 11.2% 11.5% Source: U.S. Census Bureau, 2010, 2011, and 2012; 1-year Estimates Compiled by: Health Council of Southeast Florida, 2014 Table 8 shows the percentages of the population living below the poverty level in Palm Beach County and Florida in 2010, 2011 and In 2012, 14.3% of the total population in the county was living below poverty level. There was disparity between races and ethnicities with 26.8% of black individuals and 22.3% of Hispanic individuals in the county living below poverty in Table 8: % of Population Living Below Poverty by Race and Ethnicity, Palm Beach County and Florida, 2010, 2011, 2012 Palm Beach County Florida White 11.2% 12.5% 11.3% 13.7% 14.0% 14.3% Black 27.0% 30.9% 26.8% 28.6% 29.6% 29.0% Hispanic 21.5% 22.3% 22.3% 21.8% 22.7% 22.4% Total 14.2% 15.9% 14.3% 16.5% 17.0% 17.1% Source: U.S. Census Bureau, 2010, 2011, and year Estimates Compiled by: Health Council of Southeast Florida, P a g e

23 Rate per 100,000 Palm Beach County HIV/AIDS (Area 9) Epidemiological Profile HIV Incidence HIV incidence is the number of newly reported HIV cases during a time period. Figure 1 shows HIV incidence in Palm Beach County and in Florida from 1993 to Data labels are shown for the county s rates. In both the county and the state, the rate of new HIV cases decreased considerably. In 2012, there were 332 new HIV cases reported in the county. In 2012, the rate in the county (24.9 per 100,000) was slightly lower than the rate in the state as a whole (28.3 per 100,000). Figure 1: HIV Incidence, Palm Beach, Florida, Palm Beach Florida 10 0 Data Source: FloridaCHARTS, Florida Department of Health, Bureau of HIV/AIDS Data Notes: HIV and AIDS cases by year of report are NOT mutually exclusive and should NOT be added together. These data represent reported new cases of HIV. No data available prior to The increased number of cases for 2007 is partially attributable to changes in HIV case definitions for HIV reporting. Data Compiled by: Health Council of Southeast Florida, P a g e

24 Rate per 100,000 Figure 2 shows HIV incidence rates in Palm Beach County and in Florida by gender from 1993 to Data labels are shown for the county s rates. In 2012, the rate of new cases of HIV was higher in males than in females in both the county and the state. The rate of new HIV cases in males was lower in the county (34.1 per 100,000) than in the state (44.9 per 100,000), however the rate of new HIV cases in females was higher in the county (16.3 per 100,000) than in the state (12.4 per 100,000). Figure 2: HIV Incidence Rates, by Gender, Palm Beach County and Florida PBC Male PBC Female Florida Male Florida Female 0 Data Source: FloridaCHARTS, Florida Department of Health, Bureau of HIV/AIDS Data Notes: HIV and AIDS cases by year of report are NOT mutually exclusive and should NOT be added together. These data represent reported new cases of HIV. No data available prior to The increased number of cases for 2007 is partially attributable to changes in HIV case definitions for HIV reporting. Data Compiled by: Health Council of Southeast Florida, P a g e

25 Rate per 100,000 Figure 3 shows HIV incidence rates in Palm Beach County and in Florida by ethnicity from 2004 to Data labels are shown for the county s rates. In 2012, the rate of new HIV in Palm Beach County was considerably higher in non-hispanic individuals (26.8 per 100,000) than in Hispanic individuals (17.3 per 100,000). The disparity between the ethnicities was not as great in Florida with the rate in non-hispanic individuals being only slightly greater (28.6 vs per 100,000). Figure 3: HIV Incidence Rates, by Ethnicity, Palm Beach County and Florida PBC Hispanic PBC Non- Hispanic Florida Hispanic Florida Non- Hispanic Data Source: FloridaCHARTS, Florida Department of Health, Bureau of HIV/AIDS Data Notes: HIV and AIDS cases by year of report are NOT mutually exclusive and should NOT be added together. These data represent reported new cases of HIV. No data available prior to The increased number of cases for 2007 is partially attributable to changes in HIV case definitions for HIV reporting. Data Compiled by: Health Council of Southeast Florida, P a g e

26 Rate per 100,000 Figure 4 shows HIV incidence rates in Palm Beach County and in Florida by race from 2004 to Data labels are shown for the county s rates. Considerable racial disparity was seen in both the county and the state between non-hispanic white and non-hispanic black individuals. In 2012, the rate of new HIV cases in non-hispanic black individuals in the county was 70.9 per 100,000, over 6 times the rate in non-hispanic white individuals (11.3 per 100,000). The county s rate of new HIV cases in non-hispanic black individuals was greater than in the state however, the rate in non-hispanic white individuals was lower in the county than in the state. Figure 4: HIV Incidence Rates, by Race, Palm Beach County and Florida PBC Non- Hispanic White PBC Non- Hispanic Black and Other Races Florida Non- Hispanic White Florida Non- Hispanic Black and Other Races Data Source: FloridaCHARTS, Florida Department of Health, Bureau of HIV/AIDS Data Notes: HIV and AIDS cases by year of report are NOT mutually exclusive and should NOT be added together. These data represent reported new cases of HIV. No data available prior to The increased number of cases for 2007 is partially attributable to changes in HIV case definitions for HIV reporting. Data Compiled by: Health Council of Southeast Florida, P a g e

27 HIV Prevalence HIV prevalence refers to the total number of individuals living with HIV at a given point in time. This differs from HIV incidence which is the number of newly diagnosed HIV cases during a period of time. Table 9 shows HIV prevalence in Palm Beach County through 2012 by race and ethnicity. There were 2,984 individuals living with HIV at the end of Racial disparity is evident as black, non-hispanic individuals represented 60% of living HIV cases though the black, non-hispanic population only represented just over 17% of the county s total population. Table 9: HIV Prevalence by Race and Ethnicity, Palm Beach County, through 2012 Number % of Total White, Non-Hispanic % Black, Non-Hispanic 1, % Hispanic % Asian/Pacific Islander % American Indian/Alaskan Native 1 0.0% Not specified/other % Total: 2, % Source: Florida Department of Health, HIV/AIDS & Hepatitis Program, 2013 Data Compiled by: Health Council of Southeast Florida, 2014 Table 10 shows HIV prevalence by exposure category in males through Nearly 60% of male HIV cases in the county (1,057) were men who have sex with men (MSM), and an additional 48 cases were MSM/injection drug users. Males represented nearly 60% of individuals living with HIV in the county. Table 10: HIV Prevalence, Males, Palm Beach County through 2012 Number % of Total MSM (Men who have sex with men) 1, % IDU (Injection drug user) % MSM/IDU % Heterosexual % Other % Total: 1, % Source: FLORIDA Department of Health, HIV/AIDS & Hepatitis Program, 2013 Compiled by: Health Council of Southeast Florida, P a g e

