An Analysis of CDC HIV Prevention Funding by State AIDS... · 2009 National HIV Prevention...
Transcript of An Analysis of CDC HIV Prevention Funding by State AIDS... · 2009 National HIV Prevention...
The AIDS Institute 1
An Analysis of CDC HIV Prevention Funding by State
Carl SchmidJessica Ladd
2009 National HIV Prevention ConferenceAtlanta, GA
August 26, 2009
The AIDS Institute 2
Purpose
• Analyze how CDC HIV prevention funding (FY2007) is distributed to states, territories, and DC.
• Analyze if this distribution correlates with demographic information such as:
– Population (2007 Census Data)
– Living AIDS Cases (2007 from CDC Surveillance Report)
– Living HIV/AIDS Cases (2007 from CDC Surveillance Report)
– New HIV Diagnoses (2007 from CDC Surveillance Report)
– Living AIDS Rate and Population
The AIDS Institute 3
CDC FY 2007 HIV/AIDS Prevention Funding
• HIV Prevention Cooperative Agreements (56%)
• HIV/AIDS Surveillance Cooperative Agreements (13%)
• Community-Based Organization (CBO) and Capacity Building Assistance (CBA) Providers (15%)
• Division of Adolescent and School Health (DASH) (3%)
• Miscellaneous Funding (6%)
• Expanded HIV Testing in African American Communities (7%)
• Total: $530 million
The AIDS Institute 4
Map of CDC Prevention Funding Distribution
Source: Kaiser Family Foundation’s http://www.statehealthfacts.org, data provided by National Alliance of State and Territorial AIDS Directors
(NASTAD)
The AIDS Institute 5
The AIDS Institute 6
Funding per Capita
The AIDS Institute 7
The AIDS Institute 8
2007 Funding per Capita
Rank State $/Capita
1 District of Columbia $34.42
2 Virgin Islands $15.34
3 New York $4.20
4 Guam $3.90
5 Maryland $3.50
6 Alaska $3.00
7 Delaware $2.95
8 Vermont $2.85
9 New Jersey $2.77
10 Rhode Island $2.67
11 Connecticut $2.48
12 Louisiana $2.47
13 Massachusetts $2.46
14 Wyoming $2.43
15 Hawaii $2.20
16 Florida $2.03
17 Montana $2.00
18 Puerto Rico $1.92
19 South Carolina $1.90
20 California $1.78
21 Colorado $1.77
United States $1.7322 Mississippi $1.65
23 Maine $1.63
24 Georgia $1.62
25 North Dakota $1.52
26 Nevada $1.50
27 Illinois $1.47
Rank State $/Capita
28 New Hampshire $1.46
29 Pennsylvania $1.46
30 New Mexico $1.43
31 Texas $1.36
32 South Dakota $1.18
33 West Virginia $1.17
34 Oregon $1.16
35 Michigan $1.15
36 Tennessee $1.12
37 Missouri $1.09
38 Virginia $1.05
39 North Carolina $1.03
40 Washington $1.01
41 Arizona $0.96
42 Oklahoma $0.94
43 Minnesota $0.90
44 Nebraska $0.88
45 Arkansas $0.83
46 Alabama $0.83
47 Wisconsin $0.80
48 Idaho $0.79
49 Kansas $0.71
50 Iowa $0.69
51 Kentucky $0.66
52 Ohio $0.65
53 Indiana $0.63
54 Utah $0.47
The AIDS Institute 9
2007 Funding per Capita
Top 10 States Bottom 10 States
Average: $1.73
Rank State $/Capita
1 District of Columbia $34.42
2 Virgin Islands $15.34
3 New York $4.20
4 Guam $3.90
5 Maryland $3.50
6 Alaska $3.00
7 Delaware $2.95
8 Vermont $2.85
