Gaps Analysis BARRIERS

Transcription

1 Gaps Analysis MOST COMMONLY REPORTED BARRIERS Core Services For the core services, the three barriers reported most often by all 764 survey respondents were difficulties making or keeping appointments, long wait times for services and informational barriers. TABLE 41.1: CORE SERVICES: TOP 3 REPORTED BARRIERS, TOTAL RESPONDENTS 1 It's hard to make or keep appointments (275 reports) 2 I would have to wait too long to get the services (265 reports) 3 I don't know where to get the services (255 reports) The following table shows the full list of barriers included in the client survey, and the core services reporting the highest number of reports for each barrier. The first table lists the main or standard barriers that were presented to in the client survey Houston Area HIV/AIDS Needs Assessment Page 579

2 TABLE 41.2: CORE SERVICES WITH THE HIGHEST NUMBER OF REPORTS PER BARRIER, MAIN BARRIERS Main Barriers It's hard to make or keep appointments I would have to wait too long to get the services I don't know where to get the services It's hard for me to get there The services cost too much The people who run the services are not friendly The services are not in my area I was told I am not eligible to get the services I don't think I'm eligible to get the services I'm afraid someone will find out about my HIV There is no one to watch my kids if I go there My jail/prison history makes it hard to get services People at the agency don't speak my language Core Service with Highest Reports # of respondents reporting the barrier Core Service with Second Highest Reports Dentist Visits 87 Primary Medical Care Dentist Visits 74 HIV/AIDS Medications # of respondents reporting the barrier Total Reports Dentist Visits 58 Medical Case Management Primary Medical 53 Dentist Visits Care HIV/AIDS Medications Primary Medical Care 48 Dentist Visits Medical Case Management Dentist Visits 33 Primary Medical Care HIV/AIDS Medications Dentist Visits Dentist Visits 17 HIV/AIDS Medications Primary Medical Care Primary Medical Care Primary Medical Care HIV/AIDS Medications 20 Dentist Visits HIV/AIDS Medications 8 HIV/AIDS Medications 8 Medical Case Management 5 Primary Medical Care The following table lists additional barriers that were subsequently identified during data analysis as open-ended responses by survey respondents. In other words, the additional barriers represent barriers that respondents experienced when trying to access services, but were not included on the standard list. Page Houston Area HIV/AIDS Needs Assessment

3 TABLE 41.3: CORE SERVICES WITH THE HIGHEST NUMBER OF REPORTS PER BARRIER, ADDITIONAL BARRIERS Main Barriers Difficulties with paperwork Personal health issues Fear, denial or stigma (internal and/ or external) Homeless/unstable housing Core Service with Highest Reports # of respondents reporting the barrier Core Service with Second Highest Reports Dentist Visits 24 Primary Medical Care Primary Medical Care HIV/AIDS Medications Psychological Counseling CM left/staff turnover Medical Case Management Was incarcerated/in jail Using drugs Not enough, resources/funds run out too quickly Psychiatric Services or Medications Dentist Visits 4 Primary Medical Care # of respondents reporting the barrier Total Reports Home Health Care Medical Case Management Psychological Counseling Primary Medical Care HIV/AIDS Medications Rehabilitation Services Immigration status Not enough, resources/funds run out too quickly Rehabilitation Services Immigration status Supportive Services For the supportive services, the three barriers reported most often by all 764 survey respondents were informational barriers, long wait times and services not being in respondents areas Houston Area HIV/AIDS Needs Assessment Page 581

