Harlem UnitedThe Blocks Project

Presented by Sara Gillen

Prepared by Z. Naqvi, S. Gillen, E. Aponte, V. Mojica, P. McGovern

HIV in Harlem

District Diagnoses (per 100,000)

Prevalence (% of population)

Death (per 1,000 PLWHA)

NYC Total 47.6 1.3% 17.9Central Harlem

137.6 2.9% 25.8

East Harlem 91.6 2.8% 26.9

Data from the NYC Department of Health and Mental Hygiene, 2008 Surveillance Report

East and Central Harlem report the 2nd and 3rd highest rates of HIV diagnoses and prevalence, and the death rate is 1.5 times the city rate

Opportunities for Intervention

People Living With HIV/AIDS* New Infections

Marks G et al. AIDS. 2006;20(10):1447-1450.

~54%of new

infections

~46% of new

infections

Accounting for:

Accounting for:

~25% unaware

of infection(n=250,000)

~75%aware of infection

(n=750,000)

*N=1,000,000.

42% of these people are not in care

The CBO Challenge

2006: Federal guidance on HIV screening in clinical settings changed – universal testing, regardless of HIV risk history– Universal access to testing in medical

settings does not reach all NYC residents• lack of health insurance or a primary care

doctor• stigma related to same sex behavior or drug

use keeps people from seeking care• Risk perception is low, patients may refuse

test

Testing Services

Blocks/Zone Based Testing Risk Based Testing

Identification of high prevalence zones, community saturation

with prevention messages and HIV facts, increased testing accessibility via alternative venue and mobile testing

Social Networks: MSM, high-risk African American women

Venue Based: IDU, MSM, high

risk women, immigrants

Risk is defined as sharing syringes, unprotected anal or vaginal sex with an HIV-positive person or a person of unknown HIV status in a high risk group, STI in the last 12 months, unprotected sex in the last 12 months with multiple partners

Changing the Paradigm: Risk-Targeting with a Zone/Geographic

Approach

1) Geo-code clients to identify hot-spots for outreach and testing;

2) Saturate the zone with relevant and targeted HIV prevention facts and messages to remove stigma of testing and HIV;

3) Provide accessible, on-the-spot HIV testing; and

4) Provide referrals to linkage to care

Blocks: Tools and Tactics

Identification of Zones: Hot Spot Maps

• Saturate the identified zone with messages and promotional materials: “HIV is a community disease”, emphasis on routine testing and access to care

• Use guerilla marketing techniques to prompt interest in our services and promote testing (i.e., “Let’s Do It” blitz)

• Community-wide and local HIV awareness & outreach events

• Door-by-door surveys and outreach

Message Saturation

Year 1 Year 2 Year 3 Year 1 Year 2 Year 3Zone A Zone B

0

20

40

60

80

100

120

140

It's All About Access

In-House Mobile

Num

ber

of T

ests

Increasing Accessibility

Overall Increase in Testing: 84% from

2008 to 20091200 1550

2662

4642

8431

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

2005 2006 2007 2008 2009

Num

ber o

f Tes

tsFindings: Increase In Overall

Testing

Testing 2008Approach Tests Positives Sero-positivity

Zone-Based 3,351 90 2.7%Risk-Based 1,291 48 3.7%� Venue-based 1,186 38 3.2%

� Social Networks 105 10 9.5%Totals 4,642 138 3.0%

Testing 2009Approach Tests Positives Sero-positivity

Zone-Based (incl. collabs) 5,919 86 1.5%Risk-Based 2,512 70 2.7%� Venue-based 1,201 37 3.1%

� Social Networks 1,311 33 2.5%Totals 8,431 156 1.9%

Findings: Positive Cases

Increasing Linkage to Care57%63%

78%81%

0%10%20%

30%40%50%60%

70%80%90%

2006 2007 2008 2009

Perc

enta

ge

We have increased connection to primary care for HIV positive clients to 80%, far surpassing the NYCDOHMH connection to care rate for Harlem (57. 7%).

Findings: Linkage to Care

Modification of Beliefs: N=693

χ2 =402.216, df 6 p<0.001;χ2=536.97, df 12 p<0.001; χ2=375.72, df 12, p<0.001;

Dispelling Myths

0%20%40%60%80%

100%120%

Can Tell By Lookingat Someone That

They Have HIV

Only Gay Men, DrugUsers & Sex

Workers Get HIV

MosquitoesTransmit HIV

% A

gree Baseline

Post

Findings

HIV Testing Since Blocks : N=693

χ2= 62.79, df 12 p<0.001;

0

10

20

30

40

50

60

frequ

ency

Never At Least Once Twice

Statistically Significant Increase in # of People who Tested for HIV in the Last 2 Years

Baseline

Post

Findings

%

Self-Perceived HIV Risk Among HIV+ Clients: N= 138

Medium =20

High= 55

Low =29

Other= 34 Don't know

= 21

No answer= 13

Specifically older adults (>40 yr old) and women make up the majority in the “low,” “medium,” and “other” categories.

Findings: 2008 Risk Perception

In high prevalence communities:

• Universal testing is critical

• Testing programs outside the clinical setting have a vital role in reaching community residents

• Stigma can be reduced by promoting HIV testing as a community norm

Conclusion

Thanks to the Gilead Sciences, MAC AIDS Fund and New York City Department of Health and Mental Hygiene for funding that supports our Blocks and Linkage to Care activities.

For more information, please contact:Sara Gillen: sgillen@harlemunited.org

Acknowledgements