The Family Planning Program provides approximately $10 million in supplemental funding for HIV prevention integration grants to Title X Service Grantees. It is comprised of Minority AIDS Initiative funds and the Title X appropriation which together fund approximately 80 projects. The purpose of the supplemental grants is expanding the availability of on-site HIV testing and related referral services, with a focus on implementing the Centers for Disease Control and Prevention's (CDC) 2006, "Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health Care Settings."
Responding to the HHS Priority on Prevention, OFP has increased efforts to address HIV prevention integration as a part of Title X family planning services. Over the past decade, it has become increasingly evident that family planning providers must play a major role in HIV/AIDS prevention. Inadequate attention has been focused on prevention and clinical services for populations who are now at great risk - women (in particular, women of color and poor women) and adolescents, many of whom receive reproductive health services through the Title X family planning program. Family planning clinics have the structure in place to provide HIV/AIDS prevention, counseling, testing, and referrals to populations at risk; however, family planning clinics continue to be viewed as "low prevalence" settings, and in many cases, the usual sources of funds are not available for provision of HIV counseling and testing services. All Title X funded agencies are required to provide, at a minimum, HIV/AIDS prevention education, including education on risks and infection prevention, and testing, either on-site or by referral. The extent of on-site HIV testing and counseling services in Title X clinics is based on the availability of financial resources, and many are not able to provide those services without specific sources of funding to do so.
Since 2001, OFP has received funds through the Minority AIDS Fund (MAF) to provide on-site HIV counseling and testing services in communities where racial and ethnic minorities are under-served or disproportionately impacted by HIV/AIDS. Projects are currently required to addresses the following National HIV/AIDS Strategy (NHAS) goals:
- Reducing HIV incidence;
- Increasing access to care and optimizing health outcomes;
- Reducing HIV-related health disparities.
An article on this collaboration entitled "Collaboration for the Integration of HIV Prevention at Title X Family Planning Service Delivery Sites" was published in 2010 in Public Health Reports.
The Title X integration of HIV prevention projects receive funding from the Minority AIDS Fund and from Title X appropriations. The chart below describes the amount of funding from each source by fiscal year.
|Table I. Integration of HIV/AIDS Prevention Services in Title X Family Planning Projects|
|Fiscal Year||Title X Appropriation||MAI Discretionary Fund||Total Award||Number of Awards||Average|
|2001||$2,004,000||$3,000,000||$5,004,000||34 Total/18 MAI||Average: $147,000|
Range: $58,000 - $185,000
|2002||$2,039,000||$3,000,000||$5,039,000||34 Total/18 MAI||Average: $148,200|
Range: $55,000 - $186,000
|2003||$2,087,000||$3,000,000||$5,087,000||34 Total/18 MAI||Average: $149,600|
Range: $59,000 - $192,000
|2004||$3,200,000||$6,000,000||$9,200,000||63 Total/41 MAI||Average: $146,000|
Range: $6,5000 - $185,000
|2005||$3,435,500||$6,000,000||$9,435,500||63 Total/41 MAI||Average: $149,770|
Range: $9,000 - $195,000
|2006||$3,389,572||$6,000,000||$9,389,572||62 Total/40 MAI||Average: $151,145|
Range: $12,300 - $215,000
|2007||$3,854,000||$6,500,000||$10,035,400||77 Total/47 MAI||Average: $130,000|
Range: $22,000 - $185,000
|2008||$3,850,000||$7,000,000||$10,850,000||80 Total/50 MAI||Average: $135,000|
Range: $14,000 - $187,000
|2009||$3,792,200||$7,270,000||$11,062,000||78 Total*/50 MAI||Average: $141,821|
Range: $14,500 - $195,000
|2010||$3,550,900||$ 7,942,865||$11,493,765||78 Total/54 MAI||Average: $147,356|
Range: $39,700 - $200,000
|2011||$3,189,000||$7,200,000||$10,389,000||78 Total/54 MAI||Average: $133,974|
Range: $40,000 - $197,300
|2012||$3,452,270||$6,800,000||$10,252,270||75 Total/55 MAI||Average: $135,802|
Range: $40,000 - $200,000
* Due to internal problems, two agencies voluntarily relinquished their supplemental HIV funds.
Title X of the PHS Act, 42 U.S.C. 300, et seq., authorizes the Secretary of Health and Human Services to award grants to public or private nonprofit entities to assist in the establishment and operation of voluntary family planning projects which shall offer a broad range of acceptable and effective family planning methods and services (including natural family planning methods, infertility services, and services for adolescents). Title X Program Guidelines require that HIV prevention education must be provided in all Title-X funded projects. Although HIV prevention education is required in all Title X- funded projects, not all are able to provide on-site HIV testing and related counseling and referral services.
Since September 2001, the Office of Family Planning (OFP), with funds from the Minority AIDS Fund and Title X appropriations, has funded HIV/AIDS Prevention Integration grants to a select number of Title X service projects. The HIV/AIDS prevention integration supplemental grant funds are made available to existing Title X service grantees through a competitive process. All project sites have established clinical operations. Many provide primary care services as well as Title X family planning services. The funds for the HIV/AIDS projects represent value-added services within already functional sites, thus minimizing overhead costs. Each project site was awarded a three-year project period, so that subsequent years of funding are awarded through non-competing continuation applications. There have been three cycles of awards, Cycle I - 09/2001 - 09/2004, Cycle II - 09/2004 - 09/2007, Cycle III - 09/2007 - 09/2010. Projects in 34 U.S. states and territories are currently in Cycle IV, with an award period of 09/2010 - 09/2013.
The purpose of these supplemental grants is to expand the availability of on-site HIV counseling, testing and HIV- related referral services in family planning clinics. The resources provided by the Minority AIDS Fund support projects in communities where racial and ethnic minorities are under-served or disproportionately impacted by HIV/AIDS. While the resources provided by the Title X appropriation may also support projects in these communities, there is flexibility to support projects that serve other individuals, areas, or populations that are at risk for HIV/AIDS. Examples include, but are not limited to, areas where there has been a significant shift in HIV prevalence, where STD rates are high or increasing, programs that serve individuals that engage in behaviors that place them at high risk for HIV/AIDS, and/or projects that serve groups or communities where there are identified pockets of need for further HIV prevention services. The OPA/OFP HIV Prevention Integration Project funds existing Title X service delivery sites where there are little or no other resources available for providing on-site HIV counseling, testing, and HIV-related referral services.