Special Report on Prevention Initiatives

Rural HIV service center needs a creative approach 

HIV testing has been done in karaoke bar

The Southwest Louisiana Area Health Education Center in Lafayette has found some creative solutions to the problems HIV staff have with trying to identify high-risk populations for HIV testing and counseling.

Since the organization serves a rural population in a small enough community where everyone knows each other, center staff have made some adjustments to the HIV rapid testing and social network demonstration projects funded through the Centers of Disease Control and Prevention (CDC).

"There’s still a lot of stigma and discrimination related to HIV in this area," says Robin Boyles, director of health education. "It’s probably more than what you would have in urban metropolitan areas."

The program has two active recruiters, who are not referred to by that title, but whose job it is to bring in high-risk clients for HIV testing.

The center’s a little behind in its goal of having three recruiters, but the staff’s focus has been on finding the right people, she says.

"We are enlisting people to recruit who really have contact with networks," Boyles explains. "One of the recruiters has recruited 35 people; and while we haven’t tested any positives yet, we know when we talk with people about their risk behaviors that they’re at very high risk for HIV."

Potential recruiters are provided with an orientation and coaching session, and they are encouraged to provide names of at-risk individuals within their social network, she says.

"They give us names, and it could be just a first name because some recruiters don’t want to give full names since these are their friends and they don’t want to set them up for something," Boyles notes.

Then the center’s staff will review the names with the recruiter and find out the best way to reach individuals, she says.

The center also provides HIV testing at churches and local organizations since it would be a hardship for many people to have to come into the center for testing, Boyles adds.

Typically, the center will set up a date in which HIV testing can be done at the church or community site. Staff give the recruiters cards with this date and address to pass out to associates who might need HIV testing services. Sometimes, recruiters will open up his or her home for testing, she notes.

Other rapid HIV testing sites include community centers, housing developments, barbershops, and hair salons, where staff will set up a private testing area in a back office or room, Boyles says.

"We do go out and check out these places to make sure they are adequate and the temperature is fine because the rapid test needs to stay within a certain temperature," she adds.

"Barbershops and hair salons often are a community institution where people go and will sometimes hang out, and a lot of information is transferred back and forth from hairstylists to customers."

HIV testing staff try to saturate the social network possibilities of recruiters by talking with them about all of their weekly activities and contacts, Boyles says.

For example, one recruiter visits a karaoke club every week, and the club serves a clientele of men who have sex with men. The center received permission from the club owner to set up a center in a back room for HIV testing, and the recruiter talked with the club’s clients about having a rapid HIV test. That allowed the center to conduct 18 HIV tests in three hours, she says.

Likewise, if a social recruiter played pickup basketball regularly, then the center might send staff to that site to make HIV information and testing available, Boyles says.