Iowa is an agricultural state, with a land area of 55,869 square miles. Iowa comprises 99 counties with an estimated 2020 population of 3,190,369 persons. Six counties (Dallas, Dubuque, Pottawattamie, Story, Warren, and Woodbury) have between 50,000 and 120,000 people, and five counties (Black Hawk, Linn, Johnson, Polk and Scott) have more than 120,000 people. Iowa’s population has shifted over the past ten years from rural to urban centers with the most significant growth occurring in and around the capital of Des Moines and in the Interstate-380 corridor between Iowa City and Cedar Rapids. The features of Iowa’s HIV epidemic that are most significant for the Ryan White Part B Program are the emerging needs of the black/African American population and other communities of color, the impact of comorbidities and the complexity of providing care, and access to health care due to a unique population distribution issue and the changing landscape of the health delivery system. These challenges are detailed in this application. As of December 31, 2020, there were 3,012 Iowans who had been diagnosed with HIV and were living in the state. In 2020, there were 98 Iowans diagnosed with HIV. This is lower than the average number of people diagnosed with HIV over the last 10 years (117) and the same as the number of Iowans diagnosed in 2019 (98). The number of Iowans diagnosed with HIV peaked in 2016 at 136. The high number of diagnoses from 2015 through 2018 was a sign that people who are at risk for HIV are being reached and getting tested. When looking at HIV prevalence in Iowa regardless of where diagnosis occurred, the actual number of persons living with diagnosed HIV disease in Iowa at the end of 2020 was 3,012, a prevalence rate of 95 per 100,000 persons. When the number is adjusted for our estimated percentage of undiagnosed persons in Iowa (14%), there may have been as many as 3,384 Iowans living with HIV or AIDS at the end of 2020, with an est
imated 474 persons undiagnosed. Since Iowa undertook an integrated jurisdictional planning process in early 2012, the care continuum has been used as a framework to guide activities in the HIV Program (which consists of HIV prevention, care and treatment, and surveillance). The HIV treatment continuum provides a useful framework for assessing the health system and strategically targeting limited resources. Iowa’s HIV program continues to “shore up” the core components of programming such as case-finding, client core and support services, and the AIDS Drug Assistance Program. Initiatives exist to increase testing in rural areas, reduce client-case manager ratio, and ensure less stress for clients when navigating to a “benefit home.” In addition, Iowa has prioritized examining and addressing the role of social determinants of health (SDOH) on the epidemic.