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Outreach - Bathhouse

Decline in Rates of Syphilis Screening Following the Implementation of Rapid HIV Testing in Commercial Sex Venues Antonio Purcell de Ogenio, Denver Public Health May 11, 2006. Outreach - Bathhouse. Program started following syphilis outbreak in Spring/Summer 2002

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Outreach - Bathhouse

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  1. Decline in Rates of Syphilis Screening Following the Implementation of Rapid HIV Testing in Commercial Sex VenuesAntonio Purcell de Ogenio, Denver Public HealthMay 11, 2006

  2. Outreach - Bathhouse • Program started following syphilis outbreak in Spring/Summer 2002 • Objective: Confidential/Anonymous, free STD/HIV testing

  3. Client demographics • Median age: 41 • Over 40% of the • population are from • outside Denver County • Around 30% do not • identify as gay

  4. Bathhouses w/Clinical Facilities • Testing at all three bathhouses considered a norm • Clinic or Private room set up as a clinic

  5. STD/HIV Testing and Counseling • Services since inception of program: • Veni-puncture, urine, and swab cultures • Testing for: • HIV • Syphilis • HEP C • Chlamydia and Gonorrhea (rectal, pharyngeal, & urethral or SDA) • Rapid HIV introduced Spring/Summer 2004

  6. Pre-HIV Rapid Testing • Appointments made at the bathhouse to come in to Health Department for HIV Results • Results for HIV not always given due to no-shows • Follow-up letter for no-shows • State notified after 1 month

  7. Rapid Test Introduction BH-B BH-C BH-A ‘02 ‘03 ‘04 ‘05 ‘06 May Aug Sep Started Testing For HIV/Syphilis Started Rapid test

  8. Post-HIV Rapid Test • HIV Rapid Test is a finger puncture (not requiring blood draw) • HIV results given after 20 minutes • STD results other than HIV given by phone • Process time is anywhere from 4-8 business days • Some STDs require veni-puncture (syphilis and Hepatitis C) • Urine samples (Chlamydia and Gonorrhea) • Phone call or follow-up letter for those that don’t call in • State notified after 3 weeks if results not given

  9. Rates of HIV and Syphilis screening by year

  10. Rates of HIV and Syphilis screening by year

  11. Rates of HIV and Syphilis screening Pre- and Post-Rapid test Note: Post - Sep 04 through Dec 05

  12. Rates of HIV and Syphilis screening Pre- and Post-Rapid test

  13. Possible Reasons for Decrease • Of all STDs, HIV considered the greatest threat • Convenience and speed of screening process for both client and clinic staff if testing only for HIV • Client fear of veni-puncture • Concern over veni-puncture within facility • Visibility of bandage on arm • Perceived sanitary conditions of facility • Not being able to use jacuzzi, pool or sauna for a period of time

  14. Other Challenges • Not everyone is calling in for STD Results • Lack of syphilis data means Syphilis outbreak less likely to be determined • Decrease in perceived susceptibility to STDs

  15. Conclusions • Protocol re-evaluated for testing at bathhouses • Returned to veni-puncture for all testing • Need for ongoing monitoring • Adjunctive efforts to increase testing rates • Increase marketing of STD screening • Educate population regarding correlation between HIV and other STDs • Educate bathhouse staff (gatekeepers)

  16. Acknowledgements • Kees Rietmeijer, M.D., Dir DPH STD Clinic • Mark Thrun, M.D., Dir. of Prevention Training Center and Research • Stewart Thomas, Outreach Staff Supervisor, DPH Bathhouse Staff Supervisor • Bathhouse Screeners: James Collins; Aron Shipman; Charles Chen; and Philip Osteen. • Bathhouse Owners and Staff

  17. Questions?

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