The Fairfield County AIDS Plan

            Located in southern Connecticut, Fairfield County accounts for approximately 25% of all cumulative AIDS cases in Connecticut. Ten percent of the state’s cumulative cases are located in the city of Bridgeport alone (1, 16)). Although AIDS cannot be deemed a pressing issue in many towns in Fairfield County, the disease, nevertheless, cannot be ignored. Connecticut has already taken great strides in combating the disease, however. In 1992, for example, Connecticut passed several pieces of legislation allowing for the legal possession of up to ten clean syringes at one time. Moreover, these laws permitted the sale of ten or fewer syringes in a pharmacy to somebody without a prescription. (2) In Bridgeport specifically, Family Services Woodfield operates a $10 million budget, offering “traditional mental health services” and “parenting classes”, and serves “victims of crime”, among other helpful programs (3). However, several improvements can still be made to ameliorate the problem with AIDS in this area.

            There are several aspects of AIDS rates, specifically those in Bridgeport, that one must take into account when devising a plan to fight AIDS. To start, MSM rates are low, especially in Bridgeport (1). On the other hand, injection drug use (IDU) in Bridgeport is the cause of 51% of AIDS cases, double the rate in the United States overall (1,5). However, IDU rates are on the decline (perhaps due in part to the 1992 legislation). Conversely, rates of heterosexual transmission are rising in this area. In terms of race, AIDS rates in whites in Bridgeport are quite low. Hispanic rates are both higher than the national average and climbing across Fairfield County (1).

            That said, there are several problems Fairfield County health officials must confront in the future battle against AIDS in this area.

The Problem

            There are three main problems that lie at the core of the AIDS epidemic as it pertains to Fairfield County:

1)      Stigma surrounding HIV testing and the disease in general,

2)      The sense of disconnect and invisibility children gain by living in towns, such as Wilton, with low AIDS rates, and,

3)      IDU use.

Solutions

            Considering that Connecticut has already made substantially headway in fighting AIDS in injection drug users and Bridgeport offers many services to minorities and those suffering from the disease already, it seems most efficient to tackle AIDS in an arena which has not yet been addressed: the public school system. Given Connecticut’s lax mandates regarding AIDS much can be done to improve this feature of public education.

            Additionally, IDU transmission can be additionally restricted with a late-night needle exchange, HIV testing, and condom distribution van in Bridgeport, modeled after San Francisco’s “Late Night Breakfast Buffet”.            

I. Programs in Schools

            Considering that most of the total cumulative AIDS cases in Fairfield County were diagnosed in patients between the ages of 30 and 39, it may seem strange to target schoolchildren in a plan for intervention.(1) Moreover, the number of AIDS cases diagnosed in patients 29 years old and younger are relatively low and have remained stable since the start of the epidemic in this area. While 42.2% of the cumulative AIDS cases in Fairfield County have been diagnosed in the 30-39 years-old category, only 12.3% can be attributed to patients 20-29 years old. (1)

            Despite this, addressing the issue of HIV transmission in schools would have tremendous impacts in this area. Health education, specifically regarding AIDS, would be effective for several reasons. To start, by examining the high school dropout rates for Fairfield County Schools presented in “Paper II”, one can see that attendance at public schools is quite high in the county; many young people could be informed through these programs, as dropout rates are quite low across the board. Even in Bridgeport, the city with the highest AIDS rate in Fairfield County, the dropout rate was only approximately 7% in 1997 (see Paper II). Additionally, a recent article in the New York Times announced that Bridgeport and Hartford (the capital of Connecticut with a high AIDS rate as well) had both received grants to study the problem of Hispanic dropouts in their schools. (5) The success of this study would also have a positive impact on the newly implanted program to combat AIDS in Bridgeport schools, particularly because of climbing Hispanic AIDS rates.

Program Proposition:

            Health education programs implemented in Fairfield County Schools would supplement programs already in place and make changes in the current curriculum requirements. Connecticut legislation has already laid the framework for sexual education in public schools, yet requirements are vague and not effective in their efforts. (6) However, such a framework lends itself to making these changes in school health education policy extremely cost-effective, as teachers are already hired in schools to teach health classes.  Goals of new school programs attempting to prevent HIV transmission should include: discussion of the AIDS epidemic to heighten awareness of its presence in Fairfield County, attack stigma and cultural barriers in the fight against AIDS, and, in towns where rates are highest, implementation of school-based clinics for HIV testing and counseling.

