New Haven-Fairfield Counties End of Year Studies: Ryan White Planning Council New Haven-Fairfield Counties End of Year Studies: Ryan White Planning Council April 5, 2012 Foreign Born, MSM and Return to Care

Overview 1.  Three (3) studies were conducted from February through March of total clients responded to these surveys, with representation from all five (5) strategic planning regions. 1) Foreign Born (n = 66) 2) Men having Sex with Men (MSM) (n = 91) 3) Return to Care (n = 38)  The studies were conducted to inform the Early Intervention Services strategy, and to populate the Comprehensive Strategic Plan.

Foreign Born 2.  Sixty-six (66) respondents with the highest percentage of recently diagnosed of the three groups with 45% (29/66) diagnosed in the past 4 years.  Serostatus upon testing: 68% were diagnosed with AIDS, 27% with HIV and 5% seroconverted to AIDS within one year of initial HIV diagnosis.  Gender of Foreign Born Respondents: 67% male, 33% female  Age Group of Foreign Born: Youngest group with 46% below age of 30 but also has high percent of above 50 with 40%

Foreign Born 3.  Twenty (20) different countries of origin  The majority (79%) were diagnosed in this EMA, with 19% diagnosed in the U.S. and only 2% outside this country COUNTRY OF ORIGINWHERE DIAGNOSED

Foreign Born 4.  Time in U.S. prior to testing HIV positive – mean of 7.8 years, median of 5 years and mode of 1 year (only 2 tested positive prior to emigration)  Place informed of HIV diagnosis (testing location) – 59% tested in clinical settings and zero foreign-born were informed of their HIV diagnosis or tested via Outreach.  Reason for testing – 49% were sick, diagnosed while in the hospital or went to the ED; 23% were told by partner or doctor to get tested; 6% had a physical (immigration or insurance) and only 5% had routine testing. Other: Immigration Clinic 4 Jail 3 TIME BETWEEN EMIGRATION TO U.S. AND HIV DIAGNOSIS

Foreign Born 5.  Suspected exposure/ transmission – dominant self-disclosed transmission was heterosexual, followed by equal MSM and IDU but 2/3 of respondents were men, and 1/3 of these claiming to be heterosexual (15) also took the MSM survey.  Time from testing HIV diagnosis to care entry – median of 4 years  Reasons and Services that led Foreign Born to enter care – advanced HIV (and other ) disease, Medical Case Management TIME BETWEEN HIV DIAGNOSIS AND HIV MEDICAL CARE ENTRY REASON/ SERVICES TO HELP FOREIGN-BORN ENTER HIV MEDICAL CARE SELF-REPORTED TRANSMISSION

Foreign Born 6.  Issues with staying in care: - 21% reported problems staying in care with the highest mention of lack of health insurance - 15% are erratically in care with 5% reporting recent technically out of care  Unique problems as Foreign Born with HIV diagnosis - the top 3 issues were: 1. Illegal/Undocumented and fear to access any systems 2. Stigma & Non-Disclosure to their families and even among married /partnered couples 3. Language and communication issues including illiteracy in their own language  Resources to help Foreign Born stay in HIV Medical Care: 1. More translators 2. Medical Case Managers 3. Evening hours  Help for Foreign Born to Access Services: 1. Help with Immigration 2. Ways to provide care without health insurance 3. Language issues  Ideas to Improve Services for Foreign Born 1. Help with Education to avoid having to access free HIV or other medical care 2. Providing instructions so I don’t have to read them—perhaps pictures or guidelines as I can’t read even in my own language

MSM 7.  Ninety-one (91) respondents with the highest percentage of respondents in oldest age group (25+ 6%).  High percentage in newly diagnosed: 34% in past 2 years and 41% in past 4 years  Race/Ethnicity & Age Group: Race/ Ethnic groups are evenly split among Whites and Hispanics followed by Blacks. Age groups are bimodal at (14) and (14 and 15). Average age is 41 years.

MSM 8.  Self-Reported Transmission  Current Health Insurance  Area first diagnosed WHERE DIAGNOSED

MSM 9.  Place informed of HIV diagnosis (testing location).  HIV Status – 38% initially diagnosed as AIDS, 5% seroconverted, 62% HIV as initial diagnosis  Role of Emergency Dept – 29% report using the ED as their primary care location, 44% have been to an ED before being diagnosed but only 10% were asked to take an HIV test and only 8% did.  Reason for testing and time suspected of HIV+ prior to test

MSM 10.  Partner Notification: Of the 30 MSM testing positive in the past two years, 18 individuals were contacted by Partner Notification (60%), and 40% or 12 stated that they had not been offered this service.  Behavioral Risk: Sexually Transmitted Infections – 81% report History of STD with syphilis (38%) and gonorrhea (24%) most commonly reported  Behavioral Risk: Social networking most frequently cited, then Clubs, then Streets  Other Risks : 45% report mental health counseling, 20% substance use rehabilitation

MSM 11.  Time to enter care upon testing HIV positive – mean, median and mode of 1 month. Fastest of three groups to enter HIV medical care (75% under a 3 months, the National HIV/AIDS Strategy goal).  Race/Ethnicity for later entrants shows all over 1 year are Latino.  Reasons/Services to enter care – all due to ‘feeling sick’, least support service related. TIME BETWEEN HIV DIAGNOSIS AND HIV MEDICAL CARE ENTRY REASON/ SERVICES TO HELP MSM ENTER HIV MEDICAL CARE

MSM 12.  Issues with staying in care  Only 2 are erratically in care (2/91 = 2.2%)  Unique problems as MSM with HIV diagnosis  Condom use most commonly cited, then employment, then housing support  Resources to help MSM stay in HIV Medical Care  Doctors, then HIV medications, Housing Support then Medical Case Managers  Top services that MSM have trouble getting  CADAP (most frequently cited at 19% with correlation to income over $40,000)  Employment  Education or Re-training  Vision Care

Return to Care 13.  Thirty-eight (38) respondents  Demographics  Average current age: 42 years  Average age when diagnosed:  Race/Ethnicity:  Gender: 23 male (60%) 14 female (37%), 23 male, 1 transgender (3%)  Self-reported transmission

Return to Care 14.  Initial HIV Medical Care Entry:  Services initially referred to (when first entered care):

Return to Care 14.  Reasons for Leaving Care  Services that helped you Return to Care

End of Year Studies Appendices - Maps New Haven-Fairfield Counties Ryan White Planning Council April 5, 2012

Foreign-Born Residence 17.

MSM Residence 18.

Return to Care Residence 19.