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.

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Good morning and welcome to the uh 429 Health and Safety Committee meeting.

My name is Daryl Watts, and 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 nine.

We have a very important briefing uh this morning.

Uh we're um being briefed on HIV H programming that our city provides.

But before we go into the presentation, why don't we start with introductions with council members in a room and we'll start on the right.

Sarah Purdy, I'm one of your council members at large.

Amanda Starrior district five.

Uh good morning, everyone.

Sadana Gonzalez Cochetas, your other council member at large.

And we have council members online.

Council member, Council President Pro Tem.

Uh 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, um, 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.

And then I'm Kelly Brevard.

I'm the program development administrator for the Ryan White Part A 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 um 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.

Um of the key things that's happening right now is that legislatively we're required to do an integrated um plan around um 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.

Um they also receive Ryan White funding, and I'll get into what that looks like here in a second.

Um 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 were 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 uh we we turn it in the end of June, and so it's still going through some like revisions and some approvals before it's finalized, but I could be glad to share that with you all.

Um so yeah, so the framework for this presentation is the Colorado HIV AIDS Strategy, um, which we fondly and lovingly call the COHAS.

Um, and again, it's a collaboration between us here at DDPG 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 uh Ryan White Part A funding.

Again, that's it's legislatively um organized, I would say, and mandated.

Um 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 that I talked to don't always know that Ryan White was a real person and who he was.

Um but yeah, so it was named after him.

Um yeah, it was enacted at a time when there were a few resources.

We were seeing a lot of deaths related to HIV, and um, so there was something that needed to be done to help to support people who were um being diagnosed with HIV at that time.

Um the legislation uh Denver actually has been receiving Ryan White funding since 1994.

We're in our 33rd year of funding, consecutive funding.

Um Ryan White.

And we receive um Ryan White Part A.

Um, and it serves um Part A funding is designated specifically for metropolitan areas.

So here in Denver, we're serving the sixth county metro area through our funding, which includes Denver, Broomfield, Adams, Douglas Rappo, and Jefferson counties.

We also get a portion of minority 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 Part B, Ryan White Part B funding is for states.

And so CDPHE receives that funding, and it can 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.4 million dollars in funding.

That was actually a 4.35% decrease in funding from the previous year.

We serve a little over 5,000 individuals.

We have 12, 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.

And the planning council is required to have 33% of the membership be made up of people with lived experienced 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 the decisions the planning council has made, these are the funded service categories that we provide.

And so, you know, I would highlight that we do provide direct medical care and oral health care, behavioral health services, and case management services is kind of those top priority area 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 the COHAS included a lot of just hard number data, epi data, and other service level data.

And then there was 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 limited experience, professional experience, state there was statewide representation, and folks that had focused on care and prevention services.

We 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 SDI 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 in the state.

And then also some of the community groups that are involved in this process were, of course, our planning council, the state uh CDPHE's alliance, which is their advisory group, um, the state drug assistance program committee, um, and then the Colorado HIV AIDS prevention program, which is state money specifically designated for HIV prevention services.

So now I'm just gonna 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 15,700 individuals living with HIV in the state.

Um 70% of the people living with HIV are in the Denver area, the six Denver 6 County area.

And in 2024, um, there were 487 new diagnoses of HIV in the state.

Um then this slide shows you that uh the trends around new diagnoses since 2018.

Um we've been in that 400 range um since then at 2020 was just a unique year, as you all know, and so that's why there is a dip there.

Um, and then you can see you know, the top counties over here on the right where new diagnoses are found.

So Denver, Adams Arapo in 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.

Um, and then the Hispanic, Latino, Latina 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, 40 in 2024, 42% of new diagnoses were made up of Hispanic Latino men.

Um and then which that pop, you know, Hispanic Latino Latina population only makes up 23% 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 age 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 uh we want to just highlight here are black African American women.

