HIV Screening and Women’s Health

1. Originally developed by: Health Care Education & Training, Inc. HIV Screening and Women’s Health Section 6: Considerations for Implementation

2. 2007 Contributors from AETC Women’s Health and Wellness Workgroup: • Laura Armas, MD; Texas/Oklahoma AETC • Monique M. Clesi; Planned Parenthood of Indiana • Andrea Norberg, MS, RN; AETC National Resource Center • Tonia Poteat, MPH, MMSc, PA-C; Southeast ATEC (SEATEC) • Barbara Schechtman, MPH; Midwest ATEC (MATEC) • Karen Sherman, MA; Health Care Education and Training, Inc. • Barb Sturbaum, LPN; Planned Parenthood of Indiana • Jamie Steiger, MPH; AETC National Resource Center The original curriculum was developed in 2002 by MATEC and Health Care Education & Training, Inc. HIV Screening and Women’s Health

3. Objectives for Section 6: • List major aspects of integrating HIV services into family planning clinics • Describe the importance of knowing your community • Describe an effective referral system • List protocols and procedures your organization needs to have in place HIV Screening and Women’s Health

4. Goal for Providing HIV Services in Family Planning Clinics • Ensure that all women have the • opportunity to know their HIV status. HIV Screening and Women’s Health

5. Aspects of Integrating HIV Services • State policies • Cost/reimbursements • Type of test –which test • Confirmatory testing • Management and staff buy-in • Basic staff training and ongoing staff needs • Support for staff who give test results • Chart documentation • Referral sources for positive clients HIV Screening and Women’s Health

6. 2001 Title X Program Guidelines on HIV • Educational services • Referral services • Risk assessment • Counseling and testing • History taking • Charting • Physical examination HIV Screening and Women’s Health

7. Musts • Analyze HIV risk factors and behaviors of all clients • Offer education and counseling on HIV • Include HIV risks in medical history taking • Do risk reduction counseling if risk behaviors are identified HIV Screening and Women’s Health

8. Organizational Options • Onsite testing • Anonymous • Confidential • What type of test? • Referral for testing HIV Screening and Women’s Health

9. Organizational Procedures and Protocols • Staff responsibilities • Training for staff • Quality assurance program • Notification of test results • Referral for care HIV Screening and Women’s Health

10. Client’s concerns Pregnancy history Artificial insemination Blood exposure Pregnancy prevention methods used Past HIV testing Condom use Alcohol/other drug use # of sex partners Gender of sex partner(s) Type of sex (anal, vaginal, oral) STI history Hepatitis history Sex for money or goods Partner’s alcohol/other drug use Partner’s sex history Partner’s criminal history Partner’s circumcision status Client Risk—An Integrated Risk Assessment HIV Screening and Women’s Health

11. Community Risk—Integrate Community Factors • Alcohol and other drug use • Proportion of older clients based on relationships status • Proportion of adolescents • Sex workers • Prevalence of STIs • Unintended pregnancy rate • Ex-offenders HIV Screening and Women’s Health

12. Community Risk—Integrate Community Factors • Interstate truck stops or rest areas • Gathering places where high risk behaviors take place • Immigration and migration • Bath houses HIV Screening and Women’s Health

13. Youth Risk—Understanding Risk Behaviors • Youth Risk Behavior Survey (YRBS) among females • in grades 9-12 in Michigan • 41% have had intercourse • 10% had more than four sex partners • 31% had sex within the last three months • 19% used alcohol or other drugs during most recent episode • 40% did not use a condom during last episode HIV Screening and Women’s Health

14. Types of Testing • Confidential • Anonymous HIV Screening and Women’s Health

15. Referral and Deferral of Testing • Opt-out, if possible • Risk reduction for identified risk factors • Guidelines for referrals • List of referral sites HIV Screening and Women’s Health

16. Client Records • Consult with your state health department • Informed consent is required HIV Screening and Women’s Health

17. Chart Documentation • Risk assessment • Risk reduction plan • Referrals for testing • Deferrals • HIV specific medical record release • Informed consent • Other referrals and ID need • Medical • Psychosocial HIV Screening and Women’s Health

18. Protocols for Positive Test Results • Method of partner notification • Partner notification records • Follow-up efforts • Risk reduction plan • State case report HIV Screening and Women’s Health

19. Ongoing Staff Training Needs • Base training on evidence from site reviews • Changing community risk factors • Knowledge of types of HIV tests • Legalities of HIV-related consent forms • Legalities of testing/state laws • Notification/partner notification • Referral sources HIV Screening and Women’s Health

20. Evaluate Staff Performance • Observe staff educational sessions • Observe testing • Observe counseling • Design ongoing training, as needed HIV Screening and Women’s Health

21. Resources • AIDS Education and Training Centerswww.aidsetc.org • Title X Family Planning Regional Training Centershttp://opa.osophs.dhhs.gov/titlex/ofp-training-grantees-listing.html • National HIV/AIDS Clinicians’ Consultation Center (NCCC) www.ucsf.edu/hivcntr • Family Health International • Establishing Referral Networks for Comprehensive HIV Care in Low-Resource Settings http://www.synergyaids.com/documents/RefNetsGuide2.pdf Reproductive Health and HIV HIV Screening and Women’s Health

22. References • Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. Healthy Youth! State-by-State, Michigan. Retrieved on November 5, 2007 from http://www.cdc.gov/HealthyYouth/states/mi.htm • MacDonald, S.R., Skor, A., Socol, M.L., & Garcia, P.M. (1998). Human immunodeficiency virus infection and women: a survey of missed opportunities for testing and diagnosis. American Journal of Obstetrics and Gynecology,178(6):1264-71. Reproductive Health and HIV HIV Screening and Women’s Health