1. Poster produced by Faculty & Curriculum Support (FACS), Georgetown University Medical Center
Youth Access to HIV Testing in DC Wards 7 & 8
Kevin Donnelly1
; Ayesha Rahman1
; Elizabeth Serino1
;
Ellen Stolle1
; Kathy Sweeney1
; Meghaan Walsh1
Abstract
1
Georgetown University School of Medicine, Washington, DC
Introduction
Methods
Discussion Future Directions
References
Acknowledgments
A special thank you to Dr. Eileen Moore and Mary Beth Levin.
Georgetown
University
1. CDC. HIV Prevalence Estimates—United States, 2006. MMWR
2008;57(39):1073-76
2. “Sexual Health of Adolescents and Young Adults in the United States.” Kaiser Family
Foundation, September 2008
3. “Surveying HIV Risk Factors Among Young People in Washington, D.C.”
Metro TeenAIDS Issue Brief, June 2007
4. “Minors’ Access to STI Services.” State Policies in Brief. Guttmacher Institute, 2009.
www.guttmacher.org.
Results
Background: The prevalence of HIV in DC is among the highest of any
major city in the US, and the disease is increasingly affecting the youth
population. There are many factors thought to contribute to the
disproportionate burden in young adults, and access to HIV testing is
proposed to play a significant role. Our study sought to evaluate youth
access to HIV testing in Wards 7 and 8. Methods: A list of healthcare
clinics was compiled using internet search engines, a major resource
available to adolescents. Exclusion and consolidation criteria were
applied to the results. Clinics were posed a survey of eleven questions
by telephone under youth pretense. Answers to questions were
aggregated and identifying information was excluded. Results: Ninety-
six clinics were initially found by search strategy. After exclusion and
consolidation criteria were applied and informed consent was obtained,
seventeen clinics participated in the survey. Of the seventeen clinics
surveyed, twelve had responses in accordance with DC minors’ rights
laws, eight required payment for HIV testing, and four required parent
permission. The majority of clinics were additionally open during non-
school hours and accessible by public transportation. Discussion:
Given the seemingly positive results of this study regarding youth to
access HIV testing, our results indicate that other factors may play a
role in infrequent HIV testing of DC adolescents.
By the end of 2006, the number of people in the US living with HIV/AIDS
was estimated to be between 1,056,000 and 1,156,400.1
Approximately
46,000 young adults ages 13 to 24 in the US are living with HIV, and more
new HIV cases occur in the adolescent and young adult population ages 13
to 29 than any other age group. Sixty percent of newly HIV infected young
adults in 2006 were African-American, making this racial minority
disproportionately affected by HIV. Despite high rates of infection in
adolescents and young adults, only 16% of 18 to 24 year-olds nationally
reported getting tested for HIV.2
The rate of HIV/AIDS in Washington, DC is high compared to other major
US cities, making it a critical health disparity for the patient population of
DC. Additionally, the number of adolescents and young adults that have
HIV is also high in DC, with an estimated 1,000 to 1,500 13 to 24 year-olds
infected. However, few receive the necessary health care or social
services that accompany the diagnosis.3
Metro TeenAIDS, a community
health organization focused on HIV education, treatment and prevention for
Washington DC’s youth population, conducted a survey that focused on the
HIV risk factors in DC youth ages 13 to 24. Many surveyed did not know
their HIV status. According to the survey, 65% reported being tested for
HIV, and of that 65%, 5% reported never getting the results of their test. Of
those surveyed, 91% were African-American and 84.8% reported living in
Wards 5, 6, 7 or 8.3
Because the racial status of this young adult population
in DC puts them at an additional risk for contracting HIV, it is imperative
that they have access to necessary medical care.
As of May 2009, all states in the US and DC allow minors to consent to STI
health services.4
Though eighteen states allow physicians to inform parents
of a minor consenting to STI services, only one requires parental
notification of a positive HIV test. Legally, no state or DC requires
physicians to notify parents of providing STI services to minors.4
DC
explicitly grants minors the right to confidential contraceptive, prenatal,
abortion, and STI health services. Thus, while adolescents and young
adults living in DC legally have access to critical health care services, it is
unclear why few pursue HIV testing. For our Health Justice Scholars
project, we sought to investigate whether barriers to accessing HIV/AIDS
health services exist for the high-risk adolescent population (ages 13-18) in
Wards 7 and 8 of Washington, DC.
