At the end of 2010, an estimated 25% of adults and adolescents aged 13 years or older living with a diagnosis of HIV in the United States were women. Women of color, especially black/African American women, are disproportionately affected by HIV infection compared with women of other races/ethnicities. Integrating HIV prevention education, testing and counseling into family planning service delivery is an effective strategy for increasing access to these services and detecting HIV infection among high risk women and adolescents. Title X-funded family planning centers serve clients at greatest risk for HIV infection including racial/ethnic minorities and low-income women.
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 funding.
Responding to the HHS Priority on Prevention, the Office of Population Affairs (OPA) has increased efforts to address HIV prevention integration as a part of Title X family planning services. Since September 2001, OPA has received funds from the Secretary’s Minority AIDS Initiative Fund (SMAIF) and combined with Title X appropriations, has competitively funded HIV prevention projects integrated with Title X family planning services. The purpose of these grants is to expand the availability of on-site HIV testing and related linkage 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.
OPA uses funds from the SMAIF 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.
All project sites are established health providers services. Many provide primary care services as well as Title X family planning services. The HIV/AIDS funding enables value-added services within existing sites, thus minimizing overhead costs.
The current three-year funding cycle, beginning September 2013, has two related components. Grantees may receive one or both of two related components. Grantees funded for Part A have projects that provide high-impact HIV prevention services integrated with Title X Family Planning Services. Funded activities include opt-out HIV testing, linkages to care, behavioral interventions through counseling sessions, condom distribution, and sexually transmitted infection (STI) screening and treatment.
Grantees that received Part B funding will provide enhanced, bi-directional linkage services between Title X Family Planning service sites and Ryan White-funded HIV medical service sites that are either co-located with a Title X site, or have an established, collaborative relationship with a Title X service site funded under Part A. Some projects will provide family planning services for HIV positive clients either in the family planning or Ryan White-funded HIV medical service site.
18 Title X grantees were funded, beginning September 1, 2013. Approximately 60 projects were awarded under Part A and 11 projects under Part B.
An article on OPA’s initiative 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 Secretary’s Minority AIDS Initiative Fund (SMAIF) and from Title X appropriations. The chart below describes the amount of funding from each source by fiscal year since OPA began receiving SMAIF funds.
|Table I. Integration of HIV/AIDS Prevention Services in Title X Family Planning Projects, 2001-2012|
|Fiscal Year||Title X Appropriation||MAI Discretionary Fund||Total Award||Number of Awards|
|2001||$2,004,000||$3,000,000||$5,004,000||34 Total/18 MAI|
|2002||$2,039,000||$3,000,000||$5,039,000||34 Total/18 MAI|
|2003||$2,087,000||$3,000,000||$5,087,000||34 Total/18 MAI|
|2004||$3,200,000||$6,000,000||$9,200,000||63 Total/41 MAI|
|2005||$3,435,500||$6,000,000||$9,435,500||63 Total/41 MAI|
|2006||$3,389,572||$6,000,000||$9,389,572||62 Total/40 MAI|
|2007||$3,854,000||$6,500,000||$10,035,400||77 Total/47 MAI|
|2008||$3,850,000||$7,000,000||$10,850,000||80 Total/50 MAI|
|2009||$3,792,200||$7,270,000||$11,062,000||78 Total*/50 MAI|
|2010||$3,550,900||$ 7,942,865||$11,493,765||78 Total/54 MAI|
|2011||$3,189,000||$7,200,000||$10,389,000||78 Total/54 MAI|
|2012||$3,452,270||$6,800,000||$10,252,270||75 Total/55 MAI|
* Due to internal problems, two agencies voluntarily relinquished their supplemental HIV funds.
|Table II. Integration of HIV/AIDS Prevention Services in Title X Family Planning Projects, 2013|
|Beginning in FY 2013, funding was awarded as distinct grants to Title X grantees.|
Each grant includes a number of project areas
|Fiscal Year||Title X Appropriation||MAI Discretionary Fund||Total Award||Number of Projects|
48 MAI/23 Title X
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