Um 15% of new diagnoses in 2024 were black, non-Hispanic people, and then um 32% of those new diagnoses were um women uh 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 you know, an aging group of people with 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 um black African American women who have an HIV 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 HERSA likes to see, and um nationally, they are very proud of that viral suppression rate amongst jurisdictions that are supported that have HIV or Ryan White funding.

Um, yeah, within at HARSA, the virus suppression rate is 90% 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 68% viral suppression rate.

Obviously, it doesn't, 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 American Alaska Native identified individuals are 70%, and then people age 50 plus or 71%.

So it's just really interesting to look at this data and to see who are 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 Wade Part A and Ryan White Part B services, and again, Ryan 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 80%.

Now, you know, there's a lot of different pieces things that go into play around that equation.

And so, you know, if we look at people that are actually seeing medical care that are actively accessing medical care, you're going to see higher rates of viral suppression, more closer to 90% 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 that in this information we're not really touching on, but you know, income level poverty rates are pretty low for people living with HIV.

And so, you know, of course, housing costs in the Denver area and Colorado are really high and somewhat impossible for people with limited income capability.

So that resource is really important in 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 is 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 395 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 life now 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.

79% of respondents reported that their health was their general health was good or better.

And I think and again, a lot of these the respondents were folks who actually access rainwhite supported services.

But one of the standouts, and our community is really concerned about this as well as that the social and emotional support piece.

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 this these stats really stand out for us.

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 are is a factor that impacts someone's housing stability.

And then of course, there's stigma still exists around people living with HIV.

So 37% of people reported being experiencing stigma or discrimination in their own community.

And 15% 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 is 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, like the additional health concerns that they experience is something that they're concerned about, and just wanting some attention to.

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 are increasing health care costs as well as changes in Medicaid.

Also here we can see that transportation is and the distance to getting to health care and services is a big barrier in concern for folks.

And of course, this is statewide data.

So, 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 a 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 yeah, transportation can be one of those barriers that impacts motivation to even go to your healthcare appointments.

Um 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.

Um again, um black respondents are in are more challenged with transportation.

Um then, of course, some of our Hispanic Latino-Latina respondents are concerned about immigration status, um, 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 are 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 HIV aid 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.

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 some of the main 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 and partnerships and efforts within the community.

So we also just want to relate some of this work back to DDPHE strategic plan.

And I won't go into all of it so specifically, but just here is an organization of what DPHE'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 that increasing that viral load suppression rate because I have U equals U here, so 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, then we know that we're also impacting new diagnoses of HIV as well.

And then just to end, I want to just share some highlights about our Part A funding.

Part A funding or funding is continuing for 2026.

We'll see what 2027 looks like.

There's always points of conversation around different parts of Ray 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 we 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 there's always those conversations.

You have the president's budget, you have the house budget, you have the setup 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 that 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, um, that's always already been threatened or reduced within this year, and um 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 um trying to move funding out more quickly.

So we're doing these large uh dollar amounts and 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.

Um, and so that's why we're doing that now, and you'll be seeing some difference in those contracts, and then um, 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 um 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.

Um I think there might be some interest in some from some of our providers to come and talk with you all and share with you what's happening um with their programs in their communities.

So that's it.

I made it through.

Any questions for us?

We have questions, so thank you so much, uh, Robert and Kelly.

Lots of data, lots of information, and I can tell you as an openly queer man, um, this is good news, this report.

There's a lot that needs to still be done.

Um, but uh 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 uh that administers these funds as well as other funds, and we simply just are there for folks that are living um with HIV.

So yeah.

Thank you so much.

And in the queue, we have uh councilmember Flynn and Councilmember Sawyer and Councilmember Perry.

Um, just to echo that, Robert, I feel like I'm swimming in a vast sea of data.

Sure.

I love that, and I like to try to synthesize it so maybe you can help me understand how this is put to use.

Uh age 50 plus seems to be a tipping point in approach or data collection.

Um the new diagnoses uh 2.7 per 100,000 population.

