Denver Department of Public Health and Environment:
Dr. Karen Wendel,Director
HIV/STD Prevention and Control, Denver Public Health
Dr. Sarah Rowan, Associate Director
HIV and Viral Hepatitis Prevention, Denver Public Health
Dr. Edward Gardner, Medical Director of the Infectious Disease Clinic and the Center for Positive Health
Denver Public Health
Denver’s Commitment to Ending AIDS by 2030
Deputy Mayor and Chief Financial Officer Cary Kennedy signed the FTCI Initiative on August 15, 2015 to help achieve 90-90-90 targets and zero discrimination and stigma. By signing the FTCI Initiative, Denver became the fourth city in North America to join the fight to end AIDS by 2030. Denver Health and Denver Public Health help achieve these goals by providing treatment and prevention services, as well as referrals to testing centers and other resources.
Snapshot of Programs and Best Practices
Metro Denver counties are served by state and locally-supported HIV and STI testing. Local public health officials test for HIV, syphilis, gonorrhea, and chlamydia at regular outreach testing sites and coordinate collection of urine specimens for gonorrhea and chlamydia testing from additional community partners. The Denver Metro Health Clinic serves as the primary STD clinic for the five county area. Outreach testing services also include assessment of health insurance, substance abuse and mental health needs, with subsequent referrals. PrEP linkage referrals are also offered through outreach testing. Metro Denver is a site for the CDC-funded National HIV Behavioral Surveillance program, enabling collection of invaluable data about risk behaviors and awareness of HIV and HCV infection.
Denver Public Health has a well-established linkage to care program funded primarily through the Ryan White Care Act. This program links individuals who are newly HIV-diagnosed, re-engaging in care, or new to the area to insurance enrollment services and HIV care providers. The linkage staff are initial counselors for newly HIV-diagnosed individuals, providing support in an effective and standardized manner during that critical period.
Colorado expanded access to health insurance through the Affordable Care Act. This allowed for expansion of services offered through the AIDS Drug Assistance Program. New services included expanded access to copay assistance, a critical events system, and coverage of HCV medications for coinfected individuals, along with provisions for additional services.
Clinical services throughout the metro area benefit from academic affiliations as well as an AIDS Education Training Center and an STD Prevention Training Center. A new level of clinical collaboration will be undertaken in the coming months in the form of a Data to Care program that utilizes engagement data from the HIV BI Tool and retention services expertise from the state and local health department to extend retention services to all patients in Metro Denver. To further support persons living with HIV, case managers from local community-based organizations are now embedded in medical clinics.
Pre-exposure prophylaxis services have grown exponentially in Denver necessitating a coordinated approach at Denver Public Health. This approach has included formation of a PrEP work group, development of outreach and linkage to care PrEP materials and workflow, creation of local clinical and financial protocols that are available online to Denver Health providers, delivery of primary care educational sessions at Denver Health, and maintenance of list of PrEP providers.
Denver Public Health participates in the Denver Pride Festival and AIDS Walk Colorado. The Deputy Mayor publically signed the Paris Declaration committing Denver to the goals of the Fast Track Cities initiative at the kickoff of the 2015 AIDS Walk. Efforts are made to participate in many local festivals and events. This year Denver Public Health is looking to increase its presence at Latino-sponsored or focused events.
Reports or plans
The creation of a coalition to end the AIDS epidemic in Metro Denver is in the planning phase. The coalition will be guided by the principals of collective impact. Critical to the formation of the coalition will be a newly created HIV report that utilizes some of the metrics presented here with a focus on county-level data with leading and lagging metrics. The aim for the coalition will be quarterly meetings and measurable progress.
Dr. William Burman
Interim CEO of Denver Health and Hospital Authority, Former Director of Denver Public Health
"I think it's the experience of having worked in [HIV and AIDS care] for a long time, and having developed the people part and the information part. That makes us feel we can both do the things that need to be done to end AIDS as well as measure it. Measurement is really critical in helping us all understand where we are, where we need to improve and how to do that."
"In 1992, when I started in this field, no I don't think we could conceive of this day. At that time, we didn't have effective therapy. We had a couple of medicines that weren't that effective and didn't last very long. And we were mostly treating complications. So the idea that we could both completely control the virus and have this kind of reduction in new infections, really seemed impossibly far off [back then]."
