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HIV/AIDS in North Carolina: 2009-2010

July 1, 2011

While the Federal government's investment in treatment and research is helping people with HIV/AIDS live longer and more productive lives, HIV continues to spread at a staggering national rate. The latest incidence data from the Centers for Disease Control and Prevention (CDC) estimates nationally there were 48,100 new HIV infections in 2009. The graph below depicts the HIV/AIDS epidemic in North Carolina through 2009 according the NC Department of Health and Human Services. Note that the following HIV/AIDS statistics only represent a portion of the epidemic in the U.S. -- those cases that have been both confirmed through testing and reported. The NC DHHS estimates 35,000 people were living with HIV/AIDS as of December 31st, 2009, including those unaware of their status.i

Reported AIDS Casesii

Reported AIDS Cases

Demographic Trendsiii

The HIV/AIDS epidemic disproportionately affects those at risk from social factors such as disparity and discrimination. The following demographic numbers are from the North Carolina Department of Health and Human Services as of December 31, 2009.

Demographic Trends
Counties


Fiscal Year 2010 Funding for HIV/AIDS in North Carolina

At-a-Glance

Fiscal Year 2010 Funding for HIV/AIDS in North Carolina at a Glance

Prevention

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The Centers for Disease Control and Prevention provided North Carolina with $10,746,302 for HIV prevention programs in 2010. These funds were allocated to state and local health departments and community-based organizations to finance counseling, testing programs, health education/risk reduction activities, and surveillance/monitoring programs.v

Ryan White CARE Act

The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, enacted in 1990 and reauthorized in 1996, 2000, 2006, and 2009 is the centerpiece of the federal government's efforts to improve the quality and availability of care for medically underserved individuals and families affected by HIV/AIDS. The CARE Act, administered by the HIV/AIDS Bureau of the Health Resources and Services Administration, provides funding to states, territories, and other public and private nonprofit entities to develop, organize, coordinate, and operate more effective and cost-efficient systems for the delivery of essential health care and support services to people living with HIV/AIDS and their families.

  • Part A -- Eligible Metropolitan Areas (EMAs) and Transitional Grant Areas (TGAS): Part A provides funding to Eligible Metropolitan Areas (EMAs) and Transitional Grant Areas (TGAs), areas that are disproportionately affected by the HIV epidemic. To be considered EMAs, metropolitan areas must have more than 2,000 cumulative AIDS cases over the last five-years and a population of 50,000 or more. Cities are considered TGAs if they have at least 1,000, but not more than 1,999, cumulative AIDS cases in the last five years, and a population of 50,000 or more.

    In FY 2010, North Carolina received $5,418,647 in Part A funding. Of that, all went to a TGA (Charlotte-Gastonia).vi

  • Part B -- States and Territories: Part B helps state health departments improve the quality, availability, and organization of HIV health care and support services. In additional to base grant, Part B funds support the AIDS Drug Assistance Program (ADAP) which provides medications to individuals with low income, the Minority AIDS Initiative (MAI), and Supplemental Grants for Emerging Communities (EC), cities reporting between 500 and 1,999 cumulative AIDS cases in the past five years.

    In FY 2010, the state received $38,640,253 in CARE Act Part B funds.vii

  • Part C -- Early Intervention Services: Part C supports competitive grants to provide medical treatment and medical support services for people living with HIV including HIV testing, early intervention services, risk reduction counseling, case management, outreach, oral health, nutrition, and mental health services. Part C supports Early Intervention Services (EIS) grants that provide services for HIV positive individuals with low income who are uninsured or underinsured as well as grants for planning and capacity building to help rural or underserved communities develop high-quality HIV primary care. In FY 2010, the state received $5,958,454 in Part C funds.viii
  • Part D -- Capacity Building and Women, Infants, Children, Youth and Their Families: Part D focuses on the operation and development of primary care systems and social services for women and youth, who represent a growing share of the epidemic. In FY 2010, the state received $2,984,762 in Part D funds.ix
  • Other CARE Act Funding Programs:

    AIDS Education and Training Centers (AETC) Program: AETCs provide training, consultation, and information to HIV health care providers through a network of 1 international center; 5 national centers (the AETC National Resource Center, the National HIV/AIDS Clinicians' Consultation Center, the National Evaluation AETC, the AETC National Center for HIV Care in Minority Communities, and the AETC National Multicultural Center); 11 regional centers, each of which serves between two and ten states and/or territories; and over 130 local performance sites across all 50 states, the District of Columbia, and the U.S. territories. Funding is allocated to each of the 17 national and regional centers, which then distribute resources to local performance sites in each state.