28 Table 11 shows HIV prevalence by exposure category in females through Females represented nearly 40% of individuals living with HIV in the county (1,186). The majority of females with HIV in the county were in the heterosexual exposure category. Table 11: HIV Prevalence, Females, Palm Beach County, through 2012 Number % of Total IDU % Heterosexual 1, % Other % Total: 1, % Source: Florida Department of Health, HIV/AIDS & Hepatitis Program, 2013 Compiled by: Health Council of Southeast Florida, 2014 Table 12 shows HIV prevalence by exposure category in the pediatric population in Palm Beach County through The 19 cases of pediatric HIV in the county were infected via maternal exposure. Table 12: HIV Prevalence, Pediatric, Palm Beach County, through 2012 Number % Total Mother with/at risk for HIV infection % Risk not reported/other 0 0% Total: % Source:Florida Department of Health, HIV/AIDS & Hepatitis Program, 2013 Compiled by: Health Council of Southeast Florida, 2014 Table 13 shows HIV prevalence in the county by age group through Individuals represented 28.6% of HIV cases, the highest percentage among a ten-year age group, followed by the age group. It is important to recognize that these are not necessarily newly diagnosed cased, but people living with HIV. Table 13: HIV Prevalence, Palm Beach County, by Age, 2012 Number % of Total 0-2 years 2 0.1% 3-12 years % years % years % years % years % years % years % years % 60+ years % Total: 2, % Source: FLORIDA Department of Health, HIV/AIDS & Hepatitis Program, 2013 Compiled by: Health Council of Southeast Florida, P a g e

29 Table 14 shows HIV prevalence by race, ethnicity and age in Palm Beach County through The greatest number of individuals in the county living with HIV are white MSM (535), followed by black women of child-bearing age (493) and then by black MSM (351). Table 14: HIV Prevalence, by Race, Ethnicity and Age, Palm Beach County, through 2012 Number White MSM 535 Male Haitian Born 216 Black MSM 351 Female Haitian Born 246 Hispanic MSM 199 Number White Male Youth (current ages 13-24) 14 White Male IDU 45 Black Male Youth (current ages 13-24) 82 Black Male IDU 59 Hispanic Male Youth (current ages 13-24) 11 Hispanic Male IDU 22 White Female Youth (current ages 13-24) 9 White Female IDU 38 Black Female Youth (current ages 13-24) 61 Black Female IDU 32 Hispanic Female Youth (current ages 13-24) 6 Hispanic Female IDU 7 White WCBA (current ages 15-44) 83 Black WCBA (current ages 15-44) 493 White Male Homeless 0 Hispanic WCBA (current ages 15-44) 68 Black Male Homeless 2 White Pediatric Cases (current ages 0-12) 4 Hispanic Male Homeless 0 Black Pediatric Cases (current ages 0-12) 12 White Female Homeless 1 Hispanic Pediatric Cases (current ages 0-12) 3 Black Female Homeless 4 Hispanic Female Homeless 0 DOC Cases 28 Data Source: Florida Department of Health, Bureau of HIV/AIDS Data Notes: MSM includes MSM & MSM/IDU; Male IDU includes IDU and MSM/IDU; WMCA women of child bearing age 25 P a g e

30 AIDS Incidence AIDS incidence is the number of newly diagnosed AIDS cases during a period of time. Table 15 and Figure 5 show the AIDS incidence in Palm Beach County and in Florida from 1993 to Data labels are shown for the county s rates. The rate in both areas decreased considerably in the time period shown. In 2012, there were 205 newly diagnosed AIDS cases in the county resulting in a rate of 15.4 per 100,000, which was slightly higher than the state s rate of 14.6 per 100,000. Table 15: AIDS Incidence, Palm Beach County, Florida, Palm Beach Florida Number Rate per 100,000 Rate per 100, Data Source: FloridaCHARTS, Florida Department of Health, Bureau of HIV/AIDS Date Notes: HIV and AIDS cases by year of report are NOT mutually exclusive and should NOT be added together. Many 2007 cases were not reported until 2008 because of the change from paper to electronic lab reporting (ELR). This results in an artificially low count of AIDS cases in Compiled by: Health Council of Southeast Florida, P a g e

31 Rate per 100,000 Figure 5: AIDS Incidence Rates, Palm Beach, Florida Palm Beach Florida Data Source: FloridaCHARTS, Florida Department of Health, Bureau of HIV/AIDS Date Notes: HIV and AIDS cases by year of report are NOT mutually exclusive and should NOT be added together. Many 2007 cases were not reported until 2008 because of the change from paper to electronic lab reporting (ELR). This results in an artificially low count of AIDS cases in Compiled by: Health Council of Southeast Florida, P a g e

32 Rate per 100,000 Figure 6 shows AIDS incidence in Palm Beach County and in Florida by gender from 2004 to Data labels are shown for the county s rates. In 2012, the incidence of AIDS was greater in males (17.7 per 100,000) than in females (13.2 per 100,000) in the county. However, the gender disparity in the rate of individuals diagnosed AIDS in the county narrowed considerably in the time period shown. Figure 6: AIDS Incidence Rates, by Gender, Palm Beach County and Florida PBC Male PBC Female Florida Male Florida Female Data Source: FloridaCHARTS, Florida Department of Health, Bureau of HIV/AIDS Date Notes: HIV and AIDS cases by year of report are NOT mutually exclusive and should NOT be added together. Many 2007 cases were not reported until 2008 because of the change from paper to electronic lab reporting (ELR). This results in an artificially low count of AIDS cases in Compiled by: Health Council of Southeast Florida, P a g e

33 Rate per 100,000 Figure 7 shows AIDS incidence in Palm Beach County and in Florida by race from 2004 to Data labels are shown for the county s rates. Considerable disparity was present between the rates of AIDS in non-hispanic white individuals and non-hispanic black individuals in both the county and the state. In 2012, the rate of newly diagnosed AIDS cases in black non-hispanic individuals (52.5 per 100,000) was over eleven times the rate in non-hispanic white individuals (4.6 per 100,000) in Palm Beach County. Figure 7: AIDS Incidence Rates, by Race, Palm Beach County and Florida PBC Non- Hispanic White PBC Non- Hispanic Black and Other Races Florida Non- Hispanic White Florida Non- Hispanic Black and Other Races Data Source: FloridaCHARTS, Florida Department of Health, Bureau of HIV/AIDS Date Notes: HIV and AIDS cases by year of report are NOT mutually exclusive and should NOT be added together. Many 2007 cases were not reported until 2008 because of the change from paper to electronic lab reporting (ELR). This results in an artificially low count of AIDS cases in Compiled by: Health Council of Southeast Florida, P a g e

34 Rate per 100,000 Figure 8 shows AIDS incidence in Palm Beach County and in Florida by ethnicity from 2004 to Data labels are shown for the county s rates. In 2012 in Palm Beach County the incidence of AIDS in non-hispanic individuals was nearly two times the rate in Hispanic individuals. Figure 8: AIDS Incidence Rates, by Ethnicity, Palm Beach County and Florida PBC Hispanic PBC Non- Hispanic Florida Hispanic Florida Non- Hispanic Data Source: FloridaCHARTS, Florida Department of Health, Bureau of HIV/AIDS Date Notes: HIV and AIDS cases by year of report are NOT mutually exclusive and should NOT be added together. Many 2007 cases were not reported until 2008 because of the change from paper to electronic lab reporting (ELR). This results in an artificially low count of AIDS cases in Compiled by: Health Council of Southeast Florida, P a g e

