Health Safety Education and Services - Regular Meeting

Welcome back to this weekly meeting of the Health and Safety Committee with Denver City Council. Coverage of the Health and Safety Committee starts now.

I wish you the best with that.

Good morning, and welcome to the, four twenty nine health and safety committee meeting. My name is Darryl Watson. I'm honored to serve as the chair of the health and safety committee as well as the city council member representing all of the fine District 9. We have a very important briefing this morning. We're being briefed on an HIV AIDS programming that our city provides. But before we go into the presentation, why don't we start with introductions with council members in the room, and we'll start on the right.

Thank you, mister chair. Kevin Flynn, Southwest members, District 2.

Sir, podium one. I'm your council members at large.

Amanda Sawyer, District 5.

Good morning, everyone. Sedona Gonzalez Gutierrez, your other council member at large.

And we have council members online. Council member council president for town.

Good morning. Diana Romero Campbell, Southeast Denver, District 4.

Thank you all for being here. And Robert and Kelly, thank you so much for being present and able to provide this presentation. We'll turn the floor over to you.

All right. Yeah. Well, yeah, my name is Robert George. I'm the HIV Resources Section Manager at DDPHE, managing our HIV program and our Ryan White Part A funding that we get from the Health Resources Service Administration, which is federal funding for HIV care treatment and support services. Then

Hi, I'm Kelly Brevard. I'm the program development administrator for the Ryan White Parney program.

So thanks so much for having us and allowing us to share with you our information about our program and what's happening. I think we were just talking earlier about how I don't know that we've been able to bring this information to you all for quite some time at least. And I am aware that you all see our service contracts come through and are approving them, and we appreciate that support. And so we just wanted to be able to give you an update on what's happening with the program. One of the key things that's happening right now is that legislatively we're required to do an integrated plan around how we're going to respond to HIV in the state of Colorado.

And that's something that we're required to do with our friends and partners at CDPHE. They also receive Ryan White funding, and I'll get into what that looks like here in a second. So the information I'm sharing today is all the information that went into putting together our integrated plan, as well as some of the findings and outcomes and the goals that are in that plan. It's a 99 page document. I don't have it here. I'm not presenting all of it here. I'm just giving you some of the highlights. If you're interested in that, we'd love to share it with you. It's still in its draft form. It's we We turn it in the June, and so it's still going through some revisions and some approvals before it's finalized.

But I could be glad to share that with you all. So yeah, so the framework for this presentation is the Colorado HIVAIDS Strategy, Strategy, which we fondly and lovingly call the COHAS. And again, it's a collaboration between us here at DDPHE and our friends and partners at CDPHE at the Office of STI HIV and Viral Hepatitis. So just to give you a larger view about where our funding comes from. So it's the Ryan White Part A funding.

Again, it's legislatively organized, I would say, and mandated. It was enacted in 1990, and it was named after Ryan White. Are you all familiar with who Ryan White was? Yeah. It's interesting.

Some groups of people I talk to don't always know that Ryan White was a real person and who he was. But, yeah, so it was named after him. And, yeah, it was enacted at a time when there were a few resources. We were seeing a lot of deaths related to HIV, and so there was something that needed to be done to help to support people who were being diagnosed with HIV at that time. Denver actually has been receiving Ryan White funding since 1994.

We're in our thirty third year of funding, consecutive funding. I'll do Ryan White. And we receive Ryan White Part A, and it serves Part A funding is designated specifically for metropolitan areas. So here in Denver, we're serving the six county metro area through our funding, which includes Denver, Bloomfield, Adams, Douglas, Arapahoe, and Jefferson Counties. We also get a portion of Viberty AIDS Initiative funding, which is designated specifically to ensure that services are adequately provided to our communities of color.

It's a smaller percentage of what we receive, but it's a very important piece of what we offer. And then b, Ryan White part b funding is for states and so CDPHE receives that funding and it serve any area in the state of Colorado. Part c funding is specifically for community health clinics And in Colorado, the clinics that receive Part C funding are Denver Health, Beacon Clinic up in Boulder County, Pueblo Community Health, and St. Mary's Hospital, which is in Grand Junction. There's Part D funding, which is focused on women, infants, children, and youth.

And locally, Children's Hospital receives that funding. And then Part F funding is for the AIDS Education Training Centers, which provides clinical training for clinical providers who are responding to HIV. And it also includes some oral health funding, and University Hospital receives that funding. The current Denver Part A landscape includes we received in 2025, we received $7,400,000 in funding. That was actually a 4.35 percent decrease in funding from the previous year.

We serve a little over 5,000 individuals. We have currently 12 service providers, and we fund 10 different service categories, which I'll talk about here in a minute. Another piece of our program is we are legislatively required to have a planning council. So this is a community group of folks who have some particular decision making responsibilities around our program. And Philip Doyle is our program manager who manages and coordinates that.

Yeah. Who manages the planning council. And so currently, the planning council includes specialty care providers, public health, and representatives from other federal programs. And the planning council's required to have 33% of the membership be made up of people with lived experience, people living with HIV. So the main purpose of the planning council is to prioritize the services that are important for people living with HIV in the geographic area.

