Abstract Formats

TITLE: Unrecognized HIV Infection among Injection Drug Users in Baltimore

AUTHORS
German, D; Johns Hopkins Bloomberg School of Public Health
Villanti, A; Johns Hopkins Bloomberg School of Public Health
Towe, V; Johns Hopkins Bloomberg School of Public Health
Flynn, C; Johns Hopkins Bloomberg School of Public Health
Holtgrave, D; Johns Hopkins Bloomberg School of Public Health

BACKGROUND: Baltimore has a strong legacy of HIV prevention among injection drug users (IDUs). This study examined the extent to which HIV-positive IDUs were aware of their HIV status and explored associated socio-demographic characteristics and service utilization.

METHODS: Injection drug users anonymously completed behavioral surveys and voluntary HIV testing as part of the 2009 wave of the National HIV Behavioral Surveillance System in Baltimore, Maryland. Participants were recruited using respondent driven sampling, with remuneration for survey participation, HIV testing, and successful peer referral. Non-seed participants (n=510) who tested HIV-positive but did not report positive HIV status were those defined as having unrecognized HIV infection. Descriptive statistics and logistic regression were conducted in Stata.

RESULTS: HIV prevalence was 16.1% and prevalence of unrecognized infection was 47.6%. Socio-demographic characteristics, drug use patterns, and injection risk behaviors were not significantly associated with unrecognized infection. Compared to those who were aware of their HIV status, those who were not aware were more likely to report any unprotected sex in the past year (O.R.: 2.47, 95% C.I.:1.00, 6.07) and less likely to visit a doctor in the past year (O.R.: 0.23, 95% C.I.: 0.06, 0.91). Twenty-eight percent of those with unrecognized infection had never tested for HIV. Of those who had tested, 36% had been tested in the past year. Main reasons for not testing among those with unrecognized infection were: afraid of being HIV+ (65%), worried someone would find out results (38%), no time (34%), perceived low risk (24%), worried about social consequences (24%), worried about names reporting (24%), and no health insurance (21%).

CONCLUSIONS/IMPLICATIONS: There is a continued need for targeted HIV prevention among Baltimore injection drug users. Prevention for positives activities could be enhanced by increasing the proportion of IDUs who are aware of their status. Respondent driven sampling methods may be useful for enhancing targeted HIV testing.

• Importance [All formats] (0-8 points)
  Innovation, relevance, creativity, new or cutting edge information, originality of approaches/interventions, significance or interest to the audience.
• Methodology [Format I] (0-7 points)
  Appropriateness of conceptual basis and design for the identified purpose of the study, appropriateness of the data collection techniques, development stage (level of data collection completeness).
• Clarity [All formats] (0-5 points)
  Development of ideas and findings; communication of ideas and findings.

TITLE: CDC's One Test. Two Lives. (OTTL): Programmatic, Process and Outcomes Results, 2007- 2010

AUTHORS
Green, D; Centers for Disease Control and Prevention
Griffith, J; Centers for Disease Control and Prevention
Burke, M; RTI International
Eguino-Medina, P; RTI International

ISSUE: CDC recommends opt-out HIV testing of pregnant women to increase early detection. Despite perinatal HIV testing recommendations from CDC and ACOG guidelines that have been released for more than a decade, not all pregnant women are tested for HIV in the US. The estimated overall transmission rate remains nearly 3 times as high (2.8%) as the less than 1% achievable when appropriate treatment is received.

SETTING: OTTL is a national marketing program under the CDC's Act Against AIDS campaign and the first HIV prevention effort with a focus on healthcare providers. The goal of OTTL is to increase testing of pregnant women in the first and third trimester using an opt-out approach.

PROJECT: OTTL focuses on obstetric providers in all clinical settings. Key campaign messages for the program were disseminated through: 1) outreach to key stakeholders; 2) promotion at medical and midwifery conferences through exhibits and workshops; 3) placement of campaign advertisements in obstetric journals; 4) trade media advertising; 5) electronic media communications; 6) materials dissemination; and 7) an accredited curriculum to further promote awareness and implementation of the recommendations among OB/GYN residents and midwifery students. Process evaluation was conducted to assess exposure of OTTL to providers and whether the program was implemented as planned. Outcome evaluation was conducted to examine the impact of the key messages on knowledge, awareness and implementation of CDC's HIV testing recommendations. This presentation will highlight the implementation and evaluation of OTTL.

