DO HIGH RISK YOUTH USE TARGETED HIV TESTING SERVICES: EXPERIENCE OF A PROGRAM OF CARE FOR HIGH RISK YOUTH. Elizabeth Goodman, MD, Cathryn Samples, MD, MPH, Peter M. Keenan, RN, BSN, Durrell J. Fox, BA, Maurice Melchiono, RN, FNP, Elizabeth R. Woods, MD, MPH. Children’s Hospital, Harvard Medical School, and Martha Eliot Health Center, Boston, MA.

OBJECTIVE: HIV infection is increasing among youth. With the advent of new therapies for HIV, case identification through HIV testing has become critically important. Little is known of teens’ use of HIV counseling and testing services (CTS). This report describes clients who access CTS at a 3 year old program of care for high risk youth living in and near an eastern, urban, metropolitan area and evaluates whether youth at highest risk are using CTS.

DESIGN: 531 clients from a teaching hospital (69%) and a community health center (31%) enrolled in the program. Enrollment criteria included: (1) HIV+, (2) homeless or street youth, (3) referred by their provider for engaging in high risk behaviors, or (4) desire HIV testing (available at both sites). A summary Risk Score of 8 target youth HIV risk factors was created. Data were analyzed with chi square analyses, Fisher’s exact tests, Mann Whitney U tests, and logistic regression analyses.

RESULTS: Of the 531 clients, 72% were female, 40% White, 24% Black, 25% Hispanic, 11% Other Race. 5% self identified as gay/lesbian/bisexual (g/l/b). Mean age at entry was 19.1+ 3.0 yr. 226 reported a prior STD, 52 substance abuse problems, 30 (20% females) prior pregnancy, 19 survival sex, 14 sex with an injection drug user (IDU), 13 sex with an HIV+ partner, and 6 IDU. 39% reported previous HIV testing. Being older (p<0.001), g/l/b (p=0.015), or White (p<0.0001), having had sex with an HIV+ partner (p=0.013) or a substance abuse problem (p=0.047) increased the likelihood of a prior HIV test. A prior STD (p<0.001) decreased the likelihood of prior testing. Program testing was widely used. 77% (N=408) received pretest counseling, 68% (N=360) HIV testing, and 42% (N=224) posttest counseling. No unsuspected cases of HIV infection were identified through program testing. 17 clients were HIV+. 14 knew their HIV status at program entry. Two were tested after an acute illness requiring hospitalization thought to be a seroconversion illness, one secondary to generalized lymphadenopathy. Factors positively associated with the program testing included: having been tested in the past (83.2% prior test vs. 36.5% no prior test, p<0.001), White race (88.3% White vs. 52.4% non-White, p<0.001) and receiving care at the teaching hospital (84.7% vs. 30.3%, p<0.001). A prior STD (53.5% with prior STD vs. 73.6% without, p<0.001) was negatively associated with program testing, as was the Risk Score. Youth who engaged in more risk factors were less likely to test (p<0.001). Logistic regression revealed that White race (OR = 3.6, 95% CI 1.74, 7.51) and receiving care at the teaching hospital (OR 5.4, 95% CI 3.18, 9.08) were the only independent predictors of program testing.

CONCLUSIONS: Despite targeted, youth-specific, developmentally appropriate and culturally sensitive outreach and intervention efforts, youth of color and high risk youth are poorly accessing CTS. A greater understanding of the barriers to and cultural norms regarding CTS needs to be elucidated so that interventions can be developed to target youth at highest risk and assure that they can and will access services.

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
Health Service Needs For HIV Positive And At-Risk Young Women
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
Youth Involvement In The Boston Happens Program

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