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New Haven-Fairfield Counties End of Year Studies: Ryan White Planning Council

New Haven-Fairfield Counties End of Year Studies: Ryan White Planning Council. Foreign Born, MSM and Return to Care. April 5, 2012. Overview 1.

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New Haven-Fairfield Counties End of Year Studies: Ryan White Planning Council

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  1. New Haven-Fairfield Counties End of Year Studies:Ryan White Planning Council Foreign Born, MSM and Return to Care April 5, 2012

  2. Overview1. • Three (3) studies were conducted from February through March of 2012. 195 total clients responded to these surveys, with representation from all five (5) strategic planning regions. • Foreign Born (n = 66) • Men having Sex with Men (MSM) (n = 91) • Return to Care (n = 38) • The studies were conducted to inform the Early Intervention Services strategy, and to populate the 2012-2015 Comprehensive Strategic Plan.

  3. Foreign Born2. • Sixty-six (66) respondents with the highest percentage of recently diagnosed of the three groups with 45% (29/66) diagnosed in the past 4 years. • Serostatus upon testing:68% were diagnosed with AIDS, 27% with HIV and 5% seroconverted to AIDSwithin one year of initial HIV diagnosis. • Gender of Foreign Born Respondents: 67% male, 33% female • Age Group of Foreign Born:Youngest group with 46%below age of 30 but alsohas high percent of above 50with 40%

  4. Foreign Born3. • Twenty (20) different countries of origin • The majority (79%) were diagnosed in this EMA, with 19% diagnosed in the U.S. and only 2% outside this country COUNTRY OF ORIGIN WHERE DIAGNOSED

  5. Foreign Born4. • Time in U.S. prior to testing HIV positive – mean of 7.8 years, median of 5 yearsand mode of 1 year (only 2 tested positive prior to emigration) • Place informed of HIV diagnosis (testing location) – 59% tested in clinical settingsand zero foreign-born were informed of their HIV diagnosis or tested via Outreach. • Reason for testing – 49% were sick, diagnosed while in the hospital or went to the ED; 23% were told by partner or doctor to get tested; 6% had a physical (immigration or insurance) and only 5% had routine testing. TIME BETWEEN EMIGRATIONTO U.S. AND HIV DIAGNOSIS Other:Immigration Clinic 4 Jail 3

  6. Foreign Born5. • Suspected exposure/ transmission – dominant self-disclosed transmission was heterosexual, followed by equal MSM and IDU but 2/3 of respondents were men, and 1/3 of these claiming to be heterosexual (15) also took the MSM survey. • Time from testing HIV diagnosis to care entry – median of 4 years • Reasons and Services that led Foreign Born to enter care – advanced HIV (and other ) disease, Medical Case Management SELF-REPORTEDTRANSMISSION TIME BETWEEN HIV DIAGNOSISAND HIV MEDICAL CARE ENTRY REASON/ SERVICES TO HELP FOREIGN-BORN ENTER HIV MEDICAL CARE

  7. Foreign Born6. • Issues with staying in care:- 21% reported problems staying in care with the highest mention of lack of health insurance- 15% are erratically in care with 5% reporting recent technically out of care • Unique problems as Foreign Born with HIV diagnosis - the top 3 issues were:1. Illegal/Undocumented and fear to access any systems 2. Stigma & Non-Disclosure to their families and even among married /partnered couples 3. Language and communication issues including illiteracy in their own language • Resources to help Foreign Born stay in HIV Medical Care:1. More translators 2. Medical Case Managers 3. Evening hours • Help for Foreign Born to Access Services:1. Help with Immigration 2. Ways to provide care without health insurance 3. Language issues • Ideas to Improve Services for Foreign Born1. Help with Education to avoid having to access free HIV or other medical care2. Providing instructions so I don’t have to read them—perhaps pictures or guidelines as I can’t read even in my own language

  8. MSM7. • Ninety-one (91) respondents withthe highest percentage of respondentsin oldest age group (25+ years @ 6%). • High percentage in newly diagnosed:34% in past 2 years and 41% in past 4 years • Race/Ethnicity & Age Group: Race/ Ethnicgroups are evenly split among Whites and Hispanics followed by Blacks. Age groups are bimodal at 30-34 (14)and 45-54 (14 and 15). Average age is 41 years.

  9. MSM8. • Self-Reported Transmission • Current Health Insurance • Area first diagnosed WHERE DIAGNOSED

  10. MSM9. • Place informed of HIV diagnosis (testing location). • HIV Status – 38% initially diagnosed as AIDS, 5% seroconverted, 62% HIV as initial diagnosis • Role of Emergency Dept – 29% report using the ED as their primary care location, 44% have been to an ED before being diagnosed but only 10% were asked to take an HIV test and only 8% did. • Reason for testing and time suspected of HIV+ prior to test

  11. MSM10. • Partner Notification: Of the 30 MSM testing positive in the past two years, 18 individuals were contacted by Partner Notification (60%), and 40% or 12 stated that they had not been offered this service. • Behavioral Risk: Sexually Transmitted Infections – 81% report History of STD with syphilis (38%) and gonorrhea (24%) most commonly reported • Behavioral Risk: Social networking most frequently cited, then Clubs, then Streets • Other Risks: 45% report mental health counseling, 20% substance use rehabilitation

  12. MSM11. • Time to enter care upon testing HIV positive – mean, median and mode of 1 month. Fastest of three groups to enter HIV medical care (75% under a 3 months, the National HIV/AIDS Strategy goal). • Race/Ethnicity for later entrants shows all over 1 year are Latino . • Reasons/Services to enter care – all due to ‘feeling sick’, least support service related. TIME BETWEEN HIV DIAGNOSISAND HIV MEDICAL CARE ENTRY REASON/ SERVICES TO HELP MSMENTER HIV MEDICAL CARE

  13. MSM12. • Issues with staying in care • Only 2 are erratically in care (2/91 = 2.2%) • Unique problems as MSM with HIV diagnosis • Condom use most commonly cited, then employment, then housing support • Resources to help MSM stay in HIV Medical Care • Doctors, then HIV medications, Housing Support then Medical Case Managers • Top services that MSM have trouble getting • CADAP (most frequently cited at 19% with correlation to income over $40,000) • Employment • Education or Re-training • Vision Care

  14. Return to Care13. • Thirty-eight (38) respondents • Demographics • Average current age: 42 years • Average age when diagnosed: 28-30 • Race/Ethnicity: • Gender: 23 male (60%) 14 female (37%), 23 male, 1 transgender (3%) • Self-reported transmission

  15. Return to Care14. • Initial HIV Medical Care Entry: • Services initially referred to (when first entered care):

  16. Return to Care14. • Reasons for Leaving Care • Services that helped you Return to Care

  17. New Haven-Fairfield Counties Ryan White Planning CouncilApril 5, 2012 End of Year Studies Appendices - Maps

  18. Foreign-Born Residence17.

  19. MSM Residence18.

  20. Return to Care Residence19.

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