Data Trends: FPAR & HIV Prevention Project OPA/OFP HIV Prevention Project Annual Technical Support Conference June 12, 2007 Presented by Kelly Morrison Opdyke, MPH Cicatelli Associates Inc.

Learning Objectives  Describe key findings from the 2005 Family Planning Annual Report (FPAR)  Review epidemiology of HIV/AIDS in relation to Title X users  Examine national and regional OPA HIV Prevention Project data trends  Compare trends in FPAR and HIV Prevention Project data with national trends

Family Planning Annual Report  The only source of annual, uniform reporting by all Title X service grantees  Enables Title X administrators and grantees to: Monitor program performance Monitor program performance Comply with federal accountability rules Comply with federal accountability rules Guide strategic and financial planning Guide strategic and financial planning Estimate impact of Title X-supported activities on key reproductive health outcomes Estimate impact of Title X-supported activities on key reproductive health outcomes  Published reports available online from OPA:

FPAR 2005: User Demographics  5,002,961 family planning users 95% female, 5% male 95% female, 5% male 66% below 100% of federal poverty level (FPL) 66% below 100% of federal poverty level (FPL) 60% uninsured 60% uninsured 58% under age 25 58% under age 25 48% racial and/or ethnic minorities 48% racial and/or ethnic minorities

FPAR 2005: Users by Age Group

FPAR 2005: Users by Race/Ethnicity N=5,002,961

FPAR 2005: HIV Testing  HIV test volume increased by 14% in 2005  607,974 confidential HIV tests 519,221 tests among females (85% of all tests) 519,221 tests among females (85% of all tests) 88,753 tests among males (15% of all tests) 88,753 tests among males (15% of all tests)  1,114 positive confidential tests (0.18%)  13,349 anonymous HIV tests

FPAR 2005: STD and HIV Testing *Confidential HIV Tests Only

HIV/AIDS among Women Nature of the epidemic  Women of color (especially African American women) are the hardest hit  Younger women are more likely to get HIV  AIDS is a common killer, second only to cancer and heart disease for women Most common modes of transmission  Having sex with a man who has HIV  Sharing injection drug works (needles, etc.) Source: CDC HIV/AIDS among Women Fact Sheet, March 2007

HIV/AIDS among Women  Since 1985 the proportion of estimated AIDS cases diagnosed among women has more than tripled, from 8% in 1985 to 27% in  In 2004, women of color accounted for 80% of all women estimated to be living with AIDS; black women made up 64% of this total. Source: CDC HIV/AIDS among Women Fact Sheet, March 2007

HIV/AIDS among Youth Nature of the epidemic  13% of the persons diagnosed with HIV or AIDS in 2004 were age years  Young people of racial/ethnic minorities are at increased risk for infection through sexual risk behavior (heterosexual and MSM) Risk Factors  Earlier age at sexual initiation  Higher STD rates Source: CDC HIV/AIDS among Youth Fact Sheet, June 2006

HIV/AIDS Diagnoses by Age Source: CDC Surveillance 2004

OPA/OFP Integration of HIV/AIDS Prevention Project

HIV Prevention Project (HIVPP) GOAL:  To supplement existing Title X grants, in communities with demonstrated high risk for HIV/AIDS, to implement or expand HIV on ‑ site prevention counseling, testing, and referral services Cycle 1: Oct 2001 – Aug projects 8 PHS regions (19 states) Cycle 2: Sep 2004 – Sep projects 10 PHS regions (27 states)

HIVPP: Outcome Measures  Number of individual HIV counseling sessions  Number of HIV tests by test mode and type Confidential v. Anonymous Confidential v. Anonymous Standard v. Rapid Standard v. Rapid  Number of positive HIV tests  Number of clients returning for test results and post-test counseling  Number of positive clients referred for Tx/care  HIV testing by race & ethnicity  HIV testing by gender & age group

HIVPP: Counseling, Testing & Referral Outcome Cycle 1: Oct-01 to Aug-04 N % Cycle 2: Sep-04 to Dec-06 N % # counseled 365,461n/a391,897n/a # tested 187,70251%263,62367% # returning for results 97,06753%169,04964% # positive % % # positives referred for Tx 54078%66496%

HIVPP: Counseling Sessions Cycle 1, Periods 1-5 (Oct-01 to Aug-04) and Cycle 2, Periods 1-4 (Sep-04 to Dec-06)

HIVPP: Counseling Sessions Cycle 1 Cycle 2 Cycle 1, Periods 1-5 (Oct-01 to Aug-04) and Cycle 2, Periods 1-4 (Sep-04 to Dec-06)

HIVPP: HIV Tests by Period Cycle 1, Periods 1-5 (Oct-01 to Aug-04) and Cycle 2, Periods 1-4 (Sep-04 to Dec-6)

HIVPP: HIV Tests by Test Mode Cycle 1 Cycle 2 Cycle 1, Periods 1-5 (Oct-01 to Aug-04) and Cycle 2, Periods 1-4 (Sep-04 to Dec-06)

HIVPP: HIV Tests by Test Type Cycle 2, Periods 1-4: Sep-04 to Dec-06 %Rapid C2P1: 20% C2P2: 31% C2P3: 41% C2P4: 46%

HIVPP: Return Rate by Test Type Cycle 2, Periods 2-4: July-05 to Dec-06

HIVPP: Testing by Race/Ethnicity Race/EthnicityTestsPositives%Pos Black/African American, not Hispanic % Hispanic or Latino (All Races) % American Indian/Alaska Native % White, not Hispanic % Asian % More than one race % Native Hawaiian/Pacific Islander % Unknown or NR % Total % Cycle 2, Periods 2-4: July-05 to Dec-06

HIVPP: Positivity by Race/Ethnicity Cycle 2, Periods 2-4: July-05 to Dec-06

HIVPP: Testing by Race/Ethnicity Cycle 2, Periods 2-4: July-05 to Dec-06

HIVPP: Testing by Gender Cycle 2, Periods 1-4: Sep-04 to Dec-06

HIVPP: Testing by Age Group Cycle 2, Periods 2-4: July-05 to Dec-06

HIVPP: Positivity by Region Cycle 2, Periods 1-4: Sep-04 to Dec-06

Summary  HIV testing among FP users is increasing steadily (especially rapid testing)  Racial/ethnic disparities persist, especially among Black/African American users  The HIV positivity rate (>1 per 1,000 tests) in family planning clinics in most regions appears to be cost-effective  HIV prevention strategies should continue to emphasize the importance of the reduction of sexual risk behavior to prevent the spread of infection