Special Report on Prevention Initiatives

Social network enlists community recruiters

Targeted testing has produced 8% positive rate

The Center for Multicultural Wellness and Prevention in Orlando, FL, has identified 14 HIV-positive cases out of 173 people tested in its first year of a demonstration project funded by the Centers for Disease Control and Prevention (CDC).

"It is a fairly high percentage compared with national outreach HIV testing," says Laud Jean-Jacques, program coordinator.

"We’re reaching more HIV-positive people than we did previously," he says. "Our [goal] was 0.05 under extended outreach [testing], but with the social network program we’re reaching 8%."

Specific requirements for recruiters

The center’s staff recruits HIV-positive or high-risk HIV-negative people, targeting Hispanics and blacks primarily of Caribbean and African descent, to be recruiters.

The recruiters participate in a program of counseling and testing before joining, Jean-Jacques explains.

The goal is to find recruiters who are meeting other high-risk people in the community, so people who are HIV-positive but who have low-risk behaviors and were infected by a partner who did not share their monogamous behavior are not asked to be recruiters, he says.

"We are looking for people who are out in the street, like at a bar venue or even in a park to meet people, and who do drugs, have multiple sex partners — these are the people we target," Jean-Jacques notes.

"We prefer to have HIV-positive people as recruiters, but they have to be adherent to treatment, and you might not find that person because he might not be disciplined enough to be part of a group or organization."

Recruiters refer their associates to the center for testing by giving them cards with information about HIV and the center, he says.

Sometimes the recruiter will go out into the community with an outreach worker and the outreach worker will ask the associates to be tested, Jean-Jacques adds.

Another part of the program is venue referral in which the recruiter points out a place where people engaging in high-risk behaviors congregate. The outreach worker will contact the owner of the site and ask permission for a health promoter to informally make contacts, he continues.

When network associates agree to be tested, the center offers them the choice of coming into the center for testing or having an outreach worker come to their home or to some other location of their choice, Jean-Jacques points out.

The program has 16 recruiters, about half of whom are active at one time, he says.

After some months of participating, a recruiter often runs out of contact associates to refer to the center’s testing program, and so new recruiters have to be found, Jean-Jacques explains.

The program has been successful so far, but needs to be continued longer than what the two-year CDC funding calls for, he says.

"I know it’s a demonstration project, but we had a contractors meeting last month at the CDC, and we were all saying that two years is not enough time," Jean-Jacques adds.

"The first year, we sold the project to our community, so it’s only a year later when people are really getting interested because they’re seeing results."

Ideally, it should be a three-year demonstration project, although it does not appear that an extension will be possible with CDC funding, he notes. "I think we’re going to keep using the program because we have seen the results."