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Uruguay HIV-AIDS Timeline 1959-2000 PowerPoint Presentation

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Slide 1 - Public Health Response to HIV/AIDS NASTAD Minority Leadership Program Washington, DC February 27, 2012 Humberto Cruz, Director, AIDS Institute NYS Department of Health
Slide 2 - What Happened in the 1980s?HIV/AIDS Began to Emerge Earliest cases concentrated in a few areas (e.g., LA, SF, NYC). The epidemic unfolded in different ways around the country. What we now refer to as HIV/AIDS was not well-understood. The community response preceded an organized governmental response. Public health responses at the local, state and national levels were required. Early efforts focused on understanding the epidemic and providing educational messages/materials.
Slide 3 - Emergence of HIV/AIDS in the United States
Slide 4 - Public Health and Civil Liberties Protecting the privacy of those with, or at risk for, HIV/AIDS was seen as crucial to public health (e.g., to obtaining epi data, to engage those most at risk, to protect persons with the disease). This perspective led to policy debates that persist today, for example: Testing Policies, Including Informed Consent Newborn HIV Screening Name-Based Reporting
Slide 5 - Public Health Approaches Evolved asMore Became Known About Modesof Transmission Sexual Transmission Transmission Through Needle Sharing Perinatal Transmission Transmission through Transfusion of Blood and Blood Products
Slide 6 - Public Health HIV/AIDS Surveillance Named Reporting Standard for Other Reportable Infectious Diseases AIDS Surveillance Implemented at State and Local Levels Reports Forwarded to CDC Some Jurisdictions Used Codes Instead of Names When HIV Diagnostics Became Available (1985) HIV Surveillance was Possible HIV Surveillance with Identifiers Faced Political Opposition Risks Due to Stigma and Discrimination No Treatment or Services Available
Slide 7 - Public Health HIV/AIDS Surveillance (cont’d) “Surveillance Events” Include: Incident HIV Infection (New Infections; STAHRS) HIV Diagnosis AIDS Diagnosis CD4 and T-Lymphocyte Count Viral Load Test Deaths due to HIV/AIDS STD
Slide 8 - Examples of Uses of HIV/AIDS Surveillance Data Monitor the HIV/AIDS Epidemic Identify Populations and Communities at Risk Target Prevention and Care Services Identify Gaps and Missed Opportunities for Interventions Ensure Proper Treatment and Partner Services Demonstrate Need for Funding Allocation of Funding (e.g., Ryan White, Prevention FOA)
Slide 9 - Focus on Prevention Public Education - What to Say? To Whom? Confronting Stigma and Discrimination Changing Behavior Among IDUs – Drug Treatment, Sterile Syringes, “Works” Promotion of Voluntary Testing (Anonymous, Confidential) Target Interventions Based on Surveillance Data
Slide 10 - Contact Tracing and Partner Notification (public health tools used in STD control) Closing/Regulation of Facilities (e.g., bathhouses) Compulsory Measures in Same States for Some Populations (e.g., inmate testing) Preventing Occupational Exposure, Perinatal Transmission Behavioral Interventions (e.g., today’s DEBIs) Bio-medical Interventions (PREP, PEP) Focus on Prevention (con’t)
Slide 11 - Advent of Antiretroviral Therapy Ryan White CARE Act Emphasis on Testing and Referral to Care, Retention in Care Access to Medication, ADAP Adherence Optimize Role of the Health Care System Integration of Prevention and Care Accelerated Process for FDA Approval of Medications Reducing community viral load Biomedical Interventions ART Policy
Slide 12 - Multi-Level Public Health Interventions for HIV/AIDS Are Employed Individual Level - Harm Reduction/Syringe Exchange - Biomedical Interventions - Condom Availability - Behavioral Interventions - Circumcision - ART Community Level - HIV Testing Events - Community Viral Load - Social Marketing/Media Campaigns - Faith Based Initiative - Integration of Primary Care in Substance Abuse Treatment Systems Level - Financing – Reimbursement, Grants - Audits - Quality Monitoring - Utilization Reviews - Laws and Regulations
