Preventing HIV/AIDS transmission on Historically Black Colleges and Universities (HBCUs)

Peter Thomas, PhD, MPHDivision of HIV/AIDS Prevention, Division of Adolescent and School

HealthCenters for Diseases Control and Prevention

"The findings and conclusions in this presentation are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention."

Background: Risk of HIV/AIDS on Historically Black Colleges and Universities (HBCUs)

• Poor data on HIV prevalence on HBCU campuses• Increased risk among some social networks that

include HBCU students• North Carolina investigation (2002)• Mississippi investigation (2008)

• Higher risk of infection among blacks/black students (particularly men who have sex with men)

• Like other college-aged adults, HBCU students continue to practice high-risk sex behaviors

Rapid HIV Testing in HBCU Settings• September 2004 – June 2007 • 4 sites to provide HIV testing at 7 HBCUs • 2 year project

– Demonstrate new models for HIV testing– Include testing in alternative venues – Use creative strategies to encourage people to

be tested

New Models for HIV Testing on HBCUs

•Testing Venues▫On campus▫Off campus▫Event-based (social)

•Testing Strategies• Walk-In testing on set days • Appointment testing• Direct recruitment

•Streamlined pre-test counseling•Group testing

• Total persons tested: 8,498• Total interviewed: 6574

• Total HIV positive: 14 (0.2%)▫ Students and non-students▫ Mostly MSM (12 of 14)▫ Self-identified as heterosexual, bisexual, and gay▫ Lower HIV positivity among non-gay identifying (NGI-)

MSM ▫ Behaviorally bisexual and homosexual ▫ Similar risk behavior to sexually active HIV negative

persons (e.g., # of sex partners, use of condoms, perception of risk, high-risk behaviors)

Tested and Surveyed Population

HIV risk perception and behavior among participants

• Perceived themselves at no/low risk for HIV infection (62%)

• Agree that HIV does not cause AIDS (34%)

HIV Testing Among Participants • Asked their last partner’s HIV status before sex

(52%) • Person’s not previously tested for HIV (34%) • Persons who were tested in the past 12 months

(34%)• More likely to report high-risk behaviors

▫ (e.g., MSM, women who have sex with MSM, history of STD)

Surveyed Population at HBCUs

• Men who have sex men (14% of sexually active men)▫ 54% of AA MSM in self-identified as gay or bisexual (GI-MSM) ▫ 46% were non gay-identifying-MSM (NGI-MSM)

• NGI-MSM less likely than Gay-Identified MSM to report▫ Behaviors associated with HIV testing▫ Being tested within past 12 months▫ Condom use with last partner▫ High perception of risk▫ Exclusively male sex partners

• Women who had sex with MSM (10% of 2040 sexually active women)▫ Age 21 years or older▫ >1 sex partners in past 12 months▫ No condom for last intercourse▫ In a committed relationship ▫ Increased perception of risk for HIV infection▫ Never or infrequently attending church

Risk Behavior Among Participants

Key - Best Practices for Implementing HIV Testing I

• Social marketing • Support from top administration • Peer educators • Prepping testing supplies• Incentives

Successful/ Best Practices for Implementing HIV Testing II

• Using the same testing place on campus rather than rotating to different campus locations

• Extending invitation to collaborate with other campus organizations

• Partnering with already scheduled events (e.g., social events, fraternity/sorority parties, etc.)

• Consider academic calendar in planning

Barriers / Challenges

•Recruitment for testing•Student fear, stigma•Institutional support

(prioritization)•Higher risk student recruitment

▫Males▫Off-campus students▫MSM

Limitations

• Self reported risk

• Variation in project sites ▫Testing and survey strategies▫Recruitment practices▫HIV testing options in the community

• Not generalizable (non randomly sampled, cross-sectional)

Summary• HIV infection on HBCU campuses

▫ Is a function of HIV risk among black sub populations▫ Not exclusive to individuals reporting the most high-risk

behavior▫ May be related to social networks and the community

• HBCU students ▫ Are accepting of HIV testing▫ Don’t see personal risks being related to HIV infection▫ Continue to practice high-risk behaviors

• MSM students and non students in HBCU settings ▫ Are diverse and may not identify as gay or bisexual▫ Have risk behaviors like others

• Effective HIV testing in HBCU settings ▫ Requires innovative strategies and methods ▫ Can reach high-risk persons and can identify new HIV infection ▫ Includes strategies that address stigma and ways to reach MSM

• Albany State UniversityBrenda Williams, RNMattie Shiloh, RN

• Fort Valley State UniversityJoanne Nobles, RN

• Jefferson Comprehensive CareDr. Michelle Smith

• Philander Smith College

• The University of Arkansas at Pine Bluff

• Philander Smith College

• Howard UniversityAda BabinoDr. Denyce CallowayDr. Carolyn GoodeDr. Lynette Mundey

• Jackson State UniversityDr. Kaye SlyKevin PatersonDr. Leandro Mena

• CDC/NCHHSTP/DHAP/BCSB Many staff

Acknowledgements

Thanks

Peter Thomas: pbt7@cdc.gov