1. Strategies for Effective NHAS Partnership with Community Based Organizations HIV Prevention Leadership Summit | December 13, 2010 | Washington, D.C.

2. 2 Getting on the same page… The majority of community-based organizations are on board – –Reflect standard operating procedure – –Want this initiative to succeed in the interest of current and future endeavors We got what we were asking for – –Eager to partner in formative process Not excited about having the future dictated to us – –12-city initiative is exciting One-size-fits-all approaches have never worked Tailored strategies promise new progress CDC will establish new standards for reviewing State and local prevention plans to ensure that Federal funds are used in a manner addressing people living with HIV and reflecting populations with greatest need. Community and organizational understood goals: – –Reduce and/or eliminate HIV incidence – –Improve individual access to/engagement in high-quality medical care – –Facilitate antiretroviral treatment access and adherence – –Connect those in need with supportive services to optimize health outcomes – –Eradicate HIV-related stigma and discrimination from our community

3. 3 Three Key Opportunities Doing a better job of treating the whole person Resolving the funding stream dilemma Addressing the social drivers of HIV vulnerability

4. 4 Treating the Whole Person Where They Are CBO’s should embrace 12-city initiative NHAS Objectives CDC will continue to evaluate all existing HIV prevention programs every five years to ensure that Federal dollars support programs that are effective and have demonstrated improved health outcomes. HHS OS and relevant agencies will consult with States and other jurisdictions prior to allocating prevention funding to targeted populations and communities to ensure coordination of efforts. Partnership Opportunity Recalibrate program protocols to provide greater flexibility in funding announcements/applications to design programs that meet the needs of the client entering the door Maximize the potential of short-term opportunities such as PEP, PrEP, and TLC+

5. 5 From This Integrated Care AIDS Service Org COBRA Case Management Assessment, Intensive Case Management, Advocacy, Crisis Intervention Supportive Housing Programs Case Management, Primary Care Support, Treatment Education, Mental Health Services, Substance Use Counseling, Advocacy, Structured Socialization Mental Health Services Crisis Intervention, Individual and Group Psychotherapy, Medication Management, Expressive Therapies Testing Services Rapid HIV testing: Risk and Zone Based approaches ♦ STD and Hepatitis C Screening ♦ Innovative Recruitment Strategies ♦Connection to Healthcare ♦ADAP & Medicaid Enrollment ♦ Uptown Health Link: HIV Awareness and Prevention Services for Upper Manhattan ♦ Peer Training Services Black Men’s Initiative Individual, Group and Community Level Interventions targeting Men of Color Who Have Sex With Men Youth Development for Health, for Young Men of Color Who Have Sex with Men Evening Food & Nutrition Nutritional Assessment and Support, Treatment Education, Psycho-Social Support Women’s Housing (Scatter-Site) Transitional Housing (Scatter-Site) Permanent Congregate Housing Prevention Services Prevention Services Federally Qualified Health Center & Related Services Supportive Housing Programs Supportive Housing Programs Adult Day Health Center East Fully Bilingual (Spanish/English) Case Management, Treatment Education, Support Groups, Harm Reduction Counseling, Auricular Acupuncture, Primary Care Support Adult Day Health Center West Medical Care, Adherence Support, Nutrition Counseling, Substance Use Counseling, Structured Socialization, Pastoral Care, Expanded Syringe Access Program HUD Housing (Scatter-Site) HRA Housing (Scatter-Site) Dental Clinic Primary Care (Westside & Eastside) Emergency Congregate Housing (Foundation House North & South) FROST’D @ Harlem United Harm Reduction ♦Syringe Exchange ♦HIV/HCV Testing and Linkage to Care and Treatment ♦ Overdose Prevention Healthcare for the Homeless Healthcare & related services for the homeless in Central & East Harlem Vocational Education Program Building Bridges Mental Health Program

6. 6 To This Integrated Healthcare Service Organization

7. 7 Medical Home Model: Principles for Quality Care Personal physician in physician- directed practice Whole person orientation Coordinated care, integrated across settings Quality and safety emphasis Enhanced patient access to care Supported by payment structure that recognizes services and value Principles developed by the American College of Physicians Team-based care: NP/PA RN/LPN Medical Assistant Care Coordinator Office Staff Nutritionist Health Educator Behavioral Health Pharmacist Case Manager Social Worker

