1. 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

2. Overview 1.  Three (3) studies were conducted from February through March of 2012. 195 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 2012-2015 Comprehensive Strategic Plan.

3. 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%

4. 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

5. 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

6. 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

7. 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

8. MSM 7.  Ninety-one (91) respondents with the highest percentage of respondents in oldest age group (25+ years @ 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 30-34 (14) and 45-54 (14 and 15). Average age is 41 years.

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

10. 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

11. 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

12. 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

13. 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

14. Return to Care 13.  Thirty-eight (38) respondents  Demographics  Average current age: 42 years  Average age when diagnosed: 28-30  Race/Ethnicity:  Gender: 23 male (60%) 14 female (37%), 23 male, 1 transgender (3%)  Self-reported transmission

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

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

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

18. Foreign-Born Residence 17.

19. MSM Residence 18.

20. Return to Care Residence 19.