35 AIDS Prevalence AIDS prevalence is the number of individuals living with AIDS at a given time. This differs from AIDS incidence which is the number of newly diagnosed AIDS cases during a period of time. Table 16 shows AIDS prevalence in Palm Beach County through 2012 by race, ethnicity and age. The greatest number of individuals living with AIDS were white MSM (742), followed by Haitian born males (609) and then by black women of child-bearing age (527). Table 16: AIDS Prevalence, by Race, Ethnicity and Age, Palm Beach County, through 2012 Number Number White MSM 742 Male Haitian Born 609 Black MSM 505 Female Haitian Born 357 Hispanic MSM 255 White Male Youth (current ages 13-24) 2 White Male IDU 88 Black Male Youth (current ages 13-24) 56 Black Male IDU 190 Hispanic Male Youth (current ages 13-24) 5 Hispanic Male IDU 57 White Female Youth (current ages 13-24) 3 White Female IDU 63 Black Female Youth (current ages 13-24) 50 Black Female IDU 118 Hispanic Female Youth (current ages 13-24) Hispanic Female IDU 25 White WCBA (current ages 15-44) 78 Black WCBA (current ages 15-44) 527 White Male Homeless 2 Hispanic WCBA (current ages 15-44) 70 Black Male Homeless 9 White Ped Cases (current ages 0-12) 0 Hispanic Male Homeless 2 Black Ped Cases (current ages 0-12) 2 White Female Homeless 1 Hispanic Ped Cases (current ages 0-12) 0 Black Female Homeless 3 Hispanic Female Homeless 0 DOC Cases 52 Data Source: Florida Department of Health, Bureau of HIV/AIDS Data Notes: MSM includes MSM & MSM/IDU; Male IDU includes IDU and MSM/IDU; WMCA women of child bearing age 5 31 P a g e

36 Comorbidities and Other Infections Populations disproportionately affected by HIV are also affected by other infections including tuberculosis and STDS. The risk of acquiring these diseases is associated with similar behaviors and environmental conditions that put individuals at risk of becoming infected with HIV or they can put individuals at risk for reciprocal or interdependent effects. 16 Infectious Syphilis Infectious syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidum.. 17 STDs such as syphilis share common modes of transmission and increase the risk for HIV infections. 18 Table 17 shows the number of infectious syphilis cases in Palm Beach in 2011 and 2012 by gender. In 2012, 79.2% of the 77 infectious syphilis cases were males. The number of cases in 2012, 77, increased from 65 cases in Table 17: Infectious Syphilis, Palm Beach County, by Gender, 2011, Cases % Total Rate Cases % Total Rate Male % % 9.4 Female % % 2.3 Other/Unknown 0 0.0% N/A 0 0.0% N/A Total % % 5.8 Source: FLORIDA Department of Health, HIV/AIDS & Hepatitis Program, 2013 Compiled by: Health Council of Southeast Florida, HIV Planning Guidance, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, July FloridaCHARTS, Accessed 3/12/14 18 HIV Planning Guidance, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, July P a g e

37 Table 18 shows the number of infectious syphilis cases in Palm Beach in 2011 and 2012 by age. In 2012, the year old age group represented 42.9% (33 diagnosed cases) of the 77 diagnosed cases. Table 18: Infectious Syphilis, Palm Beach County, by Age, 2011, Cases % Total Rate Cases % Total Rate % % % % % % % % % % % % % % % % 1.6 Other/Unknown 0 0.0% N/A 0 0.0% N/A Total % % 5.8 Source: FLORIDA Department of Health, HIV/AIDS & Hepatitis Program, 2013 Compiled by: Health Council of Southeast Florida, 2014 Table 19 shows diagnosed infectious syphilis cases in Palm Beach County in 2011 and 2012 by race. Black non-hispanic individuals represented 45.5% of the total diagnosed cases. The rate of infectious syphilis diagnosis was over four times the rate in white non-hispanic individuals. Table 19: Infectious Syphilis, Palm Beach County, by Race and Ethnicity, 2011, Cases % Total Rate Cases % Total Rate White, Non-Hispanic % % 3.7 Black, Non-Hispanic % % 15.3 Hispanic % % 3.4 Asian/Pacific Islander 1 1.5% N/A 1 1.3% N/A Amer. Indian/Alaskan 0 0.0% N/A 1 1.3% N/A Other/Unknown 4 6.2% N/A 2 2.6% N/A Total % % 5.8 Source: FLORIDA Department of Health, HIV/AIDS & Hepatitis Program, 2013 Compiled by: Health Council of Southeast Florida, P a g e

38 Gonorrhea Gonorrhea is a common sexually transmitted infection (STI). Gonorrhea is caused by the bacteria Neisseria gonorrhoeae. 19 STDs such as gonorrhea share common modes of transmission and increase the risk for HIV infections. 20 Table 20 shows gonorrhea cases in Palm Beach County in 2011 and 2012 by gender. In 2012 there were 725 cases of gonorrhea in the county, a decrease from 856 from Males represented 53.7% of the total cases. Table 20: Gonorrhea, Palm Beach County, by Gender, 2011, Cases % Total Rate Cases % Total Rate Male % % 59.9 Female % % 48.7 Other/Unknown 0 0.0% N/A 0 0.0% N/A Total % % 54.1 Source: FLORIDA Department of Health, HIV/AIDS & Hepatitis Program, 2013 Compiled by: Health Council of Southeast Florida, 2014 Table 21 shows gonorrhea cases in Palm Beach County in 2011 and 2012 by age. Individuals years old represented over half (52.4%) of the 725 total cases in Table 21: Gonorrhea, Palm Beach County, by Age, 2011, Cases % Total Rate Cases % Total Rate % % % % % % % % % % % % % % % % 2.1 Other/Unknown 0 0.0% N/A 2 0.3% N/A Total % % 54.1 Source: FLORIDA Department of Health, HIV/AIDS & Hepatitis Program, 2013 Compiled by: Health Council of Southeast Florida, FloridaCHARTS, Accessed 3/12/14 20 HIV Planning Guidance, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, July P a g e

39 Table 22 shows gonorrhea cases in Palm Beach County in 2011 and 2012 by race and ethnicity. Considerable racial disparity was present as the rate in non-hispanic black individuals was nearly ten times the rate in non-hispanic white individuals. Table 22: Gonorrhea, Palm Beach County, by Race and Ethnicity, 2011, Cases % Total Rate Cases % Total Rate White, Non-Hispanic % % 19.1 Black, Non-Hispanic % % Hispanic % % 23.9 Asian/Pacific Islander 4 0.5% N/A 5 0.7% N/A Amer. Indian/Alaskan 0 0.0% N/A 0 0.0% N/A Other/Unknown % N/A % N/A Total % % 54.1 Source: FLORIDA Department of Health, HIV/AIDS & Hepatitis Program, 2013 Compiled by: Health Council of Southeast Florida, P a g e