And then they also make decisions around the percentage allocations of how our funding is used for different services. So they're choosing the services we provide in the area and what percentage of funding goes to those services. And they also center the experiences of people living with HIV as the decision makers in shaping the structure of how our program actually works. And then they are also responsible for being a part of this integrated plan development, and then they have responsibility to endorse the plan before it goes for submission. So based on decisions the planning council has made, these are the funded service categories that we provide.

And so I'd highlight that we do provide direct medical care and oral health care, behavioral health services, and case management services as kind of those top priority services as well as with the highest percentage of allocation. You can see the ones that are also designated for our Minority AIDS Initiative funding. And so that's how we use that particular funding to support those services for people of color in our area. So the pieces that went into Cohas included a lot of just hard number data, epi data, and other service level data. And then there is an effort around a statewide coordinated statement of need, which included a quality of life survey.

We had listening sessions and focus groups with people with lived experience. And then there was the development of a steering committee, and the people that were on that steering committee represented people with lived experience, professional experience, there was statewide representation, and folks that had a focus on care and prevention services. In Denver, through our program, we're only doing care and treatment. We don't do prevention services. That is all managed by CDPHE.

But within our integrated plan, we're including those prevention pieces. I'm not highlighting on that in this presentation. But again, if you want to read the 99 page document, you'll see a lot of that prevention work. And another piece is our strong partnership with CDPHE and the Office of STI HIV and Viral Hepatitis. You know, we in this time of, you know, tighter resources, that relationship is more important than it's ever been.

So and I think we do a really good job of maintaining that and just being responsive to the needs of the community and the state. And then also, some of the community groups that are involved in this process were, of course, our planning council, the state CDPHE's alliance, which is their advisory group, the State Drug Assistance Program Committee, and then the Colorado HIVAIDS Prevention Program, which is state money specifically designated for HIV prevention services. So now I'm just going to get into some of the data and give you a picture of what HIV looks like in the metro area and the state of Colorado. We're estimating about fifteen thousand seven hundred individuals living with HIV in this state. Seventy percent of the people living with HIV are in the Denver area, the Denver 6 County area.

And in 2024, there were four eighty seven new diagnoses of HIV in the state. And then this slide shows you the trends around new diagnoses since 2018. We've been in that four hundred range since then. 2020 was just a unique year, as you all know. And so that's why there is a dip there.

And then you can see the top counties over here on the right where new diagnoses are found. So Denver, Adams, Arapaho, and our metro area being those top three in the state. And then when we look at the disproportionate effect on our different populations, we see that people who identify as Black and African American are the highest community that are disproportionately impacted by HIV. And then the HispanicLatinoLatina population also being largely disproportionately affected by HIV in those new diagnoses. And then with that, if we focus down into some of those specific populations, in 2024, forty two percent of new diagnoses were made up of Hispanic Latino men, that HispanicLatinoLatina population only makes up twenty three percent of the state population.

And I think that one of the interesting things, too, if you look over here on the right, is that that population represented half of new diagnoses amongst people aged 15 to 29. So those are some particular pieces of data that we need to pay attention to as we put together some of our services. And then the other group that we want to just highlight here are black African American women. Fifteen percent of new diagnoses in 2024 were black non Hispanic people. And then thirty two percent of those new diagnoses were women within that community, within that population.

And then when we go back to people living with HIV, half of the people living with HIV in Colorado are over age 50. So we've definitely seen an aging group of people in people living with HIV, which is a good thing, which is a great thing because we used to not see that earlier on. But, of course, that just brings up some new concerns and some new things that we need to respond to. And, again, just focusing on black African American women who have an HIV rating of 18 times that of white non Hispanic women in Colorado. So one of our main points of focus is viral suppression amongst people living with HIV.

And that's a big outcome that HRSA likes to see. And nationally, they are very proud of that viral suppression rate amongst jurisdictions that are support that have HIV or Ryan White funding. And so, yeah, within HRSA, the virus suppression rate is ninety percent of people that receive Ryan White services nationally are virally suppressed. When we look at Colorado and we just look at everybody living with HIV through the clinical data that we have, we have a sixty eight percent viral suppression rate. I don't think that that's horrible.

Obviously, it shows that there's some work that we need to do. And again, we're looking at that statewide. And then when we look at different populations and their viral suppression rates, it's really interesting to see that Spanish speaking individuals have the highest rate of viral suppression statewide. And Native AmericanAlaska Native identified individuals are seventy percent, and then people age 50 are seventy one percent. So it's just really interesting to look at this data and to see what populations are achieving higher rates of viral suppression.

So focusing back down to Ryan White, specific services and people that access those services. Between Ryan White Part A and Ryan White Part B services, and again, White Part B services are supported by CDPHE, we have about a little over 7,000 individuals who are accessing those services. And our viral suppression rate amongst people that are receiving Ryan White services is eighty percent. Now,

you

know, there's a lot of different things that go into play around that equation. And so, you know, if we look at people that are accessing medical care, that are actively accessing medical care, you're gonna see higher rates of viral suppression, more closer to ninety percent viral suppression rates. And then the top services that are accessed across both parts A and B are outpatient ambulatory health services, which is that direct medical care and support, medical case management, and then housing and emergency financial assistance. It's one of the things that I realize in this information we're not really touching on but income level poverty rates are pretty low for people living with HIV. And of course, housing costs in the Denver area and Colorado are really high and somewhat impossible for people with limited income capabilities.

