Community Awareness and Use of HIV/AIDS-Prevention Services Among Minority Populations -- Connecticut, 1991

Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)-prevention efforts supported by the federal government include programs offered through community-based organizations (CBOs) and state and local health departments (1). To assess the extent of community awareness and use of these HIV/AIDS-prevention services among Hispanics and non-Hispanic blacks in three cities in Connecticut, the Connecticut State Department of Health Services (CSDHS) included questions on HIV/AIDS-prevention programs in its population-based chronic disease and health risk survey. This report summarizes survey results regarding awareness and use of these community-based programs during 1991.

The Connecticut HIV/AIDS Risk Survey was a household probability sample of Hispanics and non-Hispanic blacks aged 18-45 years living in Bridgeport (1990 population: 141,686), Hartford (1990 population: 139,739), and New Haven (1990 population: 130,475). During October 1991, 926 respondents from 1370 households with telephones were interviewed by telephone for the chronic disease portion of the survey, using methods adapted from the Behavioral Risk Factor Surveillance System (2). Of these 926 respondents, 769 were eligible (i.e., non-Hispanic black or Hispanic aged 18-45 years) to respond to survey questions related to HIV/AIDS-prevention programs; of those ineligible, 111 were white and 46 were aged greater than 45 years. In addition, 45 households without telephones were visited to obtain interviews; 31 respondents from the 45 households were eligible and were interviewed. Survey questions for the 800 eligible respondents addressed awareness of HIV/AIDS-prevention programs and services, HIV-testing experience, and self-perceived risk for HIV infection. Nonrespondents were not characterized. Data were weighted to compensate for unequal sampling probabilities and nonresponse.

Overall, 35% of respondents were aware of special AIDS outreach and information services (Table 1). Persons with higher education levels were more likely to be aware of these services in all locations. Of respondents who stated that they were aware of services, 81 (10.6% of all respondents) reported they had received services. Among all respondents, women were more likely to have received services than men (13.4% versus 7.2%), as were Hispanics than were non-Hispanic blacks (18.5% versus 5.4%). However, when those who had no knowledge of services were excluded from the analysis, the reported use of services by men and women were similar.

The 81 respondents who reported receiving services identified sources of service including community health clinics (e.g., Bridgeport Community Health Center), hospitals, and community-based organizations (e.g., Latinos Contra SIDA, Hartford, and AIDS Interfaith Network, New Haven). Eight (9.9%) of 81 respondents had received services in cities other than where they resided.

Of all respondents, 23.5% reported having been tested for HIV antibody. Rates of testing were highest in Bridgeport and varied substantially among groups (Table 1). Rates were higher among men, blacks, younger persons, unmarried persons with steady partners, persons with higher education, and those whose self-perceived risk for infection was high or medium. Most tests, whether required (e.g., for insurance, employment, blood donation, and military) or voluntary, were obtained from hospitals, physicians' offices, and health centers (Table 2); HIV testing clinics, public health departments, and other clinics that receive public funds for HIV testing accounted for 19% of reported tests.

Persons who had not been tested but who indicated they might be tested during the next 6 months identified private-sector physicians, health centers, and hospitals as likely sources for testing. Approximately 25% identified public sources, and 13.1% reported they would use HIV testing centers.

Reported by: PJ Checko, MPH, B Weinstein, MPH, A McLendon, MEd, AIDS Section, M Adams, MS, Div of Chronic Disease, JL Hadler, MD, State Epidemiologist, Connecticut State Dept of Health Svcs. Behavioral Risk Factor Surveillance Br, Office of Surveillance and Analysis, National Center for Chronic Disease Prevention and Health Promotion; Behavioral and Prevention Research Br, Div of Sexually Transmitted Diseases and HIV Prevention, National Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: HIV/AIDS-prevention efforts in the United States involve public health agencies and CBOs that provide services such as public information; health education; risk-reduction counseling; and HIV counseling, testing, and referral (1,3-5). These programs may be aimed especially at persons with specific risk behaviors (e.g., injecting-drug users), population groups (e.g., homeless and young adults), and geographic areas (e.g., inner cities). The use of representative population-based surveys can help in assessing the impact of these programs on various groups and may reduce the methodologic constraints associated with sampling based on clinic populations or convenience sampling of groups targeted by programs (6). Findings from this survey regarding the level of reported HIV-antibody testing and the sources of testing in Connecticut are consistent with national data (7-9).

