April 16, 2003
In an effort to expand the number of at-risk individuals who receive STD and HIV counseling, testing and referral (CTR) services, health departments have implemented outreach programs that target these individuals. A measure of the effectiveness of these HIV CTR programs, aside from the number of new cases found, is the extent to which they reach populations at high risk for HIV who are not otherwise receiving care at a municipal STD/HIV clinic. If new populations are reached by such programs, this information can inform public policy.
Mobile health clinics (vans) are an appealing means of conducting outreach in that they provide an appropriate setting for both STD testing and HIV CTR. The use of such vans is expensive, however, frequently costing two to three times more per patient compared to traditional clinics.
The objective of the current study was to determine whether there are demographic, behavioral and clinical differences between clients seen at a mobile STD/HIV clinic in Baltimore City when compared to clients seen at a traditional Baltimore City STD/HIV clinic serving the same ZIP codes.
The researchers found that the clients of the mobile clinic were older, more likely to be injecting drug users themselves and/or have sex partners who were, or have engaged in prostitution for money or drugs.
More than half (54.4 percent) of the mobile clinic clients sought testing for HIV, and they were much less likely to be seeking care for symptoms of an STD. Only 7.1 percent of municipal clinic clients indicated HIV testing as the reason for their visit, while nearly two-thirds (64.5 percent) reported symptoms of disease. Two percent of municipal clinic clients and 5.4 percent of mobile clinic clients had a positive HIV test; 17.8 percent of STD clinic clients and 5.6 percent of mobile clinic clients had a positive test for gonorrhea and/or chlamydia. The authors report that the data suggest a mobile STD/HIV clinic may be an effective strategy to reach individuals at high risk for HIV who are not being served by traditional municipal STD/HIV clinics.
"In Baltimore City, HIV and STD transmission is largely due to injection drug use and heterosexual sex," the wrote. "Our results are thus most generalizable to urban populations, where the epidemiology of HIV is most related to IDUs and their sex partners. Many studies have assessed HIV and STDs in cities where MSM is the major route of HIV transmission. In these populations, where the routes of transmission for HIV and STDs are the same (i.e., sexual transmission), the behavioral risk factors and clinical characteristics of individuals seeking care in different venues may be quite similar.
"Our study instead characterizes the evolving face of HIV and STDs in heterosexual and drug-using populations such as those in Baltimore City, where the behavioral risk factors and clinical characteristics of patients seeking care in different settings may be different. A mobile STD/HIV clinic placed in high-risk neighborhoods may be the most effective solution to accessing hard-to-reach asymptomatic clients with HIV concerns who would not otherwise present to a traditional STD clinic for care. Policy makers should consider this when distributing scarce resources for HIV CTR services," they concluded.
Journal of Acquired Immune Deficiency Syndromes
04.01.03; Vol. 32: P. 388-393; Jonathan M. Ellen; Sekhar Bonu; Jaime S. Arruda; Michael A. Ward; Ruth Vogel