"HIV, if undetected, can be asymptomatic for years. So a person can, without their knowledge, potentially expose others. That's the power of diagnosis and treatment -- to take a person who may have had an infectious disease for a long period of time and make them non-infectious."
Community Leadership Messages
“While there have been great advancements in the medical realm, we haven’t made nearly as much progress in dealing with the social aspects of living with HIV. Stigma, lack of housing, being under or un-insured, income inequity, and discrimination leave many fighting to survive rather than being focused on their health (and rightfully so). My hope is that together, medical professionals, program managers, case workers, community members, and people living with HIV, can change the tide. It is up to us to be innovative, compassionate, and share the expertise we each have in order to break down barriers and achieve our goals for treatment, care and prevention while improving the overall quality of life for people living with HIV.”
"We can decrease the number of new HIV cases, put an end to HIV-related stigma, and eliminate the barriers to care that people living with HIV face, but we can only do so together."
"It has been difficult hearing ongoing ignorant and stigmatizing comments, but I have grown a thicker skin and educate offline when possible. I have great hopes that we will be successful modernizing our STI statutes to reflect scientific advances and support public health partnerships as well [as] repealing laws that target people living with HIV."
"Being involved in the battle to change current laws that specifically target people living with knowledge of HIV in Colorado has been a real labor of love. I have loved partnering with our elected officials and champions, the state and local health department, ASOs [AIDS Services Organizations], and especially the community of people living with HIV — and those who ally to join in the struggle."
"Treatment for HIV can suppress one’s viral load, greatly decreasing the chances of transmission especially when combined with other protective methods, like condoms. For some, sharing their HIV diagnosis can be hard. It is crucial we come together to end stigma surrounding HIV, both for those living with HIV, and for those who are not. Opening the doors of communication allows people to freely talk about their status with partners, get tested, and begin treatment if necessary."
"No matter who you are, it can and will affect you. But you can also have a positive effect on those around you. And I have shown people that you can live with HIV and still make a positive change in the world doing so. We live, breathe, cry, laugh, run and dance as well as the next but it just happens that we get to put a symbol next to our names, and that symbol is a positive one."
"My choice to work primarily with adolescents and young adults speaks to what I’m most passionate about – identifying young people early, giving them care and changing their individual lives to allow them to live with a chronic illness, and thrive as adults."
“We share a common goal – for people to get the care they need, at a price they can afford, and take charge of their HIV infection now and in the future. The Affordable Care Act is opening new opportunities for coverage. We expect that very few people with HIV or AIDS will remain uninsured after it is fully implemented.”
"We shouldn’t have this fear around HIV anymore – we shouldn’t have a fear around getting tested, or talking about it with sexual partners, family and friends. There’s still a stigma our community has about HIV/AIDS, and if there’s stigma you’re less likely to talk about it and less likely to get tested."
"The pioneering spirit of Denver has always been and continues to be an inspirational and progressive means of ending AIDS around the world. From the Denver Principles in 1983, to the Gardner Cascade in 2012, to signing on as a Fast Track City in 2015, Denver has been a leading influence on global HIV/AIDS eradication. This is possible for all cities and all nations with the perseverance of their community partnerships, foresight of their professional caregivers, and the meaningful efforts of dedicated volunteers. As Denver is situated at the base of the Rocky Mountains, I am constantly reminded that the sun only sets behind something larger than we as a community are."
"When I started, the saying was kinda, ‘you die with AIDS,’ now it’s ‘you with AIDS.’ There was a stigma everywhere about a person with AIDS, people thinking you got it from a toilet seat or shaking hands – that’s pretty much gone away. It’s a big improvement, but we need to keep working."
“We have been beneficial in addressing some of those misconceptions but I think overall hopefully we’re getting some message out [so] people will get tested and know their HIV status. More importantly though, is to practice safe sexual activities.”
“The understanding of the immune system has been greatly enhanced by research into HIV, which targets specific white blood cells. In fact, the whole field of immunology has greatly benefited. Medications to fight HIV have been models for development of medications for other diseases, such as protease inhibitors for Hepatitis C. Fifteen years ago, protease inhibitors were developed for HIV.”
“Public worry about HIV and AIDS has diminished as the disease is seen as more manageable with new therapies. But we’re still seeing some 400 new cases each year; that has not changed a whole lot.”