The Broward County HIV Planning Council develops the comprehensive HIV Care Plan for Broward County. This plan forms the basis for most public funding of HIV services in Broward County. In August, the chair of that council, Brad Gammell, agreed to be interviewed by SFGN about changes occurring in HIV policies in Broward.
Over the next few years, HIV prevention and care services in Broward will be integrated into one coordinated system of care. Brad Gammell explained this change as follows: “We’ve been using a model for 15 or 20 years across the country and that model doesn’t fit today’s needs.” This integration is not just occurring in South Florida. According to Brad, it has already occurred in Chicago and Los Angeles.
Brad stated “Things have really changed in a good way in the last four years. We have the National HIV/AIDS Strategy. We’ve never had a strategy before, a direction on the national level. All our work feeds upward into the national strategy. And part of that strategy we get rid of silos.” The National HIV/AIDS Strategy itself integrates prevention and care.
In the past, different funding streams separated prevention and care, each having its own comprehensive plan. According to Brad, the two major federal HIV funding agencies (CDC and HRSA) now want a single comprehensive three-year plan for both HIV prevention and care.
The Broward HIV Planning Council will be writing that comprehensive three-year plan. Brad stressed that this will not be simple, “What we’re doing is really hard, bringing the two groups, prevention and care, together: two different worlds that speak two different languages.” Brad described current thinking about HIV testing. “It’s no longer test to test. They have to test people to get positives. It’s not about numbers of people testing; it’s about the number of people testing positive.” This follows the recommendation of the National HIV/AIDS Strategy to intensify efforts to test where HIV/AIDS is most heavily concentrated.
Several other factors also contribute to this merging of HIV prevention and care. The new bio-medical advances (PrEP, PEP, and Treatment as Prevention) thoroughly blur the line between prevention and treatment. The measurement tool, the Cascade of Care (see graphic) links prevention and care in six stages from initial infection to viral suppression. As it shows where people fail to move to the next stage, it clearly shows problem areas. This measurement tool has become a key way to understand both the epidemic and efforts to contain it.
The next comprehensive three-year plan for HIV prevention and care will describe the state of the epidemic in Broward, identify problem areas, and identify success criteria for resolving those problem areas. It will have measures for success that are solid enough to show progress against HIV, and to defend HIV funding against “budget hawks.”
Brad asserted that Ryan White Care groups throughout the county have produced solid enough data to win the unlikely support of people like Senator Tom Coburn (R-OK). It will also be the basis of a large part of HIV funding in Broward for three years. The council’s meetings are open to the public and its documents, including the current comprehensive plan, are available on line.
Major changes are now occurring in how people think about, understand, and deal with the epidemic. Brad summarized the position of the Planning Council, “Our nation is shaking up and we can be part of that national discussion and move on or we can stay here locally and not do a thing. We don’t have a choice “