40 Tuberculosis Tuberculosis is an AIDS-defining opportunistic condition and the disease accelerates HIV disease progression. 21 Table 23 shows tuberculosis cases in Palm Beach County in 2011 and 2012 by gender. The number of cases decreased from 59 to 40 cases from 2011 to In 2012 the number of cases was evenly distributed between males and females. Table 23: Tuberculosis, Palm Beach County, by Gender, 2011, Cases % Total Rate Cases % Total Rate Male % % 3.1 Female % % 2.9 Other/Unknown 0 0.0% N/A 0 0.0% N/A Total % % 3.0 Source: FLORIDA Department of Health, HIV/AIDS & Hepatitis Program, 2013 Compiled by: Health Council of Southeast Florida, 2014 Table 24 shows tuberculosis cases in Palm Beach County in 2011 and 2012 by age. The rate was highest in the year old age group at 5.0 per 100,000. Individuals 60 years and older represented nearly a third of all cases in Table 24: Tuberculosis, Palm Beach County, by Age, 2011, Cases % Total Rate Cases % Total Rate % % % % % % % % % % % % % % % % 3.5 Other/Unknown 0 0.0% N/A 0 0.0% N/A Total % % 3.0 Source: FLORIDA Department of Health, HIV/AIDS & Hepatitis Program, 2013 Compiled by: Health Council of Southeast Florida, HIV Planning Guidance, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, July P a g e

41 Table 25 shows tuberculosis cases in Palm Beach County in 2011 and 2012 by race and ethnicity. Black non-hispanic individuals had the highest rate (7.4 per 100,000) of Tuberculosis cases and represented 42.5% of the 40 total cases in Table 25: Tuberculosis, Palm Beach County, by Race and Ethnicity, 2011, Cases % Total Rate Cases % Total Rate White, Non-Hispanic % % 1.1 Black, Non-Hispanic % % 7.4 Hispanic % % 3.4 Asian/Pacific Islander % N/A 2 5.0% N/A Amer. Indian/Alaskan 0 0.0% N/A 1 2.5% N/A Other/Unknown 2 3.4% N/A 2 5.0% N/A Total % % 3.0 Source: FLORIDA Department of Health, HIV/AIDS & Hepatitis Program, 2013 Compiled by: Health Council of Southeast Florida, P a g e

42 HIV Counseling and Testing Table 26 shows HIV counseling and testing data from 2011 and 2012 in Palm Beach County by gender. In 2012, there were 33,920 tests administered in the county of which 12,686 were males, 19,894 were females and 1,340 were unknown. The overall percent positive was.7%. The percent positive in males was 1.1%,.4% in females and.9% in cases where the gender was unknown. Table 26: HIV Counseling and Testing, Palm Beach County, by Gender, 2011, 2012 Number of Tests Number Positive % Positive Male 12,255 12, % 1.1% Female 19,767 19, % 0.4% Unknown 364 1, % 0.9% Total 32,386 33, % 0.7% Source: FLORIDA Department of Health, HIV/AIDS & Hepatitis Program, 2013 Compiled by: Health Council of Southeast Florida, 2014 Table 27 shows HIV counseling and testing data from 2011 and 2012 in Palm Beach County by race and ethnicity. In 2012, the greatest number of tests were administered to black individuals (15,306), followed by Hispanic individuals (10,557). The percent positive was.9% in black individuals,.7 % in white individuals and.3% in Hispanic individuals. Table 27: HIV Counseling and Testing, Palm Beach County, by Race and Ethnicity, 2011, 2012 Number of Tests Number Positive % Positive White 6,436 6, % 0.7% Black 14,311 15, % 0.9% Hispanic 10,330 10, % 0.3% Asian % 0.3% Am. Native % 0.0% Other % 0.7% Unknown % 0.8% Total 32,386 33, % 0.7% Source: FLORIDA Department of Health, HIV/AIDS & Hepatitis Program, 2013 Compiled by: Health Council of Southeast Florida, P a g e

43 Table 28 and Figure 9 show adults under age 65 in Palm Beach County and in Florida who reported ever having been tested for HIV. In 2010, the rate in Palm Beach County 45.5% was slightly lower than Florida, 48.4%. Table 28: Adults <65 who have ever been tested for HIV, Palm Beach County and Florida, 2002, 2007, 2010 Palm Beach County Florida % 47.7% % 49.1% % 48.4% Data Source: FloridaCHARTS, Florida County-level Behavioral Risk Factors Surveillance Telephone Survey conducted by the Florida Department of Health, Bureau of Epidemiology Data Compiled by: Health Council of Southeast Florida, 2014 Figure 9: Adults <65 who have ever been tested for HIV, Palm Beach County and Florida, P a g e

44 Rate per 100,000 Number of Deaths in PBC HIV Death Rates and Counts Figure 10 shows the death rates and counts from HIV and AIDS in Palm Beach County and Florida from Data labels are shown for the county s rates. The purple and blue trend lines show the rate per 100,000 in the county and the state and correspond to the left axis. The red bars show the number of deaths in the county and corresponds to the right axis. The rate decreased considerably in both areas in the time period shown. In 2012, the rate was slightly higher in the county (4.9 per 100,000) than in the state (4.8 per 100,000). Figure 10: HIV/AIDS Crude Death Rates and Count, Palm Beach County and Florida, PBC Count PBC Rate Florida Rate Data Source: FloridaCHARTS, Florida Department of Health, Bureau of HIV/AIDS Data Notes: ICD-10 Code(s): B20-B24 Table 29 shows deaths from HIV and AIDS in Palm Beach County and in Florida in 2010, 2011 and 2012 by gender. In 2012, the rates of deaths in males were higher in both the county (6.0 vs. 3.8 per 100,000) and in the state (6.4 vs. 3.3 per 100,000) than in females. Table 29: Deaths from HIV/AIDS, Palm Beach County and Florida, by Gender 2010, 2011, 2012 Palm Beach County Florida Count Rate Count Rate Count Rate Count Rate Count Rate Count Rate Male Female Data Source: FloridaCHARTS, Florida Department of Health, Bureau of HIV/AIDS Data Note: Rates per 100,000 Compiled by: Health Council of Southeast Florida, P a g e

45 Table 30 shows deaths from HIV and AIDS in Palm Beach County and in Florida in 2010, 2011 and 2012 by race. In Palm Beach County in 2012, the rate of death from HIV/AIDS of individuals who are black or other races death (12.9 per 100,000) was over 5 times the rate in white individuals (2.5 per 100,000). The rate of death in the black and other race individuals decreased during the time period shown. Table 30: Deaths from HIV/AIDS, Palm Beach County and Florida, by Race 2010, 2011, 2012 Palm Beach County Florida Count Rate Count Rate Count Rate Count Rate Count Rate Count Rate White Black & Other Races Data Source: FloridaCHARTS, Florida Department of Health, Bureau of HIV/AIDS Data Note: Rates per 100,000 Compiled by: Health Council of Southeast Florida, 2014 Table 31 shows deaths from HIV and AIDS in Palm Beach County and in Florida in 2010, 2011 and 2012 by ethnicity. In 2012 the rates of death in non-hispanic individuals were higher in both the county (5.2 vs. 3.8 per 100,000) and in the state (5.5 vs. 2.6 per 100,000) than in Hispanic individuals. Table 31: Deaths from HIV/AIDS, Palm Beach County and Florida, by Ethnicity 2010, 2011, 2012 Palm Beach County Florida Count Rate Count Rate Count Rate Count Rate Count Rate Count Rate Hispanic Non-Hispanic Data Source: FloridaCHARTS, Florida Department of Health, Bureau of HIV/AIDS Data Note: Rates per 100,000 Compiled by: Health Council of Southeast Florida, P a g e

