2017-2021INTEGRATED HIVPREVENTION ANDCARE PLANOrlando Service AreaThe 2017-2021 Integrated HIV Prevention and Care Plan for the OrlandoService Area follows the guidance set forth by the Center for Disease Control(CDC) and the Health Resources and Services Administration (HRSA) and willaccelerate reaching the goals in the NATIONAL HIV/AIDS STRATEGY.

2017-2021 INTEGRATED HIV PREVENTION AND CARE PLANOrlando EMA HIV Health ServicePlanning Council 2015-2016Shirley Lanier, ChairpersonCentral Florida AIDS Planning (CFAP)Consortium 2016 – 2017Karen Jaeger, Patient Care ChairpersonJohn Curry, Prevention Chairperson2

2017-2021 INTEGRATED HIV PREVENTION AND CARE PLANCONTRIBUTORSThe Orlando Service Area Integrated HIV Prevention and Care Plan is the product of manydedicated individuals working together to improve the quality of prevention, early intervention andtreatment for individuals at risk or living with HIV disease in the region. In particular, we wouldlike to thank the following members of the 2017-2021 Integrated HIV Prevention and Care PlanWorkgroup, who generously participated in the development of this plan:Imole Akinlana, Orlando EMA Planning CouncilLisa Barr, Hope and Help CenterLester Burgos, Miracle of LoveAndrea Dunn, Lets BeeHiveNicole Elinoff, The GLBT CenterTheresa Feroldi, Health Council of East Central FloridaSam Graper, Orlando Immunology CenterMaria Hobbs, Ryan White Part A OfficeEarl Hunt, Florida Department of Health in Orange CountyKaren Jaeger, The PLACE of ComfortMarcia King, Comprehensive Health CareMarilyn Lipsey, Planning Council SupportAlelia Munroe, Planning Council SupportNicola Norton, Miracle of LoveKen Peach, Health Council of East Central FloridaJessica Raymond, Ryan White Part B Lead AgencyMarion Stephney, Orlando EMA Planning CouncilDebbie Tucci, Area 7 HIV/AIDS Program CoordinatorChristine Uranaka, Ryan White Part A OfficeClaudia Yabrudy, Ryan White Part A Office3

2017-2021 INTEGRATED HIV PREVENTION AND CARE PLANThis Plan was coordinated byThe Health Council of East Central Florida, Inc.and funded by the Ryan White HIV/AIDS Treatment Extension Act of 2009administered by the Orange County Health Services Part A Recipient’s Office and theOrlando EMA HIV Health Services Planning Council4

2017-2021 INTEGRATED HIV PREVENTION AND CARE PLANTable of ContentsSection III: Monitoring and ImprovementDescribe the Process for Reporting on the Progress of the Plana.Describe the Plan to Monitor and Evaluate the Implementation of Goals 1414250505051515151525252535454c.Section IV: Submission and Review ProcessAppendix A: Letter Of Concurrence565860Section I: Statewide Coordinated Statement of Need/Need AssessmentA. Epidemiological OverviewGeographic Region of the Jurisdictiona.Socio-Demographic Characteristicsb.Describe the Burden of HIVc.Indicators of Risk for HIV Infectiond.HIVCareContinuumB.Descriptive Narrative of HIV Care Continuuma.Description of Disparities in Engagementb.HIV Care Continuum Planningc.C. Financial and Human Resources InventoryFunding Sourcesa.HIV Workforceb.Funding Sources to Ensure Continuity of Carec.Identify Needed Resourcesd.D. Assessing the Needs, Gaps and BarriersProcess to Identify HIV Prevention and Care Service Needsa.HIV Prevention and Care Service Needs of Persons at Risk for HIV and PLWHb.Describe Service Gapsc.Describe Barriers to HIV Prevention and Cared.E. Data: Access, Source, and SystemsDescribe Main Data Sourcesa.Describe Data Policies that Served as Barriersb.Describe Any Data That Was Needed but Not Availablec.Section II: Integrated HIV Prevention and Care PlanA. Integrated HIV Prevention and Care Plana-d Sectionse.Challenges/Barriers in Implementing the PlanB. Collaborations, Partnerships and Stakeholder Involvementa.Describe Specific Contributionsb.Describe Stakeholders and Partners Who are Neededc.Provide Letter of ConcurrencePeopleLiving With HIV (PLWH) and Community EngagementC.a.How are People Involved in Plan Developmentb.Describe the Inclusion of PLWHA with Plan Developmentc.Describe Methods to Engage Communitiesd.Describe How Impacted Communities are Engaged in the Planning ProcessSMART ObjectivesDescribe the Strategy to Utilize Data and Improve Health Outcomes5

