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HIV AND STDS IN GUILFORD COUNTY:
A COMPREHENSIVE GUIDE
FOR A WAY FORWARD
Center for Health Policy
Health Inequalities Program
Duke University
Beth Stringfield
There is an HIV/STD epidemic
in Guilford County
Number of new HIV/AIDS cases in 2007
HIV/STDs in Guilford County
 33,635 cases of reportable STDs
 Underestimated
 Rates exceed NC averages
 Number excludes other STDs
HIV/STDs in Guilford County

1615 cases of
HIV/AIDS
 3rd highest in
the state
 Approximately
339 with
unknown HIV
infection
HIV/STDs in Guilford County

Many more at high risk!
 Drug use
○ 39% HS students drank alcohol
○ 38% HS students smoked marijuana
 Sexual risk
○ 48% HS, 17% of MS students sexually active
○ Only 37% of adolescents reported condom use
○ Only 26% of adults reported condom use
HIV/STDs in Guilford County

Racial and ethnic disparities
 Rates of STDs 10x greater among non-Whites
 New AIDS cases
○ 69.1% African American
○ 29.1% White
 Why?
○ Lower income and education levels
○ Poorer access to health care
○ High levels of HIV/STD stigma
HIV/STDs in Guilford County

Economic and Societal Costs
 Lifetime medical costs range from $266,600 to
$385,000, depending on when an individual
begins treatment.
 ARV therapy alone costs around $1,500 per
month for a patient with >300 CD4 count.
 The lifetime costs associated with productivity
losses are $742,100.
HIV/STDs in Guilford County

In addition to a worsening epidemic and
widening disparities…
 America has gone silent on HIV/STDs
 Federal funding has decreased or remained stable
 Restrictions on federal funding
 Access to care limitations
 Economic downturn
What is currently being done in
Guilford County?

Community based organizations work
together to meet the prevention and
treatment needs of Guilford County’s
population
 Outreach, testing, and coordinating services
 ASOs already implement evidenced based
interventions to reach high risk populations
 ASOs have demonstrated competence
What are the gaps in services?

Needs assessments, personal interviews,
and focus groups have highlighted areas of
need
 Prevention services for youth, Hispanics, MSM, and
HIV+ individuals
 Treatment and service capacity
Reducing Transmission in
Guilford County

Efforts to prevent disease transmission are
critically important

Effective HIV prevention efforts combine
behavioral, biomedical, and structural
interventions
Reducing Transmission in
Guilford County

Behavioral Interventions
 Designed to reduce HIV/STD risk and are
conducted at the individual, group, or
community level
 Evidence of efficacy (25-50% risk reduction)
 63 Evidenced-Based Interventions ( EBIs)
 21 Diffusion of Evidenced Based Intervention
programs (DEBIs)
Reducing Transmission in
Guilford County

Biomedical Interventions
 Based on biological sciences
 HIV/STD testing
○ Identify to prevent future transmission
○ Facilitate early entry into treatment
 Antiretroviral treatment
○ Reduce infectiousness
○ Improve quality of life
Reducing Transmission in
Guilford County

Structural Interventions
 Address structures, laws, or policies which may
affect transmission risk or access to prevention,
treatment, and care services
 Improve availability, accessibility, and
acceptability of HIV/STD services
What can MC-WLCHF do?

Funding is needed to address HIV/STDs
 Recommendations consider current funding
and service availability, forthcoming funding
changes, service gaps, and intervention efficacy
and cost-effectiveness
 Build on the strengths of service providers
 Behavioral, biomedical, and structural
strategies
What can MC-WLCHF do?

Behavioral Interventions
 Implement behavioral interventions to meet
prevention needs of youth, Hispanics, MSM,
and HIV+ individuals
○ DEBI examples: Focus on imPACT, VOCES, Popular
Opinion Leader, CLEAR
 Continue to support behavioral interventions
for high risk populations
○ DEBI examples: SISTA, RAPP, Community Promise
What can MC-WLCHF do?

Biomedical Interventions
 Support routine HIV testing in medical care
settings
 Increase funding for case management and
continue funding for support services

Structural Interventions
 Support an HIV/STD advocacy group
 Provide capacity building services including
evaluation assistance
What are the consequences of
doing nothing?

Many programs which currently provide essential services to
high risk populations will not be funded

Additional services that could help prevent future infections
will not be available

The number of individuals with unknown infection will
remain high and these people may unknowingly infect others

Reductions in support services for HIV+ individuals will likely
result in less access and adherence to medications, poorer
QOL, and increases in HIV transmission

Disparities by race/ethnicity will continue to widen

Moses Cone remains the only major private funder in Guilford
County. Removing this funding will have a significant impact
on treatment, care and prevention services in Guilford County
Authors
Sara LeGrand, MS
Matthew Toth, MSW
Beth Stringfield, Program Director
North Carolina Community AIDS Fund
Duke University Center for Health Policy
2812 Erwin Road, Suite 403
Durham, NC 27705
919.613.5431