New Haven-Fairfield Counties End of Year Studies:New Haven-Fairfield Counties End of Year Studies:Ryan White Planning CouncilRyan 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 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.

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 AIDSwithin 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 alsohas high percent of above 50with 40%

LENGTH HIV DX YEAR DX # % % TIME HIV+

19851 1%

1991 1 1%

1993 1 1%

1996 4 6%

1997 6 9%

1998 3 5%

1999 3 5%

2000 2 3%

2001 7 11%

2002 2 3%

2003 1 1%

2004 1 1%

2005 3 5%

2006 2 3%

2007 2 3%

2008 1 1%

2009 14 21%

2010 7 11%

2011 4 6%

2012 1 1%

40%

15-19 YEARS

10-14 YEARS

5-9 YEARS

3-4 YEARS

0-2 YEARS

2%

7%

32%

14%

5%

OVER 20 YEARS

AGE GROUP # %

Under 19 4 6%

20-24 9 14%

25-29 10 15%

30-34 7 11%

35-39 4 6%

40-44 3 5%

45-49 3 5%

50-54 12 18%

55-50 6 9%

60-64 5 8%

65-69 2 3%

70-74 1 2%

TOTAL 66 100%

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 countryCOUNTRY OF ORIGIN WHERE DIAGNOSED

AREA FIRST DXED # % OF TOTALREGION 1 (New Haven) 15 23%REGION 2 (Waterbury/Meriden/ Naugatuck) 11 17%REGION 3 (Bridgeport) 14 21%REGION 4 (Stamford/ Norwalk) 10 15%REGION 5 (Danbury) 2 3%

WITHIN NHFF EMA 52 79%New York City 6 9%Hartford, CT 3 5%J ail 2 3%Immigration Clinic in Fairview, CT 1 1%San Francisco, CA 1 1%

OUT OF EMA 13 19%New Delhi, India 1 1%Dominican Republic 1 1%

OUT OF U.S. 2 2%GRAND TOTAL 66 100%

COUNTRY OF ORIGIN # % OF TOTAL COUNTRY OF ORIGIN # % OF TOTALMEXICO 18 27% ARGENTINA 1 1%HAITI 10 15% BRAZIL 1 1%J AMAICA 5 8% CHINA 1 1%ECUADOR 5 8% KENYA 1 1%GUATEMALA 4 6% PORTUGAL 1 1%COLOMBIA 3 5% GHANA 1 1%HONDURAS 3 5% THAILAND 1 1%SOUTH AFRICA 3 5% TRINIDAD & TOBAGO 1 1%DOMINICAN REPUBLIC 2 3%PERU 2 3%INDIA 2 3%ANTIGUA 2 3%

GRAND TOTAL 66 100%

Foreign Born 4.

Time in U.S. prior to testing HIV positive – mean of 7.8 years, median of 5 yearsand mode of 1 year (only 2 tested positive prior to emigration)

Place informed of HIV diagnosis (testing location) – 59% tested in clinical settingsand 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 4Jail 3

REASON FOR TESTING # %

SICK 15 23%

IN HOSPITAL 14 21%

PARTNER TOLD ME TO 8 12%

DOCTOR TOLD ME TO 4 6%

HUSBAND DXED 3 5%

ROUTINE 3 5%

ED 3 5%

IMMIGRATION PHYSICAL 2 3%

INSURANCE PHYSICAL 2 3%

HIGH RISK-CSW 2 3%

PREGNANT 2 3%

STD 1 2%

JAIL 1 2%

DID NOT ANSWER 6 9%

GRAND TOTAL 66 100%

TIME BETWEEN EMIGRATIONTO U.S. AND HIV DIAGNOSIS

DELTA # % DELTA # %

-4 2 3% 12 3 5%

0 4 6% 13 1 2%

1 8 12% 14 1 2%

2 6 9% 15 2 3%

3 6 9% 16 2 3%

4 5 8% 17 1 2%

5 5 8% 19 2 3%

6 1 2% 24 1 2%

7 2 3% 28 1 2%

8 5 8% 30 1 2%

9 3 5% 36 1 2%

10 1 2% 40 1 2%

11 1 2% TOTAL 66 100%

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 FROM HIV DX TO CARE ENTRY # % YEARS # %

