200142 Time gaps between HIV infection, testing, and treatment among racial/ethnic minority drug users: Opportunities for enhanced prevention

Tuesday, November 10, 2009

Ashly E. Jordan, BA , Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, NY
Carmen Masson, PhD , Department of Psychiatry, University of California San Francisco, San Francisco, CA
Pedro Mateu-Gelabert, PhD , Iar, National Develpment & Research Institutes, New York, NY
Nicole Pepper, MSSW , Department of Psychiatry, University of California San Francisco, San Francisco, CA
Courtney McKnight, MPH , Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, NY
Brad Hare, MD , Positive Health Program, University of California San Francisco, San Francisco, CA
James Sorensen, PhD , Department of Psychiatry, University of California San Francisco, San Francisco, CA
Don C. Des Jarlais, PhD , Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, NY
David C. Perlman, MD , Beth Israel Medical Center; NDRI, Inc., New York, NY
Background: Many infected persons are unaware of their HIV infection and are not receiving needed care. Factors contributing to gaps in time between HIV infection, diagnosis, and medical care are not completely understood.

Methods: Fourteen focus groups were conducted with drug users (DUs) recruited from methadone maintenance, HIV primary care, and syringe exchange programs in New York City and San Francisco (7 all Latino/a and 7 all African American groups; 95 total subjects). Themes were identified using ethnographic software (Atlas.ti Version 5.5) to aid in analysis.

Results: Despite awareness of HIV risk and easy access to HIV testing, many participants reported waiting years before getting tested. Reasons included anxiety about test results, foreseeing difficulty coping with a positive HIV test, anticipating stigma, time consumed accessing/using drugs. Subjects reported dissatisfaction with post-test counseling (citing inadequate support or referrals, and confidentiality concerns). Similar time gaps were reported between testing HIV positive and seeking medical care. Reasons given included denial, inability to accept the diagnosis, depression, and a belief that HIV is untreatable.

Conclusions: Racial/ethnic minority DUs reported wide time gaps between recognizing their risk and being HIV tested, and between a positive HIV test and obtaining care. Psychological factors, incomplete knowledge of treatment and effectiveness, and anticipating social stigma were principal reasons reported for delays. These findings highlight the potential for interventions addressing risk perception, stigma, self efficacy, treatment efficacy, knowledge, and post-test counseling referral mechanisms to enhance HIV prevention efforts.

Supported by: NIH Grants (R01DA20781, R01DA020841, P30 DA 011041, & U10DA15815)

Learning Objectives:
-Identify barriers to HIV testing and treatment among minority drug users. -List reasons cited for delays in accessing HIV testing and starting HIV treatment. -Discuss potential for specific interventions to enhance HIV prevention efforts.

Keywords: HIV/AIDS, Minority Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Worked under supervision of Drs. Perlman, Masson, Des Jarlais, and Sorensen, all PhD or MD senior research scientists who ran this project and supervised my work.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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