2017-2021 INTEGRATED HIV PREVENTION AND CARE PLANSECTION IStatewide CoordinatedStatement of Need/NeedAssessment6

2017-2021 INTEGRATED HIV PREVENTION AND CARE PLANSECTION I: Statewide Coordinated Statement of Need/Need AssessmentSECTION I: Statewide Coordinated Statement ofNeed/Need AssessmentA. Epidemiological Overviewa. Geographic Region of the JurisdictionThe Orlando Service Area consists of five counties in East Central Florida: Brevard, Lake, Orange,Osceola and Seminole. The service area includes the four counties that comprises the Orlando EMA(Lake, Orange, Osceola and Seminole) three of which overlaps with the Part B Consortium or Area7 (Orange, Osceola and Seminole). The fifth county of the Service Area, Brevard County,completes the four counties that comprise Area 7. Lake County, an EMA County, is one of 15counties of Area 3/13. Together the five counties represent 14.8% of the total population of Florida.Orange County is home to 42.8% of the population of the Orlando Service Area with a populationdensity of 1,268 persons per square mile. Brevard County has 19.2% of the Orlando Service Areapopulation; Seminole County at 15.1%; Lake County at 10.7%; and Osceola County at 10.3%.Seminole County is the most densely populated at 1,367 persons per square mile. Populationdensity ranges from 202.4 to 535.0 persons per square mile for Osceola, Lake and Brevard counties.Population estimates from the Florida Department of Health, Office of Health Statistics estimatedthe total population of the Orlando Service Area at 2,884,534 persons, with 71.0% of the populationidentifying as White; 18.6% Black, and 29.4% Hispanic. By age, 15.9 percent are 0-12 years;16.6% are 13-24 years; 26.4% are 25-44 years and 41.2% of the population is 45 years of age.The general population is younger when compared to the PLWHA population where 60.0% are atleast 45 years or older.Population growth among the five counties in the Orlando Service Area was greatest in Osceola, at11.3% from 2010 to 2014. Brevard County’s population is older when compared to other countiesin the service area. By gender, females represented a slightly larger percentage of the populationwhen compared to their male counterparts, but still well within the 1:1 ratio.Osceola County had the highest percentage of those living in poverty (2014) in the Orlando ServiceArea at 19.3%. Orange County, with poverty at 18.2% was higher than the poverty rates in BrevardCounty at 14.5%, Lake County at 13.8% and Seminole County at 11.8%.According to the American Community Survey (2010-2014), Osceola County had the highest rateof uninsured adults at 23.3%, while Lake County adults were the lowest at 15.7%. Uninsuredamong adults in Brevard County, at 16.0% was lower that the percentages in Orange, at 21.6% andSeminole, at 16.6%.The number of PLWHAs by zip code was mapped to depict the geographical areas where therewere high concentrations of HIV prevalence. Each county had several zip codes where the rates ofPLWHA were very high when compared to other zip codes within the Orlando Service Area. Themap below highlights the number of PLWHA by zip code for the five-county area. The very darkshaded areas are located in Orlando and had the highest rates of PLWHA in the Orlando ServiceArea.A. Epidemiological Overview7