RESULTS: From May 2007 through December 2010, a total of 15,524 kits and 130,000 patient pieces were disseminated. Overall, conference outreach and media activities yielded over 1.2 million exposures to the campaign. Twenty outreach activities and 68 stakeholder promotional/educational activities occurred. Results from the DocStyles surveys revealed that providers who reported having seen OTTL materials (20%) were significantly more likely to report awareness of CDC's recommendations [X2(1) = 25.43, P<.001], implementation of the recommendations [X2 (1) =38.50, P<.05], and include HIV testing as a regular screening test for all patients (i.e., universal testing) [X2 (1) = 4.98, P<.05]. Although only 25% of providers who took the ACOG survey were aware of OTTL and only 47% of those aware were currently using one or more OTTL materials, willingness to use the materials ranged from 63% for the provider resource/tip sheet to 72% for the comprehensive perinatal testing handout.

LESSONS LEARNED: There are positive benefits to packaging and promoting CDC recommendations for health care providers. OTTL results indicate that promotion of CDC recommendations to obstetric care providers may result in an increase in desired HIV testing behaviors. The volume of OTTL materials ordered by providers indicated their interest in these resources. This national program was an excellent best practice program showing involvement of key stakeholders to increase OTTL exposure.

• Importance [All formats] (0-8 points)
  Innovation, relevance, creativity, new or cutting edge information, originality of approaches/interventions, significance or interest to the audience.
• Lessons Learned [Format II] (0-7 points)
  Appropriateness of conceptual basis and design for the activity, extent to which the lessons learned advance the state of the art of HIV prevention, merit of the conclusions
• Clarity [All formats] (0-5 points)
  Development of ideas and findings; communication of ideas and findings.

TITLE: The Paradigm Shift: Embracing New Scientific Paradigms for Effective HIV Prevention among Black MSM

FACILITATORS:
Simmons, R;  Us Helping Us, People Into Living, Inc.
Clue, J; National Association of State and Territorial AIDS Directors

ISSUE: Current HIV prevention research and practice with Black MSM is dominated by a scientific paradigm focused on behavioral determinants. Numerous recent studies challenge the traditional long held hypothesis that reductions in HIV risk behavior will lead to significant reductions in HIV incidence among Black MSM. Compared to white and Latino gay men, Black MSM report less risky sexual behavior, greater condom use, and fewer sexual partners yet still bear a disproportionate burden of new HIV infections.

KEY POINTS: A 2010 behavioral surveillance study of 500 MSM in the District of Columbia found that 32% of Black MSM over the age of 30 and 12% of Black MSM under 30 were HIV-infected. In comparison, 8% of the white MSM over age 30 and none of the white MSM under 30 were HIV-infected. Yet, Black MSM reported using condoms 50% more and having fewer sex partners than white or Latino MSM. The Centers for Disease Control's (CDC) 2005 five-city behavioral study of MSM, and a recent surveillance study in Chicago, found a similar discrepancy between sexual risk behavior and HIV prevalence among Black MSM. It is clear that Black MSM realize the importance of protection and HIV prevention as evident by their higher rates of condom usage compared to other MSM. However, the increased use of condoms is only one piece of the larger puzzle. At the 2011 National Black MSM Leadership Conference on HIV/AIDS and Other Health Disparities in Brooklyn, NY, Black MSM researchers and community members proposed and endorsed alternative areas that warrant scientific investigation to determine their contribution to the disproportionate impact of HIV on Black MSM communities. The facilitators will summarize current research on disparities in HIV infection in Black MSM and recommendations from the researchers and community members, and lead a discussion on new strategies and paradigms for effective HIV prevention among Black MSM, including community-level, biomedical, and structural interventions.

IMPLICATIONS: The scientific community can no longer evade the anomalies in behavioral surveillance reports which continue to subvert current behavioral prevention research paradigms and by extension, prevention practice efforts. As evidence continues to mount regarding the limits of the behavioral HIV prevention paradigm for Black MSM, the research and practice communities must commit to exploring new avenues that consider social, structural, community/network, biomedical, and intersectional determinants of HIV infection. Engaging Black MSM in critical analysis, discourse, and scientific leadership is imperative. Such explorations open the way for unconventional yet promising interventions that may reduce HIV infection among Black MSM in the United States.

• Importance [All formats] (0-8 points)
  Innovation, relevance, creativity, new or cutting edge information, originality of approaches/interventions, significance or interest to the audience.
• Appropriateness [Format III] (0-7 points)
  The extent to which the roundtable topic lends itself to discussion versus presentation of information.
• Clarity [All formats] (0-5 points)
  Development of ideas and findings; communication of ideas and findings.