That resource is really important and then other emergency financial assistance as well. So as I mentioned earlier, some of the elements that went into putting together the Cohas included a quality of life survey. So in the past, we've always just done this general needs assessment, like what services are you needed? But this time, we took a different approach just to talk to people about what what does your quality of life look like and what factors contribute to your quality of life, whether positively or negatively. So in collaboration with CDPHE, we did a survey that included three ninety five survey respondents.

48% of those respondents actually lived in Denver County. 92% of them lived in an urban county. So we're looking at that like Larimer all the way down to Pueblo as those urban counties in the urban corridor. 15% of individuals completed the survey in Spanish and the average age was 48. And through that survey, we found that 72% of respondents reported being satisfied or very satisfied with LifeNow as it stands.

And some of those factors that contributed to that were social and emotional support, overall health, education and employment opportunities, and substance use mental health support. Seventy nine percent of respondents reported that their general health was good or better. And again, a lot of the respondents were folks who actually access Ryan White supported services. But one of the standouts, and our community is really concerned about this as well, is the social and emotional support piece. Fifty four percent of the respondents reported always or usually having the social and emotional support that they need.

And 52% reported always or usually have someone in their life to listen to when they needed to talk. So those concerns around social isolation are big within our population. And I don't think it's unique just to people living with HIV. I think we just see in our society a lot of people experiencing social isolation. But I think that when we look at how important that social connection is to someone's overall health, I think these stats really stand out for us.

We also just wanted to highlight some of the information we got around housing. You can see over here on the left side that three in five respondents reported having housing concerns, so housing stability concerns. You can also see that broken down in different populations and community with Hispanic, Latina, Latina being the highest group that are struggling with housing stability. And then you can see on the right some of the factors that folks consider when they're talking about housing satisfaction with their housing or housing stability. But down at the bottom of that, you can see that income stability or lack of income is one of the big factors.

And then that sexual orientation or gender identity also comes into play around someone's housing stability, HIV status, and then a history of criminal justice involvement or incarceration also is a factor that impacts someone's housing stability. And then, of course, their stigma still exists around people living with HIV. So thirty seven percent of people reported experiencing stigma or discrimination in their own community and fifteen percent reported feeling stigmatized or discriminated against by a health care provider as well. Again, just focusing a little bit on our aging population, you can see that I think that one of the things as we all age that a lot of different health concerns start coming into play. And I don't think that that's different for folks living with HIV.

So I think that as people age, the additional health concerns that they experience is something that they're concerned about and just wanting some attention to. You can see some of the other concerns here on the right that people are experiencing experience as they age. And then also through this survey, looked at barriers to accessing care. And you can see here that one of the top concerns or barriers is insurance coverage or the cost of services. A lot of folks have concerns about that just in general.

And I think with some of the changes federally that are happening, particularly around Medicaid, it's really concerning to folks. Folks' health costs are going up already. And then with the change in the requirements around Medicaid that are coming later this year, I think we're going to see a lot of our folks that are going to be affected by that as well. I will say that the Ryan White funding that goes to CDPHE, that Part B funding, has a portion of it that's the AIDS drug assistance program that provides assistance to folks particularly around their medication costs if they need help around that and also around any insurance costs. So those like premiums or copay costs that folks might be struggling with there.

And I will say that our partners at CDPHE have done a great job of managing that funding and ensuring that folks that need it have access to it and are planning for some of these impacts that are happening currently with some of those federal decisions that increasing health care costs as well as changes in Medicaid. Also here we can see that transportation and the distance to getting to health care and services is a big bearing concern for folks. And of course, this is statewide data. You know, if you're looking at if you're living in Steamboat and you have to go to Grand Junction or Denver for services, I mean, that's that's quite, you know, that's quite a journey to get there. But, also, we see folks here in Denver having those same challenges.

So if you're living in Green Valley Ranch but you receive your care at Denver Health, that could be a two hour bus ride either way. So transportation can be one of those barriers that impacts motivation to even go to your health care appointments. And then you can see we have some notes on the right hand side about how different populations are responding or what some of their particular highlighted barriers might be. Again, black respondents are more challenged with transportation. And then, of course, our Hispanic Latina Latina respondents are concerned about immigration status, which is a big barrier for folks accessing services, and then women having those challenges around child care, dependent care.

So again, in all of our work, we're not providing direct prevention services. CDPHE does that. And so as part of all the data collection that we did around this, some of the themes that came up around prevention, I just want to mention here. So increasing PrEP access, that pre exposure prophylaxis access for folks who are vulnerable to acquisition of HIV. Also increasing provider education around post exposure prophylaxis.

A lot of providers just aren't knowledgeable enough to know when and how and what that means to prescribe that. Also, just increasing HIV testing access, more community based HIV testing, which is more accessible and comfortable for people than going into a clinic setting. And then also increasing resources for syringe access programs. So there are three main areas of the Colorado HIVAIDS strategy preventing HIV, so ensuring that prevention services and interventions are available to all Coloradans. There's also a focus on improving outcomes for people living with HIV, so ensuring care is available when and where people need it in order to thrive.