46 Provider and Community Perspective Palm Beach County HIV/AIDS Provider Survey Methodology HCSEF developed a survey tool to gather insight from HIV/AIDS service providers for the Prevention Plan (Please see Appendix A for survey tool). Previous iterations of the Plan had utilized multiple survey tools, however, in an effort to streamline the process and maximize the engagement of organizations, a single survey tool, comprised of multiple sections was developed. The CPP was engaged to provide insight on the list of providers and specifically, the point persons within agencies to whom the survey would be sent. The tool was loaded into the SurveyMonkey software and disseminated to providers via . The survey was disseminated the second week in December 2013 to over forty entities in the county. Providers were given approximately three weeks to complete the survey and were incentivized to complete the survey with the chance to win, via drawing, one of three (3) $100 breakfasts for their agencies. Twenty-two responses were received. Results Respondents representing twenty-two agencies participated in the survey and their responses are summarized and analyzed below. Background Information Respondents were asked to categorize their agencies and the distribution of responses was as follows: o Non-governmental 77.8%, o Governmental-Local 11.1%, o Governmental-State 5.6% or o Governmental-Federal 5.6%. From the agencies represented in this survey, 59.1% have more than one location in Palm Beach County. 69.2% of the respondents from agencies with multiple locations indicated that the survey was being completed on behalf of all of the agency/organization's locations. 42 P a g e

47 AIDS Service Organization City/County Government Community-based Organization (not HIV/AIDS-specific) Criminal Justice System/Prison Educational Institution Faith-based Organization Family Planning Clinic Hospital Lesbian/Gay Organization Local/County Health Department Mental Health Center Persons Living with AIDS (PLWA) Coalition Primary Care Provider Sexually Transmitted Disease (STD) Clinic Specialty Care Provider Substance Abuse Treatment Center Youth Services Provider Other (please specify) Percentage of Respondents Figure 11 shows responses to the question Which of the following best describes your agency? Included open-ended responses to Other selection were: Not-for-profit health & human services provider, Homeless prevention and intervention services, Care coordination for children with special health care needs, VA Medical Center and Non-profit medical free clinic. Community-based organization (not HIV/AIDS-specific) (n=6), Substance abuse treatment center (n=4), Youth services provider (n=4) and AIDS service organization (n=4) were among other most frequently selected responses. Figure 11: Provider Survey - Which of the following best describes your agency? 35.0% 31.8% 30.0% 27.3% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 13.6% 0.0% 0.0% 13.6% 9.1% 4.5% 4.5% 4.5% 4.5% 13.6% 0.0% 13.6% 4.5% 9.1% 18.2% 18.2% 43 P a g e

48 Incarcerated Individuals Intravenous Drug Users (IDU) Commercial Sex Workers HIV Positive Individuals Homesless Individuals Men who have Sex with Men (MSM) Minority Populations - Black or African American Individuals Minority Populations - Hispanic Individuals Minority Populations - Individuals of Other Races / Ethnicities (please specifiy Partners of Person Living with HIV/AIDS Pregnant Women Other (please specify) Percentage of Respondents Figure 12 shows responses to the question Please indicate which population(s) your agency serves. Respondents were asked to select all that apply. Respondents identified the following categories as the top five population groups served by their agencies: Minority populations - black or African American individuals (n=18), Minority populations - Hispanic individuals (n=18), Homeless individuals (n=14), HIV positive individuals (n=14) and Pregnant women (n=11). Figure 12: Provider Survey - Please indicate which population(s) your agency serves. 90.0% 85.7% 85.7% 80.0% 70.0% 60.0% 50.0% 40.0% 38.1% 38.1% 33.3% 61.9% 66.7% 47.6% 47.6% 42.9% 52.4% 33.3% 30.0% 20.0% 10.0% 0.0% 44 P a g e

49 Percentage of Respondents Figure 13 shows responses to the question "Which age and gender group(s) best describe the population(s) your agency serves? Respondents were asked to check all that apply. The most frequently selected groups were: Females years old (n=20), Females 0-17 years old (n=19), Females 46+ years old (n=18), Males years old (n=18) and Males 46+ years old (n=17). Figure 13: Provider Survey - "Which age and gender group(s) best describe the population(s) your agency serves? 100.0% 90.0% 80.0% 81.8% 77.3% 86.4% 90.9% 81.8% 70.0% 68.2% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Respondents were asked to report the number of unduplicated clients who received HIV/AIDS services at their agency each year. The responses varied greatly, ranging from 10 to Respondents were asked where in the county their agencies provide HIV/AIDS services. The majority of the respondents indicated that services are provided countywide however, other respondents were more specific and included the following responses: Southern Palm Beach County, (x2); 33403, 33404, (x2); 33436, 33458, 33444, and (x2). Nearly three-quarters (72.7%) of respondents indicated that agencies are linked to local HIV/AIDS Community Planning Partnership (CPP). Respondents were asked about the number of full time and part time employees and volunteers who work specifically in HIV prevention or AIDS related service provision. Twenty respondents answered the question and a total of 39 full-time, 7 part-time and 66 volunteers were reported. Just over half of respondents (n=12, 54%) indicated that their agencies receive some type of funding for the provision of HIV/AIDS services. The following were listed as funding sources: Ryan White, Centers for Disease Control and Prevention (adolescent health), Centers for Disease Control and Prevention (Expanding Testing Initiative), Florida Department of Health, Children Medical Services and Health Resources Services Administration, Department of Children and Families. 45 P a g e

50 Number or Responses HIV/AIDS Services The survey included a series of questions about HIV/AIDS services. Figure 14 shows responses to the survey item Please indicate the HIV/AIDS prevention services your agency provides. Respondents were asked to indicate whether the services were primary or secondary prevention. Primary prevention was defined as: efforts to reach persons at high or increased risk of becoming HIV-infected or, if infected, of transmitting the virus to others, with the goal of reducing the risk of these events occurring. Secondary prevention was defined as: ensuring that clients who are HIV positive receive appropriate counseling, and are entered and maintained in an appropriate system of care, which includes prevention services. Most of the services being provided by respondents were related to primary prevention. The most frequently selected responses were: Education (n=17), HIV testing (n=15), HIV counseling and advocacy (n=9). The most frequently provided services related to secondary prevention were: Case management (n=9), Medical treatment (n=7) and Mental health services (n=7). Figure 14: Provider Survey - Please indicate the HIV/AIDS prevention services your agency provides N/A Secondary Prevention Primary Prevention Respondents were asked whether their agencies go into the community (churches, health fairs, etc.) to perform HIV testing. Half of the respondents (n=11) indicated that their agencies do go into the community for testing. Respondents who answered yes, were asked how often they go out into the community for testing. The responses ranged and while some agencies reported that they conduct testing nearly every day, other agencies reported more infrequent testing. Among the responses as to where testing is conducted were: drug treatment centers, health fairs, bars, clubs, churches, apartment complexes, everywhere and Fortis Institute. 46 P a g e

