1. Decline in Rates of Syphilis Screening Following the Implementation of Rapid HIV Testing in Commercial Sex Venues Antonio Purcell de Ogenio, Denver Public Health May 11, 2006
This program started in May 02..
Documenting started in May 02

2. Eligible clients in CSV % of total eligible screened
Outreach - Bathhouse
Program started following syphilis outbreak in Spring/Summer 2002
Objective: Confidential/Anonymous, free STD/HIV testing
Year
Eligible clients in CSV
Overall screened
% of total eligible screened
2002
4923
298
6.1%
2003
7568
475
6.3%
2004
9850
642
6.5%
2005
14204
831
5.9%
We are currently offering…
Regarding the Urethral and SDA
Faced with alcohol and dehydration
Some people will come in to talk about various symptoms and not get tested
Some people are from out of town

3. Client demographics Over 40% of the population are from
Median age: 41
Over 40% of the
population are from
outside Denver County
We are currently offering…
Regarding the Urethral and SDA
Faced with alcohol and dehydration
Some people will come in to talk about various symptoms and not get tested
Some people are from out of town
Around 30% do not
identify as gay

4. Bathhouses w/Clinical Facilities
Testing at all three bathhouses considered a norm
Clinic or Private room set up as a clinic

5. STD/HIV Testing and Counseling
Services since inception of program:
Veni-puncture, urine, and swab cultures
Testing for:
HIV
Syphilis
HEP C
Chlamydia
and Gonorrhea
(rectal, pharyngeal, & urethral or SDA)
Rapid HIV introduced Spring/Summer 2004
We are currently offering…
Regarding the Urethral and SDA
Faced with alcohol and dehydration
Some people will come in to talk about various symptoms and not get tested
Some people are from out of town

6. Pre-HIV Rapid Testing
Appointments made at the bathhouse to come in to Health Department for HIV Results
Results for HIV not always given due to no-shows
Follow-up letter for no-shows
State notified after 1 month
Show appointment cards
Phone results are made by either calling the clinic or my work phone.
They all get my business card, though due to my odd schedule they have the option of calling the clinic
We get a good number of no-shows which will be displayed at a later slide
I do have form letters that I send out in order to remind them about their results
- I don’t state what type of test
- I don’t state location
For those that are positive, I inform the state after one month

7. Rapid Test Introduction
BH-B
BH-C
BH-A
‘02
‘03
‘04
‘05
‘06
May
Aug
Sep
Started
Testing
For HIV/Syphilis
Started
Rapid test
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….and I’m creating flyers through Publisher and posting them within the bathhouses

8. Post-HIV Rapid Test HIV Rapid Test is a finger puncture
(not requiring blood draw)
HIV results given after 20 minutes
STD results other than HIV given by phone
Process time is anywhere from 4-8 business days
Some STDs require veni-puncture (syphilis and Hepatitis C)
Urine samples (Chlamydia and Gonorrhea)
Phone call or follow-up letter for those that don’t call in
State notified after 3 weeks if results not given
Show appointment cards
Phone results are made by either calling the clinic or my work phone.
They all get my business card, though due to my odd schedule they have the option of calling the clinic
We get a good number of no-shows which will be displayed at a later slide
I do have form letters that I send out in order to remind them about their results
- I don’t state what type of test
- I don’t state location
For those that are positive, I inform the state after one month

9. Rates of HIV and Syphilis screening by year
% screen HIV
% Pos
Syp
% screen Syp
2002
298
251
84%
4.78%
280
94%
1.79%
2003
475
392
83%
6.63%
368
78%
0.54%
2004
624
548
88%
3.47%
309
50%
1.62%
2005
766
731
95%
5.20%
37%
Show appointment cards
Phone results are made by either calling the clinic or my work phone.
They all get my business card, though due to my odd schedule they have the option of calling the clinic
We get a good number of no-shows which will be displayed at a later slide
I do have form letters that I send out in order to remind them about their results
- I don’t state what type of test
- I don’t state location
For those that are positive, I inform the state after one month

10. Rates of HIV and Syphilis screening by year

11. Rates of HIV and Syphilis screening Pre- and Post-Rapid test
% Screen HIV
% Pos
Syp
% Screen Syp
Pre-
Sep 04
1143
988
86%
5.06%
841
74%
1.19%
Post-
1020
934
92%
4.82%
396
39%
1.77%
Show appointment cards
Phone results are made by either calling the clinic or my work phone.
They all get my business card, though due to my odd schedule they have the option of calling the clinic
We get a good number of no-shows which will be displayed at a later slide
I do have form letters that I send out in order to remind them about their results
- I don’t state what type of test
- I don’t state location
For those that are positive, I inform the state after one month
Note: Post - Sep 04 through Dec 05

12. Rates of HIV and Syphilis screening Pre- and Post-Rapid test

13. Possible Reasons for Decrease
Of all STDs, HIV considered the greatest threat
Convenience and speed of screening process for both client and clinic staff if testing only for HIV
Client fear of veni-puncture
Concern over veni-puncture within facility
Visibility of bandage on arm
Perceived sanitary conditions of facility
Not being able to use jacuzzi, pool or sauna for a period of time
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….and I’m creating flyers through Publisher and posting them within the bathhouses

14. Other Challenges Not everyone is calling in for STD Results
Lack of syphilis data means Syphilis outbreak less likely to be determined
Decrease in perceived susceptibility to STDs
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15. Conclusions Protocol re-evaluated for testing at bathhouses
Returned to veni-puncture for all testing
Need for ongoing monitoring
Adjunctive efforts to increase testing rates
Increase marketing of STD screening
Educate population regarding correlation between HIV and other STDs
Educate bathhouse staff
(gatekeepers)
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16. Acknowledgements Kees Rietmeijer, M.D., Dir DPH STD Clinic
Mark Thrun, M.D., Dir. of Prevention Training Center and Research
Stewart Thomas, Outreach Staff Supervisor, DPH Bathhouse Staff Supervisor
Bathhouse Screeners: James Collins;
Aron Shipman; Charles Chen; and
Philip Osteen.
Bathhouse Owners and Staff
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17. Questions? Show demo paper with add Show t-shirt with logo
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