HEALTH SERVICE NEEDS FOR HIV POSITIVE AND AT-RISK YOUNG WOMEN. Elizabeth R. Woods, MD, MPH, Cathryn L. Samples, MD, MPH, Maurice Melchiono, RN, MS, C-FNP, Peter M. Keenan, RN, BSN, Durrell J. Fox, BS, Louise Chase, LICSW, Michelle Burns, RN, CPNP, MPH, Jan Paradise, MD, Virginia Price, MEd, Lars Kula, MD, and Elizabeth Goodman, MD, Children’s Hospital, Martha Eliot Health Center, Justice Resource Institute, Boston Medical Center, Bridge Over Troubled Waters, and Roxbury Comprehensive Community Health Center, Boston, MA.

OBJECTIVE: The HAPPENS (HIV Adolescent Provider and Peer Education Network for Services) Program is an innovative SPNS model of HIV care for adolescents. This network integrates 8 agencies (2 youth outreach multi-service agencies, 3 health centers and 3 teaching hospitals) to plan and coordinate care for HIV infected, homeless, and at-risk youth in a large metropolitan area. This report assesses differences in the care needs and health services utilized by confirmed HIV positive compared to HIV negative and untested at-risk young women served by the program.

DESIGN: Service information from the first 24 months of data collection was assessed: 6 sites generated 96% of the data including 36% from teaching hospitals, 15% from community health centers, and 49% from multi-service agencies.

RESULTS: 616 females, including 14 HIV positive (HIV+) young women, provided sufficient information for this report: mean age at first contact was 19.3±2.9 years (range 12-29); 50% were White, 22% African American, 14% Hispanic, 5% Asian, 5% Other and 4% missing ethnicity; 5.4% self-identified as lesbian/bisexual (none of whom were HIV+); 5.7% have been pregnant; 10.9% were homeless and/or runaways. Less than 1% had ever used injection drugs (IDU). Compared to negative and untested at-risk women, HIV+ women were more likely to have been pregnant (21% vs. 5%, p=0.040) or have a history of substance abuse (67% vs. 15%, p=0.00091), sex with an IDU (57% vs. 7%, p=0.0012), sex with an HIV+ partner (71% vs. 2%, p<0.00001), and survival sex (33% vs. 9%, p=0.046). There were no differences in IDU (0% vs. 1.8%, p=NS) or history of STDs (89% vs. 65%, p=NS) based on clients’ HIV status. HIV+ women were more likely to have received Network-related health services including: more scheduled medical appointments (79% vs. 32%, p=0.00059), medical emergency visits (43% vs. 1%, p<0.00001), physical exams (64% vs. 15%, p=0.00005), non-HIV laboratory tests (64% vs. 16%, p=0.00010), and substance abuse/mental health screening (43% vs. 4%, p=0.00003). 2/14 referrals to substance abuse treatment programs were for HIV+ women.

CONCLUSIONS: HIV positive women have a higher rate of prior pregnancy and potential HIV exposure through survival sex and sex with high risk men than HIV negative and untested women served by this program. Health care policies for HIV+ and at-risk young women should facilitate the development of comprehensive integrated health services focusing on reducing high risk sexual encounters and substance use.

Related Information:

Evaluation Of A Model Health Care For Homeless, At Risk And HIV Positive Youth
The Evolution Of An Adolescent-Specific Network Of Care For HIV-Positive, Homeless And At-Risk Youth
Providing Mental Health And Substance Abuse Services To HIV Positive And Homeless Youth
Mental Health And Substance Abuse Services For HIV Positive, Homeless, And At-Risk Youth
Do High Risk Youth Use Targeted HIV Testing Services: Experience Of A Program Of Care For High Risk Youth
Youth Involvement In The Boston Happens Program

Evaluation and Dissemination Center: Innovative Models of Adolescent HIV/AIDS Care 1993-1998