And then reducing disparities, so creating a Colorado where all people living with HIV and communities disproportionately impacted by HIV have access to care and services in their communities. The Cohast has 22 goals in it. So it's a very and it's and, again, just to clarify, this plan will cover the next five years starting in 2027. And so, yeah, we actively work through that plan in our partnership with CDPHE and our community, but there are a lot of things we need to do to respond to these areas. And the main themes as it's organized in the plan include reducing stigma, improving access to care and services, provide training and education to providers as well as to individuals who are living with or vulnerable to the acquisition of HIV, prioritizing peer services, expanding capacity, and then coordinating partnerships and efforts within the community.

So I also just want to relate some of this work back to DDPHE's strategic plan. And I won't go into all of it so specifically, but just here is an organization of what DEPHE's main themes in the strategic plan are and how this work around HIV fits into each one of them. I will talk about a little bit over here on the public health impact. So improving outcomes for people living with HIV also includes increasing that viral load suppression rate because, and I have u equals u here, that we know that people that are undetectable, also HIV is untransmissible. So if we're able to provide those services and support to people living with HIV, and help connect them to care.

They're able to access the medications they need. Know that we're also impacting new diagnoses of HIV as well. And then just to end, I wanted to share some highlights about our Part A funding. Part A funding or Ryan White funding is continuing for 2026. We'll see what 2027 looks like.

There's always points of conversation around different parts of Ryan White, so the minority AIDS initiative funding that I was mentioning is always one of those things that's on the chopping block to be cut. Part f funding, if you go back, if you remember that, that was for AIDS education training centers and some oral health funding that's always in the conversation to be cut. Last year, there was some conversation about part d funding being cut, which is for women, infants, children, and youth. And so there's always those conversations. You have the president's budget, you have the house budget, you have the senate budget, and they all have different pieces related to what could be reduced around HIV funding.

So we'll see what happens as we get into the budget discussion this year. I think one of the main concerns is on the state level around some of the CDC funding, particularly for HIV prevention that's already been threatened or reduced within this year. And there could be some reductions in that moving into the next year as well. And then the second point I want to talk about is our contracts. Again, we really appreciate you all supporting our program, getting those contracts out in the community so we can get these important services going for folks.

And we know you're always looking at our contracts. This year, you might see something a little different. You might see these large dollar amounts in these contracts as well as a five year term for these contracts. And that's because we're trying to move funding out more quickly. So we're doing these large dollar amounts in these and timelines in these contracts now so that we can do option letters moving forward, and we don't have to wait for amendments to get money in place and out the door.

And so that's why we're doing that now, and you'll be seeing some difference in those contracts. And then with our future funding in the next few years, we'll just work through option letters. Providers will get that money and start to provide those services a little bit more quickly. And then the last thing I'd offer to you all if you're interested is, you know, if you're interested in any of our providers to come and talk with you about what they're particularly doing at their agency and for their community, we'd love to coordinate that and set that up. I think there might be some interest from some of our providers to come and talk with you all and share with you what's happening with their programs and their communities.

So that's it. I made it through. Any questions for us? Absolutely.

We have questions. Thank you so much, Robert and Kelly. Lots of data, lots of information. And I can tell you as a openly queer man, this is good news, this report. There is a lot that needs to still be done.

Mhmm.

But this report provides great news for our community and the good work that you do and all the folks lined up there and the tens and hundreds of folks across the state that administers these funds as well as other funds, and we simply just are there for folks who are living with HIV. So thank you so much. And in the queue, we have council member Flynn and council member Sawyer and council member Perry.

Hey, mister chair. Yeah. Just to echo that, Robert, I feel like I'm swimming in a vast sea of

data. Sure.

And I love that and I like to try to synthesize it. So maybe you could help me understand how this is put to use. Age 50 seems to be a tipping point

Mhmm.

In approach or data collection. The new diagnoses, two point seven per hundred thousand population. Mhmm. I'm trying to square that with the later slide that said nearly half of of all people currently living with a with HIV are 50.

Mhmm.

So I guess that's good. That reflects that people living with AIDS or with HIV are who are 49 will be 50 in a year. Yeah. So that's part of it. But my underlying question, are you able to distribute the age data across a broader spectrum and see where are we seeing the most new diagnoses, what age cohort, and is there a tailored approach for each particular age cohort? Or is that just not possible because there are many, many different vectors, where people could contract a new diagnosis?

Yeah, there's definitely data that shows what new diagnoses look like across all the age groups, as well as folks who are more vulnerable to acquiring HIV. And so I think a lot of the prevention efforts are trying to focus in on making education services available for folks, HIV education services available to different age groups, as well as creating testing environments that are more comfortable for people to access and come in and talk to someone about their sexual health needs and get tested for HIV and other STIs. So, yeah, we're able to pull that out. I mean, we do have this focus on people aging with HIV because it's something we're also celebrating, that people are living longer and living healthier with HIV and and just making sure that our direct services are tailored specifically to those needs that population.

Just to interrupt for a second. Are you seeing that a higher a growing percentage of the whole are 50? It's nearly half now. Is that a growing percentage?

Or is

that what reflect

that people are living.