8. 8 Available Doesn’t Mean Accessible Recognize the strength of community-based organizations Immediately arrest preventable transmission through combination prevention approaches, inclusive of: Individual behavior interventions (condom access, HIV education, HIV testing) Biomedical prevention (PEP, PrEP, Microbicides, Vaccines) Systemic intervention (patient and peer navigation) Structural intervention (community outreach) CBOs must be included and find ways to become part of the conversation Innovate new ways of partnership building on effective comprensive models Helping Our Men Evolve (HOME) - Black Men’s Initiative Don’t let perfect be the enemy of good Identify new way to embrace, rather than resist change to optimize shifts in the environment Prefer direct partnership over dictatorship

9. 9 Revisit Strategic Partnerships Community Health Clinics are Essential to our Success 18.8 million socioeconomically disenfranchised individuals with limited or no access to health care visit CHCs each year Can only account for less than 800,000 HIV tests administered – –Partially explained by an infrastructure issue. Presents a strong prospect for quality improvement. Paradigm shift: HIV is not someone else’s problem. It is not okay for people to receive episodic health care without being offered an HIV test. – –Current USPSTF guidelines embrace community health centers – –Routine testing is vital in areas where the HIV epidemic is generalized Case management should include focus on medical care and treatment support

10. 10 End fragmentation of care - NHAS heralds opportunity for more synergistic funding and administration Funding Dilemma CBOs have to treat the whole person and have to overcome challenges to meet program deliverable while responding to the needs of the individual Competing needs are essential to retention in health care and treatment adherence AIDS Adult Day Health Care Centers are an excellent model for comprehensive care under one reimbursement stream Fragmented care can result from varied interpretations in Medicaid licensing Health care Mental health Addiction and subtance use

11. 11 Addressing Social Drivers of HIV Vulnerability is Key Public Service Announcement Let this presentation serve as a clarion call for all providers, including some of us in this room, to get real about and confront our character and moral challenges that inhibit our ability to provide the best standard of care to every individual that walks through our doors. Every person deserves to be treated with full respect and dignity irrespective of their socioeconomic circumstances, incarceration history, sexual orientation, substance use, disability, or mental health condition

12. 12 Important Opportunity to Program More Comprehensively DOL, SSA, DOJ, and HHS OS will develop a joint initiative to consider ways to help individuals living with HIV access income supports, including job skills and employment. Many social and structural issues inhibit the success of HIV prevention efforts and contribute to ongoing HIV vulnerability among the most marginalized populations. Effective strategies to combat the following social drivers are urgently needed: homo-hatred racism addictophobia convictophobia xenophobia Economic inequalities and employability Driving a great deal of risk for her and him Occassional gifts and money can be tied to expectations of condomless sexual reciprocity Homelessness Housing is critical to prevention and health care

13. 13 Important Opportunity to Program More Comprehensively DOL, SSA, DOJ, and HHS OS will develop a joint initiative to consider ways to help individuals living with HIV access income supports, including job skills and employment. Health care access Health literacy Trust of the system Relationship with provider Openness and honesty is key Agency-preservation is critical Personal safety Education inequity and access

14. 14 HCH Services – An Integrated Care Model Primary Care clinic (Westside & Eastside) GYN, Health Education, Directly Observed Therapy, Psychiatry services, Preventive Health Services, Management Of Chronic Conditions Dental Clinic - Diagnostic X-rays and Exams - Preventive Care - Emergency Care - Restorations -Endodontics -Prosthodontics -Periodontics - Oral Surgery - Referral to outside specialists for complex Surgical Procedures Mental Health and Substance Use Services Crisis Intervention, Individual And Group Psychotherapy, Medication Management, Expressive Therapies Other services Referrals, Outreach, and Case Management. Federally Qualified Health Center

15. 15 Contact Information Kali D. Lindsey Senior Director of Federal Policy Klindsey@harlemunited.org (212) 801-2455