4 TABLE 41.3: SUPPORTIVE SERVICES: TOP 3 REPORTED BARRIERS, TOTAL RESPONDENTS 1 I don't know where to get the services (599 reports) 2 I would have to wait too long to get the services (319 reports) 3 The services are not in my area (244 reports) The following table shows the full list of barriers included in the client survey, and the supportive services reporting the highest number of reports for each barrier. The first table lists the main or standard barriers that were presented in the client survey. TABLE 41.4: SUPPORTIVE SERVICES WITH THE HIGHEST NUMBER OF REPORTS PER BARRIER Main Barriers I don't know where to get the services I would have to wait too long to get the services The services are not in my area I was told I am not eligible to get the services Supportive Service with Highest Reports # of respondents reporting the barrier Supportive Service with Second Highest Reports # of respondents reporting the barrier Total Reports EFA* 78 Housing Related Services EFA* 80 Housing Related Services EFA* 42 Transportation EFA* 66 Housing Related Services It's hard for me to get there Food Bank 32 Transportation I don't think I'm eligible to get the services It's hard to make or keep appointments The people who run the services are not friendly The services cost too much My jail/prison history makes it hard to get services I'm afraid someone will find out about my HIV EFA* 36 Rental/Shelter** EFA* 36 Rental/Shelter** EFA* 27 Rental/Shelter** Housing Related Services Employment Assistance Employment Assistance 15 Rental/Shelter** Housing Related Services EFA* There is no one to watch my kids if I go there People at the agency don't speak my language *EFA = Emergency Financial Assistance **Rental/Shelter = Rental Assistance & Shelter Vouchers Child Care 4 EFA* Housing Related Services Legal Assistance 5 Translation/ Interpretation Page Houston Area HIV/AIDS Needs Assessment

5 The following table lists additional barriers that were subsequently identified during data analysis as open-ended responses by survey respondents. In other words, the additional barriers represent barriers that respondents experienced when trying to access services, but were not included on the standard list. TABLE 41.5: SUPPORTIVE SERVICES WITH THE HIGHEST NUMBER OF REPORTS PER BARRIER Main Barriers Not enough, resources/ funds run out too quickly Supportive Service with Highest Reports Food Bank Rental/Shelter** # of respondents reporting the barrier Supportive Service with Second Highest Reports # of respondents reporting the barrier Total Reports EFA* Difficulties with paperwork Transportation 8 EFA* 4 23 Personal health issues EFA* 5 Rental/Shelter** 4 21 Homeless/unstable housing Fear, denial or stigma (internal and/or external) Rental/Shelter** 5 Housing-Related Services 5 21 EFA* Substance abuse Food Bank 2 HIV Education for HIV+ Immigration status Rental/Shelter** 2 Food Bank Transportation CM left/staff turnover Rental/Shelter** 1 Legal Services Referrals to Services 2 6 Was incarcerated/in jail Legal Services *EFA = Emergency Financial Assistance **Rental/Shelter = Rental Assistance & Shelter Vouchers SERVICES ASSOCIATED WITH THE HIGHEST NUMBER OF REPORTED BARRIERS Core Services The three core services with the highest numbers of reports of barriers for all 764 respondents were: Dentist visits (431 reports) Primary medical care (332 reports) HIV/AIDS medications (269 reports) 2008 Houston Area HIV/AIDS Needs Assessment Page 583

6 It is important to note that these three services also have the highest number of access attempts therefore, the high volume of access attempts may be correlated with the high number of barrier reports. Dentist Visits The following graph shows the top barriers reported most often for dentist visits ranked by number of reports. For dentist visits, the barrier reported most often was related to difficulties making or keeping appointments (87 reports). FIGURE 41.1: BARRIER REPORTS - DENTIST VISITS, ALL RESPONDENTS Total Reports of Dentist Visit Barriers, Total Respondents (431 Total Reports) It's hard to make or keep appointments 87 I would have to wait too long to get the services 74 I don't know where to get the services 58 It's hard for me to get there 43 The services are not in my area 33 The people who run the services are not friendly 27 The services cost too much 26 Difficulties with paperwork 24 I don't think I'm eligible to get the services I was told I am not eligible to get the services I'm afraid someone will find out about my HIV 10 Barriers reported less often for this service were lack of child care during services (6 reports), jail/prison history (5 reports), fear/denial/stigma (4 reports), homelessness/ unstable housing (1 report) and personal health issues (1 report). Page Houston Area HIV/AIDS Needs Assessment