9 New Jersey $2.77
10 Rhode Island $2.67
Rank State $/Capita
54 Utah $0.47
53 Indiana $0.63
52 Ohio $0.65
51 Kentucky $0.66
50 Iowa $0.69
49 Kansas $0.71
48 Idaho $0.79
47 Wisconsin $0.80
46 Alabama $0.83
45 Arkansas $0.83
The AIDS Institute 10
2007 Funding per Capita
The AIDS Institute 11
Regional Funding per Capita
• Northeast: $2.86
• U.S. Average: $1.73
• South: $1.72
• West: $1.54
• Midwest: $0.98
The AIDS Institute 12
Funding per PLWA
The AIDS Institute 13
The AIDS Institute 14
The AIDS Institute 15
2007 Funding per Estimated Persons Living with AIDS
Rank State $/PLWA
1 Guam $19,311
2 North Dakota $12,147
3 Wyoming $11,992
4 Montana $9,334
5 Vermont $7,398
6 South Dakota $6,369
7 Alaska $5,969
8 Virgin Islands $5,026
9 Maine $3,987
10 Idaho $3,720
11 New Hampshire $3,271
12 West Virginia $2,711
13 District of Columbia $2,277
14 Iowa $2,256
15 Hawaii $2,145
16 New Mexico $2,104
17 Rhode Island $2,094
18 Colorado $2,010
19 Wisconsin $1,945
20 Minnesota $1,912
21 Nebraska $1,871
22 Massachusetts $1,731
23 Michigan $1,635
24 Oklahoma $1,488
25 Oregon $1,470
26 Mississippi $1,445
27 Kansas $1,425
28 Delaware $1,386
Rank State $/PLWA
29 New Jersey $1,361
30 Nevada $1,280
31 Maryland $1,255
32 Connecticut $1,255
33 Louisiana $1,247
34 Arizona $1,190
35 Washington $1,156
United States $1,13336 South Carolina $1,117
37 Missouri $1,114
38 Illinois $1,103
39 New York $1,078
40 Utah $1,035
41 Arkansas $1,027
42 North Carolina $1,018
43 Ohio $1,011
44 Tennessee $1,007
45 Indiana $998
46 California $994
47 Kentucky $989
48 Alabama $947
49 Pennsylvania $944
50 Texas $933
51 Virginia $917
52 Georgia $860
53 Florida $772
54 Puerto Rico $659
The AIDS Institute 16
2007 Funding per Estimated Persons Living with AIDS
Top 10 States Bottom 10 States
Average: $1,133
Rank State $/PLWA
1 Guam $19,311
2 North Dakota $12,147
3 Wyoming $11,992
4 Montana $9,334
5 Vermont $7,398
6 South Dakota $6,369
7 Alaska $5,969
8 Virgin Islands $5,026
9 Maine $3,987
10 Idaho $3,720
Rank State $/PLWA
54 Puerto Rico $659
53 Florida $772
52 Georgia $860
51 Virginia $917
50 Texas $933
49 Pennsylvania $944
48 Alabama $947
47 Kentucky $989
46 California $994
45 Indiana $998
The AIDS Institute 17
2007 Funding per Estimated Persons Living with AIDS
The AIDS Institute 18
Regional Funding per PLWA
• Midwest: $1,314
• Northeast: $1,198
• West: $1,180
• U.S. Average: $1,133
• South: $1,032
The AIDS Institute 19
Funding per PLWHA
The AIDS Institute 20
The AIDS Institute 21
2007 Funding per Estimated Persons Living with HIV/AIDS
Excluded from analysis due to lack of data: California, Connecticut, Delaware, District of Columbia, Hawaii, Illinois, Kentucky,Maine, Maryland, Massachusetts, Montana, New Hampshire, Oregon, Pennsylvania, Rhode Island, Vermont, and Washington
Rank State $/PLWHA
1 Guam $7,041
2 Wyoming $6,231
3 North Dakota $5,819
4 Alaska $3,240
5 Virgin Islands $2,898
6 South Dakota $2,645
