Addressing HIV in Milwaukee through the "Power of Partnerships"

This month, World AIDS Day calls attention to the serious impact HIV is having globally. It is estimated that 33.2 million people will be living with HIV at the end of 2007, worldwide.¹ Although new cases of HIV in the United States have leveled out at roughly 40,000 new cases a year, the face of HIV has changed since its first diagnosis and the disparity has widened.² Over 50% of people living with HIV in Wisconsin reside in southeastern Wisconsin.³ HIV cases in Milwaukee truly demonstrate the serious disparity found nationwide. Race/ethnic minorities comprise 12% of the Wisconsin population, but 49% of all HIV cases reported in 2006. The reported HIV infection rate in 2006 was ten-fold greater for African Americans and six-fold greater for Hispanics compared to the rate for whites.³ It is increasing important to learn more about why this disparity exists and how to address it.

This year's World AIDS Day theme is The Power of Partnerships. The Center for Urban Population Health has a portfolio of partnerships that are addressing HIV in Milwaukee. The Center's mission: advancing population health research and education to improve the health of urban communities, guides these partnerships. The following projects also highlight the strength of the Center to collaborate with the community and its three institutional partners, the University of Wisconsin School of Medicine and Public Health, the University of Wisconsin–Milwaukee, and Aurora Health Care, Inc. in a way that addresses HIV along the population health continuum.

Midwest AIDS Training and Education Center

MATECs mission is to enhance the capacity of clinicians to provide quality health care services for people living with HIV/AIDS and other related co-morbidities. This is accomplished through workshops, lectures, hands-on supervised clinical training, case conferences and specialty conferences.

This year, the Center of Urban Population Health partnered with MATEC to provide program support through the hiring of a full time Outreach Specialist for Milwaukee and Southeastern Wisconsin activities. The Center leveraged MATEC's contribution in order to hire this full time position. Located at the Center for Urban Population Health, the position will expand and enhance clinic and community based organization relationships and share other Center responsibilities. This partnership is an example of how the Center is addressing HIV by helping to build capacity on the Health Services side of the population health continuum.

Piloting a Community Based Participatory Research Approach to Investigate the Health Issues and Resource Needs of Latinas Living with HIV

In Wisconsin, rates for HIV infection among Hispanic women are 19 fold greater respectively compared to white women.³ Racial and ethnic disparities in access to and quality of care are pervasive with the largest access disparities being for Spanish-speaking Hispanics.⁴ There is a need for systematic attention to the ways in which cultural factors such as language, acculturation, and meaning of HIV illness affects Latinas. The goal of this project is to pilot a community based participatory research approach to investigate the health issues and resource needs of urban HIV-infected Latinas residing in southeastern Wisconsin. With funding from the Center for Urban Population Health's Center Scientist Development Program through the University of Wisconsin's Wisconsin Partnership Fund for a Healthy Future Strategic Initiatives Allocation, this project's primary aim is to integrate a dynamic involvement of the community in research that addresses health issues and resource needs of women living with HIV. Secondary outcomes of this project highlight the aims of the Center Scientist Development Program to develop and increase capacity for conducting population health research and in this case foster community engagement and community-based participatory research. This project demonstrates another example of how the Center has been able to leverage resources from its institutional partners and hire a full time position that provides project specific support and will also expand the Center's community connectedness. This partnership lies closer to the community partnerships side of the population health continuum in its implementation but will provide recommendations that impact the health service side of the continuum.

Using Social Network Testing to Identify Undiagnosed HIV Infection in Vulnerable Populations in Wisconsin

It is estimated that about one quarter of HIV-positive individuals in the United States are unaware of their HIV status.⁵ Studies show that individuals generally reduce risk-taking behavior after they have been diagnosed with HIV.^6–13 Recent data suggests that individuals unaware of their HIV infection do not change behaviors that may put others at risk of contracting HIV.^14–16 In addition to posing a significant barrier to reducing new infections, failure to promptly diagnose HIV infection results in increased morbidity and mortality for the infected patient.