7 Primary Medical Care The graph below shows the top barriers reported for primary medical care ranked by number of reports. For primary medical care, the barrier reported most often was related to difficulties getting to services (53 reports). FIGURE 41.2: BARRIER REPORTS - PRIMARY MEDICAL CARE, ALL RESPONDENTS Reports of Barriers for Primary Medical Care, Total Respondents (332 total reports) It's hard for me to get there 53 It's hard to make or keep appointments 53 I would have to wait too long to get the services 41 I don't know where to get the services 31 The people who run the services are not friendly 31 The services are not in my area 25 The services cost too much 24 I'm afraid someone will find out about my HIV 20 Difficulties with paperwork (due to volume, confusing process, etc) 10 Barriers reported less often for this service were being told, or not believing, they were eligible for services (8 and 9 reports, respectively), jail/prison history (8 reports), lack of child care during services (4 reports), fear/denial/stigma (3 reports), language barriers (3 reports) and incarceration (1 report) Houston Area HIV/AIDS Needs Assessment Page 585

8 HIV/AIDS Medications The graph below shows the top barriers reported for HIV/AIDS medications ranked by number of reports. For HIV/AIDS medications, the barrier reported most often was related to cost of services (48 reports). FIGURE 41.3: BARRIER REPORTS - HIV/AIDS MEDICATIONS, ALL RESPONDENTS Barriers Reported for HIV/AIDS Medications, Total Respondents (269 total reports) The services cost too much 48 I would have to wait too long to get the services 44 I don't know where to get the services 27 It's hard for me to get there 23 The people who run the services are not friendly 22 It's hard to make or keep appointments 19 I was told I am not eligible to get the services 17 The services are not in my area 16 I don't think I'm eligible to get the services 13 I'm afraid someone will find out about my HIV 10 Barriers reported less often for this service were difficulties with paperwork (7 reports), lack of child care during services (7 reports), language barriers (5 reports), personal health issues (4 reports), jail/prison history (4 reports), homelessness/unstable housing (1 report), fear/denial/stigma (1 report), and incarceration (1 report). Page Houston Area HIV/AIDS Needs Assessment

9 Supportive Services The three supportive services with the highest numbers of reports of barriers for all 764 respondents were: Emergency Financial Assistance (455 reports) Housing-related services (312) Rental assistance/shelter vouchers (290 reports) GAPS ANALYSIS Emergency Financial Assistance The graph below shows the top barriers reported for Emergency Financial Assistance ranked by number of reports. For Emergency Financial Assistance, the barrier reported most often was related to long wait times for services (80 reports). FIGURE 41.4: BARRIER REPORTS - EMERGENCY FINANCIAL ASSISTANCE, ALL RESPONDENTS Reported Barriers to Emergency Financial Assistance, Total Respondents (N=764) I would have to wait too long to get the services I don't know where to get the services I was told I am not eligible to get the services 66 The services are not in my area 42 It's hard to make or keep appointments I don't think I'm eligible to get the services The people who run the services are not friendly 27 It's hard for me to get there 23 My jail/prison history makes it hard to get services Not enough, resources/funds run out too quickly I'm afraid someone will find out about my HIV The services cost too much Number of Reports Barriers reported less often for this service were personal health issues (5 reports), difficulties with paperwork (4 reports), lack of child care during services (4 reports), fear/ denial/stigma (3 reports), homelessness/unstable housing (1 report) and language barriers (1 report) Houston Area HIV/AIDS Needs Assessment Page 587

10 Housing Related Services The graph below shows the top barriers reported for Housing Related Services ranked by number of reports. For Housing Related Services, the barrier reported most often was related to informational barriers (67 reports). FIGURE 41.5: BARRIER REPORTS - HOUSING-RELATED SERVICES, ALL RESPONDENTS Reported Barriers to Housing Related Services, Total Respondents (N=764) I don't know where to get the services 67 I would have to wait too long to get the services 55 I was told I am not eligible to get the services 31 The services are not in my area 30 I don't think I'm eligible to get the services 22 My jail/prison history makes it hard to get services 21 It's hard for me to get there 16 It's hard to make or keep appointments 16 The services cost too much 15 The people who run the services are not friendly 13 Barriers reported less often for this service were not enough resources (7 reports), being afraid someone finding out about HIV status (7 reports), homelessness/unstable housing (5 reports), lack of child care during services (4 reports), fear/denial/stigma (1 report), difficulties with paperwork (1 report) and language barriers (1 report). Page Houston Area HIV/AIDS Needs Assessment

