Decline in Rates of Syphilis Screening Following the Implementation of Rapid HIV Testing in Commercial Sex Venues Antonio Purcell de Ogenio, Denver Public Health May 11, 2006 This program started in May 02.. Documenting started in May 02

Eligible clients in CSV % of total eligible screened Outreach - Bathhouse Program started following syphilis outbreak in Spring/Summer 2002 Objective: Confidential/Anonymous, free STD/HIV testing Year Eligible clients in CSV Overall screened % of total eligible screened 2002 4923 298 6.1% 2003 7568 475 6.3% 2004 9850 642 6.5% 2005 14204 831 5.9% We are currently offering… Regarding the Urethral and SDA Faced with alcohol and dehydration Some people will come in to talk about various symptoms and not get tested Some people are from out of town

Client demographics Over 40% of the population are from Median age: 41 Over 40% of the population are from outside Denver County We are currently offering… Regarding the Urethral and SDA Faced with alcohol and dehydration Some people will come in to talk about various symptoms and not get tested Some people are from out of town Around 30% do not identify as gay

Bathhouses w/Clinical Facilities Testing at all three bathhouses considered a norm Clinic or Private room set up as a clinic

STD/HIV Testing and Counseling Services since inception of program: Veni-puncture, urine, and swab cultures Testing for: HIV Syphilis HEP C Chlamydia and Gonorrhea (rectal, pharyngeal, & urethral or SDA) Rapid HIV introduced Spring/Summer 2004 We are currently offering… Regarding the Urethral and SDA Faced with alcohol and dehydration Some people will come in to talk about various symptoms and not get tested Some people are from out of town

Pre-HIV Rapid Testing Appointments made at the bathhouse to come in to Health Department for HIV Results Results for HIV not always given due to no-shows Follow-up letter for no-shows State notified after 1 month Show appointment cards Phone results are made by either calling the clinic or my work phone. They all get my business card, though due to my odd schedule they have the option of calling the clinic We get a good number of no-shows which will be displayed at a later slide I do have form letters that I send out in order to remind them about their results - I don’t state what type of test - I don’t state location For those that are positive, I inform the state after one month

Rapid Test Introduction BH-B BH-C BH-A ‘02 ‘03 ‘04 ‘05 ‘06 May Aug Sep Started Testing For HIV/Syphilis Started Rapid test Show demo paper with add Show t-shirt with logo Show incentives ….and I’m creating flyers through Publisher and posting them within the bathhouses

Post-HIV Rapid Test HIV Rapid Test is a finger puncture (not requiring blood draw) HIV results given after 20 minutes STD results other than HIV given by phone Process time is anywhere from 4-8 business days Some STDs require veni-puncture (syphilis and Hepatitis C) Urine samples (Chlamydia and Gonorrhea) Phone call or follow-up letter for those that don’t call in State notified after 3 weeks if results not given Show appointment cards Phone results are made by either calling the clinic or my work phone. They all get my business card, though due to my odd schedule they have the option of calling the clinic We get a good number of no-shows which will be displayed at a later slide I do have form letters that I send out in order to remind them about their results - I don’t state what type of test - I don’t state location For those that are positive, I inform the state after one month

Rates of HIV and Syphilis screening by year % screen HIV % Pos Syp % screen Syp 2002 298 251 84% 4.78% 280 94% 1.79% 2003 475 392 83% 6.63% 368 78% 0.54% 2004 624 548 88% 3.47% 309 50% 1.62% 2005 766 731 95% 5.20% 37% Show appointment cards Phone results are made by either calling the clinic or my work phone. They all get my business card, though due to my odd schedule they have the option of calling the clinic We get a good number of no-shows which will be displayed at a later slide I do have form letters that I send out in order to remind them about their results - I don’t state what type of test - I don’t state location For those that are positive, I inform the state after one month

Rates of HIV and Syphilis screening by year

Rates of HIV and Syphilis screening Pre- and Post-Rapid test % Screen HIV % Pos Syp % Screen Syp Pre- Sep 04 1143 988 86% 5.06% 841 74% 1.19% Post- 1020 934 92% 4.82% 396 39% 1.77% Show appointment cards Phone results are made by either calling the clinic or my work phone. They all get my business card, though due to my odd schedule they have the option of calling the clinic We get a good number of no-shows which will be displayed at a later slide I do have form letters that I send out in order to remind them about their results - I don’t state what type of test - I don’t state location For those that are positive, I inform the state after one month Note: Post - Sep 04 through Dec 05

Rates of HIV and Syphilis screening Pre- and Post-Rapid test

Possible Reasons for Decrease Of all STDs, HIV considered the greatest threat Convenience and speed of screening process for both client and clinic staff if testing only for HIV Client fear of veni-puncture Concern over veni-puncture within facility Visibility of bandage on arm Perceived sanitary conditions of facility Not being able to use jacuzzi, pool or sauna for a period of time Show demo paper with add Show t-shirt with logo Show incentives ….and I’m creating flyers through Publisher and posting them within the bathhouses

Other Challenges Not everyone is calling in for STD Results Lack of syphilis data means Syphilis outbreak less likely to be determined Decrease in perceived susceptibility to STDs Show demo paper with add Show t-shirt with logo Show incentives ….and I’m creating flyers through Publisher and posting them within the bathhouses

Conclusions Protocol re-evaluated for testing at bathhouses Returned to veni-puncture for all testing Need for ongoing monitoring Adjunctive efforts to increase testing rates Increase marketing of STD screening Educate population regarding correlation between HIV and other STDs Educate bathhouse staff (gatekeepers) Show demo paper with add Show t-shirt with logo Show incentives ….and I’m creating flyers through Publisher and posting them within the bathhouses

Acknowledgements Kees Rietmeijer, M.D., Dir DPH STD Clinic Mark Thrun, M.D., Dir. of Prevention Training Center and Research Stewart Thomas, Outreach Staff Supervisor, DPH Bathhouse Staff Supervisor Bathhouse Screeners: James Collins; Aron Shipman; Charles Chen; and Philip Osteen. Bathhouse Owners and Staff Show demo paper with add Show t-shirt with logo Show incentives ….and I’m creating flyers through Publisher and posting them within the bathhouses

Questions? Show demo paper with add Show t-shirt with logo Show incentives ….and I’m creating flyers through Publisher and posting them within the bathhouses