Slide 13 - HIV/AIDS Has Changed Public Health: “PIR” and Shared Decision-Making Well-Organized, Well-Informed Advocacy Community(GMHC, ACT-UP) PLWHA Self-Empowerment Movement (Denver Principles, 1983) HIV Prevention Community Planning, “PIR” Required by CDC Guidance for HIV Prevention Cooperative Agreements P = Parity, Equitable Access/Participation I = Inclusive Process R = Representative of Populations Affected Ryan White Planning Councils Community Advisory Boards Commitment to Leadership Development National HIV/AIDS Strategy (Community/City Consultation) Presidential Advisory Council on HIV/AIDS (PACHA)
Slide 14 - HIV/AIDS Has Changed Public Health:Enhanced Community Collaboration “Traditional” Public Health System Lacked Access to Some Populations Increased coordination/ collaboration with community based organizations Diversity Requires Cultural Sensitivity and Multiple Approaches Community-Based Organizations Have Access to Individuals at High Risk, Staff Reflective of Population Served Faith Leaders Can Foster Trust and Access Peer Models of Service Delivery
Slide 15 - Past Efforts – Find ‘Em, Count ‘Em, Treat ‘Em STD Control Can Reduce New HIV Infections – Power of Prevention! Increased Emphasis on Innovation & Evaluation Integration of Primary and Secondary HIV Prevention Activities Community Capacity Building, Mobilization & Engagement Improved Sexual Health of Communities/Populations HIV/AIDS Has Changed Public Health:Transformation of STD Prevention and Control
Slide 16 - HIV/AIDS Has Changed Public Health: Sociocultural Approach Context for Public Health Initiatives and Interventions Those at Greatest Risk are Poor and Marginalized Considerations: - Culture - Education - Poverty - Disparities - Trauma - Socio-economic - Stigma - Discrimination Public Health Interventions Tailored to Communities/Populations; Context for Greatest Impact
Slide 17 - HIV/AIDS Has Changed Public Health: Multiple Points of Entry for Services Co-located Services (i.e. Substance Use and HIV/AIDS) Outreach and Testing in Family Planning, Planned Parenthood, Prenatal Care, Emergency Departments Integration of Prevention and Care HIV, STD, TB, Hepatitis Integration HIV Testing in Health Care Settings New York State HIV Testing Law requiring a mandatory offer to individuals 13-64 years old Enhanced Collaboration Between Public Health and the Criminal Justice System Managed Care Settings Faith Communities Harm Reduction Service Settings
Slide 18 - System Considerations HIV/AIDS specific reimbursement Mandatory managed care for patients living with HIV/AIDS Health Homes Prevention/ Prevention for Positives Community Health Center Designated AIDS Centers Insurance Continuation /ADAP HOPWA/SAMHSA NIH Grants Changes in Medicaid/Medicare (donut hole) Changes in immigration restrictions Funding Reprioritization
Slide 19 - HIV/AIDS and Public Health:On-Going Challenges for Public Health HIV/AIDS as a Chronic Disease HIV/AIDS and Aging Intersection with Other Chronic Diseases Aging of Public Health Work Force and Community Leaders HIV/AIDS Fatigue Stigma
Slide 20 - HIV/AIDS and Public Health: On-Going Challenges for Public Health (cont’d) Health Care Reform Global Epidemic Immigration Reform Unanswered Questions and Need for Research Competing Priorities (e.g. military) Resources/Financing for Prevention, Care and Supportive Services
Slide 21 - The HOPE is that each of you… Will learn from each other. Will carry the torch. Will take leadership roles and develop responses that bring positive change within your communities.
Slide 22 - The FUTURE is TODAY!
Slide 23 - Public Health Response to HIV/AIDS Thank You for Listening! Humberto Cruz, Director, AIDS Institute (212) 417-5500 NYSDOH AIDS Institute 90 Church Street; 13th Floor New York, NY 10007 E-Mail Address: HXC01@health.state.ny.us