11 Rental Assistance/Shelter Vouchers The graph below shows the top barriers reported for Rental Assistance/Shelter Vouchers ranked by number of reports. For Rental Assistance/Shelter Vouchers, the barrier reported most often was related to informational barriers (51 reports). FIGURE 41.6: BARRIER REPORTS - RENTAL ASSISTANCE/SHELTER VOUCHERS ALL RESPONDENTS Reported Barriers to Rental Assistance/Shelter Vouchers, Total Respondents (N=764) I don't know where to get the services 51 I would have to wait too long to get the services 47 I was told I am not eligible to get the services 28 It's hard to make or keep appointments 27 I don't think I'm eligible to get the services 24 The people who run the services are not friendly 20 The services are not in my area 20 Not enough, resources/funds run out too quickly 14 The services cost too much 14 It's hard for me to get there 12 Barriers reported less often for this service were jail/prison history (8 reports), being afraid someone will find out about HIV status (7 reports), homelessness/unstable housing (5 reports), personal health issues (4 reports), difficulties with paperwork (3 reports), immigration status (2 reports), lack of child care at services (2 reports), staff turnover (1 report) and substance abuse (1 report) Houston Area HIV/AIDS Needs Assessment Page 589

12 GAPS ANALYSIS: : SERVICE BARRIERS : S TABLE 41.6: TYPES OF BARRIERS REPORTED BY PROVIDERS Limitations N % There is a lack of funding for our agency 14 29% There is a lack of transportation to our services % Shortage of community partnerships/linkages (affecting referrals, etc.) % The community is unaware of the availability of services. 7 15% Insufficient Staff 6 13% Immigration Issues 6 13% There is a lack of other services the client needs at our program site. 4 8% We have a lack of childcare. 4 8% Other 4 8% Our staff are not comfortable working with HIV+ clients. 3 6% The waiting lists are too long at our agency. 1 2% We cannot provide services in appropriate languages. 1 2% We have problems with issues like licensure, facility permits, etc. 0 0% We just started providing services for HIV+ individuals. 0 0% The community doesn t want our services. 0 0% Clients are unable to afford our service(s). 0 0% Providers were asked to indicate any barriers experienced in providing services to people living with HIV or AIDS. The table above outlines the types of barriers reported by providers. Overall, the five most frequently reported barrier among providers was there is a lack of funding (n=14). In addition, other commonly reported barriers were there is a lack of transportation to our services (n=11), shortage of community partnerships/ linkages (n=11), the community is unaware of the availability of services (n=7), insufficient staff (n=6), immigration issues (n=6). Among providers that reported experiencing other barriers, the following issues were specified manually on the survey: need for shelter, unhealthy environment for PLWHA, burden of reporting requirements, and lack of transgender services. Page Houston Area HIV/AIDS Needs Assessment

13 GAPS ANALYSIS: : REFERRALS : R Core Services The provider survey included a table that allowed the 48 respondents to indicate whether or not they knew where to refer clients for certain services. The table below outlines the reported number of service providers that do not know where to refer clients for core services. TABLE 41.7: REPORTED NUMBER OF SERVICE PROVIDERS THAT DO NOT KNOW WHERE TO REFER CLIENTS FOR CORE SERVICES Service N % Rehabilitation services 10 21% Home Health Care 7 15% HIV Medications 5 10% Dental/Oral Health 4 8% Medical Case Management 3 6% Alcohol/substance abuse treatment services 3 6% Primary Medical Care 1 2% Mental Health 1 2% Among all core services, rehabilitation services ranked highest as the service to which respondents did not know where to refer clients. Mental health and primary medical care services, however, ranked the lowest as the lowest core services to which respondents did not know where to refer clients. For home health care, 7 respondents (15%) indicated not knowing where to refer clients. Approximately 10% (5 respondents) of providers did not know where to refer clients for assistance with HIV medications. A smaller percentage (4 or 8%) did not know where to refer clients for dental or oral health services. For both medical case management and alcohol/substance abuse treatment, three (6%) of respondents did not know where to refer clients for these services. Support Services The five support services with the lowest numbers of access attempts among all 764 client survey respondents were: 1. Developmental Assessment (6 client reports) 2. Child Welfare Services (9 client reports) 3. Day/Respite Care for Adults (19 client reports) 4. Permanency Planning (28 client reports) GAPS ANALYSIS 2008 Houston Area HIV/AIDS Needs Assessment Page 591