I think as people, you know, if younger people are gonna live longer in age with HIV. So, yeah, I think we might see that increase, you know, fifty percent.

How difficult is it to tailor prevention, education, and outreach depending on depending on an age cohort that may have different vectors?

Yeah. I think that's just something that we're working on and just making sure that we're getting community input around what works for people. You know, we have a value of just being respond responding to our community around any of their needs. So, like, yes, we're just trying to engage more of that community and helping us to formulate and tailor our services to to them. Them. Mhmm. Okay. Thanks. I hope that's answering your question.

Yes. Yes. We should have had I wish there were more answers,

but that Okay.

That's why

I don't know. I think UNMIT must have jumped on.

Itself has a lot of data around age. And so, again, in once that document is finalized, and we'd be happy to send you some of the specific sections about age. Yeah.

I appreciate that. Thank you. Thank you, Thank

you, Councilmember Sawyer and Councilmember Parody, and then Council President Pro Tem.

Awesome. Thank you. Thanks, you guys. Really appreciate this information and all the work that you do. I have a good friend who has been living with HIV for over twenty years now. And when he was first diagnosed, it was twenty years ago, and we weren't sure that he was still going to be here. So the extraordinary work that is being done on this front is making the difference. So really appreciate that. I want to ask about our viral suppression numbers because I feel like a lot of the prevention side is done at the state, we have no control over that. But the viral suppression side is our side.

So what are we hearing from our providers about why that average at 67%, 68% is like, significantly lower than the national average? Why are you smiling?

This is a good question. And there's there's a lot there's a lot of factors that go into that. So

And and there's a lot of there's a lot of opinions about how you should calculate viral load suppression. So

So this might be a data analysis issue and not a reality issue.

It is in part. I mean, it is still real if you form the question a certain way. Right? And and we know that in our rural communities, reaching the 90% viral load suppression rate is is much more difficult, and urban areas tend to have higher viral load suppression. We know clients who access Ryan White services are more likely to be virally suppressed than if they are not.

Our big clinics, so some of our biggest providers who are seeing people for medical care, they are at or above the 90% viral load suppression. And, again, we know if you're engaged medical care, you are more likely to be virally suppressed. For a client who is only engaged in, say, food bank services and is not receiving any medical care, our average is closer to that sixty eight percent. So it's really about how you ask the question. One of the big efforts of HRSA right now is focusing on reengagement in care.

So people who fall out of care, maybe they go get a lab, but they never actually see a medical provider. So one of our big pushes is to get people reengaged in care, and we are actively working on that as a program. The state is actively working on that and so are our providers because we all know that we can close the gap on that 10%, but there's so many variables about why people aren't engaged in care. And then, again, why Robert and I laughed is because depending on how you ask the question, you'll get a different number.

Got it. Okay. That's really good to know. I think that's really helpful because it is hard. You can't see that from the slide. So just getting that additional context, I think, is super helpful. In terms of the effort on reengagement that is upcoming,

what does that look like then? Yeah. So there's a lot of different approaches. Our program, along with the state, will be working together to look at clients who we can identify as having fallen out of care. Typically, we look at people who have fallen out of care in the past twelve months, so had a medical visit there.

And then for our providers, there's a lot of different approaches. Sometimes they're working with actual outreach teams, but many of them are working within a clinic, and they have someone who is combing through their patient caseloads and just finding people who have not been in care. And different sites have different capacity to do that. Right? And so one of our efforts is to be a support to them and expand capacity so that they can have more time or we can provide support in following up with clients and identifying clients.

If someone's moving out of state, let's move them off the list. We don't need to follow-up with them anymore. But if someone truly is lost to care in the state of Colorado, then we can pull in the connections we need to try to reengage them.

Okay. I really appreciate that. I think that's really interesting, and I think that there's an opportunity there. I will say Colorado Health Network is in my district, and they provide these services in District 5. They're awesome.

And they have, I think, more capacity than some of our providers, so we're lucky in that. But I think that there are if there's a way for us to ex I I don't know how the grant money comes in, right, like what the grant says specifically. So I don't know what options there are on the table in terms of providing that additional support, but I think whatever we can do for those smaller providers to expand that bandwidth would be really valuable. So really appreciate that. And then I will just say, terms of the contracts, I think it's so interesting that you brought up what you are doing differently in your contracts in order to get the money out the door faster.

And more specifically, this is one of the reasons why several council members and I are bringing forward a potential charter change to move to an optional two year budget for this exact reason. Because being able to budget for two years to get that money out the door faster to our community partners is really, really valuable. And this is, like, one of the first times that I have a specific example in front of me in committee that we're talking about that would actively make that better. So I just wanted to use you guys as an example.

Absolutely. We appreciate that.

Mhmm. Thanks. Council member. Council member Parity?

Yes. I'm so glad that we have this today. This is just such a it's really nice sometimes to get big updates on programmatic areas, especially because, like like you said, I don't know that we've had you all present your work specifically. So thank you. I zone in a little bit on the housing slide because that's such a perennial topic. And looking at that number that 63 of respondents are worried about their ability to pay for housing or utilities is just so stark. So that led me to be curious whether are we able to directly support housing for people? Okay. Tell me about that.

Yeah. So we're able to provide direct financial assistance to individuals around their rent. The funding is limited. We can't meet the full needs. There are

how much it is annually? I'm just curious.