I'm trying to square that with the later slide that said uh nearly half of all people currently living with a with HIV are 50 plus.

So I guess that's good.

That reflects that people living with AIDS who are with uh HIV are who are 49 will be 50 in a year.

Yeah.

Um so that's part of it.

Uh but here my my underlying question are you able to uh 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 uh where people could contract uh 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 um acquiring HIV, and so yeah, I think a lot of the prevention efforts are trying to focus in on making um education services available for folks, HIV education services available to different um age groups as well as creating testing environments that are more comfortable for people to access and um come in and talk to someone about some their sexual health needs and get tested for HIV and other STI.

So, yeah, we're able to pull that out.

As I 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 um and just making sure that our direct services are tailored specifically to those needs that population.

Just to direct for a certain are you seeing that a higher a growing percentage of the whole uh R50 plus, it's nearly half now.

Is that a growing percentage?

Because that would reflect that people are living.

I think as people, you know, if yeah, younger people are gonna live longer and age with HIV.

So yeah, I think we might see that increase beyond 50%.

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.

Um, 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 deform it and tailor our services to them.

I hope that's answering your question.

Yes, yes, we should have had I wish there were more answers, but I know and the UNMIT message.

And so again, in uh once that document is finalized, and um, we'd be happy to send you some of the specific sections about age.

Yeah, I appreciate that.

Thank you.

Thank you, Councilmember Councilmember Sawyer and Councilmember Parity, and then uh council president Prote.

Awesome.

Thank you.

Thanks, you guys.

Um, really appreciate this information and all the work that you do.

Um, I have a good friend who has been living with HIV for over 20 years now, and when he was first diagnosed, um, you know, we it was 20 years ago and we weren't sure that he was still gonna be here.

So the extraordinary work um that is being done on this front is is making the difference.

So yeah.

Really appreciate that.

Um I want to ask about our viral suppression numbers.

So because I feel like a lot of the prevention side is done at the state, and we have no control over that, but the viral suppression side is uh like our side.

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

This is a good question.

And there's a lot, there's a lot of factors that go into that.

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

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.

Um big clinics, so um, 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 in 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 68%.

So it's really about how you ask the question.

Um of the big efforts of HERSA right now is focusing on re-engagement in care.

So people who fall out of care, maybe they go get a lab, but they never actually see a medical provider.

Um so one of our big pushes is to get people uh re-engaged 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 it is hard, it you can't see that from the slide, right?

So just sort of getting that additional context, I think is super helpful.

Um, in terms of the effort on re-engagement that is upcoming, what does that look like then?

Yeah, so there's a lot of different um approaches.

Uh, 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 um in the past 12 months who kind of had a medical visit there.

Um and then for our providers, there's a lot of different approaches.

Sometimes they're working with um actual outreach teams, but many of them are working within a clinic and they have someone who is combing through their um 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 um 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 re-engage them.

Okay.

I really appreciate that.

I think that's um really interesting.

And um, 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 five.

Um, they're awesome.

And they have, I think um more capacity than some of our providers, so we're lucky in that, right?

But um I think that there are, you know, 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 kind of smaller providers to expand that bandwidth would be really valuable.

Yeah.

Um so really appreciate that.

And then I will just say in terms of the contracts, um, I think it's so interesting that you brought up the um 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 um several council members and I are bringing forward um a potential charter change to move to an optional two-year budget for this exact reason.

Nice 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.

Council member, council member parody.

Yes, um, I'm so glad that we had this today.

That this is just such a it's really nice sometimes to get big updates um 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.

Um I zoned in a little bit on the housing slide um because that's such a perennial topic, and looking at that number that you know, 63% of respondents are worried about their ability to pay for housing or utilities is just so stark.

Um, so that led me to be curious whether are we able to directly support housing for people?

Okay, tell me about that.

Yeah, so uh we're able to provide direct financial assistance to individuals around their rent.