14 5. Child Care Services (44 client reports) Some of the aforementioned services are not funded by Ryan White resources in the HSDA, which may contribute to accessibility issues among clients. The table below outlines the percentage of providers that did not know where to refer clients for the five aforementioned support services only. TABLE 41.8: REPORTED NUMBER OF SERVICE PROVIDERS THAT DO NOT KNOW WHERE TO REFER CLIENTS FOR LEAST ACCESSED SUPPORT SERVICES Service N % Permanency Planning 9 19% Child Care Services 9 19% Developmental Assessment 8 17% Child Welfare Services 5 10% Day/Respite Care for Adults 5 10% Among the five services in the table above, permanency planning and child care services ranked highest as the services to which respondents did not know where to refer clients. For developmental assessment services, 8 respondents (17%) indicated not knowing where to refer clients. Approximately 10% (5 respondents) of providers did not know where to refer clients for child welfare services. The same percentage did not know where to refer clients for day/respite care services for adults. GAPS ANALYSIS: : PREVENTION : P The following charts summarize risky behaviors for the various sub-populations of the survey sample. Sub-populations of note are ones in which a higher proportion than that of the total sample reported the risk behavior. These sub-populations are highlighted and discussed below each chart. A sub-population of interest may be recommended for targeted HIV transmission and reinfection prevention activities, as deemed appropriate by the planning bodies. Page Houston Area HIV/AIDS Needs Assessment

15 TABLE 41.9: SUMMARY OF THOSE REPORTING SEX FOR DRUGS OR MONEY BY SUB-POPULATION Sub-Population Total # in Sub- Population % of Total Sample Reporting Sex for Drugs or Money # % In Care % 44 6% Out-of-Care 77 10% 12 16% Men % 31 6% Women % 24 10% Youth ages % 4 11% Blacks/African-Americans % 42 10% Hispanics/Latinos % 3 2% Whites % 11 6% White MSM % 6 6% MSM of Color % 17 8% Substance Abuse % 45 18% Mental Health Needs % 44 10% Recently Released % 21 18% Homeless 89 12% 13 15% Total Sample % 56 7% Seven percent (7%) of the overall population surveyed reported that they had exchanged sex for drugs or money in the previous 6 months. Eighteen percent (18%) of those recently released from jail or prison reported that they had exchanged sex for drugs or money, as did those who reported a history of substance abuse. Sixteen percent (16%) of those who were Out-of-Care reported exchanging sex for drugs or money, which contrasts with only 6% of those who are in care. Eleven percent (11%) of youth aged reported exchanging sex for drugs or money. Ten percent (10%) of those reporting mental health needs also reported that they had exchanged sex for drugs or money in the previous 6 months Houston Area HIV/AIDS Needs Assessment Page 593

16 TABLE 41.10: SUMMARY OF THOSE REPORTING ANONYMOUS SEX BY SUB-POPULATION Sub-Population Total # in Sub- Population % of Total Sample Reporting Anonymous Sex # % In Care % % Out-of-Care 77 10% 24 31% Men % % Women % 27 11% Youth ages % 7 19% Blacks/African-Americans % 79 18% Hispanics/Latinos % 23 16% Whites % 36 21% White MSM % 29 28% MSM of Color % 52 25% Substance Abuse % 63 25% Mental Health Needs % % Recently Released % 27 23% Homeless 89 12% 25 28% Total Sample % % Eighteen percent (18%) of the overall population surveyed reported that they had anonymous sex in the previous 6 months. Several populations reported a higher proportion of anonymous sex than that reported by the total sample. Thirty one (31%) of those who are Out-of-Care, contrasted with 17% of those who are in care, reported that they had anonymous sex during the previous 6 months. Twenty eight percent (28%) of White MSM reported that they had anonymous sex, while 25% of MSM of color reported this risk factor. Twenty five percent (25%) of those reporting substance abuse also reported that they had anonymous sex in the past 6 months. Page Houston Area HIV/AIDS Needs Assessment