7 Idaho $1,627
8 West Virginia $1,463
9 Iowa $1,325
10 New Mexico $1,224
11 Nebraska $1,012
12 Wisconsin $945
13 Michigan $853
14 Colorado $832
15 Minnesota $801
16 Oklahoma $750
17 Kansas $717
18 New Jersey $682
19 New York $667
Rank State $/PLWHA
20 Louisiana $652
21 Mississippi $626
22 South Carolina $593
23 Missouri $587
24 Nevada $585
Average $58325 Utah $578
26 Arizona $537
27 Texas $530
28 Indiana $504
29 Arkansas $499
30 Tennessee $492
31 Georgia $486
32 Ohio $470
33 Florida $423
34 Virginia $418
35 North Carolina $418
36 Puerto Rico $404
37 Alabama $391
The AIDS Institute 22
2007 Funding per Estimated Persons Living with HIV/AIDS
Top 10 States Bottom 10 States
Average: $583
Rank State $/PLWHA
1 Guam $7,041
2 Wyoming $6,231
3 North Dakota $5,819
4 Alaska $3,240
5 Virgin Islands $2,898
6 South Dakota $2,645
7 Idaho $1,627
8 West Virginia $1,463
9 Iowa $1,325
10 New Mexico $1,224
Rank State $/PLWHA
37 Alabama $391
36 Puerto Rico $404
35 North Carolina $418
34 Virginia $418
33 Florida $423
32 Ohio $470
31 Georgia $486
30 Tennessee $492
29 Arkansas $499
28 Indiana $504
The AIDS Institute 23
2007 Funding per Estimated Persons Living with HIV/AIDS
The AIDS Institute 24
Funding per New HIV Diagnosis
The AIDS Institute 25
The AIDS Institute 26
2007 Funding per New HIV Diagnosis
Excluded from analysis due to lack of data: Vermont, Maryland, and Hawaii
Rank State $/HIV diagnosis
1 Guam $675,897
2 Montana $382,712
3 North Dakota $323,919
4 Wyoming $105,927
5 Virgin Islands $97,863
6 Alaska $97,500
7 Massachusetts $87,828
8 Idaho $69,580
9 New Hampshire $60,100
10 Maine $59,478
11 South Dakota $58,518
12 West Virginia $42,561
13 Rhode Island $42,202
14 District of Columbia $41,928
15 New Mexico $35,219
16 New Jersey $34,717
17 Connecticut $33,580
18 Oregon $32,380
19 Colorado $31,447
20 Nebraska $30,037
21 Delaware $29,034
22 New York $28,610
23 Iowa $25,230
24 Kansas $25,067
25 Wisconsin $24,672
26 California $24,257
Rank State $/HIV diagnosis
27 Michigan $23,264
28 Minnesota $20,814
29 Illinois $20,128
30 Oklahoma $19,669
Average $18,75631 South Carolina $18,602
32 Missouri $18,071
33 Pennsylvania $18,036
34 Utah $17,119
35 Washington $16,853
36 Louisiana $16,488
37 Georgia $14,628
38 Virginia $14,522
39 Puerto Rico $13,067
40 Arkansas $13,049
41 Texas $13,004
42 Nevada $12,827
43 Indiana $12,817
44 Kentucky $12,815
45 Ohio $12,517
46 Arizona $12,466
47 Mississippi $11,750
48 Tennessee $9,724
49 Florida $9,321
50 Alabama $8,568
51 North Carolina $6,344
The AIDS Institute 27
2007 Funding per New HIV Diagnosis
Top 10 States Bottom 10 States
Average: $18,756
Rank State $/HIV diagnosis
1 Guam $675,897
2 Montana $382,712
3 North Dakota $323,919
4 Wyoming $105,927
5 Virgin Islands $97,863
6 Alaska $97,500
7 Massachusetts $87,828
8 Idaho $69,580
9 New Hampshire $60,100
10 Maine $59,478
Rank State $/HIV diagnosis
51 North Carolina $6,344