2017-2021 INTEGRATED HIV PREVENTION AND CARE PLANSECTION I: Statewide Coordinated Statement of Need/Need AssessmentFigure 1: PLWH by ZIP Code for the Orlando Service AreaPLWH by ZIP CodeSource: eHARSb. Socio-Demographic CharacteristicsAs of 2014, a total of 12,659 persons were living with HIV/AIDS in the Orlando Service Area.PLWHA are predominately Black males, ages 45 years with a transmission exposure of MSM.The Black population is disproportionately represented as they account for 39% of PLWHA butonly comprise 18.6% of the general population. The White and Hispanic populations areunderrepresented as they account for 71.6% and 29.4% of the general population, respectively, but35.0% and 24.0% of the PLWHA population. Among the PLWHA population, 66% are below theage of 45 years, with 16% between 13-24 years.A. Epidemiological Overview8

2017-2021 INTEGRATED HIV PREVENTION AND CARE PLANSECTION I: Statewide Coordinated Statement of Need/Need AssessmentFigure 2: Number and Percent of HIV, AIDS, and PLWHA in the Orlando ServiceArea (as of 12/31/2014)HIV %IndicatorTotalWhite, Non-HispanicBlack, Non-HispanicHispanicOtherAIDS IncidencePLWHANumberPercent Number Percent381100% ,48572%28%0-12 yrs.13-24 yrs.25-44 yrs.45 4643,80421554%11%4%30%2%Source: eHARSAccording to the CDC, individuals with sexually transmitted diseases and TB are at a higher risk ofHIV infection than that of the general population who are disease-free. The table below contains thenumber of individuals in the Orlando Service Area who had been diagnosed with an STD in 2014.Figure 3: Persons at Higher Risk for HIV B84Hepatitis A5Hepatitis B16Hepatitis 62,9227,9795727141241,3508910-12 yrs.13-24 yrs.25-59 yrs.60 3361501,552538TotalWhite, NonHispanicBlack, NonHispanicHispanicOtherSource: Florida Department of Health, Bureau of Communicable Disease, HIV/AIDS SectionA. Epidemiological Overview9

2017-2021 INTEGRATED HIV PREVENTION AND CARE PLANSECTION I: Statewide Coordinated Statement of Need/Need AssessmentThe clients in the Ryan White system of care tend to have lower employment rates, live in poverty,have unstable housing, and higher than average rates of poverty. The socioeconomic data that wasreported by the RSR is found in the table below. It should be noted that Insurance Status wasunknown/not reported for 1,283 clients.Figure 4: Ryan White Clients by Health Insurance Status and PovertySocioeconomic IndicatorMedicaidMedicareMarketplace ExchangesUninsured138% FPL400% 12.6%34.9%Source: RSR Clinical Summary Report FY 2014c. Describe the Burden of HIVThe number of PLWHA grew from 10,548 in 2010 to 12,659 in 2014, which represented an 18.5%increase of those living with HIV infection. Among population groups, Blacks represented 18.6% ofthe Orlando Service Area population. However, they represented 33.0% of the new HIV cases,45.0% AIDS cases, and 38.9% of PLWHA in the Orlando Service Area. Hispanics represented 27%of the general population and comprised 29% of the new HIV cases and 26% of new AIDS cases.The most significant increases were among new AIDS and HIV cases in the Hispanic populationwhen comparing eHARS data from 2012 to 2014. They are as follows: among Hispanic MSM newAIDS cases increased 52% and new HIV cases 106.2%; HIV cases among Hispanic male IDUincreased 141.7%; HIV case among Hispanic male youth (13-24 years) increased 45%; HIV casesamong Hispanic female youth increase from 1 case in 2012, to 5 cases in 2014 (400%); and newAIDS cases among Hispanic Women of Childbearing Age (WCBA) were up 85.7% while new HIVcases for this population increased 181.8%.Percent of PLWHAPopulationFigure 5: PLWH by Race/Ethnicity, 2010-201445%40%35%30%25%20%15%10%5%0%White, Non-HispanicBlack, Source: eHARSA. Epidemiological Overview10