Yeah. What is our

We provide 1,500 per client per fiscal fiscal year year for rent or deposit assistance. And

and and I think you're asking asking for what the total amount available is. So we have in order to meet that full need, like Ryan White part a, we can't do that alone. So we have a strong collaboration with our partners at CDPHE. And so we're putting out a little over 2,000,000 a year in direct financial assistance for housing services. Okay. That's interesting. I didn't In that collaboration between the two of us. Not all,

yeah, City money, but city and state money combined. Yeah. That's interesting and helpful to know. I I feel like I

With that individual limit of 1,500 that Kelly was mentioning. So that and and if you put that, like In context of may not even be a full month's rent for somebody. But that's what we can do. And when you total that up to $2,000,000 that's a lot of money, and our funding can't just go beyond that.

Right. So it's a lot of individual people getting a small amount of annual help, is what that amounts to. So another

direct housing program is the Housing Opportunities for People with AIDS funding that comes through HUD. Host is actually managing that right now, and we're doing a lot of work to collaborate with them. So that funding helps to support people with deposit assistance. It also provides some eviction prevention or eviction fund. Like, if someone's facing eviction, it will help them to catch up so they won't experience that eviction.

And it also provides some housing subsidies, and it operates similar to section eight. So there is that additional funding that we help we coordinate with Host around as well. And just to talk about on the federal budget, the president's budget completely takes that HOPWA funding out. Really? Okay. So there's

a threat there. So the HOPWA funding is through host, and is it specifically the population that it can go to? Is that exactly coextensive with Ryan the White population? Okay. So it's essentially your exact people. Mhmm. But then host is administering that funding. Mhmm. And you're administering the 1,500 per year funding. Right. Okay. Okay. And then how often do you all get asked or drawn into then advocating I don't know if this happens, but trying to help people access other pots of money for housing assistance since you're trying to meet people's supposed Yeah. So

we fund a very robust case management program within the service area. And those case managers are really smart around what other services are available. So they know that the services that we provide don't meet all the need. And so their understanding of what some of the other services and resources are in the areas, that's really critical. So we really work with our case management system just to make sure that they're knowledgeable about what those resources are

and engaging clients in those resources. That makes sense. And the case managers work where?

At our funded agencies. So I forget how many agencies have case management dollars, Claro Health Network.

Eight or nine agencies out of our 12 that are funded for management.

Okay. Great. I also the other I'm very interested in this, so I just will sort of put a flag up that thinking about housing that's sort of matched to specific populations that need housing is, I think, such a huge perennial problem. Like, we hear that from so many different service providers that, like, the people the population of people we serve have housing needs, and it would be effective and helpful for us to be able to more directly help them with their housing needs and pair that with the other needs that were meet. You know?

Like, that. I just hear that it doesn't matter what kind of, like, social services provider we're talking about. That's always sort of the issue. So I think that's just something that I'm grappling with and now have this sort of population group of people in mind too for that. So and then the other I wanted to ask about was that you had a slide talking a little bit about syringe access. How is that going in Denver? I know that DDPHE funds our three providers. Have they seen more access, less access? Anything you want to tell us about that, I guess.

Yeah. And when I mentioned that, that's on the prevention side of things, because we know that supporting syringaxas programs helps to reduce disease transmission. And so by offering those cleans and unused supplies for folks to be able to use. I think that, you know, funding is getting really tight for Syngexis services particularly. And so I think that that's, you know, one of the big challenges.

And even within DDPHE, you know, we've just had to work through our budgets to make sure that we're able to continue that support, as you're mentioning. And so we're doing it. We haven't seen any decreases in that funding level that the city is providing. I think those programs are really critical, not only just just syringe access services, but just being able to engage with folks that use substances or who are experiencing homelessness just to be able to get a sense of what they need beyond just rent access services and make those connections as well. So I think our programs are doing a lot of work, and they're ripping at the seams in a lot of ways.

But there's not been any major change in how they're operating recently.

When you say funding is tight, just am curious if that's an area where you've seen any loss of other funding sources, whether federal, state, private, or anything like that, or if we're just talking about our city budget being tight?

No. I think it's more broader in those other funding resources. Besides, yeah, we've been doing the best we can just to maintain what we've been able to provide. Do you

know specifically if those programs have lost other funds in the last little bit? We can check-in with them.

I just Yeah. Can't really answer that specifically. Okay.

All right. Thank you so much. Thanks, mister chair.

Thank you. Council member council president Pro Tem.

Thank you. Thank you. Thank you, committee chair. And thank you for the presentation. I think this was so interesting.

And just to get an update as to the coordinated services that are not only in Denver, but in the broader region. There was a slide where you had talked about the HIV trends and geography. And what really struck me was you said that the identification rate in Denver has increased and is exceeding the entire region. And so maybe you can you just talk a little bit more about, like, what does that what exactly does that mean? Like, is it is the rate increasing identification across the state and Denver just has the highest number of identified cases, or is that something that is just unique to Denver?

And do you have any other information behind the why?

