Harlem United The Blocks Project

1. Harlem UnitedThe Blocks Project Presented by Sara Gillen Prepared by Z. Naqvi, S. Gillen, E. Aponte, V. Mojica, P. McGovern

2. HIV in Harlem Data from the NYC Department of Health and Mental Hygiene, 2008 Surveillance Report East and Central Harlem report the 2nd and 3rd highest rates of HIV diagnoses and prevalence, and the death rate is 1.5 times the city rate

3. Opportunities for Intervention People Living With HIV/AIDS* New Infections ~25% unaware of infection (n=250,000) Accounting for: 42% of these people are not in care ~54%of new infections ~75%aware of infection (n=750,000) Accounting for: ~46% of new infections *N=1,000,000. Marks G et al. AIDS. 2006;20(10):1447-1450.

4. The CBO Challenge • 2006: Federal guidance on HIV screening in clinical settings changed – universal testing, regardless of HIV risk history • Universal access to testing in medical settings does not reach all NYC residents • lack of health insurance or a primary care doctor • stigma related to same sex behavior or drug use keeps people from seeking care • Risk perception is low, patients may refuse test

5. Changing the Paradigm: Risk-Targeting with a Zone/Geographic Approach Testing Services Blocks/Zone Based Testing Risk Based Testing Identification of high prevalence zones, community saturation with prevention messages and HIV facts, increased testing accessibility via alternative venue and mobile testing Social Networks: MSM, high-risk African American women Venue Based: IDU, MSM, high risk women, immigrants Risk is defined as sharing syringes, unprotected anal or vaginal sex with an HIV-positive person or a person of unknown HIV status in a high risk group, STI in the last 12 months, unprotected sex in the last 12 months with multiple partners

6. Geo-code clients to identify hot-spots for outreach and testing; 2) Saturate the zone with relevant and targeted HIV prevention facts and messages to remove stigma of testing and HIV; 3) Provide accessible, on-the-spot HIV testing; and 4) Provide referrals to linkage to care Blocks: Tools and Tactics

7. Identification of Zones: Hot Spot Maps

8. Saturate the identified zone with messages and promotional materials: “HIV is a community disease”, emphasis on routine testing and access to care Use guerilla marketing techniques to prompt interest in our services and promote testing (i.e., “Let’s Do It” blitz) Message Saturation • Community-wide and local HIV • awareness & outreach events • Door-by-door surveys and • outreach

9. Increasing Accessibility

10. Overall Increase in Testing: 84% from 2008 to 2009 Findings: Increase In Overall Testing

11. Findings: Positive Cases

12. Increasing Linkage to Care Findings: Linkage to Care We have increased connection to primary care for HIV positive clients to 80%, far surpassing the NYCDOHMH connection to care rate for Harlem (57. 7%).

13. Modification of Beliefs: N=693 Findings χ2 =402.216, df 6 p<0.001;χ2=536.97, df 12 p<0.001; χ2=375.72, df 12, p<0.001;

14. HIV Testing Since Blocks : N=693 Findings % χ2= 62.79, df 12 p<0.001;

15. Self-Perceived HIV Risk Among HIV+ Clients: N= 138 Findings: 2008 Risk Perception No answer High= 55 = 13 Other= 34 Don't know = 21 Low =29 Medium =20 • Specifically older adults (>40 yr old) and women make up the • majority in the “low,” “medium,” and “other” categories.

16. In high prevalence communities: Universal testing is critical Testing programs outside the clinical setting have a vital role in reaching community residents Stigma can be reduced by promoting HIV testing as a community norm Conclusion

17. Thanks to the Gilead Sciences, MAC AIDS Fund and New York City Department of Health and Mental Hygiene for funding that supports our Blocks and Linkage to Care activities. For more information, please contact: Sara Gillen: sgillen@harlemunited.org Acknowledgements