Within 90 days 6 9% 9 2 3%

Within 1 year 9 14% 10 1 2%

2 years 11 17% 11 4 6%

3 years 3 5% 12 3 5%

4 years 6 9% 13 2 3%

5 years 4 6% 14 1 2%

6 years 2 3% 16 1 2%

7 years 3 5% 18 1 2%

8 years 6 9% 23 1 2%

TOTAL 66 100%

REASON TO ENTER CARE # %

Very Sick 22 33%

To Survive 20 30%

Stay Healthy 15 23%To take better care of myself 5 8%To be there for my children 4 6%

TOTAL 66 100%

TRANSMISSION # %Heterosexual 31 47%

MSM 17 26%

IDU 16 24%

Would Not Disclose 2 3%

TOTAL 66 100%

TIME BETWEEN HIV DIAGNOSISAND HIV MEDICAL CARE ENTRY

REASON/ SERVICES TO HELP FOREIGN-BORN ENTER HIV MEDICAL CARE

SELF-REPORTEDTRANSMISSION

SERVICES TO HELP ENTER

CARE # %

MCM 21 32%

AOMC-DR/RN 19 29%

HIV MEDS 8 12%

MENTAL HEALTH 7 11%

SUBSTANCE ABUSE6 9%

HOUSING 5 8%

TOTAL 66 100%

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 Born1. Help with Education to avoid having to access free HIV or other medical care2. 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 withthe highest percentage of respondentsin 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/ Ethnicgroups 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.

LENGTH HIV DX Year DX # %

% TIME HIV+

1982 3 3%

1984 1 1%

1985 1 1%

1986 1 1%

1987 3 3%

1989 2 2%

1990 1 1%

1992 3 3%

1993 5 5%

1995 3 3%

1996 2 2%

1997 3 3%

1998 1 1%

1999 3 3%

2000 2 2%

2001 5 5%

2002 2 2%

2003 2 2%

2004 4 4%

2005 4 4%

2006 3 3%

2007 3 3%

2008 4 4%

2009 8 9%

2010 9 10%

2011 7 8%

2012 6 7%

1-2 YEARS

6%

6%

13%

14%

15%

7%

34%

25 YEARS+

20-24 YEARS

15-19 YEARS

10-14 YEARS

3-4 YEARS

5-9 YEARS

RACE/ ETHNIC # %

White 32 35%Hispanic 31 34%Black 24 26%Multi Race 2 2%Native American 1 1%Asian 1 1%TOTAL 91 100%

AGE GROUP # %

Under 19 1 1%

20-24 5 5%

25-29 10 11%

30-34 14 15%

35-39 12 13%

40-44 9 10%

45-49 14 15%

50-54 15 16%

55-50 7 8%

60-64 4 4%

TOTAL 91 100%

MSM 8.

Self-Reported Transmission Current Health Insurance Area first diagnosed

HEALTH INSURANCE # %

Medicaid 23 25.3%

None 15 16.5%

Medicaid/Medicare 14 15.4%

ADAP 13 14.3%

Ryan White 9 9.9%

Private health insurance through work 9 9.9%

Medicare 6 6.6%

Private health insurance, not through work 2 2.2%

TOTAL 91 100.0%

WHERE DIAGNOSED

AREA FIRST DXED # % OF TOTAL

REGION 1 (New Haven) 24 26%REGION 2 (Waterbury/ Meriden/Naugatuck) 16 18%

REGION 3 (Bridgeport) 15 16%REGION 4 (Stamford/ Norwalk) 8 9%

REGION 5 (Danbury) 4 4%

WITHIN NHFF EMA 67 74%

Connecticut not in EMA 9 10%

New York City 8 9%

Massachusetts 2 2%

Maine 1 1%

Florida 1 1%

Illinois 1 1%

Maryland 1 1%

Ponce, Puerto Rico 1 1%

OUT OF EMA 24 26%

GRAND TOTAL 91 100%

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

TIME SUSPECTED HIV+ BEFORE TEST # %

0-3 months 39 43%6-12 months 26 29%Over a year 12 13%Over two years 14 15%TOTAL 91 100%