50 Alabama $8,568
49 Florida $9,321
48 Tennessee $9,724
47 Mississippi $11,750
46 Arizona $12,466
45 Ohio $12,517
44 Kentucky $12,815
43 Indiana $12,817
42 Nevada $12,827
The AIDS Institute 28
2007 Funding per New HIV Diagnosis
The AIDS Institute 29
2007 Funding per New HIV Diagnosis
Northeast: $30,275
West: $23,468
Midwest: $19,471
U.S. Average: $18,756
South: $12,603
Excluded from analysis due to lack of data: Vermont, Maryland, and Hawaii
The AIDS Institute 30
Hypothetical Model:Living AIDS Rates and
Funding per Capita
The AIDS Institute 31
Living AIDS Rate and Funding per CapitaRank AIDS
Rate
Rank $ per
CapitaState
Funding per
Capita
AIDS Rate
per 1,000
1 1 District of Columbia $34.42 15.12
2 3 New York $4.20 3.90
3 2 Virgin Islands $15.34 3.05
4 18 Puerto Rico $1.92 2.92
5 5 Maryland $3.50 2.79
6 16 Florida $2.03 2.63
7 7 Delaware $2.95 2.13
8 9 New Jersey $2.77 2.03
9 11 Connecticut $2.48 1.98
10 12 Louisiana $2.47 1.98
11 24 Georgia $1.62 1.89
12 20 California $1.78 1.79
13 19 South Carolina $1.90 1.70
14 29 Pennsylvania $1.46 1.55
United States $1.73 1.53
15 31 Texas $1.36 1.46
16 13 Massachusetts $2.46 1.42
17 27 Illinois $1.47 1.33
18 10 Rhode Island $2.67 1.28
19 26 Nevada $1.50 1.17
20 38 Virginia $1.05 1.15
21 22 Mississippi $1.65 1.14
22 36 Tennessee $1.12 1.11
23 15 Hawaii $2.20 1.03
24 39 North Carolina $1.03 1.01
25 37 Missouri $1.09 0.97
26 21 Colorado $1.77 0.88
27 46 Alabama $0.83 0.87
The AIDS Institute 32
Living AIDS Rate and Funding per Capita
Rank AIDS
Rate
Rank $ per
CapitaState
Funding per
Capita
AIDS Rate
per 1,000
28 40 Washington $1.01 0.87
29 45 Arkansas $0.83 0.81
30 41 Arizona $0.96 0.81
31 34 Oregon $1.16 0.79
32 35 Michigan $1.15 0.70
33 30 New Mexico $1.43 0.68
34 51 Kentucky $0.66 0.67
35 52 Ohio $0.65 0.65
36 53 Indiana $0.63 0.63
37 42 Oklahoma $0.94 0.63
38 6 Alaska $3.00 0.50
39 49 Kansas $0.71 0.50
40 44 Nebraska $0.88 0.47
41 43 Minnesota $0.90 0.47
42 54 Utah $0.47 0.46
43 28 New Hampshire $1.46 0.45
44 33 West Virginia $1.17 0.43
45 47 Wisconsin $0.80 0.41
46 23 Maine $1.63 0.41
47 8 Vermont $2.85 0.38
48 50 Iowa $0.69 0.31
49 17 Montana $2.00 0.21
50 48 Idaho $0.79 0.21
51 14 Wyoming $2.43 0.20
52 4 Guam $3.90 0.20
53 32 South Dakota $1.18 0.18
54 25 North Dakota $1.52 0.13
The AIDS Institute 33
The AIDS Institute 34
The AIDS Institute 35
Hypothetical Model
• If: prevention $ / capita was weighted by the average risk of acquiring HIV in that state (assuming equal behavior)
• If: PLWA is currently our best measure for all states
• Then:
• Relative risk = (state PLWA per capita)
(mean PLWA per capita)
• For each state,
$/capita = (mean $ / capita) * (relative risk)
• State $ = (state population) * (mean $/capita) * relative risk
The AIDS Institute 36
Example
• Georgia:Georgia 2007 Funding = $15,491,149
Georgia 2007 Population = 9,544,750
Georgia 2007 Living AIDS Cases = 18,011
U.S. Funding per Capita = $1.73
U.S. AIDS Rate per 1,000 = 1.53
• $/capita = (mean $ / capita) * (relative risk)Georgia Model Funding per Capita = ($1.73) * (1.89/1.53)
Georgia Model Funding per Capita = $2.14
Georgia Model Funding = ($2.14) * Population
Georgia Model Funding = ($2.14) * 9,544,750
Georgia Model Funding = $20,405,671
If funding were based on model, Georgia would see an increase of $4.9 m
Funding per Capita = $1.62
AIDS Rate per 1,000 = 1.89
The AIDS Institute 37
Redistribution of Funding Based on Model
Order StateWhat Model
PredictsActual
Amount increase /
decrease
% increase /
decrease1 Florida $54,448,735 $37,114,999 $17,333,736 46.7%
2 California $74,301,524 $65,179,685 $9,121,839 14.0%
3 Texas $39,585,485 $32,599,845 $6,985,640 21.4%
4 Puerto Rico $13,032,393 $7,579,007 $5,453,386 72.0%
5 Georgia $20,405,671 $15,491,149 $4,914,522 31.7%
6 New York $85,258,342 $81,138,356 $4,119,986 5.1%
7 Pennsylvania $21,793,543 $18,162,227 $3,631,316 20.0%
8 Virginia $10,051,586 $8,132,331 $1,919,255 23.6%
9 North Carolina $10,342,756 $9,294,097 $1,048,659 11.3%
10 Ohio $8,413,332 $7,510,248 $903,084 12.0%
11 Tennessee $7,742,622 $6,884,508 $858,114 12.5%
12 Alabama $4,583,940 $3,829,903 $754,037 19.7%
13 Indiana $4,553,350 $4,011,737 $541,613 13.5%
14 Illinois $19,345,225 $18,840,058 $505,167 2.7%
15 Kentucky $3,201,734 $2,793,682 $408,052 14.6%
16 Arkansas $2,589,938 $2,348,826 $241,112 10.3%
17 South Carolina $8,508,500 $8,389,512 $118,988 1.4%
18 Utah $1,367,478 $1,249,671 $117,807 9.4%
19 Missouri $6,486,173 $6,378,946 $107,227 1.7%
The AIDS Institute 38
Redistribution of Funding Based on Model
Order StateWhat Model
PredictsActual
Amount increase /
decrease
% increase /
decrease20 Washington $6,377,410 $6,505,354 -$127,944 -2.0%
21 Arizona $5,789,405 $6,083,430 -$294,025 -4.8%
22 Kansas $1,574,809 $1,980,268 -$405,459 -20.5%
23 Nevada $3,395,469 $3,835,348 -$439,879 -11.5%
24 Delaware $2,089,171 $2,555,017 -$465,846 -18.2%
25 Nebraska $946,018 $1,561,912 -$615,894 -39.4%
26 Guam $39,653 $675,897 -$636,244 -94.1%
27 South Dakota $166,545 $936,292 -$769,747 -82.2%
28 Oklahoma $2,576,342 $3,383,118 -$806,776 -23.8%
29 Idaho $360,280 $1,182,866 -$822,586 -69.5%
30 Connecticut $7,851,385 $8,697,330 -$845,945 -9.7%
31 North Dakota $90,636 $971,758 -$881,122 -90.7%
32 Louisiana $9,619,930 $10,585,000 -$965,070 -9.1%
33 Oregon $3,343,353 $4,338,899 -$995,546 -22.9%
34 Iowa $1,038,921 $2,068,821 -$1,029,900 -49.8%
35 Mississippi $3,785,206 $4,829,196 -$1,043,990 -21.6%
36 Wyoming $120,093 $1,271,127 -$1,151,034 -90.6%
37 West Virginia $889,371 $2,128,062 -$1,238,691 -58.2%
The AIDS Institute 39
Redistribution of Funding Based on Model
Order StateWhat Model
PredictsActual
Amount increase /
decrease
% increase /
decrease38 New Hampshire $666,178 $1,923,207 -$1,257,029 -65.4%
39 Virgin Islands $375,008 $1,663,671 -$1,288,663 -77.5%
40 Rhode Island $1,529,491 $2,827,517 -$1,298,026 -45.9%