2017-2021 INTEGRATED HIV PREVENTION AND CARE PLANSECTION I: Statewide Coordinated Statement of Need/Need AssessmentFigure 6: New AIDS Cases for Hispanic MSM and Hispanic Male IDU, SM3932304245IDU910111412Source: eHARSFigure 7: New HIV Cases for Hispanic MSM and Hispanic Male IDU, 014MSM978978111160IDU1413121129Source: eHARSA. Epidemiological Overview11

2017-2021 INTEGRATED HIV PREVENTION AND CARE PLANSECTION I: Statewide Coordinated Statement of Need/Need AssessmentFigure 8: Hispanic WCBA New AIDS and HIV Cases, 2010-20143530252015105020102011201220132014New AIDS Cases101371613New HIV Cases1317111431Source: eHARSThere were ten communities within the Service Area that experienced a disproportionate share ofinfection in 2014. They are as follows: Melbourne and Palm Bay in Brevard County; Leesburg, Mt.Dora, and Clermont in Lake County; Parramore, Pine Hills, and Holden/Oakridge in OrangeCounty; Kissimmee in Osceola County; and Altamonte Springs and Sanford in Seminole County.A county health department provider of Outpatient Ambulatory Health Services (OAHS) is locatedwithin each county in the zip code with the highest HIV/AIDS population, with the exception ofOsceola County where the health department is located in a contiguous zip code and BrevardCounty where the health department is located in a zip code with the second highest PLWHApopulation. Providers of other health services are all located in Orange County zip codes with adisproportionate share of PLWHA.An analysis of death rates from HIV/AIDS revealed the rates among those in the Black populationwas at least three times the rates among Whites. In 2012-14, deaths rates among Whites rangedfrom 0.6/100,000 in Brevard County to 2.2/100,000 in Orange County. Among the Blackpopulation, rates ranged from 9.4/100,000 in Osceola County to 28.7/100,000 in Lake County.HIV/AIDS deaths rates by county among Hispanics were very similar to those of Non-Hispanicswith the exception of Orange County where Hispanic deaths were twice the rate of Non-Hispanics.A. Epidemiological Overview12

2017-2021 INTEGRATED HIV PREVENTION AND CARE PLANSECTION I: Statewide Coordinated Statement of Need/Need AssessmentFigure 9: Deaths from HIV/AIDS by Race by County, 2008-10 to 2012-14 (rate per100,000 ack2011-13OsceolaWhiteBlack2012-14SeminoleSource: Florida CHARTS, Office of Vital Statisticsd. Indicators of Risk for HIV InfectionThe Youth Risk Behavioral Surveillance System (YRBSS) is administered to Orange County,Florida high school students. Although Orange County is the only county in the Orlando ServiceArea to participate in the survey, the data is relevant as Orange County bears the larger burden ofdisease when compared to the other four counties.Figure 10: YRBSS 2013 Orange County, Florida StudentsYRBSS QuestionPercentEver taken any illegal drugHad sexual intercourse before age 13 yearsHad sexual intercourse with 4 or more persons (Lifetime)Did not use a condom before last sexual intercourseDid not use both a condom and birth control before last sexualintercourseDrank alcohol or used drugs before last sexual intercourseWere never taught in school about HIV/AIDS e1,6251,5091,5013343293401,597Source: YRBSS 2013 Orange County, FloridaThe 2013 Behavioral Risk Factor Surveillance System (BRFSS) did not contain any questionsrelated to the risk for HIV/AIDS infection, testing, sexual orientation or gender identity.Information was available for adults who engaged in binge drinking, which is defined as consuming5 alcoholic drinks for men or four alcoholic drinks for women in one session. According to theCenter for Disease Control and Prevention (CDC), binge drinking is associated with sexual diseasetransmission.A. Epidemiological Overview13

2017-2021 INTEGRATED HIV PREVENTION AND CARE PLANSECTION I: Statewide Coordinated Statement of Need/Need AssessmentFigure 11: Adults who engaged in binge drinking, 5%13.3%Seminole20.8%20.4%15.4%13.2%Source: BRFSS 2013The estimated number of people who are HIV positive and are unaware of their status is based on amethodology created by the Centers for Disease Control and Prevention (CDC). According to theCDC, 15.8% of people who are living with HIV/AIDS do not know their status nationally. InFlorida, the percentage is between 10 and 12% due to the number of tests conducted in the state.Based on this estimate, the following is a calculation of people living in the service area who areHIV and unaware of their status: National Proportion Undiagnosed HIV (21%) pNumber of individuals diagnosed with HIV and living per FDOH 11,186Local Undiagnosed p/1-p multiplied by the number of diagnosed living (11,186 in theOrlando Service Area) the number of people living in the Orlando unaware of their HIVpositive status.According to this calculation, 2,973 people are living in the Orlando Service Area unaware of theirHIV status.Figure 12: Newly Diagnosed Positive at HIV Testing kedto erredPreventionServicesRec'dCD4& VLtestsBlack/AA,Females15-44 Yrs.1,5858878627White 65573045PopulationBlack/AA, MSMTotalSource: Florida Department of HealthA. Epidemiological Overview14

2017-2021 INTEGRATED HIV PREVENTION AND CARE PLANSECTION I: Statewide Coordinated Statement of Need/Need AssessmentFigure 13: Previously Diagnosed Positive at HIV Testing ferredPreventionServicesRec'dCD4& VLtestsBlack/AA,Females15-44 Yrs.1,58510107101057White ionBlack/AA, MSMTotalSource: Florida Department of HealthThe Recipients continue to support testing activities at health fairs, awareness days, festivals, etc.The majority of Part A and B providers offer rapid testing. Their efforts help provide a seamlesstransition from Prevention to Patient Care activities (Referring and Linking to care) in the event ofan individual testing HIV positive. Regularly scheduled EIIHA strategy meetings are convened toidentify possible strategies and collaborative partnerships to enhance service delivery.The target populations for the Early Identification of Individuals with HIV/AIDS (EIIHA) Plan arebased on epidemiological data made available from the Florida Department of Health (FDOH).Data made available from FDOH was used to trend mode of exposure, age, gender, race, ethnicity,and county of residence, with some of it cross tabulated to identify target populations. Based on theavailable data, the following target populations have been identified for the FY16 EIIHA Plan: (1)White MSM, (2) Black Heterosexual both male and female and (3) Black MSM. These groups wereselected based on several sources of information available. The first data source was recentepidemiological data, which showed these groups as having higher rates of infection compared toother groups, as well as being more likely to be out of care compared to other groups. Other datasources which were used in identifying these target groups originated from reports developed by theFDOH regarding certain populations, among them the African American community (“Silence isDeath”), men (“Man Up: The Crisis of HIV/AIDS Among Florida’s Men”), and women(“Organizing to Survive: The HIV/AIDS Crisis Among Florida’s Women”). They were alsoselected in part due to historical data, trending out prevalence and incidence rates over the last fiveyears.The Orlando Service Area continues to respond to the epidemic by supporting initiatives such as:1) The Test Orlando Campaign which aims to: Promote Routine HIV Testing Improve Orange, Osceola, Seminole and Brevard Counties resident's understanding of HIV Reduce the transmission of HIV by knowing your status – Getting to Zero2) The Black Treatment Advocates Network (BTAN) – Melbourne Chapter which aims to: Link individuals with HIV into care and treatment Strengthen local leadership Connect influential peers Raise HIV science and treatment literacy in the communityA. Epidemiological Overview15

