Routine rapid HIV testing and counseling for homeless individuals who present at health care settings in Long Beach, CA

A key strategy to reducing the incidence of HIV transmission is making the population aware of their HIV status. HIV Testing & Counseling has been the crux of public health efforts in community-based settings, yet one quarter of the 1.2 million persons estimated to be living with HIV are unaware that they are infected. Among several high-risk populations, the homeless community may represent one or more behavioral risk groups that include substance abuse, intravenous drug use, sex work, and men who have sex with men. In addition, poor health outcomes and barriers to care are exacerbated by histories of mental illness and/or incarceration, and food/shelter insecurity. The use of rapid HIV testing (results in twenty minutes) is the core strength of our policy in that loss to follow up is often the case with this hard-to-reach population. We propose that Long Beach, CA adopt a policy to routinely perform rapid HIV Testing & Counseling (with option to opt-out) to those individuals who identify as being homeless, regardless of risk or symptoms, that present at any emergency department, urgent care clinic, public health clinic, and community health clinic where medical services are delivered. Routine rapid HIV testing of homeless individuals who present at Long Beach, CA health care settings will increase the number of homeless individuals who know their status so they can be guided to appropriate resources for treatment and/or risk-reduction planning. The outcome of this policy will be a reduced incidence of HIV infection in Long Beach, CA.