51 Number of Responses Over two thirds of the respondents indicated that their agencies offer an HIV test to everyone who accesses services. Referrals The survey included a series of questions related to referrals for HIV/AIDS related services. Respondents were first asked whether they referred clients for a given service or whether they provided the service in house. If the respondent indicated that they referred clients outside of their agencies, they were asked to which agency they referred clients and then were asked if and how follow up was conducted. In the majority of cases, the referrals were made via phone and follow-up, if conducted, was also done via phone is most cases 86.4% of respondents (n=19) indicated that their agencies do not provide all HIV/AIDS-related services "in house" and refer clients to other agencies in the community form some HIV/AIDS-related services. Figure 15 shows responses related to case management. 78.9% of the agencies refer outside of their agency for case management. The agencies that respondents indicated most were CAP/FoundCare (n=9) followed by the health department (n=5) and Compass (n=4). Figure 15: Provider Survey - Case Management Referrals Does your agency make referrals for case management services? To which agency(ies) are clients referred for case management services? % 5 4 Yes No % 47 P a g e

52 Number of Responses Figure 16 shows responses related to HIV education. Half of the respondents indicated that they refer outside the agency for HIV education. The agencies that respondents indicated they are refer to included: CAP/FoundCare (n=6), health department (n=5) and Planned Parenthood (n=1). Figure 16: Provider Survey - HIV/AIDS Education Referrals Does your agency make referrals for HIV/AIDS education? To which agency(ies) are clients referred for education? % 50.0% Yes No 1 CAP/Foundcare PBC Health Department Planned Parenthood 48 P a g e

53 Number of Responses Figure 17 shows responses related to referrals for legal services. 61.1% of the agencies reported referring outside the agency for legal services. Agencies to whom respondents reported referring clients were Legal Aid Society (n=9) and Private Donor Attorney (n=1). Figure 17: Provider Survey - Legal Services Referrals Does your agency make referrals for legal services? To which agency(ies) are clients referred for legal services? % 61.1% Yes No 1 Legal Aid Society Private Donor Attorneys 49 P a g e

54 Number of Responses Figure 18 shows responses related to referrals for mental health services. 76.5% of the respondents reported referring outside their agency for mental health services. The agencies to whom the greatest number of respondents reported referring clients were Jerome Golden Center (n=5) and South County Mental Health (n=3). Figure 18: Provider Survey - Mental Health Services Referrals Does your agency make referrals for mental health services? To which agency(ies) are clients referred for mental health services? % 3 Yes % No 50 P a g e

55 Number of Responses Figure 19 shows responses related to referrals for STD testing and counseling. 52.6% of respondents indicated that they refer outside of their agency for STD testing and counseling The agency to whom the greatest number of respondents reported referring clients was the Palm Beach County Health Department (n=8). Figure 19: Provider Survey STD Counseling and Testing Does your agency make referrals for STD testing and counseling? To which agency(ies) are clients referred for STD testing and counseling? % 52.6% Yes No P a g e

56 Number of Responses Figure 20 shows responses related to referrals for substance abuse services. 68.4% of respondents indicated that they refer outside of their agency for substance abuse services. The agencies to whom the greatest number of respondents reported referring clients were Drug Abuse Foundation (DAF) (n=5) followed by Drug Abuse Treatment Association (DATA) (n=3) and Comprehensive AIDS Rehabilitation Program (CARP) (n=3). Figure 20: Provider Survey- Substance Abuse Services Referrals Does your agency make referrals for substance abuse services? To which agency(ies) are clients referred for substance abuse services? % 1 Yes No 68.4% The final question in the referral section asked respondents for other services their agencies refer clients and included in the responses were transportation (n=1) and pharmacy services at the Health Department (n=1). 52 P a g e

57 Cultural/Language Issues Inadequate Funding/Resources Lack of Information about Available Services Lack of Interagency Coordination Service and Staff Limitations Staff Training Needs None Other (please specify) Percentage of Respondents Barriers to Care The next series of questions in the survey included questions about barriers to care. Figure 21 shows responses the question What barriers does your ORGANIZATION face when providing services to individuals living with or who are at risk of acquiring HIV/AIDS? Respondents were asked to select their top three responses only. The responses most frequently selected were: Inadequate funding/resources (n=10), Cultural/language issues (n=8) and service and staff limitations (n=8). Five respondents indicated that their organizations do not experience barriers to providing services. Figure 21: Provider Survey - What barriers does your ORGANIZATION face when providing services to individuals living with or who are at risk of acquiring HIV/AIDS? 50.0% 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 38.1% 47.6% 23.8% 4.8% 38.1% 4.8% 23.8% 0.0% 53 P a g e

58 Cultural/lLanguage Barriers Housing Needs Information About Services Fear of Disclosure/Concerns about Confidentiality Fear of Stigma Lack of Consistent Payor Source Location of Services/Transportation Needs Substance Abuse and Mental Health Issues None Other (please specify) Percentage of Respondents Figure 22 shows responses to the question, What barriers do your CLIENTS living with HIV/AIDS face when accessing services? Respondents were asked to check their top three responses only. The responses most frequently selected were: Fear of stigma (n=9), Location of services/transportation needs (n=9), Fear of disclosure/concerns about confidentiality (n=8), Housing needs (n=8) and Substance abuse and mental health issues (n=8). Figure 22: Provider Survey - What barriers do your CLIENTS living with HIV/AIDS face when accessing services? 50.0% 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 28.6% 38.1% 14.3% 38.1% 42.9% 28.6% 42.9% 38.1% 4.8% 14.3% 54 P a g e

59 Cultural Barriers Difficulty Identifying High Risk Populations Difficulty Accessing HIV Testing Fear of Disclosure or Stigma Individuals Not Ready to Receive Test Results/Address Health Status Individuals Disenfranchised/Distrustful of Medical System Individuals Do Not Believe They Are at Risk Individuals Do Not Understand HIV Testing Individuals Tired of Hearing about HIV Mental Health Issues Substance Abuse Issues Other (please specify) Percentage of Respondents Figure 23 shows responses to the question What do you think are the barriers to reaching people with HIV/AIDS who are unaware of their status? Respondents were asked to check all that apply. The most frequently selected responses were: Individuals do not believe they are at risk (n=16), Fear of disclosure or stigma (n=14), Individuals not ready to receive test (n=13), Mental health issues (n=12) and Cultural barriers (n=11). Figure 23: Provider Survey - What do you think are the barriers to reaching people with HIV/AIDS who are unaware of their status? 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 52.4% 9.5% 28.6% 66.7% 61.9% 42.9% 76.2% 23.8% 9.5% 57.1% 47.6% 0.0% 55 P a g e

