Community-Based Efforts Chalk Up Successes: Sites in North Carolina and Maryland Have a Tale to Tell; Success in HIV Prevention

Joint state-federal HIV-prevention programs in North Carolina and Baltimore have reached at-risk populations and demonstrated very positive outcomes -- so much so that the CDC points them out when asked for success stories.

The nontraditional counseling program in North Carolina has a greater proportion of high-risk clients undergoing HIV testing than the local health departments, said Marti Eisenberg Nicolaysen, nontraditional counseling, testing and referral (NTS) coordinator assigned to the North Carolina STD Prevention and Care branch of the CDC in Raleigh.

Specifically, through the NTS program, 21 percent of clients tested in 2000 were people who had the risk factors of being men who have sex with men (MSM) and/or injection drug use (IDUs). Another 15 percent were individuals who exchanged sex for money or used drugs while having sex. According to Nicolaysen, by comparison, local health departments and other publicly funded sites had only 5 percent of their HIV-tested clients in the MSM and IDU categories, and only 7 percent in the sex worker or drug-during-sex categories. "So we're reaching people who are at higher risk," said Nicolaysen. "We're only testing 5,000 people and the public health department tests 100,000, but we're targeting the high-risk population and neighborhoods where high-risk activity takes place."

The program in Baltimore also targets neighborhoods where at-risk individuals might be found, said Carol Christmyer, R.N., M.S., assistant director for HIV services for the Maryland State AIDS Administration in Baltimore. "In Baltimore, a mobile van goes to predetermined neighborhoods where there are a lot of urban problems -- poverty, lead paint poisoning, sexually transmitted diseases -- and where people are very poor and are dealing in drugs," Christmyer said. "The van provides health screening, HIV testing, and treatment," she said. "And if we find people who are positive, we link them with a clinical setting where they can get care and intensive case management."

Factors that contribute to the success of these and other community prevention programs include a package of health care products -- testing for other diseases, like syphilis and diabetes, lead poisoning, sickle cell anemia -- as well as program location within areas like homeless shelters, drug treatment centers and jails. Caroline Moseley, M.Ed., C.H.E.S., health education manager at the Guilford County Department of Public Health in Greensboro, said that the advantage of combining other health services is that it takes the stigma out of visiting the program.

The NC NTS project also provides bilingual outreach staff in Hispanic communities, makes referrals for STDs and TB testing and treatment, substance abuse counseling, family planning, and domestic violence. "Early on, we realized that HIV probably was not the only service people needed in the community and that we should test for other STDs," Moseley said. "So we've offered syphilis testing pretty much since we started the HIV program in the mid-1990s, even when it was not funded."

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