t’s an unfortunate fact that has disturbed doctors and health activists: Younger people are making up a greater share of HIV infections. As it’s continued to pop up in report after report, the grim statistic has rallied health organizations to fight back. Now, a University of Cincinnati program is bringing together community organizations in Hamilton County to stop this troubling trend in young adults.
To bolster its program, the UC HIV Early Intervention Program (EIP) will receive a $140,000 grant for 15 months from the Ohio Department of Health. The grant will help EIP bring together 10 community-based nonprofits to combat the HIV epidemic, particularly among black, young men who have sex with men (MSM) in Hamilton County.
Andrew Ruffner, director of EIP, says an emphasis on demographics is important because of the recent trends. On a national level, the Center for Disease Control and Prevention (CDC) found MSM, which makes up about 2 percent of the population according to CDC estimates, accounted for 61 percent of all new HIV infections in 2009. Blacks, which represent 14 percent of the U.S. population, made up 44 percent of new HIV infections in the same year. Young MSM, meaning ages 13 to 29, made up 27 percent of new cases in 2009.
In the CDC analysis, the young, black MSM demographic was the only group in recent years to experience statistically significant increases in new HIV infections. Between 2006 and 2009, HIV infections in the group grew by about 48 percent — from 4,400 to 6,500 infections.
In Hamilton County, about 63 percent of new HIV diagnoses in 2010 were among people aged 34 and under, according to the Ohio Department of Health. About 68 percent were among blacks in the same year. About 70 percent of diagnoses among men were due to male-to-male sexual contact.
In light of these statistics, eight out of 10 organizations have so far joined EIP’s efforts: Our Daily Bread, the Drop Inn Center, St. Vincent de Paul, FreeStore Foodbank, Lighthouse Youth Services, Central Community Health Board, the Talbert House and St. Joseph’s Orphanage.
To get these organizations ready, EIP will deploy a special HIV test counselor. The counselor will travel to each organization and provide HIV testing to clients chosen by the organizations’ staff.
But deciding who gets testing comes with some challenges. The grant will fund 1,000 tests, so staff at the different organizations will have to sort out who is at the highest risk of HIV. Ruffner says additional training will be provided at the community organizations to show them what to look out for. The training will emphasize demographics, especially black, young and MSM.
Some demographics present unique problems. For example, some men who engage in sexual acts with other men may not identify as gay. This makes reaching out to the MSM demographic more difficult because they won’t be active in the more traditional community hubs and social circles. Improvements in technology have only exacerbated the problem.
“The Internet has caused a real shift in how people find partners, so you don’t have a central location where you can get messages and do a lot of messaging about prevention and testing,” Ruffner says. “People aren’t going to an actual physical spot. They’re making connections through the Internet.”
The problem gets worse when screening youth. Ruffner says younger people have flimsier ideas about their sexual identity, which makes them even less likely to identify at-risk sexual behaviors.
To reach these people, Geneva Nelson, a trainer from the Central Community Health Board, is emphasizing trust building: “Most of us are not going to talk to anybody about what we do sexually, so there has to be a trust level in order for you to give out that information to somebody.”
To Nelson, building close relationships with potential victims is a pivotal part of identifying at-risk factors. She says staff will have to be trained to tear down social and emotional barriers to access the kind of information that could warrant being placed in line for HIV testing. Trust and strong ties will become even more important as the organizations’ members look for additional at-risk signs, such as number of sexual partners, past or current drug use, history of sexually transmitted diseases and whether someone has been tested for HIV in the past.
For staff members, training could lead to some self-introspection. Nelson says she’s going to need to “help the staff get in touch with their own sexuality.” She adds, “Some staff are not going to be able to talk to a gay man or to a drag queen. Some staff are more comfortable with that and their own sexuality. So a lot of what we’re teaching them is getting comfortable with themselves.” With increased comfort, Nelson hopes the staff will have an easier time relating to potential victims and identifying problems.
After the training, conversations and testing, the question then becomes what to do with victims that are diagnosed positive for HIV. At that point, EIP will work closely with UC’s Infectious Disease Center to confirm results and link victims with health care.
Ruffner says Ohio is actually in a good place to deal with those lacking adequate insurance plans. The Ohio HIV Drug Assistance Program helps those who test HIV positive get access to drugs and medications necessary to combat HIV and HIV-related conditions.
Funding for Ohio’s HIV program comes from the federal government through the Ryan White Care Act. The law was originally passed in 1990, and it has since been reauthorized by former President George W. Bush in 2006 and President Barack Obama in 2009. It funds medical services, limited dental services and limited mental health services for low-income, uninsured and under-insured victims of HIV and AIDS and their families.
With those healthy treatment options, the big hurdle is simply identifying who is at risk and who actually has HIV. That makes EIP and early prevention programs like it all the more important in stopping the HIV epidemic, particularly among younger demographics.
“It’s in the public health interest,” Ruffner says. “The earlier we treat the HIV, the less infectious the person is and the better health outcom
es we’re going to have in the long ru