60 Number of Reponses Figure 24 shows responses to the question What strategies have you/your agency used or do you believe would assist identifying people with HIV/AIDS who are unaware of their status? The responses were grouped into categories and the following topics were most frequently indicated: Education (n=8) and Awareness and outreach (n=5). Figure 24: Provider Survey - What strategies have you/your agency used or do you believe would assist identifying people with HIV/AIDS who are unaware of their status? P a g e

61 Alcohol/Drug Recovery Services/Treatment Case Management Childcare (day care or babysitting) Dental Care Early Intervention Services Emergency Financial Assistance Food Services Health Education HIV Prevention Services Housing Services Information and Referral Services Legal Services Outreach Services Peer Advocacy or Client Advocacy Support Groups Representative Payee Risk and Harm Reduction Services Transportation (bus pass, van) Treatment Education/Adherence Other (please specify) Percentage of Respondents Figure 25 shows responses to the question, Which of these services, in your opinion, are MOST important to get, AND keep people with HIV/AIDS in HIV medical care? Respondents were asked to select the five most important services. The most frequently selected responses were: Alcohol/drug recovery services/treatment (n=14), Case management (n=11), HIV prevention services (n=10), Transportation (bus pass, van) (n=10) and Support groups (n=9). Figure 25: Provider Survey - Which of these services, in your opinion, are MOST important to get, AND keep people with HIV/AIDS in HIV medical care? 70.0% 63.6% 60.0% 50.0% 40.0% 50.0% 36.4% 45.5% 40.9% 45.5% 36.4% 30.0% 20.0% 10.0% 0.0% 0.0% 4.5% 18.2% 4.5% 22.7% 22.7% 22.7% 18.2% 13.6% 13.6% 4.5% 0.0% 9.1% Research and Activities Respondents were asked the type of prevention surveillance (collection of health, demographic and behaviors/practice data to monitor the HIV/AIDS epidemic) their agency conducts. Responses included: Monthly HIV reports and weekly testing statistics Initial bio-psychosocial assessments Collection database used to track demographic information of all clients as well as frequency of testing Personalized Cognitive Counseling (PCC) sessions to gather behavioral information on high-risk clients Collection of demographic information and risky behavior practices on every client assessed Respondents were asked the type of prevention research (e.g. KABB [Knowledge, Attitudes, Beliefs & Behavior] surveys, focus groups, interviews, etc.) their agency employs. Responses included: 57 P a g e

62 Empowerment and other HIV educational groups and programs utilized to educate community members and promote testing Youth prevention classes and interviews Verbal and written information provided by primary teams HIV Counseling/Testing Forms (DH1628) Information from CDC, Palm Beach County Health Department Respondents were asked the type of current surveillance and behavioral research data they employ to inform the development and implementation of prevention programs in their agency. Responses included: CDC/Palm Beach County Health Department Surveillance Data HIV Counseling/Testing Forms (DH1628) sent to Health Department monthly CDC reports on the epidemic Respondents were asked what needs for further prevention surveillance and research have been identified by their agency. Responses included: Coordination with other organizations specializing in services for HIV Distinction between HIV and AIDS Youth education Incentives Manpower Partner Services Respondents were asked whether their agency offers partner services and referral services. Just over half the respondents indicated, yes. For those agencies that responded no, two follow up questions were asked. First, respondents were asked whether they needed help developing a protocol for offering services; the majority responded no. Next, respondents were asked whether they knew who to contact for information about partner services; the majority responded no. Technical Assistance/ Training Needs The survey included a series of questions about technical assistance and training needs. Respondents were asked to rate the level of importance for different types of technical assistance and training in their agency. Figure 26 shows the responses. The top five types of technical assistance and training rated extremely or very important were: Program planning/ development valuation (n=14) Motivational training for staff and volunteers (n=13) Communications and public relations/ social (n=11) Policy/protocol development for partner services (n=9) Fiscal management (n=10) 58 P a g e

63 A. Administrative management B. Communications and public relations/social marketing C. Fiscal/grant management D. Grant writing/proposal development E. Motivational training for staff/volunteers F. Policy/protocol development for Partner G. Program planning/development/evalu H. Staff/volunteer recruitment Number of Responses Nearly three quarters of the respondents reported receiving training in at least one of the areas below in the last 5 years. All of the respondents indicated that the training they received was helpful. Figure 26: Provider Survey -Technical Assistance and Training Not Important Somewhat Important Very Important Extremely Important N/A 59 P a g e

64 Aging with HIV Alcohol and Drug Abuse Services Case Management/Peer Advocacy for PLWH/A Confidentiality for HIV/AIDS Cultural Competency/Sensitivity Training Effective Interventions/Risk Management for HIV Prevention HIV and Co-Morbidities Including Clinical/Medical Information HIV Partner Services How to Better Advocate for Clients/Patients Mental Health Services Networking Opportunities about HIV/AIDS Care, Prevention, and Available Resources Psychosocial Manifestations Specific to PLWH/A Services for People with HIV Other training (please specify) Percentage of Respondents Figure 27 shows responses to the question, Which of the following trainings would help you to better serve clients/patients living with or at risk of acquiring HIV/AIDS? Respondents were asked to check all that apply. The most frequently selected responses were: Networking Opportunities about HIV/AIDS Care, Prevention, and Available Resources Effective Interventions/Risk Management for HIV Prevention Services for People with HIV Cultural Competency/Sensitivity Training Aging with HIV Alcohol and Drug Abuse Services Figure 27: Provider Survey - Which of the following trainings would help you to better serve clients/patients living with or at risk of acquiring HIV/AIDS? 70.0% 60.0% 57.1% 64.3% 50.0% 40.0% 30.0% 20.0% 35.7% 35.7% 21.4% 21.4% 42.9% 28.6% 28.6% 21.4% 21.4% 21.4% 42.9% 10.0% 0.0% 0.0% Respondents were asked if their agencies offered training. Nine respondents indicated yes; and were asked a follow up question about the types of trainings offered. The following responses were received: Staff and client HIV training in Palm Beach County HIV 101, 102 and 104 HIV prevention Confidentiality and privacy, HIPAA Access to insurance ADA and employment-based issues Community and individual outreach On-line training programs through Relias Learning In response to the preferred length of trainings, respondents indicated a preference for 1-2 hour trainings or half-day trainings. 60 P a g e

65 Number of Responses Palm Beach County Consumer Survey Methodology The Palm Beach County Ryan White program conducted a survey in 2013 of consumers as part of the county s Comprehensive Needs Assessment. There were 366 respondents to the survey, including both in-care and out-of-care consumers. Participants were incentivized to complete the survey and surveys were completed on a paper form with the in-person assistance of an individual trained to administer the survey. The survey in its entirely was comprised of 63questions. Data from a subset of these questions is provided below. Results Figure 28 shows responses to the question, What services would help you get HIV/AIDS medical care? Respondents were asked to select all that apply. The most frequently selected responses were substance abuse treatment (n=90), housing (n=90) and transportation (n=83). Figure 28: Consumer Survey - What services would help you get HIV/AIDS medical care? P a g e

