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An AIDS prevention project in Baltimore sends a van to neighborhoods known to have the urban hazards of poverty, lead poisoning, high rates of sexually transmitted diseases (STDs), and drug dealing. The project also involves having health department staff visit local detention centers to offer counseling, testing, HIV services, and case management, says Claudia Bowlin, RN, MS, chief of the Center for Education and Training at the Maryland State AIDS Administration in Baltimore.
"The van has outreach workers who go to a site, park the van, and then go into the community within a several-block radius to meet people on the street and invite them to the van for a variety of services, including HIV counseling and testing," Bowlin explains.
Clients can also seek blood pressure testing, pregnancy tests, and other simple medical screenings if they desire. If the van staff can’t help them with their medical problem, the staff will refer them to a clinic or emergency department. Outreach workers hand out brochures and condoms. "The gift of a good outreach worker is that they can talk to people and meet them on their level, appearing to be peers to the individuals they encounter," Bowlin adds. "They know the street language and can convince people that it’s in their best interest to go to the van."
The program appears to be successful in reaching its targeted at-risk population, as about 5% of the people tested in the van have been HIV-positive, Bowlin says.
Funded by the Centers for Disease Control and Prevention, the project is called Prevention for HIV-Positive Persons. Its goal is to find the estimated one-third of HIV-positive people who do not know their infection status, says Carol Christmyer, RN, MS, assistant director for HIV services with the Maryland State AIDS Administration. Once clients are tested on the van, they are told to return in two weeks to the same site to receive their HIV results.
"When a test comes back positive, a worker is assigned to look for that person to explain the results and to offer medical services," Bowlin says.
The van has outreach staff teach clients how to negotiate safe sex and how to talk about sexual behavior. They give information on how an addict can enter drug treatment or, if that’s not an option, use the city’s needle-exchange program to ensure safer use of injection drugs. "If people are HIV-positive, they are given condoms and told where they can get free condoms," Bowlin says. "We give them a whole range of prevention messages, and it depends on what their behaviors are that put them in jeopardy."
Case managers try to see clients more than one time to reinforce prevention messages, but this has proven difficult, Bowlin notes.
Outreach workers also provide HIV testing and counseling services to people housed in local detention centers. Even here, the two-week waiting period for test results can prove to be a problem because inmates often are released by the time outreach workers return with their test results.
The Maryland HIV prevention project divides the state into five regions and has programs developed according to the specific needs of a particular region. "In all five regions, youths are a very high priority," Christmyer says. "So a fair amount of programming is developed to target youths and teen-agers." These programs may take place in a college setting or a drop-in community center.
Another targeted program is aimed at women of childbearing age who may be pregnant or thinking about getting pregnant. "The media message developed for that encourages these young women to be tested," Christmyer says. "Then another segment is focused on the young men, showing them playing basketball and encouraging them to be tested." Prevention campaign materials include television ads, radio spots that encourage people to call a hotline number for more information about HIV testing, bus posters, and free gifts, such as pens and cube sticky notes with the program’s logo, Christmyer says. "We’ll run the advertising campaign for a period of a month or six weeks, and we’ll run the perinatal portion over Mother’s Day, for example," Christmyer says. "Then we’ll take it off the air and start up again later."
Typically the initial impact is enormous: Calls to the hotline might increase by 1,500% in the months following a campaign, Christmyer says. "It dies down, and then to have another big impact, we’ll give it another boost."