2017-2021 INTEGRATED HIV PREVENTION AND CARE PLANSECTION I: Statewide Coordinated Statement of Need/Need Assessment Advocate for policy change and research prioritiesIn September 2006, CDC released Revised Recommendations for HIV Testing of Adults,Adolescents, and Pregnant Women in Health Care Settings. These revised recommendations adviseroutine HIV screening of adults, adolescents, and pregnant women in health care settings in theUnited States.Many infected persons decrease behaviors that transmit infection to sex or needle-sharing partnersonce they are aware of their positive HIV status. HIV-infected persons who are unaware of theirinfection do not reduce risk behaviors. Because medical treatment that lowers HIV viral load mightalso reduce risk for transmission to others, early referral to medical care could prevent HIVtransmission in communities while reducing a person's risk for HIV-related illness and death.In addition to the target populations selected for the EIIHA plan, all proposed activities are intendedto reach all newly infected individuals, as well as those who are high risk negatives.Activities to be implemented begin in collaboration with the counseling and testing sites to supporttargeted testing activities. It is critical to expand activities and look for novel ways to identify andtest them. In addition, both the Part A and B Recipients will be funding linkage coordinatorsthrough Early Intervention Service (EIS) funds beginning in FY 2016 in order to assist newlydiagnosed people to get linked into primary medical care, to reach heterosexual men and women,encourage testing and promote safe behavior, initiatives must focus less on prevalence and zip codedata, to locations where socialization occurs. To reach White MSM, similar efforts must be made.To reach Hispanic MSM, expanded testing efforts, the increase of rapid testing sites in addition totargeted testing would reduce environmental barriers in high prevalence zip code areas.The Orlando Service Area continues to partner with Prevention. Last year 41,378 tests wereconducted in the Orlando Service Area. The state of Florida, the Part B Recipient, consistently testsmore individuals than any other state. They have been EIIHA partners from the inception of theinitiative, and continue to work with Part A to develop a seamless system from testing to whateverservice is most appropriate for the individual. Several counseling and testing agencies within theOrlando EMA are now active partners in the EIIHA efforts: (1) Miracle of Love, (2) Hope and HelpCenter of Central Florida, Inc., (3) Healthcare Center for the Homeless, and (4) The Gay, Lesbian,Bisexual, Transgender Center. Each of these agencies provides linkage between preventionprograms and patient care programs. While the Brevard County providers do not currentlyparticipate in EIIHA, DOH-Brevard, Comprehensive Healthcare and Project Response offers HIVtesting and provides linkage between prevention and care. Many of the Orlando Service Areaproviders receive funding from other sources to offer testing, providing a natural connectionbetween counseling, testing, referral, and linkage. An overwhelming majority of the testing andcounseling providers hire diverse staff, which helps reach more diverse populations. The Recipients(Parts A and B) will begin funding linkage coordinators through EIS funds in FY 2016 in order toassist newly diagnosed people with getting linked into primary medical care.Governor Rick Scott of Florida signed legislation into law effective July 1, 2015 that makes HIVtesting an opt-out component of routine testing, thereby removing a tremendous legal barrier.Multiple agency representatives have collaborated since the inception of the EIIHA Plan. Chiefamong them have been individuals from Part A, Part B, Part C, Part D, Prevention, Counseling andTesting staff, and members of the planning bodies. All have been instrumental in implementing theA. Epidemiological Overview16