    Total Statewide AETC Fundingx: $0

    AETCsxi

    Regional:

    Southeast AIDS Education and Training Center
    Emory University School of Medicine
    1256 Briarcliff Road, NE
    Building A, Suite 238
    Atlanta, GA, 30322
    Email: seatec@emory.edu
    Phone: 404-727-2929
    Fax: 404-727-4562
    Web Site: www.seatec.emory.edu
    Serves: AL, GA, KY, NC, SC, TN

    Local:

    NC AIDS Education & Training Center
    Duke University, Center for Health Policy
    2812 Erwin Road, Suite 403
    Durham, NC, 27705
    Email: vivianne.vh@duke.edu
    Web Site: www.nc.aetc.net

    Dental Program: The Ryan White Care Act Dental program provides funding to the Community Based Dental Program, which aims to increase HIV-positive individuals' access to oral health care services while providing education and clinical training for dental care providers. The Dental program also provides funding for a Dental Reimbursement Program which reimburses dental schools, postdoctoral dental education programs, and dental hygiene programs for oral health care of individuals living with HIV.

    In FY 2010, the total funding allocated to the state's dental program was $43,373 all of which went to the Dental Reimbursement Program.xii

    Grant Recipients in FY 2010

    Special Projects of National Significance (SPNS): SPNS is the research and development aspect of the Ryan White CARE Act. SPNS is responsible for assessing the effectiveness of certain care models, providing support for innovative models of HIV/AIDS service delivery and for assisting the replication of effective models across the nation.

    Total SPNS Fundingxiii: $1,200,000

Housing Opportunities for Persons With AIDS

The Housing Opportunities for Persons with AIDS program (HOPWA) provides housing assistance and related supportive services for HIV positive persons with low income and their families. Funding is provided in the form of formula grants, which are awarded to eligible states and cities on behalf of their metropolitan areas, and competitive grants, which are awarded to model projects or programs.

The Department of Housing and Urban Development (HUD) provided the state a total of $4,200,628 in HOPWA funding for FY 2010.xiv

HOPWA Funding

State Issues

ADAP -- AIDS Drug Assistance Programs save lives by providing HIV-related medications to uninsured and under insured individuals. Over 2010, the economic recession put increased pressure on states budgets, at the same time also caused an increase in clients seeking to enroll in ADAPs, putting many State ADAPs in crisis. As a result, North Carolina has 292 individuals on their ADAP wait list as of July 1, 2011.xv

Syringe Exchange -- In 2009, the nationwide ban on a state's use of federal funds for Syringe Exchange Programs (SEPs) was removed through appropriations legislation and signed by President Barack Obama. Numerous studies have indicated that SEPs offer vital care and services to intravenous drug users and reduce risk behavior. Yet, despite long held support from the CDC, NIH, and the majority of the medical and scientific community, syringe exchange programs remain politically targeted.xvi There are currently exchange programs operating in Asheville, Carrboro, Durham, Greensboro, and Winston Salem.xvii

Policy and Law

Criminalization of HIV, which is often dependent on known status, creates barriers to testing along with discouraging disclosure and fostering stigma. HIV exposure in North Carolina is prohibited under the health code can be prosecuted as a health code violation with up to two years in prison. HIV has been applied in prosecution for other non-HIV specific criminal statutes. In the past few years, there have been several arrests and/or prosecutions.xviii

AIDS United Partners and Grantees

AIDS United promotes collaborative local planning and provides strategic grants and technical support to more than 400 direct service organizations annually through our Community Partnerships, Public Policy Committee, and targeted initiatives such as AmeriCorps, Access to Care (A2C), GENERATIONS/Women's Initiative, Southern REACH, Puerto Rico grantmaking, and the Syringe Access Fund.