Um the funding is limited.

Um we can't meet the full needs, so there are how much it is annually.

I'm just curious.

Uh yeah, what is there?

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

And and and I think you're asking asking for what the total amount available is.

So we have to in order to meet that full need, like Ryan Part Inc.

We can't do that alone.

So we have a strong collaboration with our partners at C DPHE.

And so we're putting out a little over two million a year um in direct financial assistance for housing services.

Okay, that's interesting.

I didn't I didn't think in that collaboration between the two of us.

Yeah.

Um 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 like a full month's right for somebody, right?

So that's but that's what we can do.

And when you total that up to two million, that's that's a lot of money, and our funding just doesn't can't go beyond that.

Right.

So it's a lot of individual people getting like a small amount of annual help, right?

Yeah, is what that amounts to.

So another um direct housing program is the housing opportunities for people with needs funding that comes through HUD.

Host is actually managing that right now, and we're doing a lot of work to collaborate with them.

Um so that funding helps to support people with um deposit assistance.

It also provides um 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.

Um so there is that additional funding that we help um we coordinate with host around as well.

Um just to talk about on the federal budget, the president's budget completely um takes that Hopw funding out.

So there's a threat there.

Um so the HOPO funding is through host, and is it specifically the population that it can go to?

Is that exactly coextensive with the Ryan White population?

Okay.

So it's essentially your exact people.

But then host is administering that funding and you're administering the 1500 per year.

For Ryan White.

Okay.

Okay.

And then how often do you all get asked or drawn into then like advocating or 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 sort of make people host.

Yeah, so you know, we'll we fund a very robust case management program within the service area, and those case managers really smart around what other services are available.

So you know, they know that like the right the services that we provide don't meet all the need, and so you know, 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 um 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, clerical health network.

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

Okay.

Um great.

I also the other I'm very interested in this, so I just will sort of put a flag up that like um thinking about uh housing that's sort of matched to specific populations that need housing is I think such a like huge perennial problem.

Like we hear that from so many different service providers that like the people of the population people we serve have housing needs, and um 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 we're meeting, 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.

Um, so I think that's just something that I'm grappling with, and um now have this sort of population group of people in mind too for that.

So um, and then the other thing I wanted to kind of ask about was um that you had a slide talking a little bit about syringe access.

Um how is that going in Denver?

Like um, I know the DDPHE funds our three providers.

Um they seen you know, more access anything you want to tell us about that, I guess.

Yeah, and you know, that when I mentioned that that's um on the prevention side of things, because we know that supporting syringe access programs helps to reduce disease transmission, and so by offering those cleans and unused supplies for folks to be able to use.

Um I think that you know funding is getting really tight um for syringe access 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 um work through our budgets to make sure that we're able to continue that support as you're mentioning, and so um, you know, we're we're doing it.

It's you know, we haven't seen any decreases in that funding level that the city is providing.

I think you know, our our those programs are really critical, not only just for um 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 um get a sense of what they need beyond just syringe access services and make those connections as well.

So, you know, I think our programs are doing a lot of work and they're uh you know, ripping at the seams in a lot of ways, but um I there's not been any major change in how they're operating recently.

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

Oh no, I think it's more broader, I think it's more broader in those uh other funding resources, but 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 like lost other funds in the last little bit we can check in with them?

But I just yeah, I can't really answer that specifically.

Okay.

All right, thank you so much.

Thanks, Mr.

Chair.

Thank you.

Uh, council member council president pro temp thank you.

Um thank you.

Uh thank you, committee chair.

Um and thank you for the presentation.

I think this was uh so interesting, and just to get an update as to um the coordinated services um that are not only in Denver but you know in the broader region.

Um there was a slide where you had talked about the HIV trends and geography.

Um and what really struck me was um you said that the identification rate in Denver has increased and is exceeding the entire region.

Um 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?

But 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, you know, exist within our Denver metro area, so you're gonna see um just higher rates there.