REASON FOR TESTING # %Partner Notification 38 42%Routine testing 27 30%Felt sick 14 15%In Hospital 7 8%Physical (Regular, Insurance) 5 5%TOTAL 91 100%

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 DIAGNOSISAND HIV MEDICAL CARE ENTRY

REASON/ SERVICES TO HELP MSMENTER HIV MEDICAL CARETIME FROM HIV DX TO

CARE ENTRY # %

Immediate 14 15%1 Day 3 3%

1 Week 11 12%2 Weeks 14 15%3 Weeks 2 2%1 Month 18 20%2 Months 6 7%3 Months 1 1%4 Months 2 2%5 Months 4 4%6 Months 6 7%1 Year 4 4%2 Years 2 2%5 Years 2 2%10 Years 2 2%TOTAL 91 100%

REASON TO ENTER CARE # %

Became Sick 41 47%

In Hospital 37 43%

Low T-Cells 9 10%

TOTAL 87 100%

SERVICES TO HELP MSM ENTER CARE # %

Doctor 25 29%

MCM 21 25%

Mental Health 11 13%

Dental Health 9 11%

Substance Abuse 8 9%

Housing Assistance 7 8%

Jail Referral 4 5%

TOTAL 85 100%

TIME SUSPECTED HIV+ BEFORE TEST # %

0-3 months 39 43%6-12 months 26 29%Over a year 12 13%Over two years 14 15%TOTAL 91 100%

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: 28-30 Race/Ethnicity:

Gender: 23 male (60%) 14 female (37%), 23 male, 1 transgender (3%) Self-reported transmission

SELF-REPORTED TRANSMISSION # %Heterosexual 17 45%MSM 9 24%IDU 8 21%Sex with Drug User 3 8%Mother with HIV/AIDS (Perinatal) 1 3%TOTAL 38 100%

RACE/ETHNIC # %Hispanic 22 58%Black 10 26%White 3 8%Multi Race 3 8%TOTAL 38 100%

Return to Care 14.

Initial HIV Medical Care Entry:

Services initially referred to (when first entered care):

Response Percent

Response Count

71.1% 2713.2% 515.8% 6

380skipped question

After getting your HIV diagnosis, how long did it take you to see a doctor?

answered question

Within 6 months

Answer Options

Longer than 1 year

Within 3 months

Response Percent

Response Count

81.6% 3155.3% 2128.9% 1126.3% 1013.2% 5

Food Bank 13.2% 510.5% 47.9% 3

38answered question

HIV medical careMedical case managementSubstance use counselingMental health counselingDental care

Answer Options

Housing supportNon HIV medical care

When you found out you were HIV positive, what services were you referred to? (Please check all that apply.)

Return to Care 14.

Reasons for Leaving Care

Services that helped you Return to Care

Response Percent

Response Count

39.5% 1526.3% 1023.7% 923.7% 923.7% 915.8% 613.2% 513.2% 5

38answered question

Transportation

Substance use treatmentMental health counseling

Medical Case ManagementFriend/Family intervention

Answer Options

Health insurance

Outreach/Early intervention

If you returned to HIV medical care in the last 12 months, what services helped you get to a doctor? (Please check all that apply.)

I got really sick

Response Percent

Response Count

36.8% 14

Depressed 34.2% 13

31.6% 12

28.9% 11

10.5% 415.8% 62.6% 12.6% 1

38

Drug use

Didn't feel sick

Tired of taking HIV meds

Doctors attitudes

answered question

Answer Options

Homelessness

J ail

Why did you fall out of care?

Moved away

End of Year StudiesEnd of Year StudiesAppendices - MapsAppendices - Maps

New Haven-Fairfield Counties New Haven-Fairfield Counties Ryan White Planning CouncilRyan White Planning Council

April 5, 2012April 5, 2012

Foreign-Born Residence 17.

MSM Residence 18.

Return to Care Residence 19.