You know, Denver's and the Denver Metro Area is gonna be more population dense than the rest of the state, obviously. And I think communities more affected by HIV exist within our Denver Metro Area. So you're gonna see just higher rates there. I don't think it's any unique issue of just Denver as it is any other metropolitan area, I would say. And so, yeah, we're just more population dense here, and so you're going to see a higher number of individuals being affected by HIV. Is that answering the question?

Yeah, a little bit. Was looking at it looks like a four year trend of increasing identification. And I was just wondering if there is the efforts to do for diagnosis. But is there an increase in awareness, or are we just having more people screened? It's on slide nine.

Yeah, Okay. I see that. Yeah. Yeah. Yeah. I'm not really sure some of the factors around that trend. Oh, there it is. Yeah. I'm not sure of the specific factors around that increase over the last four years. It could be that there's more access to testing. I know there's been a lot of efforts around that and community based testing. It could be just population shifts as well within the Denver area. Yeah, I don't have any definitive answers or information to answer that question. We can talk to our partners at CDPHE to see if they have something more definitive, and we can get that back to you too.

Yeah, that would be great. I think it's like with the trend going up, and I know we're a large city, my wondering is around, are you also thinking about the direction of dollars that go towards more preventative measures, or is it that we have more testing available? So it's just a wondering since it's been a year after year trend. I also was wondering about the next slide. It had had talked about communities of color, people of color who are disproportionately impacted and their quality.

And is that their quality of services, quality of life, is that also in consideration for in the grant process for the providers that are out there? Or do you have additional efforts that are addressing that need?

Yeah, absolutely. We make sure that we're looking at the data of people served and where some of those gaps are and just make sure that our providers are providing population specific and sensitive services to those that are disproportionately affected and who need additional support and services based on some of the barriers I was talking about later. The minority AIDS initiative portion of our funding is specifically to serve people of color. And so we just didn't make sure that the agencies that we fund with that, the MAI portion of our funding, are agencies that serve those communities specifically. And we just make sure that those services are responsive to those population needs.

Great. Thank you. Thank you, Mr. Chair. I don't have any other questions.

Thank you so much, President Quintem. Councilmember Parity?

Unless anyone else wants to get in before I get in. Okay. I remembered to ask about my favorite topic, which what are you all hearing or thinking about? Do you think any of your clients are gonna be affected by the changes to Medicaid? Yes. Okay. Tell us about that.

Well, we're just anticipating that a lot of folks with the six month updates that will need to happen, that folks won't be able to, like, keep up and manage that. I think, also, we're concerned about what the work requirements are gonna mean for people within our communities as well and being able to keep up with that. So we're just anticipating that those two factors in particular, I don't know if my team has other thoughts, but are some of our bigger And time then we're just preparing for that within our system just to make sure that our case managers are knowledgeable about that, paying attention to some of those challenges that clients may be facing, and making sure that they're addressing that and connecting them to the right services and helping them keep up with some

of those renewal requirements. So part of the reason I keep bringing this up just because it is a bit of a echo chamber of concern. We're all worried about anyone who serves people who are on Medicaid, which is a third of the city, is worried about this. And I know DHS is leading and thinking and meeting about it. Like, they're on top of it in a of ways.

But the piece that I keep worrying about a little bit is not so much on the side of Medicaid itself, like HCPF or even DHS, but on the side of the different types of people and organizations who have frequent touch points with folks on Medicaid and how if those organizations are getting supported to help with the paperwork. Because wherever it is that people have a regular case manager, which could be all kinds of places. Right? It could be in our shelter system for people experiencing homelessness. For people living with HIV and AIDS, it's probably case managers that you all are funding.

I just have this feeling that the swath of who those sort of case managers or points of contact are that need capacity, training, funding support, whatever it is to help people do the paperwork is so broad. And so I'm just you guys are gonna start laughing at some point because I'm saying this how many times have you all heard me say it at this point? Like, it's like where I I'm worried about it's like who's in charge? You know? Like, who who could sort of figure that out?

And then within the city, do we need to just think about is this something that we actually should be doing when we think about, like, funding and capacity? Not that, again, we have piles of money sitting around, but, like, I just wanna make sure that it seems like the people best positioned to help folks do the paperwork and meet the work requirements are empowered to do that. So I'll just put that flag down as well. Yeah, any thoughts, any alarms that need to be raised, I'm here for that.

Yeah. To that point, just the capacity of our providers to be able to meet that need, I think, is going be really challenging because the time it will take to do those applications and to help folks keep up with that and to address any other concerns around eligibility for Medicaid services, I think, is going be challenging. I think that just focusing on our communities, particularly in our collaboration with our partners at CDPHE, just making sure that we're as ready for that as possible and that there are other resources available for people, but that our system of service providers have the information knowledge and are preparing to be able to help folks is is one of our priorities as well. You know, we're and and a lot of our I will say that a lot of our folks touch on some of these other population groups that you're mentioning to. So hopefully, that impact will help some of those capacity concerns and with other communities.

If you all, at any point, ask your grantees, are you getting any outside support with helping with Medicaid paperwork in the future, or are you being told even where to send people for a problem? Like, if you ask them that question, I would love to know the answer. Okay. I'll put it that way.

Alright. Yeah. Thank you. Let me get back to you with that.

I don't know what I can do about it. But Yeah.