Clinics were compiled based on internet searches, which is a resource
likely to be used by high school students. We did not use local high school
counselors or nurses, although that is another resource available to high
school students. After compiling names, addresses, and phone numbers,
the following were applied to the search results:
Exclusion Criteria
clinic was not located in ward 7 or 8 based on zip code
phone number did not exist
phone number called was a wrong number
no phone number was listed
phone number was not for a clinic
Consolidation Criteria
duplicate number, duplicate address, different physician at same center
duplicate address, different extension for same center
The survey was administered by phone in four parts:
Part A: Introduction We began with an introduction requesting information
regarding obtaining an HIV test.
Part B: Survey Questions After the caller responded, survey questions
were asked (see results). Answers were recorded as yes or no.
Part C: Disclosure of study The clinic was informed that the call was part
of a study being conducted by medical students at Georgetown University
to evaluate youth access to HIV testing in Washington, DC.
Part D: Permission We asked whether the clinic would be willing to allow
their answers to the survey to be included in the study. We informed them
that all identifying information would be removed, aside from their location
in ward 7 or 8.
The Yes/No survey answers were aggregated for 10 of 11 questions. An
11th
question, “How much does it cost?”, was excluded from the Yes/No
aggregation and instead is presented as a cost range.
The search strategy and survey yielded the following:
94 total clinics were identified using the internet search
50 clinics were initially eliminated or consolidated
44 clinics were called
17 clinics agreed to participate
3 refused to participate
6 numbers were disconnected
7 numbers had no answer
5 numbers were not for clinics seeing patients
3 did not see any patients under 18 years of age
1 was a repeat of a clinic previously surveyed
12 of 17 clinics surveyed had policies in accordance with DC law
regarding confidential HIV testing for minors
8 of 17 clinics required payment for testing, ranging from $40 - $200
4 of 17 clinics required parental permission and 3 of 17 would notify a
parent if the HIV test result was positive
15 of 17 clinics were open during after-school hours (after 3 p.m. on
weekdays) and/or on weekends
16 of 17 clinics were within walking distance to a bus or metro stop
11 of 17 clinics required identification
Given our results, further investigation,
including surveys of DC youth, could be
conducted in an attempt to glean a
clearer understanding of remaining
barriers to HIV testing. Future action
could include campaigns to raise
awareness of HIV testing availability
among DC youth and information
dissemination regarding DC law to
those clinics still requiring parental
permission for HIV testing.
The relative lack of HIV testing among DC youth is concerning
given the increasing incidence of HIV infection in this age group.
Our study not only assessed the adequacy of HIV testing
available to DC youth but also attempted to determine the
potential barriers to testing, given that the District of Columbia
explicitly grants minors the right to confidential HIV testing. We
hypothesized that potential barriers to testing included fear of a
lack of confidentiality, inability to pay, inaccessible testing
locations, or clinic hours incompatible with those of a full-time
student. Our results demonstrate that a number of clinics
circumvent these potential obstacles, however, by providing free
and confidential services, being bus/metro accessible, and
having evening/weekend hours.
Given a seemingly adequate number of free, confidential, and
accessible HIV testing sites, it is alarming that so many minors
in DC do not know their HIV status. It is possible that many in
this age group have a sense of invincibility and do not believe
they will become infected. There may also be a decreasing
level of concern regarding HIV because some youth perceive it
as a disease with a less dismal prognosis than previous
decades. Further, stigma surrounding HIV persists, and some
youth may fear being seen by peers at a testing site. Lastly, DC
youth may not be aware of the free and confidential resources
available to them for HIV testing. To this end, it is vital that
schools and communities reach out to their young population,
raising awareness about available resources alongside their
traditional HIV education.
Addressing Accessibility Barriers:
Addressing Cost Barriers:
Addressing Age-Related Barriers: