Needs Assessment Late HIV Testing 0308

Late HIV Testing in SF: 

Late HIV Testing in SF Findings from the 2006 HPPC Needs Assessment HIV Prevention Planning Council March 8, 2007

What is late testing?: 

What is late testing? Late HIV testing is typically defined as receipt of an initial positive HIV test one year or less before the diagnosis of AIDS CDC estimates that nationally 40% of 2004 HIV infections progressed to AIDS within one year

Why is late testing important?: 

Why is late testing important? It results in missed opportunities for preventing and treating HIV Limited research on late testing Most studies have explored late HIV testing using surveillance data Rationale for needs assessment To learn more about late testing in SF To explore through qualitative methods

Research questions: 

Research questions What are the demographic and risk characteristics of individuals who test late for HIV in SF? What are the barriers to testing? What factors resulted in participants’ first known positive HIV test?

Research questions (cont.): 

Research questions (cont.) To what degree do local findings conform to the national research? What strategies might encourage people to get tested earlier?

Data collection methods: 

Data collection methods Review of local AIDS surveillance data In-depth interviews (n=25) Focus groups (n=2) Low HIV risk perception High HIV risk perception

Recruitment challenges : 

Recruitment challenges Complexity of eligibility criteria Service providers reported difficulty identifying potential candidates Difficulty recalling information necessary for determining eligibility i.e., HIV test dates, AIDS diagnosis dates, or date of their lowest CD4 count Screening out rapid progressors

What does the literature say?: 

What does the literature say? Those most likely to test late include… Heterosexuals Those with a low perceived risk of HIV People aged 18-29 African-Americans and Latinos Foreign-born individuals (non-US studies)

What does the literature say? : 

What does the literature say? A majority of those who delayed HIV testing received their first positive test in a medical setting Persons eventually received testing due to illness or disease-related symptoms

SF data on late testing: 

SF data on late testing 38 percent of those who received an AIDS diagnosis between 2001 and 2006 (n=2518) tested late for HIV Those most likely to test late were… Heterosexuals and no reported risk Persons under age 30 Latinos Persons born outside the US

Characteristics of participants: 

Characteristics of participants 11 African Americans, 8 Whites, 3 Latinos, and 3 multi-ethnic 21 males, 2 females and 2 MTF transgendered individuals Over one-half gay-identified (n=14) Ranged in age from 24 to 51 years 2 monolingual Spanish-speakers

Knowledge of HIV: 

Knowledge of HIV Participants felt their knowledge of HIV was limited and/or inaccurate Participants aware that condoms could prevent HIV, but did not use them regularly Major sources of HIV info included TV, newspapers, magazines & billboards

Perception of HIV risk: 

Perception of HIV risk More than half considered themselves at risk for HIV prior to their first positive test While most were concerned about contracting HIV, other priorities such as substance use affected some people’s overall level of concern

Perception of HIV risk (cont.): 

Perception of HIV risk (cont.) Persons who considered themselves to be at low risk tended to be heterosexually-identified and viewed HIV as affecting the gay community Participants who considered themselves at high risk were relatively unconcerned about HIV I was saying that I didn’t need to be tested because I’m into women. In my mind, it was like a gay thing.

HIV testing orientation: 

HIV testing orientation Individuals who had a low risk perception did not see a need to obtain HIV testing A majority of interviewees delayed testing anywhere from two weeks to 16 years It always lingered in my mind that I had to get tested. I procrastinated for a whole year until I got tested.

Prior testing experience: 

Prior testing experience Some had never been tested prior to their first positive test and others had tested one or more times in the past Prior testing experiences did not deter participants from further testing Those who perceived themselves as low risk were less likely to report having tested in the past

Testing barriers: 

Testing barriers Fear & stigma associated with HIV Denial Substance use Low perception of HIV risk Didn’t see testing as a priority I just didn’t have the time. It wasn’t something that was crossing my mind. [I put off testing], but not for any particular reason, just, I don’t feel like doing that right now. I didn’t want to get no news like that. I knew friends of mine that died of HIV… It’s like a death sentence to me.

Factors that promoted testing: 

Factors that promoted testing Illness or disease-related symptoms Encouragement from friends, including those living with HIV Knowing or suspecting a partner was positive or engaging in risk behaviors Cash incentives for HIV testing Having information about treatment

Post-testing experiences: 

Post-testing experiences Some participants were relieved to know their HIV-positive status I felt like a weight was lifted. I felt relieved. I felt like now I could take care of this situation and live. Even if you’re positive, this big load is taken off of you and you can get treated.

Post-testing experiences (cont.): 

Post-testing experiences (cont.) Post-test counseling was very important for coping with HIV status Most interviewees reported they started living healthier lifestyles Nearly 1/3 of participants reported they started practicing safer sex I’m focused on my health and taking care of my body and not doing any further damage.

Linkages from testing into care: 

Linkages from testing into care Participants received referrals to HIV care services soon after finding out they were HIV-positive While most followed-up on these right away, some said that stigma, depression and wanting to avoid the fact they were positive prevented them from seeking out services

Testing in health care settings: 

Testing in health care settings Majority of participants believe they would have agreed to be tested for HIV if offered to them as part of routine STD screening or general health check-up However, more than half of those interviewed did not have health insurance prior to finding out status Well, if they were offering it, I wouldn’t turn it down.

Participant recommendations: 

Participant recommendations Preventing Late HIV Testing Multi-media campaigns to address fears that HIV/AIDS is a death sentence Outreach & support groups for people who may be contemplating HIV testing Provide people with information regarding advances in medical treatment Provide incentives to test HIV education & awareness in schools

Participant recommendations: 

Participant recommendations Improving & expanding testing sites HIV testing sites in neighborhoods such as Mission District & Hunter’s Point Maintain welcoming place for clients at testing sites Allow medical providers to offer testing at patients’ homes Provide mobile HIV testing sites

Overall recommendations: 

Overall recommendations Need to account for rapid progression in definition of late testing Provide prevention messages that emphasize healthy living with HIV Learn more about HIV screening in health care settings Provide testing incentives to substance users

Overall recommendations: 

Overall recommendations Employ peer-based strategies to reach high-risk individuals Provide post-test counseling to those who believed they were low risk Culturally appropriate strategies for Latinos, especially immigrants Have those who test late talk with folks considering testing

Questions: 

Questions Clare M. Nolan Harder+Company Community Research 1550 Bryant Street, #1000 San Francisco, CA 94103 cnolan@harderco.com