I mean, it's just important to be aware and to know what's

Yeah. And I think this is one of those things. I think the reason I'm feeling so obsessed with it is because it feels like this thing where, like, their need some kind of coordination has gotta happen or we're we're all gonna, you know, be just really much more impacted by this then. Because because people can fill out paperwork, people can meet the work requirements if they're empowered to do so. But if they're not specifically reached out to and helped with that, it's gonna go badly as everybody knows. So okay. Thank you. Sorry. Thank you, mister chair.

Oh, that's a very important topic, and it's gonna be a continuation. I mean, quite frankly, I mean, the intention of the changes, it's intentional. Exactly. It is not just happenstance that someone lost track that Yeah. In the end, these cuts and these changes are gonna harm communities who are just trying to survive. Yeah.

Which is exactly what they're meant to do. Thank you for

saying that. Numbers look higher as far as savings, but in the long term between quality of life and health, they're all gonna be impacted. So perfect questions being asked. Look around the room, see if there are any additional questions, and I have a few that I wanted to put out. Once again, thank you all so much for your work.

I I'll share, when I came out in '93, my first volunteer work that I did in Omaha, Nebraska was at the Franciscan Motherhouse. It's a space where folks went quite frankly to die with HIV and AIDS. And even with the growth of different medications at that time, folks still weren't the survival rates weren't where they are today, obviously. And to to hear you say thirty six years for Ryan White just kind of boggles your brain when you start thinking through the fear before even while Ryan White was being diagnosed and for the first time people were seeing someone that looked like them in their minds being impacted by this insidious disease that could have been prevented with direct action. But my question is specific on the infection of African American women.

Mhmm. It is seems to be from your data, it seems to in 2024, that data shows a trend of African American women outpacing, obviously, all women across the board. I'm curious if you or your teams or CDPHE or anyone has identified causation. I think this trend has been a much longer trend than just what the chart is showing and I'm just curious kind of what what you are seeing.

Yeah. You know, I I don't have specific solid information to share about that. I think that, you know, we can think about a lot of things that contribute to this, such as racism, stigma, poverty, a lot of those factors that contribute to this vulnerability. So, yeah, I think those are some of the things that just stand out to us specifically that we try

to

impact with people through our services. But, yeah, you know, I can't say that I have any solid information to share beyond just that.

Are there specific service providers that are leaning into that community? And I don't know if you want to call out names, but just for for curious as far as the steps that are taken specifically in target of that community.

Yeah. I mean, all of our service providers serve that community in some form or fashion. I do want to say that we have a really inclusive community. But we do support the Women's AIDS Project through the empowerment program. And so they have a specific focus on women.

And I think that their population is mostly women of color. And so, yeah, they're a great group of women that work there that really care about their community. And we're in contact with them a lot about their services and what they provide there. And, again and they're located in Denver, but we also provide funding to It Takes a Village, which is located in Aurora, and they serve, the broader metro area as well. And they have a focus on people of color.

And so those are two of the main agencies that I think have a particular emphasis on black and African American women. Just women and women of color in general, we also provide funding to Cervisos de la Raza, and they obviously have a focus on the Hispanic Latina community and provide those services to women of color as well. Am I missing something, Kelly?

No. I I think that's exactly right. All the organizations Robert mentioned also engage with women outside of HIV services. So they have other programming for women. And so sometimes women are entering our programs through another program within those agencies. And I'll say at the Ryan White conference, which is held every two years, and we go to the last two conferences, so two and then four years ago. It's been an increasing highlight how to engage these populations. And there are some leaders nationwide that are coming up with new innovative ways to engage this community.

Well, thank you so much. I I I'm gonna lean in with you all on that and try to see what so I can have a deeper understanding of, you know, the work that's being done. My other my final question is on the longevity. It's happiness, applaud, that is fantastic. Are there are we identifying health impacts of long term use of medications that we have?

Are we seeing I'm trying to see how to ask the question, are we seeing health impacts that we should be paying attention to because of the impacts to liver and other things for folks who are on these very potent medications? And I'm curious if any of that study is being done within your communities, or if not, who's doing that study?

Yeah, absolutely. I think, you know, the long term impacts of medication intake, creates other health concerns, impacts on livers. You're talking about heart disease, cardiovascular health. It has some impacts on that. And our medical providers are very well versed in the broader treatment of someone living with HIV and some of those other concerns and how to manage and help impact those.

And I don't know if anybody else on my team wants to talk about that. But yeah, there is that long term impact on taking medications. And I would say not only those physical impacts, but I think the mental emotional impact of taking medication long term starts to take its toll as well. There's a lot of advances in treatment. We do have injectable treatment that someone can get an injection, it lasts two months.

They don't have to take medication in that time. I think some of the research is happening and the advancements in that is moving towards a six month injectable, which will be great. So we're on the brink of one pill a week for folks. And I think that will really help to impact some of that mental emotional impact that long term medication intake has.

Well, Robert and Kelly, thank you so much and the entire team that stick stuck around and all the folks who are watching who weren't able to be here. Thanks for the work that you're doing, only with saving lives but providing hope and also really making sure that we have the studies to back up the long term health of our community. With that, we have one item on consent, and that has now been pulled off. The meeting is adjourned. Thanks, everyone. Thank you.