41 New Mexico $1,517,028 $2,817,480 -$1,300,452 -46.2%
42 Hawaii $1,490,970 $2,822,553 -$1,331,583 -47.2%
43 Vermont $270,776 $1,768,196 -$1,497,420 -84.7%
44 Maine $608,397 $2,141,203 -$1,532,806 -71.6%
45 Alaska $388,604 $2,047,499 -$1,658,895 -81.0%
46 Montana $232,256 $1,913,559 -$1,681,303 -87.9%
47 Wisconsin $2,601,267 $4,465,692 -$1,864,425 -41.7%
48 Minnesota $2,763,280 $4,662,265 -$1,898,985 -40.7%
49 Maryland $17,767,017 $19,682,376 -$1,915,359 -9.7%
50 Michigan $8,030,393 $11,585,453 -$3,555,060 -30.7%
51 Colorado $4,855,850 $8,616,437 -$3,760,587 -43.6%
52 New Jersey $20,020,466 $24,058,962 -$4,038,496 -16.8%
53 Massachusetts $10,401,670 $15,896,805 -$5,495,135 -34.6%
54 District of Columbia $10,077,644 $20,251,263 -$10,173,619 -50.2%
The AIDS Institute 40
If the Model Was Applied…
• South +$18.4 m (+9.3%)
• Territories +$3.5 m (+35.6%)
• West -$4.3 m (-4.0%)
• Northeast -$8.7 m (-5.4%)
• Midwest -$9.0 m (-13.8%)
The AIDS Institute 41
Limitations• Other explanations for distribution of funding:
– Differences in risk behavior
– Population demographics
– How each state utilizes its prevention funding
– Supplemental state or local resources
– Difficulty in reaching people, density of regions
– Who applies for prevention money, quality of application
– Change in funding or transmission over time
– Prevention is working
– Other possible explanatory variables
• Results of distribution of funding:– We did not analyze correlation between lack of federal prevention
funding and rise in HIV transmission
The AIDS Institute 42
Findings
When analyzing funding based on selected variables:
• Large disparities
• Certain states receive less funding compared to others (Puerto Rico, Florida, Georgia, Virginia, and Alabama).
• Certain states receive more funding compared to others (Guam, Alaska, North Dakota, the Virgin Islands, and Wyoming).
• The South receives less funding compared to other regions.
The AIDS Institute 43
Findings
When analyzing funding based on the hypothetical model:
• Some of the states with the highest numbers of living AIDS cases also receive the least funding per capita (FL, CA, TX, PR, GA, NY)
• If the model was applied, the South would see the largest increase, and the Midwest the largest decrease
The AIDS Institute 44
Conclusion
• We hope these data and findings will help inform future funding allocation decisions at the CDC in order to improve HIV/AIDS prevention efforts.
• The AIDS Institute will continue to advocate for additional federal HIV/AIDS prevention funding.
• This presentation should not be interpreted to mean that The AIDS Institute is advocating for specific funding increases or decreases to any state, territory, or region.
The AIDS Institute 45
Thank You
Carl Schmid - [email protected]
Jessica Ladd - [email protected]
Offices - Washington, DC and Tampa, FL
www.theaidsinstitute.org