2017-2021 INTEGRATED HIV PREVENTION AND CARE PLANSECTION I: Statewide Coordinated Statement of Need/Need AssessmentEIIHA Plan, primarily the counseling and testing sites, Part A, Part B, and Prevention. FDOH staffhas assisted in developing reports to share with the Orlando Service Area to identify the number ofindividuals linked to care.The primary outcome of the EIIHA plan has been to create a seamless system of access to andretention in-care among the different Ryan White entities in the Orlando Service Area with the idealgoal of viral suppression for all PLWHA. Collaboration among the Parts, as well as Prevention hasbeen a main driving force behind the EIIHA Plan. A major objective in the Plan has been to workamong the different Ryan White Parts and Prevention to develop a data collection strategy todetermine the rates at which newly diagnosed individuals are referred and linked into care andsupport efforts to determine the rates at which high risk negatives are referred to services that keepthem from becoming infected. Thanks to collaborative efforts with Prevention and FDOH, reportsare available that provide counseling, testing, referral, and linkage information.One of the outcomes of the EIIHA Plan is to continue to have all of the Parts and Prevention tomeet regularly together to discuss collaboration and data collection efforts across the board. Asecond outcome is to fund linkage coordinators throughout the Orlando Service Area, therebyincreasing the overall number of people linked into medical care. These linkage coordinators will belocated at each of the five health departments throughout the Orlando Service Area. A thirdoutcome is to communicate EIIHA activities to the Planning bodies and CFAP to keep theminformed, whether it is data being collected or on the activities of the linkage coordinators. Thisensures the Planning bodies can make decisions based on data. In addition to the funding of LinkageCoordinators, another outcome in the EIIHA Plan will be continuing to partner with the Part Bfunded Anti-Retroviral Treatment and Access to Services (ARTAS) program to receive EIIHArelated referrals for newly identified positives as well as those positives who have fallen out of care.Finally, the fifth outcome will be the continued support of counseling and testing site activitiesthroughout the Orlando Service Area.The number of homeless among PLWHA has decreased 14.8% over the past two years. Data fromeHARS indicated that 75 homeless PLWHA were living in the Central Florida service area in 2014.Of these 58.7% were Black, 21.3% White and 16.0% Hispanic. The rate of homelessness amongthose living with HIV/AIDS, at 670.5/100,000 is more than six times that of the general populationat 104.6/100,000 as reported by the Council on Homelessness 2015 Report prepared by theDepartment of Children and Families. Providers within the service area are challenged by thecomplexities of retaining homeless PLWHA in care. One of the reasons that it has been such adaunting task is the lack of housing units as well as not capturing all of the data regarding this subpopulations’ need. With the new PROVIDE ENTERPRISE software system, as well as the highpriority that is being given to this sub-population, the system will be more capable of meeting theirneeds.According to the Department of Corrections, 2,707 offenders returned to the Orlando EMA in 2014.Of these, 73 (2.7%) were HIV positive. This was an increase from HIV positive offenders releasedin 2013 (2.2%) but still less than 3.0% in 2012. The number of HIV positive inmates released fromarea jails has yet to be estimated. In Brevard County, there are approximately 58 clients in treatmentwho had been previously incarcerated. Some of these clients were in the Part B system of carebefore incarceration while others were new to the system. The 2013 Ryan White Consumer Surveydata showed that 80 respondents reported living in jail and/or prison in the past 12 months.Providers in each county have developed processes to link individuals to care prior to their release.A. Epidemiological Overview17

2017-2021 INTEGRATED HIV PREVENTION AND CARE PLANSECTION I: Statewide Coordinated Statement of Need/Need AssessmentWhenever possible, jail staffers try to alert the provider representative when an inmate identified asone needing care is about to be released. In addition, funded programs in all four counties of theEMA send staff to the jails to provide assistance with linking released PLWHA to care. In Area 7,when a prisoner with HIV is released, personnel at the prison will contact the Area 7 (Part B)Linkage staff member to schedule the client’s appointment prior to their release. The Linkage staffmember maintains contact with the prisoner upon release and provides follow-up to ensure thatappointments are kept. When appointments are not kept, the staff member determines the barrier(s)that prevented the missed appointment and works with the client to remove/reduce the barrier inorder to facilitate linkage.Mental health problems usually predate substance use activity which can interfere with HIV/AIDStreatment adherence. In the Orlando Service Area, the rate of PLWHA with chronic mental illness is1,868.4/100,000 (16.7%) which is significantly higher when compared to the general population at4.1 percent.Substance abuse (including binge drinking and illicit drug use) is also more prevalent amongPLWHA than the general population. Data f

The Orlando Service Area consists of five counties in East Central Florida: Brevard, Lake, Orange, Osceola and Seminole. The service area includes the four counties that comprises the Orlando EMA (Lake, Orange, Osceola and Seminole) three of which overlaps with the Part B Consortium or Area 7 (Orange, Osceola and Seminole).