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There is a good reason why officials with the Centers for Disease Control and Prevention in Atlanta mention HIV prevention work done in North Carolina and Maryland when asked for success stories. Joint state-federal programs based in North Carolina and Baltimore have reached at-risk populations that traditionally are difficult to find, and they’ve demonstrated positive outcomes.
The nontraditional counseling program in North Carolina has a greater proportion of high-risk clients undergoing HIV testing than the local health departments have, says Marti Eisenberg Nicolaysen, nontraditional counseling, testing, and referral sites (NTS) coordinator and public health advisor assigned to the North Carolina STD Prevention and Care branch of the CDC in Raleigh.
Through the NTS program, 21% of the clients tested in 2000 were people who had the risk factors of being men who have sex with men (MSM) and/or injection drug users (IDUs). Another 15% tested were people who exchange sex for money and/or people who have sex while using drugs, Nicolaysen says. By comparison, local health departments and other publicly funded sites had only 5% of their HIV-tested clients in the MSM and IDU categories and only 7% in the sex worker or drugs-during-sex categories.
"So we’re reaching people who are at higher risk," Nicolaysen says. "We’re only testing 5,000 people, and the public health department tests 100,000, but we’re targeting the high-risk population and neighborhoods where high-risk activity takes place." As a result, the North Carolina NTS program has a high HIV-positive rate, which in 2000 was 1.1% among those tested. The local health department’s positive rate among the 100,474 people tested for HIV was 0.7%. Of 4,617 people tested through the program in 2000, there were 52 people testing positive for the virus. Of 3,732 tested for syphilis, there were 72 testing positive or 1.9%, Nicolaysen says.
An HIV prevention and testing program in Baltimore also targets neighborhoods where at-risk individuals might be found, says Carol Christmyer, RN, MS, assistant director for HIV services for the Maryland State AIDS Administration in Baltimore. "In Baltimore, a mobile van goes to predetermined neighborhoods where there are a lot of urban problems — poverty, lead paint poisoning, sexually transmitted diseases [STDs] — and where people are very poor and are dealing in drugs," Christmyer says.
"The van provides health screening, HIV testing, and treatment," she adds. "And if we find people who are positive, we link them with a clinical setting where they can get care and intensive case management." (See "Maryland program focuses on on HIV positives’" in this issue.)
One key to the success of community prevention programs is that they provide HIV screening and testing as part of a package of health care products, which makes it more attractive to potential clients. For example, while the cornerstone of a program in Greensboro, NC, is HIV prevention and counseling, the same program also tests clients for syphilis and screens for blood glucose, lead poisoning, sickle cell anemia, and other health concerns, depending on what services a particular community needs, says Caroline Moseley, MEd, CHES, health education manager at the Guilford County Department of Public Health in Greensboro. (See "NC testing projects get to the heart of the problem" in this issue.)
The program is located at five sites throughout the county, including homeless shelters, drug treatment centers, jails, and community-based organizations. An advantage to combining HIV services with general health screening is that it takes the stigma out of visiting the program and is more likely to attract the targeted population, Moseley says.
Also, the North Carolina NTS projects provide bilingual outreach staff in Hispanic communities, and they each make referrals for STD and tuberculosis testing and treatment, substance abuse counseling, family planning, domestic violence, and case management for HIV-positive and early intervention clients. Before long, the outreach program will provide more HIV tests than the health department does in some areas, and this is another reason why the program should be used to screen for other STDs, as well, Moseley says.
"Early on, we realized that HIV probably was not the only service people needed in the community and that we should test for other STDs," Moseley says. "So we’ve offered syphilis testing pretty much since we started the HIV program in the mid-1990s, even when it was not funded."