Bay Windows - July 27, 2006

O'Connor, founder of HIV Innovations and professor of nursing at Northeastern University, is part of a new statewide collaboration between the Massachusetts Department of Public Health HIV/AIDS Bureau (HAB), the Boston Public Health Commission (BPHC), Northeastern University (NU), various AIDS service organizations and publicly funded hospitals and clinics across the Commonwealth. The program offers a variety of services including HIV counseling and testing, syphilis, chlamydia, and gonorrhea screens, hepatitis A and B vaccinations, hepatitis C screens, blood pressure checks, flu shots and an enormous amount of health education.

The program is geared towards individuals at risk for HIV and other STDS who will not visit a health care provider because of lack of insurance, unfamiliarity with the health care system and discrimination by health care professionals. O'Connor's program circumvents these barriers by bringing services to the places where at risk individuals congregate and recreate on a van, providing low threshold free screenings by a professional, caring, nonjudgmental staff.

"During an average shift we see anywhere from 25 to 35 people," says O'Connor, a large number of people considering the van only has one private room. "Many of the IDUs that access our services are active injecting drug users who are generally older and out of care and may be engaged in sex work. The gay men, on the other hand, fall into a number of different categories. We work with a lot of men in nontraditional relationships they may not be able to discuss with their primary care physician, and we also work with a number of non-gay identified men who are not out to their regular health care provider. Many of these men are medically fragile, with chronic health issues including heart disease, diabetes, and high blood pressure. Although our main goal is to get people tested for HIV and other STDs, we end up addressing a lot more."

Because the setting is so unusual, the strategies for getting individuals on the van to access services are also non-traditional. "In Lynn," says O'Connor, "there is a wonderful outreach worker known as Blanche Debris or Ms. Syphilis who dances across the club with a giant martini glass filled with condoms and safer sex materials. He often delivers people right to the van and stays with them if the person needs extra support. Other times we use incentives such as gift cards to grocery stores and coffee shops to get people tested. The populations we are trying to reach are nontraditional, and so our strategies need to be nontraditional as well."

The approach may be unusual, but that doesn't mean people haven't appreciated the efforts. Robert Reardon, Prevention and Education Coordinator for Tapestry Health in Springfield, Mass., says, "People love the service. Several people who had never been tested for HIV or STDs got on the van and were tested. I doubt they would have done this if they had to go to a clinic or a doctor's office. All of the feedback we have received has been positive."

The results of the program have been phenomenal. Publicly funded HIV counseling and testing programs usually have a seropositivity rate (percentage of individuals who test positive out of all those who test) of approximately one percent. However, in the past eight months O'Connor's program has had an HIV seropositivity rate of 4.2 percent, with an additional two syphilis cases, two chlamydia cases, and three cases of hepatitis C detected.

The beneficial outcomes of the program stretch far beyond getting people into care, however. O'Connor hopes by providing an opportunity for nursing students to gain access to more marginalized populations that she is helping to create a more savvy generation of health care providers in regards to IDU and LGBT issues. "When these students move on to jobs in hospital or other health care settings, they will have a better understanding of the context of the real world lives of their IDU and GLBT patients," says O'Connor. She also hopes that the experience of working on the van will help convince some students to pursue careers in serving under-served HIV positive individuals.

"At the end of the day it is difficult to measure all of the public health outcomes of this program," says O'Connor. "We have the positive STD and HIV test results, but that does not account for the high risk HIV negative individuals we talk to and help make behavior changes, or the individual who talks with us and then gets an HIV test from their primary care provider.

"We have to be happy planting a number of seeds that we do not get to see take root and grow."

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