At-Risk Baltimore Youth Need Access to HIV Testing

With over 1.2 million individuals living with HIV in the United States, the virus continues to be a major public health concern. For younger individuals (15-24 years of age) who are at increased risk, particularly men who are a part of racial/ethnic minority populations and men who have sex with men (MSM), testing is imperative. Unfortunately, testing rates for these at-risk populations remain low.

Researchers from Johns Hopkins University decided to find out if these rates were low simply because the testing was not accessible to these populations. The researchers conducted surveys with the goal of finding out the prevalence of HIV testing among “youth-serving, nonclinical, community based-organizations” in a geographic target area in Baltimore, Maryland. Their results indicated that the majority of the organizations surveyed did not offer HIV testing and did not “have established links to refer youth to testing,” according to a press release.

In addition to surveying the organizations, the researchers also wanted to make note of the characteristics of the those organizations who did provide testing opportunities. The surveyors asked questions pertaining to the “age of members served, whether it served African American or Hispanic young people, the number of young people served per year, whether it served male young people, the number of male young people served per year, and where it served young people who were gay, out of school because of dropping out, or unstably housed.”

The organizations were chosen for inclusion based on whether or not they were located close to “high concentrations of young minority males ages 15 to 24…who have higher HIV rates than their white counterparts.” Because of their geographical location, the researchers felt that these organizations held the greatest potential to help this younger at-risk population—a population that might not have access to healthcare—be diagnosed if they have the virus, and if needed, receive treatment.

According to first author Arik Marcell, MD, MPH, “The study demonstrates the need for more transparent cross-collaboration between clinical and nonclinical realms that serve youth. We can do a better job to bridge these historical silos, and, as a result, improve the care youth receive. Having a better understanding of community-based organizations that serve youth can help clinical settings and HIV testing programs improve the access to youth being tested, especially in cities with high rates of HIV, such as Baltimore.”

Between February 2013 and March 2014, the researchers conducted 36 phone surveys and 15 in-person interviews with organization administrators. In the survey, administrators shared whether or not their organizations provided HIV testing. If the organizations did not provide testing, the researchers asked if they had an established link to testing. They also questioned the organizations on how long they had been in existence, “staff type and mission,” “nonhealth services offered, such as tutoring and sports,” and if the administrators felt that their staff were familiar with the “seven dimensions of clinical care for youth in the city.”

The researchers found that 30 out of 51 of the interviewed organizations—or 59%—did not have testing available. Seventy-three percent of those who did not provide testing—22 out of 30—did not have established links available for youth populations to refer to in order to get needed testing. Nine organizations did not provide testing, but referred to the city health department for testing access. Eighty-one percent of the organizations who did provide testing reported that the tests were conducted by individuals who were external to the organization, meaning that the testing was not done by staff members.

The researchers found that the organizations that did provide HIV testing to the at-risk youth population were more likely to offer other “general health services, referral services for sexually transmitted infections screening, and HIV care.” In addition, the administrators of these organizations also felt that their staff were very comfortable in talking about sexual health.

Overall, the researchers’ findings show that there is a need for increased access to HIV testing., especially in community-based organizations. According to the study, past evidence suggests that younger individuals, particularly those who are lesbian, gay, bisexual, or transgender, “hold favorable opinions about HIV testing in community organizations and view such places as key access points for support of their psychosocial needs.” Therefore, these community organizations can play an essential role in improving the sexual health of these younger at-risk populations. For the organizations that are unable to provide testing, they can at least provide established links to testing.

According to Dr. Marcell, “Community-based organizations that serve youth need to think more broadly about the health issues important to the population they serve and how to partner with the healthcare system to help meet their needs if specific links do not already exist.”