HIV in Palm Beach County (PBC) differs demographically from HIV in Broward or Miami-Dade. HIV in PBC mostly affects straight people. In PBC, 56 percent of HIV cases result from male-female sexual contact, but in Broward, most HIV cases result from male-male sexual contact. Miami-Dade has a similar demographic pattern to that of Broward. In 2014 in PBC, 8,020 people were living with HIV or AIDS (PLWHA). Of the 8,020 PLWHA in PBC, 81 percent were Black.

PBC has collaborated with the Florida Department of Health to use geographical information systems. These systems identify locations where clusters of PLWHA live. When planners know where PLWHA live, they can locate services to minimize transportation problems. Large numbers of PLWHA cluster in three urban areas of PBC, Riviera Beach, West Palm Beach, and Delray Beach. Unlike other South Florida counties, rural areas in PBC also have large numbers of PLWHA. These areas are near Lake Okeechobee in Belle Glade, Pahokee, South Bay, and Canal Point.

HIV service delivery in rural areas presents many unique challenges. The low population density of rural areas increases transportation difficulties. Rural areas also lack the protection against stigma that urban anonymity provides. Some rural HIV providers have begun to use telehealth technology to reduce these challenges.

 

PBC and the Continuum of Care

As a suppressed viral load has become the standard measure of HIV control at an individual level, the Continuum of Care has become the standard measure of HIV control at a group level. The diagnosis-based Continuum of Care consists of five sequential steps: diagnosis of HIV infection, linkage to care, retention in care, prescription of antiretrovirals, and suppression of HIV load. Each step leads to the next with the goal of viral suppression. When someone has suppressed their viral load, they maintain their own health and reduce the risk of transmission to others. Large declines in participation between steps indicate areas for improvement.

The Continuum of Care in PBC combines data for Ryan White Care clients with data for private sector clients. In PBC, 53 percent of PLWHA have achieved a suppressed viral load. PBC shows a 30 percent drop in participation between the steps “Linkage-to-care” and “Retention-in-Care.” Large drop-offs between these two points occur in Broward County as well.

In a survey of 366 PLWHA in PBC, 42 percent reported that they were not currently in care. When people reported their reasons for being out-of-care, an odd pattern emerged. Money issues did not dominate the reasons.  Neither did cultural clashes with providers. Most of the out-of-care, 57.4 percent, felt no need to seek care, as they did not feel sick. A second large group, 38.7 percent, reported depression, which may refer to a fatalistic attitude to HIV infection. A third large group, 37.4 percent, reported a fear of others learning that they were living with HIV, or stigma.

Unlike Broward and Miami-Dade, PBC did not include baseline data with their goals. As a result, it is difficult to compare the plans for the three counties.  All three counties, however, plan to incorporate PEP and PrEP in their HIV Prevention campaigns.

To read the full Florida 5-year plan for HIV treatment and prevention, please visit http://www.floridahealth.gov/diseases-and-conditions/aids/prevention/_documents/community_mobalization/florida-integrated-hiv-prevention-care-plan-09-29-16v2.pdf. The PBC 5-year plan is on pages 476-516.

For more information on HIV in PBC, please visit http://www.floridahealth.gov/diseases-and-conditions/aids/surveillance/partnership-slide-sets1.html, and select Partnership 9.

Follow Sean McShee on Twitter @SeanMcShee


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