17 TABLE 41.11: SUMMARY OF THOSE REPORTING GREATER THAN 5 SEX PARTNERS BY SUB-POPULATION Sub-Population Total # in Sub- Population % of Total Sample Reporting Greater than 5 Sex Partners # % In Care % 52 8% Out-of-Care 77 10% 8 10% Men % 53 10% Women % 5 2% Youth ages % 3 8% Blacks/African-Americans % 26 6% Hispanics/Latinos % 12 9% Whites % 20 11% White MSM % 17 17% MSM of Color % 28 13% Substance Abuse % 33 13% Mental Health Needs % 46 10% Recently Released % 16 13% Homeless 89 12% 13 15% Total Sample % 60 8% Eight percent (8%) of the overall population surveyed reported that they had greater than 5 sex partners in the previous 6 months. Several populations reported a higher proportion of anonymous sex than that reported by the total sample. Seventeen percent (17%) of White MSM reported that they had greater than 5 sex partners, while 13% of MSM of color did. Thirteen percent (13%) of those recently released from jail or prison and 13% substance abusers also reported that they had greater than 5 sex partners during the past 6 months Houston Area HIV/AIDS Needs Assessment Page 595

18 TABLE 41.12: SUMMARY OF THOSE REPORTING UNPROTECTED SEX BY SUB-POPULATION Sub-Population Total # in Sub- Population % of Total Sample Reporting Unprotected Sex # % In Care % % Out-of-Care 77 10% 32 42% Men % % Women % 72 30% Youth ages % 14 38% Blacks/African-Americans % % Hispanics/Latinos % 35 25% Whites % 54 31% White MSM % 31 30% MSM of Color % 76 37% Substance Abuse % % Mental Health Needs % % Recently Released % 39 33% Homeless 89 12% 35 39% Total Sample % % Thirty one (31%) of the overall population surveyed reported that they had unprotected sex in the previous 6 months. Several populations reported a higher proportion of unprotected sex than that reported by the total sample. Forty two (42%) of those who are out of care, contrasted with 30% of those who are in care, reported that they had unprotected sex during the previous 6 months. Forty two percent (42%) of substance abusers also reported unprotected sex. Thirty nine (39%) of homeless respondents reported unprotected sex. Thirty eight percent (38%) of youth reported unprotected sex, and 37% of MSM of color reported unprotected sex. Page Houston Area HIV/AIDS Needs Assessment

19 TABLE 41.13: SUMMARY OF THOSE REPORTING SHARED INJECTION EQUIPMENT BY SUB-POPULATION Sub-Population Total # in Sub- Population % of Total Sample Reporting Shared Injection Equipment # % In Care % 9 1% Out-of-Care 77 10% 3 4% Men % 10 2% Women % 2 1% Youth ages % 1 3% Blacks/African-Americans % 4 1% Hispanics/Latinos % 2 1% Whites % 6 3% White MSM % 4 4% MSM of Color % 2 1% Substance Abuse % 10 4% Mental Health Needs % 9 2% Recently Released % 4 3% Homeless 89 12% 4 4% Total Sample % 12 2% Twelve (12) of the total sample of 764 reported that they had shared injection equipment to inject a substance during the previous 6 months. Substances injected by those who shared injection equipment include cocaine (5), prescription testosterone (1), steroids (1), and multiple substances (1). Not everyone who shared injection equipment indicated what substance they were injecting. For the purposes of identifying risk of HIV transmission or reinfection, the most important thing to know is whether injection equipment is being shared. The substance being injected is important to know in order to target prevention activities to the activities in which people are practicing this risk behavior. Two percent (2%) of the overall population reported that they had shared injection equipment. Those who did not meet HRSA s definition of being in care ( Out-of-Care ) reported that they had shared injection equipment 4% of the time, as did White MSM and those who reported a history of substance abuse. Youth aged 18-24, whites, and those recently released from jail or prison reported that they had shared injection equipment 3% of the time Houston Area HIV/AIDS Needs Assessment Page 597

