HJS Poster[1]
- 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: