Geographic Information Systems As a Tool for

Community-based Advocacy

1 Morehouse School of Medicine2 Satcher Health Leadership Institute3 National Center for Primary Care4 Dept. of Family Medicine5 Dept. of Community Health and Preventive Medicine6 Georgia Equality

Khusdeep Malhotra1,3,5

Harry J Heiman1,2,4

Megan Douglas1,3

Jeff Graham 6

Presenter Disclosures

(1)The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

Khusdeep Malhotra

“No relationships to disclose”

(2) My presentation will include discussion of “off-label” use of the following:

“No relationships to disclose”

Abstract # 312788

Issue- The purpose of this project was to demonstrate the state-wide impact of HIV/AIDS in Georgia using Geographic Information System (GIS), and increase legislative support for sustained ADAP (AIDS Drug Assistance Program) funding.

Description- A legislative database of House, Senate and Congressional district representatives was created using data from an advocacy organization and the state government website. HIV/AIDS data was obtained from the Georgia Department of Public Health. Prevalence rates were calculated for 2008-2010, using population estimate from the American Community Survey. These rates were then linked to the legislative database using unique identifiers. Thematic maps exploring yearly trends in HIV/AIDS by Senate and House districts were used to prepare policy briefs for ADAP Citizen Lobby Day.

Lessons Learned- A total of 32 maps by senate districts and 17 maps by house districts were created. Twenty-eight citizen advocates used the policy briefs to lobby legislators in the House Appropriations Committee and Senate Health and Human Services Committee, providing to them an accurate and timely picture of the status of HIV/AIDS and communicating the need for targeted state-wide intervention. The maps effectively focused attention on the state-wide nature of HIV/AIDS, aided an effective academic-community partnership and allowed the strategic messaging of a public health problem.

Recommendations- Geographic Information Systems (GIS) are a powerful tool for identifying and communicating public health problems to policy makers. Its powerful visualization and analytic tools can be leveraged effectively to promote public health advocacy, empower the users of the information and inform policy decisions.

Demonstrate the use of geospatial methods to support community based advocacy and informing decision making

Learning Objectives

Background: The Academic Community Partnership

Mission

To develop a diverse group of exceptional health leaders, advance and support comprehensive health system strategies, and actively promote policies and practices that will reduce and ultimately eliminate disparities in health.

Background: Satcher Health Leadership Institute

To advance fairness, safety and opportunity for Georgia’s lesbian, gay, bisexual, transgender and allied communities

Safe Schools

Workplace Fairness

Public Safety

Parental Rights

Marriage & RelationshipsHIV / AIDS & LGBT Health

Background: Georgia Equality

Mission

Issues

Georgia HIV Advocacy Network 

• Founded in 2009• Statewide network of providers and citizen

advocates • Policy analysis, advocacy training and

coordinated community activities

Policy Priorities

• Protecting and expanding funding for HIV services and prevention

• Strengthening Georgia’s state support for HIV services and prevention

• Promoting evidence-based interventions• Strengthening community capacity for advocacy

HIV/AIDS Advocacy in GA

Federal appropriations State appropriations for ADAP Fulton County Human Services funding Extension of Ryan White Program Passage of National AIDS Strategy

Funding for HIV/AIDS

AIDS Drug Assistance Programs State administered programs Provide HIV/AIDS medications to low-income individuals Originally authorized by the Ryan White Comprehensive AIDS Resources

Emergency (CARE) Act (1990) Were authorized under the Ryan White HIV/AIDS Treatment Modernization Act

of 2006 Payer of last resort

ADAP Crisis in Georgia Nationwide, due to the economic recession

• Increases in ADAP client utilization• Costlier drug regimens• Minimal increases in federal appropriations• Heightened HIV testing

Source: NASTAD

Due to increasing unemployment in Georgia, $15 million in additional funding was needed to meet the projected need for fiscal year 2013

Source: NASTAD

= 37, 311

(2008 , 9th highest in nation)

= 40, 328

(2009, 6th highest in nation)

(2010, 6th highest in nation)

= 41,986

Source: Kaiser Family Foundation

2012

Project GoalSupport GA Equality’s legislative advocacy to address the

disproportionate impact of HIV/AIDS in LGBT communities

Specific Aim 1 Establish that HIV/AIDS is a

statewide issue (not restricted to Metro Atlanta)

• Create a user friendly, web-based

GIS database of HIV/AIDS prevalence rates between 2008-2010 at Congressional, House, & Senate district geographies

Make legislators listen!

• Identify legislators to speak with

• Prepare fact sheets  using maps for lobbying

• Participate in lobbying at the state capitol during the ADAP Lobby Day

Specific Aim 2

Georgia Legislature in 2012

• 56 Senate districts and 180 House districts (and 13 Congressional districts)

• Committees targeted: Senate Health and

Human Services House Appropriations

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2008 Rates of PLWHAby House District

29 - 226

226 - 491

491 - 922

922 - 1450

1450 - 3070

1Rates per 100,000 calculated using 1 year population totals by house district from American Community Survey

Prevalence Rates of People Living With HIV/AIDS (PLWHA) in Georgia by House District (2008-2010)1

2010 Rates of PLWHAby House District**

31 - 238

238 - 490

490 - 871

871 - 1523

1523 - 3202

2009 Rates of PLWHA by House District

149

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177

157

176

116

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142

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2010 Rates of PLWHAby House District*

24 - 181

182 - 432

433 - 851

852 - 1444

1445 - 2935

149

148

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176

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Prevalence Rates* of People Living With HIV/AIDS (PLWHA) in Georgia by Senate District (2008-2010)1

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2008 Rates of PLWHAby Senate District*

56 - 151151 - 341341 - 630630 - 11201120 - 2465

1 Rates per 100,000 calculated using 1 year population estimates from the American Community Survey

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2009 Rates of PLWHAby Senate District*

58 - 207207 - 420420 - 756756 - 16851685 - 2565

2010 Rates of PLWHAby Senate District*

44 - 150151 - 360361 - 720721 - 11901191 - 2565

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Targeted Maps

Fact Sheets

Lessons Learned: Effective Communication

Maps have communicative power Maps helped focus attention on a largely ignored crisis Maps demonstrated local impacts of a statewide crisis Maps demonstrated HIV/AIDS was an issue across all of Georgia Legislators responded to information focused on their districts and

constituents

Lessons Learned: Coalition Building

Maps helped unite stakeholders and aided coalition building This approach helped marginalized groups to participate in state advocacy GIS data & maps helped inform policy decision making

Lessons Learned: Informed Decision Making

Challenges & Conclusion

Variables to measure & quantify the impact of advocacy are difficult to define

Direct impact is difficult to measure

“Policy change is the result of multiple actions and efforts, and it can rarely

be attributed to just one project or product” – Kirwan Institute

GIS is an important and underutilized tool for public health advocacy