20 Sub-Population TABLE 41.14: SUMMARY OF THOSE REPORTING SERODISCORDANT SEX PARTNER BY SUB-POPULATION Total # of Sub- Population % of Total Sample Reporting Serodiscordant Sex Partner # % In Care % % Out-of-Care 77 10% 7 9% Men % 53 10% Women % 56 24% Youth ages % 14 38% Blacks/African-Americans % 62 14% Hispanics/Latinos % 20 14% Whites % 23 13% White MSM % 10 10% MSM of Color % 20 10% Substance Abuse % 28 11% Mental Health Needs % 66 15% Recently Released % 17 14% Homeless 89 12% 11 12% Total Sample % % Fifteen percent (15%) of the overall population surveyed reported that they had an serodiscordant (HIV negative) sex partner. Only two populations exceeded the average. Thirty eight percent (38%) of youth reported that they had an HIV negative sex partner, indicating that this population of PLWHA are not practicing serosorting as much as some other populations. It may also indicate that they are not transmitting their infections to their partner. Twenty four percent (24%) of women reported an HIV negative sex partner. Page Houston Area HIV/AIDS Needs Assessment

21 Risk Factor TABLE 41.15: HIV TRANSMISSION AND REINFECTION RISK BEHAVIOR IN CARE VERSUS OUT-OF-CARE In-Care (687) Reporting Risk Factor Out-of-Care (77) Reporting Risk Factor # % # % Sex for Drugs or Money 44 6% 12 16% Anonymous Sex % 24 31% More than 5 Sex Partners 52 8% 8 10% Unprotected Sex % 32 42% Shared Injection Equipment 9 1% 3 4% Serodiscordant Sex Partner % 7 9% For almost every risk category, those who met the HRSA definition of In Care reported less risky behavior than those who were Out-of-Care. Eight percent (8%) of those who were in care reported that they had exchanged sex for drugs or money in the previous 6 months, while 16% of those who were Out-of-Care reported this risk factor. Seventeen percent (17%) of those who were in care reported that they had anonymous sex in the past 6 months, while 31% of those who were Out-of-Care reported this risk factor. Thirty percent (30%) of those who were in care reported that they had unprotected sex at least some of the time, while 42% of those who were Out-of-Care reported this risk behavior. For nearly all of these risk behaviors, those who were Out-of-Care engaged in them at substantially higher proportions. This could be indicative of the many ways in which those who are Out-of-Care are marginalized. It could also indicate that being in care encourages a person to practice other healthier behaviors. More research with a larger sample size would be necessary to speculate further on the cause of this difference in risk behaviors Houston Area HIV/AIDS Needs Assessment Page 599

22 TABLE 41.16: HIV TRANSMISSION AND REINFECTION RISK BEHAVIOR YOUTH (AGE 18-24) VERSUS THE TOTAL SAMPLE Youth, age (37) Reporting Risk Factor All Respondents (764) Reporting Risk Factor Risk Factor # % # % Sex for Drugs or Money 4 11% 56 7% Anonymous Sex 7 19% % More than 5 Sex Partners 3 8% 60 8% Unprotected Sex 14 38% % Shared Injection Equipment 1 3% 12 2% Serodiscordant Sex Partner 14 38% % Youth aged reported that they exchanged sex for drugs or money, had anonymous sex, had unprotected sex, shared injection equipment, and had an HIV negative partner at higher proportions than the overall sample. While the sample size is small, this indicates that those youth who are living with HIV and AIDS may be engaging in behavior that puts them at risk for reinfection and transmitting infection at a higher rate than PLWHA in general. This may indicate a need for additional, or more tailored, prevention messages for youth living with HIV and AIDS. TABLE 41.17: HIV TRANSMISSION AND REINFECTION RISK BEHAVIOR WHITE MSM VERSUS MSM OF COLOR White MSM (102) Reporting Risk Factor MSM of Color (208) Reporting Risk Factor Risk Factor # % # % Sex for Drugs or Money 6 6% 17 8% Anonymous Sex 29 28% 52 25% More than 5 Sex Partners 17 17% 28 13% Unprotected Sex 31 30% 76 37% Shared Injection Equipment 4 4% 2 1% Serodiscordant Sex Partner 10 10% 20 10% White MSM and MSM of Color do not report HIV transmission and reinfection risk behaviors in the same proportions. MSM of Color report higher proportions of sex for drugs or money and unprotected sex. White MSM report higher proportions of anonymous sex, having sex with more than 5 partners, and shared injection equipment. This further indicates the need for tailored prevention intervention activities for white MSM versus MSM of Color, rather than a one size fits all approach. Page Houston Area HIV/AIDS Needs Assessment