Innovation. Perseverance. Dedication. Adaptation. These are but a few words that describe behavioral health programs that help clients to be treated for their substance use or co-occurring disorder, obtain and/or sustain their recovery, and enjoy a renewed/reinvigorated life of their choosing. Creative interventions will be discussed that canvas the entire U.S. and several of its dependent areas around the globe.

1. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT
Changing the Narrative for Women &
Girls - Treatment, Recovery & More
Alton J. King, MBA
Public Health Advisor (SAMHSA/CSAT/HSB/HIV)

2. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT
Disclosures
Presenters have no financial interest to disclose.
This continuing education activity is managed and accredited by
Professional Education Services Group in cooperation with HSRA
and LRG. PESG, HSRA, LRG and all accrediting organization do not
support or endorse any product or service mentioned in this
activity.
PESG, HRSA, and LRG staff has no financial interest to disclose.

3. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT
Obtaining CME/CE Credit
If you would like to receive continuing
education credit for this activity, please
visit:
http://ryanwhite.cds.pesgce.com

4. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT
Learning Objectives
At the conclusion of this activity, the participant will be able to:
1. Recognize how the SAVA syndemic affects your clients
2. Discuss innovative approaches to engage women where they
are at and to move them forward (e.g., TCE-HIV, NORA's
Recovery Support Service Model)
3. Understand how Recovery Support Services can assist at-risk
populations

5. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT

6. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT

7. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT
AIDS 2016 (Durban) - Quotes
o “We heard all about vaginas. But vaginas are
attached to people …”
o “HIV operates in a gendered world and it thrives
because of that.” - Elizabeth Bukusi, KEMRI
http://us7.campaign-archive1.com/?u=57d869773227fef9486fa97dd&id=cf26fcab7e&e=dc5c717e22
“I have a penis! I have a vagina! I have sex!” - Stella
Iwuagwu, 47, from Lagos
o “recently rediscovered her
sexual freedom as a young,
African woman on PrEP” -
Buhle, conference attendee who educated her physician
by walking through the CDC website together with him

8. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT
Location & Population (HIV)
Avac.org/infographics

9. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT
A Call to Action - 2020

10. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT
Target Achievement Overlooks …
Px Wire: A Quarterly Update on HIV PreventionResearch | Volume 7 | No.4 | October–December 2014
Today’stargets
leavea
prevention
gap.
UNAIDS 2014 Targets for 2020
Diagnosed
OnTreatment
Virally Suppressed
90% 90% 90%
On
Treatment
Needle
Exchange
Ending the
AIDS epidemic
by 2030 takes
comprehensive
targets and
action.

11. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT
Women – Long Ignored Globally
o 1 out of 3 substance users and 1 out of 5 substance
users in treatment are women
o Pooled HIV prevalence among injection drug users
(IDUs) who are women (13%) vs. men (9%) [30 countries]
o HIV/AIDS is the leading cause of death among
women of reproductive age (15 – 49)
o In 2015, women accounted for :
• 47% (900,000) of new HIV infections
• 51% (17.8 million) of PLWHAs
UNAIDS, 2015 estimates from the AIDSinfo online database.*; http://www.avac.org/blog/i-bleed-i-rise-day-4-aids-2016; United Nations Office on Drugs and Crime (2015) WorldDrug Report, p. 17

12. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT
Universal Factors for Women
 Gender-based (GBV) and intimate partner violence
(IPV)
 Gender inequality and discrimination
o Inclusive of unequal cultural, social, and economic status
 Women living with HIV often experience violence
due to their HIV status, including violations of their
sexual and reproductive rights
 Lack of access to healthcare services
 Discriminatory criminal laws linked to HIV

13. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT
Additional Context in the U.S.
 PTSD and trauma are common among women with
GBV histories whereby substances become coping
strategies and/or a form of self-medication
 Experiencing the substance abuse, violence, and
HIV/AIDS (SAVA) syndemic ↑ (nearly 7x) the likelihood
of depressive symptoms
 Black (63% of new HIV infections) and Latina women
are disproportionately affected by HIV and IPV
o 40.4% of reported lifetime IPV and 80% of new HIV infections
 HIV+ women experienced IPV 2x the national rate
Schwartz et al, 2014; Illangasekare, 2013; Morales-Aleman et. al, 2014; Chen et al., 2013; Machtinger,et al, 2012

14. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT
Is the Puzzle Complete?
Substance use disorders (SUDs) and co-occurring disorders
(CODs) facilitators of risky behavior and HIV progression

15. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT
Substance Use in America
Only 11.6% (2.6 million) received SUD treatment in 2014
>85% did NOT receive any form of treatment, age 12 or older
2014 National Survey on Drug Use and Health (NSDUH) - SAMHSA

16. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT
Vital Signs January 2014 (CDC); Source: CDCBehavioral Risk Factor Surveillance System (BRFSS), United states 2011-2013

17. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT
Heroin, Opiates Morphs the “War”
2014 NSDUH(SAMHSA); National Vital Statistics System, 2002-2013 (CDC); VitalSigns July 2013 (CDC)

18. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT
Treatment, Justice, & “The War”
[1] Szalavitz, M. (Nov. 7, 2011). “Study: WhitesMore Likelyto Abuse Drugs Than Blacks.” Time.
[2] “Drug Facts: Treatment Statistics.” (March 2011). National Institute on Drug Abuse

19. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT
Women’s Rights – Collateral?
http://www.huffingtonpost.com/2014/04/04/arrests-of-pregnant-women_n_5083480.html
http://www.theatlantic.com/health/archive/2015/05/into-the-body-of-another/392522/
Most pregnant women arrested
in South Carolina, the state with
the most cases 1973-2005, were
black

20. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT
Another Causality in the “War”
http://www.huffingtonpost.com/2014/04/04/arrests-of-pregnant-women_n_5083480.html
http://www.theatlantic.com/health/archive/2015/05/into-the-body-of-another/392522/
Some drug-using women have
even become skittish about
receiving prenatal care …
“There's no evidence that
punitive responses promote
healthy moms and babies, … if
you seek medical attention, you
could go to jail, or you could lose
your children.”

21. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT
President Barack H. Obama
World AIDS Day 2015
(March 6)
“... ending the epidemic
also requires a focus on
prevention. Especially
when it comes to
empowering our young
women and girls to
protect their own health,
secure economic
opportunity, and pursue
their dreams.”
Making Women a Priority

22. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT
Where Women Were At (TCE-HIV)
The TCE-HIV: Minority Women program has engaged
clients in the treatment of:
And other health and psychosocial conditions*:
 >80% self-reported traumatic experiences
 <3.5% HIV seropositivity
 <7.2% HCV seropositivity
TCE-HIV: Minority Womenprogram (FY13) as of February 2015; *Year 1 (September 2013 – August 31, 2014)
Substance SUD COD ALL Polysubstance SUD COD ALL
Alcohol 1st 1st 1st Alcohol + Marijuana 3rd 1st 1st
Marijuana 2nd 2nd 2nd Alcohol + Cocaine 1st 2nd 2nd
Cocaine 3rd 3rd 3rd Alcohol + Marijuana + Cocaine 2nd 3rd 3rd

23. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT
Client Demographics (TCE-HIV)
 Primarily Black (41.5%) and
Latino (43.6%)
 Transgender (2.6%), Males
(0.4%)
 Some HS or HS/GED (56.7%)
 Income < $20k (95%)
 96.3% live below 200% FPL
TCE-HIV: Minority Womenprogram (FY13) as of February 2015

24. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT
Changing Lives – Women & Clients
TCE-HIV: Minority Womenprogram (FY13) as of February 2015
Measure Type # Valid
Cases
% at Intake % at 6-
months
% (∆)
Change
Employment/Education: were currently
employed or attending school
1,799 24.0 32.4 35.3
Stability in Housing: had a permanent place to
live in the community
1,801 49.2 54.4 10.5
Abstinence: No alcohol or illegal drugs 1,780 52.1 68.8 32.0
Measure Type # Valid
Cases
% at Intake % at 6-
months
% (∆)
Change
Trouble controlling violent behavior 1,762 15.0 9.9 -33.7
Injected illegal drugs 1,787 4.5 2.8 -38.3
Had unprotected sexual contact 543 72.4 64.6 -10.7
Had unprotected sexual contact with someone
high on any substance
298 30.2 18.5 -38.9

25. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT
We Are Trauma-informed!!
• Realizes widespread
impact of trauma and
paths for recovery;
• Recognizes signs and
symptoms of trauma;
• Responds by integrating
trauma knowledge; and
• Seeks to actively resist
re-traumatization
SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach

26. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT
Overcoming Traumatic Effects
When trauma-informed care (TIC) is integrated into
SUD treatment, it can:
 enhance HIV care retention and medication
adherence
 improve the health/wellness of people living with or
at risk for HIV and have histories of trauma
 reduce disparities among communities of color
 enrich the quality of life for communities of color
SAMHSA’s TIP 57: Trauma-Informed Care in Behavioral Health Services

27. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT
VITEL Takes On the SAVA Syndemic
 Violence Intervention To Enhance Lives (VITEL)
o SMAIF funded (2015 award, 2016 continuation)
o Novel intervention incorporating IPV screening with
concurrent SUD screening and follow-on referral services
o A 2013 White House report reaffirms attention on
trauma, HIV, and violence against women & young girls
 To-date results
o >500 clients and nearly 100 staff educated on IPV
o 73 clients received intensive IPV-specific classes
o 22.4% clients screened positive for IPV (past 30 days)
o 93% clients referred to trauma-informed services
Secretary’s Minority AIDS Initiative Fund (SMAIF) provides supplemental funding to existing TCE-HIV: Minority Women(TFY13) grantees per funding opportunity announcements (FOAs) TI-15-013 and TI-16-010

28. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT
Utilizing a More Holistic Approach
Women of color & clients are able to maintain/sustain
their HIV negative status or viral suppression:
TCE-HIV: Minority Womenprogram (FY13)
o Provides SUD/COD treatment
o Provides TIC services in a safe and
trusting environment
o Provides HIV and Hepatitis testing
o Provides coordinated care for SUD,
HIV, Hepatitis, IPV and trauma
o Enhances overall health and
wellbeing

29. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT
Snapshot – Augusta U.
• Testimonial #1: Perseverance pays (PLWHA)
 In/out treatment for 4 years with multiple relapse episodes. History of
chronic paranoid schizophrenia, crack cocaine use, medication non-
compliance, and personal instability (e.g., multiple incarcerations,
unstable housing). Once re-engaged in HIV care CD4 = 147 & VL = 564k,
now CD4 = 300 & VL undetectable. Stably housed (1 yr) and sustained.
• Testimonial #2: Anchor for new family (PLWHA)
 Referred to SUD Tx (crack cocaine) in December 2013. Positive for HIV,
HCV, and syphilis. Became pregnant one year later, referred to prenatal
care while sustaining HIV care. Crack relapse caused premature delivery
(26 wks), linked to SUD Tx and mental health (MH) Tx and post-natal
care. Referred to long-term SUD and MH services, stably housed.
TCE-HIV: Minority Women(FY13) grantee

30. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT
Snapshot – The Village
• Testimonial #1: Convincing local government
 The Virgin Islands (VI) Legislative Finance Committee unanimously
approved funding to continue providing many of the core gender-
specific services provided by Susanna’s Place. Although significantly
less than current federal (SAMHSA) funding, Susanna’s Place will
continue to support the of women of color in need on the island.
• Testimonial #2: Incredible client & peer (PLWHA)
 C.A. has been invited to represent the VI’s Positive Women’s Network
USA and the program at the 2016 National Leadership Summit for
Women Living with HIV (September 2016). She joined the program 2+
years ago and presented with chronic crack addiction, being HIV+, and
other serious health concerns.
TCE-HIV: Minority Women(FY13) grantee

31. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT
Snapshot – PROCEED
• Personal story #1 (PLWHA)
 48 year-old Latina: experienced trauma and begun having unprotected
sex, and ↑ drug and alcohol use. Tested HIV+, referred to care and
treatment, received case management services, and was linked to
charity care, HOPWA, and other services. Now living a healthy life.
• Personal story #2 (PLWHA)
 52 year-old Black woman: PTSD due to ACE at age 5-6. Initiated cocaine
use at age 43 to deal with anxiety and depression, later diagnosed with
HIV in 1998. The program is helping her to restore her broken self.
TCE-HIV: Minority Women(FY13) grantee
“The Women’s Wellness and Recovery Care Program has been helpful in reducing my
harmful behaviors. As I learned to respect myself and my body, my confidence and
assertiveness in communicating my needs has improved. I don’t let my traumatic past
dictate my present life. I feel great and I love myself more!”

32. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT
Snapshot – Northeastern U.
• Co-located in a primary care clinic, can provide OBOT
• Utilizes the Boston Consortium Model, recently
introduced trauma-informed yoga
• Provide an intervention called Love, Sex and Choice
(LSC) - watch 12, 20-minute episodes
TCE-HIV: Minority Women(FY13) grantee
“Like, it was just really real. It could happen to anyone of us, if we
didn’t take care of us. And that was an eye opening. It was like
‘Damn you really need to start taking care of yourself.’ You really
need to start going to primary care. You really need to start
protecting yourself.”

33. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT
Snapshot – UCC
• UCC’s Cadre of Services
TCE-HIV: Minority Women(FY13) grantee
“I have learned to take care of myself and other friends, I gain more insight about the
importance of protecting against sexually transmitted diseases. I've also spread the
word and shared educational materials and condoms with a friend that is exhibiting
high-risk behaviors.”
Outreach Transportation HIV Rapid Testing HEP C& B Testing Medical services
Risk Reduction
Plan
Active Case
Management and
linkages with
services
Personalized
Treatment
Planning
Individual
Counseling using
EBP’s
Clinical
Assessment
Educational and
self-care materials
Prevention Kits
(condom,
lubricants, etc.)
Community Health
Fairs
Recovery and
Wellness Retreat

34. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT
Snapshot – LESC
• Client Demographics (n = 360):
 Primarily African-American/Black (62%) and Latino (19%) women;
nearly 50% under the age of 40 (age 8 to 63); 20% were LGBT
 33% had unprotected sex (past 3 mos); 38% have exchanged sex for
money or drugs (past 12 mos)
 23% are or have been an injecting drug user (IDU) and nearly 43% had
been a victim of sexual assault or experienced some form of IPV
• Client Outcomes:
 88.6% were abstinent at discharge and 39% were employed (up from
3.8%)
 25% had stable housing at discharge (up from 8.3%)
 IDU ↓ by 81.8% and unprotected sexual contact ↓ by 25%
TCE-HIV: Minority Women(FY13) grantee

35. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT
Snapshot – Gaudenzia
• Testimonial #1: One very inspiring lady
 Recently completed course work to become a Certified Recovery
Specialist (taking test soon). Also, she recently celebrated one year in
recovery - many emotions arose, including fear, sadness, regret, pride,
and happiness. She has become strong enough to confront her peers
and hold them accountable to support their recovery and has refused
to allow their poor decisions to affect her recovery as well.
• Testimonial #2: A self-reliant woman (PLWHA)
 Initially housed in a halfway house for co-occurring women, she is fairly
independent. She utilized the BCC ReEntry Housing Assistance Program
to help her find her own apartment (as of 4/1/16) and continues to
utilize her supports today.
TCE-HIV: Minority Women(FY13) grantee

36. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT
Always Remember That …
“Each of us has a
role to play in
giving every man,
woman and child
on Earth access to
life-saving
treatment and
care.”
President Barack H. Obama
World AIDS Day 2012
(December 1)

37. 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT
THANK YOU!!
Alton.King@samhsa.hhs.gov