66 Number of Responses Figure 29 shows responses to the question, What would be some of the reasons why you would go to the doctor for HIV/AIDS medical care? Respondents to this question were those who reported currently being out-of-care. Respondents were asked to select all that apply. The most frequently selected response was I am ready to deal with my illness (n=68) followed by I get transportation to go to a doctor or clinic (n=47) and someone else with HIV/AIDS reaches out to me (n=44). Figure 29: Consumer Survey What would be some of the reasons why you would go to the doctor for HIV/AIDS medical care? I get transportation to go to a doctor or clinic. I am ready to deal with my illness. Someone arranges to have my care paid for. Someone else with HIV/AIDS reaches out to me. Other (Explain) 62 P a g e

67 This does not apply to me. I did not receive HIV/AIDS-related medical care in the past 12 months. Walk-In/Emergency Clinic Doctor s Office Hospital Emergency Room Veteran s Administration Public Clinic/Health Department HIV Specialty Clinic Other: (please specify) Number of Responses Figure 30 shows responses to the question, Where did you regularly receive your HIV/AIDS medical care during the past 12 months? Respondents were asked to check only one response. Respondents to this question were those who reported currently being in-care. The most frequently selected response was public clinic/health department. Figure 30: Consumer Survey - Where did you regularly receive your HIV/AIDS medical care during the past 12 months? P a g e

68 Outpatient Medical Care Primary Medical Care Laboratory Diagnostic Testing Medical Specialist Health Insurance Nurse Care Coordination Case Management Medications Mental Health Services Nutrition Counseling Substance Abuse Treatment Dental/Oral Health Substance Abuse Residential Early Intervention Services (HIV Home Health Care Hospice Services Food Bank or Food Vouchers Transportation Outreach Substance Abuse Outpatient Treatment Adherence Health Education/Risk Reduction Legal Support Emergency Financial Assistance Linguistics Services (interpretation Peer Mentoring Rehabilitation Housing Support groups Other (please specify) Number of Responses Figure 31 shows responses to the question, Which five (5) services do you think are most important for people with HIV/AIDS? The most frequently selected responses were primary medical care (n=127), outpatient medical care (n=109), laboratory diagnostic testing (n=114) and medications (n=112). Figure 31: Consumer Survey - Which five (5) services do you think are most important for people with HIV/AIDS? P a g e

69 This does not apply to me. I did get the services I needed during the past 12 months. I did not know where to get services I could not get time off work I could not get an appointment I was depressed I could not get transportation I had a bad experience with the staff could not get childcare Services were not in my language I could not pay for services I did not qualify for services I did not want people to know that I have HIV Other (please specify) Number of Responses Figure 32 shows responses to the question, What were some barriers to you getting the services you needed during the past 12 months? Respondent were asked to check all that apply. The top reported barriers were: I could not get transportation (n=23), I did not know where to get services (n=20) and I was depressed (n=19). Figure 32: Consumer Survey - What were some barriers to you getting the services you needed during the past 12 months? P a g e

70 Didn't know how to apply Turned down/not eligible because: Didn't know where to apply Transportation problems On wait list Eligibility process to difficult Other (please specify) Did not have any problems trying to get needed services Number of Responses Figure 33 shows responses to the question, Have you had any of the following problems while trying to get needed services? The most frequently reported problems were: transportation (n=32), on the wait list (n=31) and eligibility process too difficult (n=30). Figure 33: Consumer Survey - Have you had any of the following problems while trying to get needed services? P a g e

71 Outpatient Medical Care (doctor's office visits) Transportation to/from HIV-related care services Assistance receiving and accessing services Outreach to HIV patients who have fallen out of care to get them back into care Payment for medications Dental/Oral health services Private health insurance co-payment or premium assistance Health education about risk reduction Mental Health Services Treatment adherence counseling Legal Services Substance Abuse Treatment Rehabilitation services Nutritional counseling for health eating habits Linking newly diagnosed HIV patients to care Hospice Services Home Health Care Food Bank/Food Voucher Other (please specify) Number of Responses Figure 34 shows responses to the question, Which five services do you think are most important for people living with HIV/AIDS to be able to access throughout the state? Respondents were asked to select their top five responses. The most frequently selected responses were: outpatient medical care (doctor s office visits) (n=170), payment for medications (n=129), transportation to/from HIV-related care and services (n=123) and food bank/food vouchers (n-110). Figure 34: Consumer Survey - Which five services do you think are most important for people living with HIV/AIDS to be able to access throughout the state? P a g e

72 Palm Beach County (Area 9) HIV/AIDS Priority Populations A main focus of the Jurisdictional HIV Prevention Plan for Palm Beach County is to develop a Plan that is specific and relevant to Palm Beach County. The identification of county-specific priority populations is an important and necessary component of a Plan that is pertinent and effective at the local level. Methodology HCSEF presented demographic, socioeconomic and HIV/AIDS epidemiologic data as well as the data from the provider and consumer surveys to a group of stakeholders, namely the Community Planning Partnership (CPP) and meeting guests. A brainstorming discussion was facilitated by the health council regarding high-risk populations for HIV/AIDS and priority target populations for HIV prevention. After a list of priority populations was generated, a multi-voting exercise was administered to rank the populations. Participants were asked to vote for or select the populations they considered to be priority in the context of HIV prevention. The results of the multi-voting exercise are shown in Table 32. Men who have sex with men (MSM) received the most votes, a total of 16, with the specific subpopulations Hispanic MSM and black MSM being identified and prioritized. Hispanic individuals as a whole were identified as a priority population with 13 votes with the specific subpopulations of Guatemalan and migrant individuals being identified and prioritized. Black / African American individuals were identified and ranked as a priority population as well as the migrant population which received 6 votes. Table 32: Priority Populations Prioritization Results Priority Populations Number of Votes MSM Total 16 MSM 0 Subpopulations White 3 Black 6 Hispanic 7 Hispanic Total 13 Hispanic 2 Subpopulations Men 2 Guatemalan 5 Migrant 4 Black / African American Total 12 Black / African American 11 Subpopulations Haitian 1 Hispanic 0 68 P a g e

73 Migrant Total 6 Migrant 6 Subpopulations Haitian 0 Mexican 0 Far Western (western part of county) 0 Injected Drug Users 2 Age 50 and Over 1 Partners of Infected Person 1 Age Age The information from this prioritization process which takes into account the personal experiences, perspective and input from many individuals working in the field of HIV/AIDS in the community should be considered along with the county s HIV/AIDS epidemiologic data and the priority populations as ranked in the Florida s HIV Prevention Plan. The priority populations for the state of Florida in the statewide Prevention Plan were selected via a three-fold path methodology which is based on 40% HIV cased data, 40% on people living with HIV/AIDS and 20% based on the summed rankings of the fourteen prevention partnerships. The results of this ranking are shown below. Local Prevention Partnerships also conducted a prioritization for their respective areas which was included in the statewide Plan. The rankings for Area 9 were: 1) black heterosexuals, 2) white MSM, 3) black MSM, 4) Hispanic heterosexuals, 5) white heterosexuals and 6) Hispanic MSM. 69 P a g e