I don't think it's uh unique 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 gonna see a higher number of individuals um being affected by HIV.

Is that answering the question?

Um Yeah, a little bit.

I was looking, it looks like a four-year trend of increasing identification, and I was just wondering if there is you know, the efforts to do um, you know, uh for diagnosis, but is there an increase in awareness or are we just having more people screened?

I I it's on um slide nine.

Yeah, okay.

I yeah.

Yeah.

Um yeah, I'm not really sure um some of the factors around that trend.

Oh, there it is, yeah.

I'm not sure the specific factors around that increase over the last four years.

Um it could be you know that there's more access to testing.

I know there's been a lot of efforts around that and community-based testing.

Um, it could be just population shifts as well within the Denver area.

Um, yeah, I don't have you know 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.

Yeah, that would be great.

I think it's like with the trend going up, and I know we're a large city.

Um, my wondering is around um, are you also thinking about you know the direction of dollars that go towards um more preventative measures, or is it that we're have more testing available?

So it's it's just a wondering since it's been um a year after year trend.

Uh I also was wondering about um the next slide.

It had um you had talked about you know 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 um in the grant process for the providers that are out there, or do you have additional um efforts that are addressing that need?

Yeah, absolutely.

I just we make sure that you know, we're looking at the data of of people served and where some of those gaps are, and just make sure that our providers are providing um 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.

Um 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 um the those communities specifically, and we just make sure that those services are responsive to those population needs.

Great.

Um thank you.

Thank you, Mr.

Chair.

I don't have any other questions.

Uh thank you so much, President.

Uh councilman repair.

Unless anyone else wants to get in before I get in.

Okay.

Um I remembered to ask about my favorite topic, which is what are you all hearing or thinking about?

Uh, do you do you think any of your clients are gonna be affected by the changes to Medicaid?

Yes.

Okay, tell us about that.

Well, you know, we're just anticipating that a lot of folks with that um the six-month um updates that will need to happen that folks won't be able to like keep up and manage that.

I think um 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 that are are some of our bigger concerns.

Um, and then you know, we're just preparing for that, you know, and within our um system just to make sure that like 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 um renewal requirements.

So um part of the reason I keep bringing this up just because it is a bit of a like echo chain of concern.

Like we're all worried about, you know, anyone who um serves people who are on Medicaid, which is a third of the city is worried about this.

Um and I know DHS is uh leading and thinking and meeting about it, like they're on top of it in a lot of ways.

But the piece that I keep worrying about a little bit is um not so much on the side of like sort of Medicaid itself, like HICPUF or um or even DHS, but on the side of uh 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?

Uh 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 um the swath of who those sort of case managers or points of contact are that need um 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 you how many times have you already 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 could sort of figure that out.

And then within the city, um, do we need to just think about is it something that we actually should be doing when you think about like funding a capacity, not that again we have piles of money sitting around, but like I just want to make sure that it seems like um 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.

And um, yeah, any thoughts, any uh alarms that need to be raised, uh, I'm here for that.

Yeah, I you know, I to that point just the capacity of our providers to be able to meet that need, I think it's gonna be really challenging because the time it's gonna take to do those applications and to help folks keep up with that um and to address any other concerns around you know eligibility for Medicaid services, I think it's gonna be challenging.

You know, I think that just you know, focusing on our communities particularly and our collaboration with our partners at CDPGE, just making sure that we're as ready for that as possible, and that there are other resources available for people, but that you know, 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.

So, you know, we're and and a lot of our folks I will say that a lot of our folks touch on some of these other population groups that you're mentioning too.

So hopefully that impact will help some of those capacity concerns and with other communities.

But if you all at any point ask your grantees, um, are you getting any outside uh support with helping with Medicaid paperwork in the future, or are you being told even where to send people from problems?

Like if you ask them that question, I would love to know the answer.

Okay.

I'll put it that way.

All right, yeah.

