STD Quarterly-Talking to teens about HIV testing
How can you encourage HIV testing among adolescents? First, take a quick look around your facility and see if it qualifies as a "teen-friendly" place. A 1999 study prepared for the Kaiser Family Foundation determined that a teen-friendly clinic offers:
• Respect for teens who are sexually active. Teens expect to be treated professionally and with respect by clinical and support staff.
• Free or low-cost testing. Because teens lack financial or insurance resources or wish to avoid involving parents in sensitive health care matters, cost is a prime consideration when seeking testing.
• A clinical environment. Teens expect facilities to be clean, neat, and well-organized, with an air of professionalism.
• A broad range of teen health services. When a wide range of services are offered at a facility, teens know that anyone who sees them there will never know why they are there.
• Options for oral or blood-drawn HIV testing. Fear of needles may keep some teens from seeking HIV testing.
• Convenient access to public transportation or locations within walking distance to schools. Many teens lack private transportation. Access to clinics via bus, rail, or easy walking distance aids in overcoming barriers to testing.
• Fewer questions and paperwork. Reducing the number of questions and paperwork, or at least explaining the need for them, helps alleviate teens' natural impatience. For gay and bisexual youth, standard questions that assume heterosexuality are particularly annoying.1
Ask the question
If your facility meets the definition of teen-friendliness, then it's time to assess your own approach when it comes to the issue of HIV testing.
Felicia Guest, MPH, CHES, associate director for training at the Southeast AIDS Training and Education Center at the Emory University School of Medicine in Atlanta, suggests this line of questioning: "For all of my patients who are having sexual experiences with another person, I always recommend that they get an HIV test. Have you had one yet?"
This approach makes it clear the patient is not being singled out, the provider views HIV testing as a routine recommendation, and knowing one's HIV status is routine, not "weird," says Guest.
Once the question has been asked, present teens with four or five options about testing, she suggests. First, explain the difference between anonymous testing, where no name is associated with the results, and confidential testing, where a person's name is recorded along with the test outcome.
Guest suggests free or sliding-scale anonymous testing as a first-choice testing option for teens. If teens are in a small town and fear exposure from local testing, they may opt to go to the next county, she notes. A third option is to use the Home Access Express HIV-1 Test System manufactured by Home Access Health Corp. of Chicago, the only home collection diagnostic test approved by the Food and Drug Administration (FDA). (For more information, see resource box at right.)
"This test avoids venipuncture; it's just done with a fingerstick," says Guest. "For teens who can afford it, it is in the range of a little less or more than $50, depending on how you want to do the rapid return [of test results], and it can be done anonymously."
If teens choose to seek testing away from your facility, remind them to ask for the availability of oral HIV testing because avoidance of needles plays a large role in fear of testing. Steer teens from choosing to donate blood as a way to learn their HIV status because it is not anonymous and runs the risk of exposing others to early infection, says Guest. Tell teens to avoid at-home tests marketed on the Internet that are not approved by the FDA.
The Division of Adolescent and Young Adult Medicine (DAYAM) at the New Jersey Medical School in Newark has developed a variety of specialized programs that respond to the health and psychosocial needs of more than 1,500 high-risk youth, says Robert Johnson, MD, division director.
DAYAM uses trained peer outreach workers (who are themselves high-risk teens) to deliver HIV risk reduction outreach messages to youth in schools and on the streets. Street outreach educators use a mobile testing van and the Orasure oral testing method from Epitope of Beaverton, OR. The van workers set appointments for teens to receive their test results.
"We realized early on that we could not just wait for kids to come in off the street for our services," Johnson says. "If we really wanted to tackle this issue, we had to go out into the community where teen-agers were and offer testing to them."
1. Michaels Opinion Research for the Henry J. Kaiser Family Foundation. Hearing Their Voices: A Qualitative Research Study on HIV Testing and Higher-Risk Teens. Menlo Park, CA; June 1999.
For more information on the Home Access HIV test kit, contact:
• Home Access Health Corp., 2401 W. Hassell Road, Suite 1510, Hoffman Estates, IL 60195-5200. Telephone: (847) 781-2500. E-mail: firstname.lastname@example.org. Web site: www. homeaccess.com.