The AIDS Resource Center of Wisconsin has partnered with the Center to pilot a social network testing strategy to identify untested individuals in southeastern Wisconsin who are high risk for HIV infection. T he social network testing strategy will improve the cost-effectiveness of HIV testing by identifying a higher percentage of high-risk individuals than is reached through traditional testing activities and link them to the appropriate care earlier in their disease. This partnership is in line with the community partnership side of the population health continuum. It is a partnership with a community based-organization and includes the community infected with HIV in the planning and implementation of the project.

These three partnerships highlight the Center's strength in building community-academic partnerships in a way that addresses local population health needs. It also provides insight into the synergy the Center creates with resources from its three institutional partners in order to realize its vision to be the destination where researchers can lead innovative, community-connected urban population health research and education. If you would like more information about any of these partnerships or the Center for Urban Population Health, please feel free to contact us or send us a message.

References

1. UNAIDS/WHO 2007 AIDS Epidemic Update
2. CDC. HIV/AIDS Surveillance Report, 2005. Vol. 17. Rev ed. Atlanta: US Department of Health and Human Services, CDC: 2007:1–46.
3. The epidemic of HIV infection in Wisconsin: review of case surveillance data collected through 2006, Neil Hoxie, MS, Epidemiologist, AIDS/HIV Program, Wisconsin Division of Public Health
4. Racial and ethnic disparities in access to and quality of health care, The Synthesis Project, Research Synthesis Report No. 12, September 2007, José J. Escarce, M.D., Ph.D.
5. Glynn M, Rhodes P. Estimated HIV prevalence in the United States at the end of 2003. National HIV Prevention Conference; June 2005; Atlanta. Abstract 595.
6. Rietmeijer CA , Kane MS, Simons PZ, et al. Increasing the use of bleach and condoms among injecting drug users in Denver : outcomes of a targeted, community-level HIV prevention program. AIDS 1996;10:291--8.
7. Rhodes F, Malotte CK. HIV risk interventions for active drug users. In: S.Oskamp, S.Thompson, eds. Understanding HIV risk behavior: safer sex and drug use. Thousand Oaks, CA: Sage Publications, 1996:297--36.
8. Gibson DR, Lovelle-Drache J, Young M, Hudes ES, Sorensen JL. Effectiveness of brief counseling in reducing HIV risk behavior in injecting drug users: final results of randomized trials of counseling with and without HIV testing. AIDS and Behavior 1999;3:3--12.
9. Doll LS, O'Malley PM, Pershing AL, Darrow WW, Hessol NA, Lifson AR. High-risk sexual behavior and knowledge of HIV antibody status in the San Francisco City Clinic Cohort. Health Psychol 1990;9:253--65.
10. Cleary PD, Van Devanter N, Rogers TF, et al. Behavior changes after notification of HIV infection. Am J Pub Health 1991;81:1586--90.
11. Fox R, Odaka NJ, Brookmeyer R, Polk BF. Effect of HIV antibody disclosure on subsequent sexual activity in homosexual men. AIDS 1987;1:241--6.
12. van Griensven GJP, de Vroome EMM, Tielman RAP, et al. Effect of human immunodeficiency virus (HIV) antibody knowledge on high-risk sexual behavior with steady and nonsteady sexual partners among homosexual men. Am J Epidemiol 1989;129:596--603.
13. Coates TJ, Morin SF, McKusick L. Behavioral consequences of AIDS antibody testing among gay men [Letter]. JAMA 1987;258:1889.
14. Wenger NS, Kusseling FS, Beck K, Shapiro MF. Sexual behavior of individuals infected with the human immunodeficiency virus: the need for intervention. Arch Intern Med 1994;154:1849--54.
15. Desenclos J-C, Papaevangelou G, Ancelle-Park R, for the European Community Study Group on HIV in Injecting Drug Users. Knowledge of HIV serostatus and preventive behaviour among European injecting drug users. AIDS 1993;7:1371--7.
16. Dawson J, Fitzpatrick R, McLean J, Hart G, Boulton M. The HIV test and sexual behavior in a sample of homosexually active men. Soc Sci Med 1991;32:683--8.