STOP HIV/AIDS project links high-risk populations to HIV testing and care; Q&A: Dr. Harrigan discusses BC-CfE’s Laboratory Program; Immediate HIV treatment delays long-term therapy, cuts costs
It’s late on a Thursday night, but the sign on the closed door reads, “The nurse is in.” A man wearing nothing more than a bath towel wrapped around his waist patiently waits his turn to enter. Techno music throbs unceasingly through the speakers in the dimly lit space. This is Steamworks, a gay bathhouse in Vancouver. It’s also where Steven Lofton, an HIV outreach nurse, works.
“It’s an odd setting, but clients here have often not been connected to care previously,” says the Vancouver Coastal Health (VCH) nurse. “These are men who, for a lot of reasons, have traditionally not been getting tested [for HIV] and there’s many complications with them accessing health care.”
Bathhouses are uniquely high-risk settings. Research from the BC Centre for Excellence in HIV/AIDS (BC-CfE) and VCH shows clients are four times more likely to have unprotected sex with an unknown or different status partner than in other populations. And as men who have sex with men represent a disproportionate number of new HIV infections in Vancouver (accounting for over 60 per cent in 2011), it’s clear how critical HIV education and testing for this population has become.
Lofton led the launch of the Vancouver Bathhouse Testing pilot in 2011 as part of Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS). STOP HIV/AIDS, a BC-CfE-pioneered concept, is a B.C. government funded, $48-million four-year pilot project. It aims to expand HIV testing and treatment as part of the Treatment as Prevention strategy, to curb the spread of HIV and AIDS. The STOP HIV/AIDS pilot project targets higher risk populations in Vancouver and Prince George, and the Bathhouse Testing pilot has been key in increasing testing and treatment services for men who have sex with men.
Lofton notes that bathhouses have played an important role in gay culture for centuries. More recently, they have provided a venue for gay men and other men who have sex with men to share information, socialize, build community and access important health information.
Before the pilot launched, however, HIV testing in bathhouses was available, but not always taken advantage of. “The STOP HIV/AIDS pilot project has provided us with the opportunity and resources to carefully examine our HIV testing practices and improve coverage,” Lofton explains.
Lofton has worked closely with the operators of three bathhouses located in downtown Vancouver to implement clinics for testing and linking newly diagnosed men to care with an eye on creating a space that is visible, welcoming and safe.
The bathhouse testing team now provides comprehensive HIV blood work, screening for sexually transmitted infections, referrals and follow-up, treatment, and counselling in a fully set-up clinic embedded in each bathhouse.
The success of the Bathhouse Testing pilot is evident: a total of 367 HIV tests were conducted from March 2011 to April 2012, including 18 per cent administered to men who had never before been tested for HIV. Over that same period, 11 new HIV diagnoses were identified (a three per cent positivity rate that exceeds the 0.01 per cent threshold for cost-effectiveness).
The upcoming International AIDS 2012 Conference in Washington, D.C. in July will provide an opportunity to present the effectiveness of STOP HIV/AIDS projects under Treatment as Prevention to an international audience. The lesson from STOP HIV/AIDS projects like the Bathhouse Testing pilot is that the projects are targeted, effective and welcomed.