Duke Addictions Program, Durham (AmeriCorps)
Duke University AIDS Legal Project, Durham (REACH)
Legal Services of Southern Piedmont, Charlotte (REACH)
North Carolina AIDS Action Network (NCAAN), Raleigh (REACH)
North Carolina Central University, Durham (AmeriCorps)
North Carolina Community AIDS Fund, Durham (Community Partnership, A2C)
North Carolina Harm Reduction Coalition, Durham (Syringe Access, REACH)
Urban Ministries of Durham, Durham (AmeriCorps)
Veteran's Affairs Hospital, Durham (AmeriCorps)
Western North Carolina AIDS Project, Asheville (REACH)

State AIDS Director

AIDS Director
Jacquelyn Clymore
State AIDS/STD Director
Communicable Disease Branch
Division of Public Health
North Carolina Dept. of Health & Human Service
1902 Mail Service Center
Raleigh, North Carolina, 27699-1902
Phone: 919-715-6783
jacquelyn.clymore@dhhs.nc.govxix


References

  1. North Carolina Epidemiologic Profile for HIV/STD Prevention & Care Planning (December 2010), Division of Public Health, North Carolina Department of Health and Human Services, available from: www.epi.state.nc.us/epi/hiv/epiprofile1210/Epi_Profile_2010.pdf.
  2. North Carolina Epidemiologic Profile for HIV/STD Prevention & Care Planning (December 2010), (December 2009), (October 2008), (July 2007), Division of Public Health, North Carolina Department of Health and Human Services, available from: www.epi.state.nc.us/epi/hiv/stats.html.
  3. North Carolina Epidemiologic Profile for HIV/STD Prevention & Care Planning (December 2010), Division of Public Health, North Carolina Department of Health and Human Services, available from: www.epi.state.nc.us/epi/hiv/epiprofile1210/Epi_Profile_2010.pdf.
  4. State & County QuickFacts, US Census Bureau, available from: http://quickfacts.census.gov/qfd/index.html.
  5. DHAP HIV Prevention Funding Allocations by State and Dependent Area (Fiscal Year 2010), Centers for Disease Control & Prevention, available from: www.cdc.gov/hiv/topics/funding/state-awards/index.htm.
  6. Ryan White Part A Awards to Eligible Metropolitan Areas (EMAs) and Transitional Grant Areas (TGAs) for FY 2010, HRSA, US Department of Health and Human Services, available from: http://hab.hrsa.gov/data/reports/partaemastgas.html
  7. Find Grant Awards: North Carolina, HRSA, US Department of Health and Human Services, available from: http://granteefind.hrsa.gov/; Breakouts provided by NASTAD: Part B totals include Base, ADAP, MAI, and EC; Base includes supplemental funds; ADAP includes supplemental and emergency funds.
  8. Find Grant Awards: North Carolina, HRSA, US Department of Health and Human Services, available from: http://granteefind.hrsa.gov/.
  9. Find Grant Awards: North Carolina, HRSA, US Department of Health and Human Services, available from: http://granteefind.hrsa.gov/.
  10. Find Grant Awards: North Carolina, HRSA, US Department of Health and Human Services, available from: http://granteefind.hrsa.gov/.
  11. About the AIDS Education & Training Centers, AETC National Resource Center, available from: www.aids-ed.org/aidsetc?page=ab-00-00.
  12. The HIV/AIDS Program: Caring for the Underserved; Part F: Dental Reimbursement Programs 2010 Award Amounts, HRSA, US Department of Health and Human Services, available from: http://hab.hrsa.gov/treatmentmodernization/dentalrosters2010.htm.
  13. Find Grant Awards: North Carolina, HRSA, US Department of Health and Human Services, available from: http://granteefind.hrsa.gov/.
  14. HOPWA Report, US Department of Housing and Urban Development, available from: www.hudhre.info/hopwa/index.cfm?do=viewHopwaRptsSelect&opt=Awards#tab.
  15. ADAP Watch Update -- July 1, 2011, NASTAD, available from: www.thebody.com/content/62830/the-adap-watch.html.
  16. Syringe Exchange and HIV/AIDS, AIDS United (published under formerly AIDS Action), available from: www.aidsunited.org/uploads/docs/Learn-Syringe_Exchange_and_HIV.pdf.
  17. Syringe Exchange Programs in the United States 2011, amfAR, available from: www.amfar.org/uploadedFiles/On_The_Hill/SEPS.pdf?n=3826%29.
  18. Ending and Defending Against HIV Criminalization: A Manual for Advocates, Volume 1, State and Federal Laws and Prosecutions, The Center for HIV Law and Policy, Fall 2010, available from: www.hivlawandpolicy.org/resources/view/564.
  19. State HIV/AIDS Program Directory, National Alliance of State and Territorial AIDS Directors, available from: http://nastaddemo.dedicated.advansiv.com/About/res_state_Directory.aspx.



  
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This article was provided by AIDS United. Visit AIDS United's website to find out more about their activities and publications.
 
See Also
U.S. HIV/AIDS State Fact Sheets: Table of Contents

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