Thank you.

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 there need that there's some kind of coordination has got to happen, or where we're all gonna, you know, be just really much more impacted by this than 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, Mr.

Chair.

Uh that's a very important topic, and it's gonna be a continuation.

I mean, quite frankly, I mean the intention of the changes.

Um, it's intentional.

Um it is not just happenstance that someone um lost track that um yeah in the end um 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, um, but in the long term, um, between uh quality of life and health, um, they're all gonna be impacted.

So perfect uh questions being asked.

Um look around the room to see if there are any additional questions, and I have a few that I wanted to um to put out.

Once again, thank you all so much um for your work.

Uh I I uh I'll share when I came out in 93.

My first um volunteer uh work that I did in um in Omaha, Nebraska was at the Franciscan motherhouse.

It's uh space where folks went quite frankly to die with HIV and AIDS, and even with the growth of um different um medications at that time, folks still weren't um the survival rates weren't um what they are today, obviously.

And to to hear you say 36 years for Ryan White, just kind of boggled your brain when you start thinking through the year before even while Ryan White was being diagnosed, and for the first time people were seeing someone that looked like them in airlines um being um impacted by this insidious disease that could have been prevented with direct action, but my question is uh specific on the infection of African American women.

It is seems to be um from your data, seems to in 2024 um uh 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 um 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 um that contribute to this, such as racism, stigma, um, poverty, a lot of those factors that contribute to this vulnerability.

So yeah, I think those are some of the things that you know just stand out to us specifically that we try to impact um with people through our services.

But yeah, um, 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?

Um and I don't know if you want to call out names, but just for curious as far as the steps that are taken um specifically and target of um that community.

Yeah, I mean, all of our service providers serve that community in some form or fashion.

And I I do want to say that we have you know a really inclusive community, but we do um support the women's AIDS project through the empowerment program, and so they have a specific focus on women, and I think that their uh their population is mostly women of color.

Um so yeah, they have they um they're a great group of women that work there that really care about their community, and so yeah, we and we're in contact with them a lot about their services and what they provide there.

Um and it again, uh and they're located in Denver, but um we also provide funding to it takes a village, which is located in Aurora, and they serve you know the broader metro area as well, and they have a focus on people of color, and so um, yeah, those are um two of the main agencies that I think have a particular emphasis on black and African American women.

Um we also provide, you know, and just out just women and women of color in general.

We also um provide funding to Servicios de la Raza, and they obviously um have a focus on the Hispanic Latino, 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.

Um all the organizations Robert mentioned also engage with women outside of HID services.

So they have other programming for women, and so sometimes women are entering our programs through another program within those agencies.

Um I'll say at the Ryan White conference, which um is held every two years, and we go to the last uh two conferences, so two and then four years ago, it's been an increasing highlight um how to engage these populations.

And there are some leaders nationwide that are um coming up with new innovative ways to engage this community.

Well, thank you so much.

I I I'm gonna lean in with y'all on that and try to see what um um 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 applauded, that is fantastic.

Um are there are we uh identifying health impacts of long-term use of uh medications and we have are we seeing um 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 your 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 meditation, medication intake, you know, creates other health concerns, yeah.

Impacts on livers or talking about heart disease, cardiovascular health, um it has some impacts on that.

And I our health our medical providers are very um well versed in uh the larger, you know, the broader treatment of someone living with HIV and some of those other concerns and and how to manage and help impact those.

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 injection injectable treatment that can, you know, someone can get an injection, it lasts two months.

They don't have to take medication in that time.

Um, I think some of them 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'll really help to impact some of that like mental emotional impact that long-term medication intake has.

Well, Robert and Kelly, thank you so much, and the entire team that stay stuck around and all the folks who are watching who weren't able to be here.

Thanks for the work that you're doing, not 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.

Um, with that, we have one item on consent, and that has not been pulled off.

The meeting's adjourned.

Thanks, everyone.

Thank you.