The CSDHS is using these findings to evaluate HIV/AIDS-prevention programs for current and potential program clients in the three communities. In Connecticut, a variety of service providers, including CBOs and public health departments in the three cities covered by the survey, are attempting to identify and enroll persons who engage in risk behaviors into HIV-prevention programs. CBOs in these areas deliver a variety of services through street-outreach programs that target injecting-drug users, adolescent males who have sex with men, and women who may not readily seek testing and counseling.

The findings in this report are subject to at least three limitations. First, the use of these survey results to evaluate targeted programs is limited because the survey did not clearly identify risk behavior and HIV status among respondents. Second, although some results were consistent with national data, results regarding program awareness and testing experience may reflect self-reporting error and recall bias. Finally, because it was not possible to characterize nonrespondents, the representativeness of this survey could not be assessed.

The findings of this survey indicated a substantial level of awareness and use of HIV services in the general population of blacks and Hispanics in these cities, and many of the respondents identified the specific program from which they had received services. However, the findings suggest the need to intensify efforts to increase the number of persons who know where to get information about existing programs in their areas, particularly among persons in lower education groups who were least aware of available services. In particular, because men and blacks used services at a lower rate than did women and Hispanics, programs delivering HIV/AIDS education and testing and counseling services need to continue to target these groups.

Survey data on HIV-antibody testing indicated that levels of testing were particularly low among residents of Hartford, Hispanics, and persons who did not graduate from high school. These data also indicated that most HIV-antibody tests take place outside of publicly funded programs, where national data suggest that pretest and posttest counseling is less likely to take place (7). The CSDHS plans to use this information to ensure that persons being tested receive the appropriate counseling and referral services whether they are tested at public- or private-sector locations.

References

1. Hinman AR. Strategies to prevent HIV infection in the United States. Am J Public Health 1991;81:1557-9.

2. Remington PL, Smith MY, Williamson DF, Anda RF, Gentry EM, Hogelin GC. Design, characteristics, and usefulness of state-based behavioral risk factor surveillance: 1981-1987. Public Health Rep 1988;108:366-75.

3. CDC. Update: reducing HIV transmission in intravenous-drug users not in drug treatment -- United States. MMWR 1990;39:529,535-8.

4. CDC. Publicly funded HIV counseling and testing -- United States, 1990. MMWR 1991;40:666-9,675.

5. CDC. Street outreach for STD/HIV prevention -- Colorado Springs, Colorado, 1987-1991. MMWR 1992;41:94-5,101.

6. Coyle SL, Boruch RF, Turner CF, eds. Evaluating AIDS prevention programs. Expanded ed. Washington, DC: National Academy Press, 1991:109-10.

7. Anderson JE, Hardy AM, Campbell CH. Counseling and testing services in the U.S.: public and private providers [Poster session]. Vol 2. VIII International Conference on AIDS/III STD World Congress. Amsterdam, July 19-24, 1992:C335.

8. Hardy AM, Biddlecom AE. AIDS knowledge and attitudes of black Americans, United States 1990: provisional data from the National Health Interview Survey. Washington, DC: US Department of Health and Human Services, Public Health Service, CDC, 1991. (Advance data no. 206).

9. Biddlecom AE, Hardy AM. AIDS knowledge and attitudes of black Americans, United States 1990: provisional data from the National Health Interview Survey. Washington, DC: US Department of Health and Human Services, Public Health Service, CDC, 1991. (Advance data no. 207).

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