# Presentation: 920891

## Jane B. Cheeks, J.D., M.P.H.
State AIDS Director
Division of HIV/AIDS Prevention & Control
Alabama Department of Public Health

- Jane B. Cheeks, J.D., M.P.H.
- State AIDS Director
- Division of HIV/AIDS Prevention & Control
- Alabama Department of Public Health

## HIV/AIDS in Alabama

**    ****Deaths and Total Living**

**     ****Reported Cases by Year**

##                         Structure of Alabama’s Program

-                         Structure of Alabama’s Program
-              November 1987, HIV was designated as notifiable disease.
-              Since 1988, 67 county HD provide  HIV CTRPN) & CPM.
-              11 HIV Coordinators facilitate & coordinate HIV/AIDS activities
-               including ERTS.
-              HIV/AIDS works with STD, TB, Mental Health, Corrections, and
-              Substance Abuse Treatment personnel to establish agreements
-              allowing the exchange of patient information.
-              In 1987, the Alabama AIDS Network was initiated to provide
-              coordination for health care professionals and volunteers working to
-              prevent and manage HIV/ AIDS in Alabama.
-              In 1994, a CPG was implemented in each public health area.
-              The state now supports only one Statewide  CPG.

##                         Structure of Alabama’s Program

-                         Structure of Alabama’s Program
-              HIV/AIDS  - disproportionate impact on African-Americans (AF-AMs)
-              in Alabama.  Less than 26% of the state’s population is AF-AM.
-              HIV/AIDS cases reported since 1982, AF-AM account for 75% of cases
-              in women, 65% - young people and 69% - infants & children.
-              Since 1998, more than 70% of newly infected individuals were Af-Am.
-              Alabama’s has 11 community-based ASOs .  Since 1990, ADPH
-              has contracted with the CBOs to do post-test education sessions for
-              individuals infected with or at high-risk for HIV.
-              Ryan White funding in 1991 allowed development of a Direct Care
-              Services Branch  responsible for all direct patient services including
-              a drug reimbursement program & development and implementation
-              of HIV Care Consortia.
-              In 1994-1995, HIV Care Consortia were implemented in each of eight
-              public health areas in Alabama.  Consortia were discontinued in 2005.

##                         Structure of Alabama’s Program

-                         Structure of Alabama’s Program
-              Alabama’s ADAP program operates a central pharmacy licensed to
-              ADPH using contracted pharmacy services.  Distribution of drugs
-              is to the HIV clinics for pick-up by clients.
-              Drugs are purchased from wholesaler using 340B pricing plus some
-              drug rebates.
-              Alabama has one lead agent who subcontracts with 20-22 providers.
-              Funds are allocated to providers based on formula calculated on
-              number of documented clients and available funding.

##                         Immediate Impact of Reauthorization

-                         Immediate Impact of Reauthorization
-              Alabama had a waiting list for drugs for 5 years –
-              Now no waiting list for last 2 years.
-              Alabama was unable to fund adequate care and social services.
-              Additional funding allowed almost doubling for funding for service
-              providers.
-              ADAP formulary included only FDA approved anti-retrovirals &
-              less than 10 other medications.
-              Two weeks ago 45 “other” medications were added to the formulary.
-              Casemangers spent a major part of their time working to get meds
-              for clients on waiting lists and for meds not on the formulary.
-              Casemangers are now able to case manage clients.

## Southern States Manifesto (Six Years after Original Document)

- 	In a context of disproportionate rates of HIV/AIDS, poverty, inadequate funding and resources, and infrastructure challenges, SAC wants to:
- reduce new infections;
- identify infections as early as possible; and
- provide adequate care, treatment, and housing.

## Disproportionate ImpactSouth Comprises 36.4% of the Population

- Top 20 states (includes 18 states, Washington, DC, and Puerto Rico) with highest AIDS case rates in 2006, 11 (55%) were in South.
- Number of persons living with AIDS from 1993 to 2005 increased at a greater rate in South than in any other region of country.
- Of 20 metropolitan areas with highest AIDS case rates in 2006, 16 (80%) are in South.
- South has highest percentage of new AIDS cases in persons living in non-metropolitan areas than in any other region of the country.

## CDC Minority HIV/AIDS Research Initiative: In 2005 South leads in AIDS case rates for adults and adolescents in metropolitan statistical areas of all sizes.

## Greatest Number of Medically Disenfranchised

## The Ultimate Outcome: Highest Death Rates

## Inequity

##                  Issues that must be addressed by nature of the language in the law

- Authorization levels
- Hold Harmless provisions
- Length of reauthorization
- Extension of protection for state with maturing HIV data
- Transitional Grant Area (TGA) eligibility issues
- Issues where a high level of consensus may exist
- Two year housing limit
- ADAP as TrOOP
- Treatment of ADAP rebate dollars
- Early Diagnosis grant program
- Inclusion of HIV prevention/focus on testing – no change necessary
- Client Level Data
- Formulas
- Issues that do not fall into either of the above categories, but warrant discussion by the group
- Severity of Need Index
- Core Medical Services/Support Services
- Definition of
- Split
- Addressing grantee mismanagement
- Provision for federal management
- Level of unobligated funds allowed
- Role and composition of planning councils
- Simplify grant and reporting requirements
- Issue of decreasing HIV clinical workforce in Ryan White
- Coordination with other programs
- Minority AIDS Initiative

##                         One  Final Thought

-                         One  Final Thought
-              Everyone who is HIV-positive or has any form of
-          sexually transmitted disease has a right to access
-          a range of health care and necessary support
-          services to achieve and maintain optimal health
-          regardless of gender, sexual orientation,
-          geographic location, economic condition,
-          race or social status.

**Notes:**
Ththek