# Presentation: 122159

##  Profile  of  Inner  City  HIV+  Clients

-           Presidential Advisory Council on HIV/AIDS
-                                  Washington,  DC
-                                March 17, 2006
-                   Dr.  Wilbert C. Jordan, Director
-               OASIS Clinic and  HIV/AIDS Program
-                     King-Drew Medical Center
-                            Los Angeles,  CA

## Table 1FAMILIARITY WITH SEX PARTNERS OF HIV POSITIVE PATIENTS WHO WERE INFECTED BY SEXUAL CONTACT

**PATIENTS INTERVIEWED DURING ONE MONTH PERIOD**
**	****	****	****	****	****	****	****Men****	****Women**
**TOTAL NUMBER****	****	****	****	****52****	****   22**
**Number who knew all sex partners****	****	****	**** 6****	****   22**
**Number who knew all partners and how ****	****	**** 5****	****   19**
**to contact****	**
**Percentages****	****	****	****	****         6/52=12****	****22/22=100**
**	****	****	****	****	****	****         ****5/52=10****	****19/22=86****	**

## Table 3OASIS CLINIC PATIENTSKING-DREW MEDICAL CENTERJUNE 1996

**FOCUSED INTERVENTION I**
**Two groups of patients ****	****14 per group**
**initially questioned**
***Group A:*****  Number who felt they knew ****	****13**
**	****people still practicing at risk sex**
***Group B:*****	****Number who felt they had friends****	****14**
**	****and acquaintances who were HIV+**

## Table 4GROUP APROFILE OF 13 PATIETNS WHO KNEW PERSONS STILL PRACTING AT RISK SEX

**Number of persons identified****	****	****	****30**
**Number of these found to be HIV+****	****	****17**
**Number of the 17 who were unaware****	****	****  9**
**of their status**
**Yield****	****	****	****	****	****	****(9/30)****	****30%**

## Table 5DATA FROM 14 OASIS CLINIC PATIENTS WHO FELT THEY KNEW PEOPLE WHO WERE HIV+

**Number identified****	****	****	****	****       ****	****15**
**Number who were HIV+****	****	****	****       ****	****	****11**
**Number who were aware and in treatment****	****	****0/11**
**Number who were aware and not in treatment****	****  ****	**** 3**
**Number unaware of status****	****	****	****	****  8****	****  ****	****	****       ****	****	****	****	****	****	****    ****	**

## The High Rollers

**Client A...referred 38 people...32 tested HIV+... two were tested previously...one was aware but not in treatment and one tested HIV+ while in prison.**
**Client A is a Transgender who has been incarcerated 4 times during the past 5 years, accounting for 2 years and 8 months. **
**Client B...referred 14 people...13 tested HIV+...none were previously tested...Client B is presently incarcerated for the 4****th**** time over the past 3 years...all have a recent history of incarceration.**

## Los Angeles County Test Rates

- Anonymous Test Sites		1.5%
- Confidential Testing Centers	1.4%

## Table 2FOCUSED INTERVENTION

**Our program lead to the GSK ACT4 Life Program**
***What we do:***
**Our caregivers identify patients to recruit (serve as a recruiter) their friends**
**Incentives are given to the client and their recruiter**

## Table 6What it allows us to know, since 93% of those testing HIV- admit to unprotected sex within past two years Who are the High Risk Negatives? 

**	**_***Women:***_
**	****1.  Young girls dating older men**
**	****2.  Older women whose partners have been incarcerated**
**	****3.  Strawberries/sex for drugs**
**	****4.  Church girls**
**	**_***Men:***_
**	****1.  Open ++/-**
**	****      ****a.  Pride Inc.**
**	****	****  ****1.  Pride week in Washington, DC (memorial day weekend)**
**	****	****  ****2.  ATB in Los Angeles (July 4****th**** weekend)**
**	****	****  ****3.  Atlanta, GA (Labor Day)**
**	****       ****b.  Gospel Groups**
**	****2.  Closeted men**
**	****3.  The incarcerated**
**	****4.  Transgenders**
**  **_***The mentally handicapped***_

## Profile  of  HIV+  Men  

-                       OASIS Clinic data
-                            1998-2002
- Number interviewed...............              374
- Number infected MSM............              353
- Number prefer  gay to homosexual         104
- Number identify as homosexual.               44
- Number identify as  bi-sexual...              .123
- Number don’t identify as  neither.............82

##  Prefer  Gay to Homosexual    104

- Total number                                    104
- Comfortable  identifying as Gay
-     everywhere and to everyone.........33
- Mom doesn’t know                               27
- Some friends know/some don’t            38
- Not ashamed, no reason to advertise  17
- Comfortable in any  Gay setting           47

## Prefer Gay to Homosexual   

- Total number                                104            w/ women
- Prefer  to Top only                            2                   0
- Prefer Top > Btm                               5                  1
- Prefer Btm > Top                             48                  3
- Prefer Btm only                                49                  3

##            Identify as  homosexual - 44

- Prefer to Top only                    7
- A.  With  younger men             6
- Prefer Top > Btm                     6
- Prefer Btm > Top                    15
-     Prefer  Btm only                      16

## Identify as  Bisexual                 123

-                                                                  active w/ women
- Prefer  to  Top  only                 2                          1
- Prefer  Top > Btm                    9                           4
- Prefer Btm > Top                   62                          11
- Prefer Btm only                      50                          17

## Don’t  accept  either term                    82

- Initial MSM  contact  in  jail                     43
- Initial MSM contact  w/friend                   24
- Initial MSM contact in Military                 14
- Initial MSM contact  for money                22

