The slides describe the process of HIV testing at the HIV/AIDS Resource Center as of April 2009.

1. Preventing HIV in Our
Community
Carrie Rheingans
AmeriCorps Intern, HIV/AIDS Resource Center
School of Public Health

2. Outline
 AmeriCorps
 Public Health
 Local epidemiology
 AIDS over the life course
 Prevention overview
 Outreach
 HIV Testing, Counseling, and Referral
 Policy
Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

3. AmeriCorps
National service
program
Peace Corps
Teach for America
Serve 1700 hours, 11
months
Living stipend,
education award
Team or individual
Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

4. What’s Public Health?
Population focus Epidemiology
It’s working when you Biostatistics
don’t think about it Health Management
Iodine in salt Health Policy
Vaccinations Health Behavior
Infectious diseases Health Education
Chronic diseases Environmental Health
Nutrition
Occupational
Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

5. Epidemiology – United States
Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

6. Epidemiology – United States

7. Epidemiology - Michigan
18,000 estimated living with HIV
52% of known transmission mode among men who
have sex with men (MSM)
17% among injecting drug users
Fastest rising rates among African-American MSM,
African-American women, especially young (13-24)
Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

8. Epidemiology – Washtenaw County
28 new infections in 22 among men
2007 6 among women
16 among MSM 16 among African-
0 among IDU American
9 among “low-risk” 11 among Whites
heterosexual 16 among youth (15-29)
Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

9. AIDS Over the Life Course
Infants/Children Teens
 Usually born with HIV  May be sexually active
 Rare in US
 Birthing process  May not take their meds
 Breastfeeding due to schedule
 Rape very rare mode of  May only take them when
transmission in US they feel sick
 Blood transfusion very rare
mode of transmission in US
 Parents assist with
medications
Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

10. AIDS Over the Life Course
Adults Seniors
 Most medically adherent  Limited finances
group  Low knowledge about
 May live for decades current medical trends
 May have children after  Overall health
infection  May need assistance with
their care
 Low risk perception
Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

11. Prevention Overview
Outreach HIV Testing, Counseling,
Where people Referral
congregate In clinics
Mobile unit to high- Health departments
prevalence zip codes Mobile unit
Education Rapid, traditional
HIV 101 presentations Anonymous,
Part of HIV testing Confidential
During outreach
Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

12. Prevention – Stigma
AIDS stigma often Intersecting stigmas
works against HIV include:
prevention activities: Race
Discrimination against Gender
those living with HIV Socio-economic Status
Compulsory HIV testing Sexuality
(jobs, apartments)
Drug use
Confidentiality issues
Violence
Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

13. Preventing Transmission
HIV transmitted only via Barrier Methods
five fluids: Condoms
Blood Internal Condoms
Semen (including pre- (“female”, “Reality”)
ejaculate) Dental Dams
Vaginal Secretions Risk Reduction
Breast Milk Lubricants
Cerebrospinal fluid Outercourse
Syringe exchange
Less risky behavior
Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

14. Outreach
Mobile Unit
HIV testing
Hand out supplies
Syringe exchange
Hepatitis C testing
Referrals
Volunteers help a lot!
Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

15. Outreach
Bar Outreach
Hand out supplies
Referrals
Promote HIV Testing
Volunteers help a
lot!
Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

16. HIV Counseling, Testing and Referral
Counseling = discuss
client’s risk behavior,
set safer behavior goals
Testing = obtain
consent, collect sample
Referral = give info
about other services of
interest
Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

17. Counseling
C = client intro to session
I = identify risk & circumstances
G = set safer behavior goals
A = action steps
R = suggest referrals to client
S = summarize & close
Acquire client consent
Collect test sample
Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

18. Client Introduction
Introduce self, ask for client “name”
Describe agency
Describe how testing works
Testing device
Anonymous, Confidential
Timeline of results
Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

19. Identify Risk & Circumstances
Open-ended questions
Sexual risks
Needle-sharing risk
Circumstances of risk behaviors
Frequency of risk behaviors
Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

20. Safer Behavior Goals, Action Steps
Client-centered
Non-judgmental
Realistic
Risk reduction
Harm reduction
Reduce barriers
Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

21. Referrals
Sexually transmitted infection testing
Pregnancy/birth control
Drug treatment
Mental health
Housing/shelters
Community resources (LGBT, youth,
cultural)
Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

22. Summarize & Close
Review risk behaviors
Review safer behavior goal(s) and action
steps
Review referrals given
Obtain client consent
Collect test sample
Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

23. Oral Swab Test
Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

24. Rapid Test
Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

25. Rapid Test
Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

26. Rapid Test
Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

27. Giving Results
Check readiness, show result promptly to
client
3 possible results:
Reactive: infected with HIV
Non-reactive: no evidence of HIV antibodies at
time sample was taken
Indeterminate: need to get retested
Pregnancy
Other immune disease
Recently infected and not enough antibodies
Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

28. Giving Results
Nonreactive Reactive
 Review safer behavior goal  Focus on client’s emotions
 Review referrals  Allow time for client to decide
if s/he wants info
 Check social support  Get client’s contact info to
check in with client
 Go over information about
care services
 Set up case management
appointment
 Discuss disclosure law, partner
services
Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

29. U.S. Policy
US Visas/Entry PEPFAR: President’s
Difficulty of getting visas Emergency Plan for AIDS
US one of 12 countries Relief
with very strict policies Initiated 2003, renewed
Syringe Exchange 2008
Programs 15 focus countries, sub-
Saharan African and
Ban on federal funding
Caribbean
Must get exemption from
Treatment available to
drug paraphernalia laws for
many
programs
Largest bilateral agreement
in world
Focuses on ABC model
Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

30. Michigan Laws
Partner Services Disclosure Law
One is not required to HIV infected persons
participate, but it is are required to disclose
encouraged that those status to future partners
living with HIV notify their before sexual
past partners. County can penetration
do it anonymously. Cannot disclose
Discrimination Law someone else’s status, +
No one can discriminate or –
against a person infected Consent
with HIV Clients must consent to
be tested for HIV
Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.

31. Carrie Rheingans
crheinga@umich.edu
www.umichsph.wordpress.com
www.nafblogger.blogspot.com
www.hivaidsresource.org
www.americorps.gov
www.sph.umich.edu
Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.