## Don’t accept  either term

-                                                        active w women
- Prefer Top only          7                              5
- Prefer Top > Btm      14                              4
- Prefer Btm > Top      22                             11
- Prefer Btm only         16                               8
- Prefer  oral by men*  23                             15
- * admit to being anal receptive  only once or twice

## Interview with 582 Black MSMOASIS Clinic King-Drew Medical CenterLos Angeles, California1997-2000

**Percent raped in childhood****	****	****	****	****	****62%**
**Percent probably infected more than 5 years****	****	****	****68%**
**Of those infected more than 5 years, the percent****	****	****17%**
**with children under 5 years of age **
**Those with a regular partner****	****	****	****  ****	****	****4%**
**Those who engage in at risk sex****	****	****	****	****52%**
**Number of drinks needed to allow them to engage****	****	****2.1%**
**in at risk sex**
**Number of drinks usually consumed when going out****	****	****4.8%**

##       Men raped  in  Childhood  - 361 

- Number  who considered  the  rapist  to be  homosexual..........38
- Initial act included sodomy.......................357
- Initial act  occurred  more than once...........223

##       Initial act repetitive   223

- Mama’s  boyfriend..............................85
- Older half brother/cousin......................43
- Step-brother......................................11
- Uncle...............................................16
- Family friend......................................37
- Teacher/coach...................................21
- Policeman..........................................3
- Other ................................................7

##     Initial contact – one time only   138

- Mama’s boyfriend...................................28
- Step-father.............................................6
- Step-brother...........................................9
- Older  brother /cousin..............................19
-  Younger uncle.......................................12
-  Family friend..........................................23
-  Someone  2-3 yrs  older...........................24
-  Someone  1-3 yrs  younger........................7
-  Policeman..............................................1
-  Teacher/coach........................................4
-   Choir director/ church related....................7
-   Grandfather...........................................5

##       Male  to female  Transgender patients- 32

- 1.  HIV + ...............................................32
- 2.  Living married/monogamous...................4
- 3.  Prefer  to be  Btm  exclusively................32
- 4.  Penetrated a man in past  2 yrs..............11
- 5.  Penetrated a woman in past 2 yrs............1
- 6.  Taking  oral hormones..........................32
- 7.  Taking  lupron infections........................23

##                    Transgender patients - 32

- 1.  Hx  of  incarceration ..................................31
- 2.  Hx of  STD..............................................23
- 3.  Started  under  age 12 ...............................1
- 4.  Started  between  12-19..............................3
- 5.  Started  over  age  20 ................................28

## Slide 23

## The incidence of HIV/AIDS within diverse communities is “a national crisis. We will not rest until the crisis is acknowledged and strategies and resources are directed to eliminate it.”

*	**—**Representative Maxine Waters **	**Then Chair of the Congressional **Black Caucus*
* **March 15, 1999*

**Notes:**
The face of AIDS is changing, and patients and providers have been compelled to address these changes.  The diverse communities, those overwhelmingly affected by HIV and AIDS, face racism, homophobia, sexism, low socioeconomic status, and inadequate healthcare—barriers that often seem insurmountable.  Healthcare providers are charged with the task of developing targeted education and disease management strategies to address and ultimately eliminate these barriers.  The face of AIDS has changed, and healthcare providers must change with it.

## Slide 25

**Notes:**
In 1998, Dr Satcher, then US Surgeon General, called for attention to the health disparities in the United States between Caucasians and persons of color. 
He identified the following concerns as the top public-health priorities:
 HIV/AIDS
 Cardiovascular disease and stroke, including hypertension
 Mental health
 Diabetes mellitus
 Cancers 
 Tobacco use
 Sexually transmitted diseases
 Substance abuse
 Violence and homicide
The identification of the highest rates of these illnesses and conditions affecting people of color has lead to:
Healthy People 2010 Project
US Department of Health and Human Services (DHHS)-sponsored programs and initiatives, such as the National Institutes of Health (NIH) Health Disparities Initiatives and the Centers for Disease Control (CDC) Prevention Strategies Program, as well as numerous other programs and initiatives

## 45% of Eligible US Patients Not On HAART

- Teshale E, et al. Abstract 167.

## HIV/AIDS UNREACHED POPULATION

_**Status**_**	****	****	****	**_**# of People**_**	****	**_**% Black**_
_**Overall**_
**Undiagnosed****	****	****	****266,000****	****	****55**
**Aware, not in health care****	****	****169,000****	****	****37**
_**African Americans**_
**Undiagnosed****	****	****	****146,000****	****	****100**
**Aware, not in health care****	****	****  63,000****	****	****100**

##                               Outreach

- Can  we  identify this large number of HIV+  African American men and women?  I think so !!
-       Resolve:  that the National Medical Association, the  national organization of  Black physicians with over 7000 members,  have  as  its  project  :
-    1.  To have all  Black physicians, and all physicians  who treat  Black patients,  to test  all of them  twice  annually,  May 15 – June 19  in honor of  Juneteenth,  and  November  1- 30, leading  up to  World AIDS  Day.

##                          NMA Project

- 1. Corldination  of outreach activities with CBO’s  and  the  Churches
- 2.  Goal:  To identify 10,000 new  HIV+ cases   bi-annually
- 3.  Through the  NMA, identify  new  physicians,  primarily minority,  to treat  this  new  influx of  HIV+ clients
- 4.  Advocate  on  behalf of  the providers  and  clients  for  funding

- Q & A