Distribution of Slack Resources

            First, many students in Fairfield County towns with low AIDS rates might be regarded as “slack resources” in the community’s fight against the disease. In other words, students who might not be at risk for contracting HIV may still become active members in trying to deter the spread of the disease outside of their towns. As was discussed in “Paper I”, the AIDS epidemic is rarely discussed in Fairfield County. As a result, students who may be interested in devoting their time to helping AIDS victims, say, at a local battered women’s shelter, may not be aware of where or how they can participate. Similarly, as displayed by the median incomes of each town (“Paper II”), there are certainly monetary resources available in the towns surrounding Bridgeport. Perhaps a heightened level of awareness developed in high school would lead to donations towards AIDS-related programs in the future.

Stigma and Culturally Sensitive Programs

            Stigma surrounding HIV and AIDS can also be addressed through school-based programs, and in several different manners. To start, Douglas Kirby seems to suggest that perhaps students are unlikely to feel a personal connection to the AIDS epidemic without knowing anyone infected with HIV. As AIDS rates are so low in much of Fairfield County, this statement is especially pertinent in this area. Kirby mentions the idea of introducing students to a speaker who suffers from AIDS as a solution to stigma by personalizing the epidemic, but has no scientific study to support notions of this method’s efficiency. (7) However, a 1993 study of female injection drug users found that having a family member or friend die of AIDS within the last six months resulted in sexual behavior change. (8) Perhaps Kirby’s proposition would have a similar effect on school children.

            Family-induced stigma can also be counteracted by stronger AIDS-awareness education in public high schools. Published in 2007, a study regarding youth adherence to the HAART treatment program found that 50% of its participants (or between 12 and 13 of the 25) “…skipped doses when they feared that friends or family might discover their status.” In the conclusion of this study, the authors noted that other figures, such as pharmacists or case manages, would have to provide the stability lacking in the patient’s home needed for them to continue taking their medicine. (9) Placing a stronger emphasis on the AIDS epidemic in Fairfield County public high schools might allow for a stronger connection between students and health teachers, providing yet another basis of support in the face of stigma from peers and family.

Curriculum concerning stigma should be generated by a community-based panel and be tailored to the specific risks of students in each particular school. For example, in the CDC report “HIV/AIDS Among Hispanics—United States, 2001-2005” it was stated that “…HIV prevention measures might not be equally effective among Hispanics and that HIV educational activities should address cultural and behavioral differences among Hispanic subgroups.” (10) Assertions such as this one are particularly important in an area such as Fairfield County where AIDS rates amongst Hispanics are so high. However, this also results in higher costs for school programs, as health classes must be taught in Spanish where necessary.

            Eliminating stigma surrounding HIV testing should also be a primary goal in the school’s education programs. First, students in every town should be taught that, while they may not be part of a risk group at that time, they might become a part of one later in life. Should this ever become the case, students would, hopefully, recall the importance of testing from their health classes. In certain schools where programs prove to be cost effective, students should be referred to testing clinics located in their schools. 

School Based Clinics and Resource Referral:

            An emphasis on HIV testing should be supplemented by school-based clinics in areas with high rates of AIDS cases (such as Bridgeport, Stamford, Norwalk and Danbury). School based clinics would offer HIV testing, counseling and, where public sentiment was positive towards the idea, distribution of condoms. Parents and faculty might be encouraged in this matter, however, by one study that found that demand for contraceptives did not increase when a direct delivery system was implemented in schools (in comparison to a program which gave students vouchers for condoms). (11) In short, better availability (such as in a school clinic) might not affect demand in the school.

Unfortunately, the cost of such a clinic is most likely to be quite high. For example, the cost of a clinic in a Massachusetts hospital that offered HIV counseling, testing and referral (all of which would be offered in the school clinic) cost $349,000 in the first year “…which amounted to $7,100 for each of the 49 new HIV-infected patients told of their diagnosis or $5,800 for each of the 60 new cases identified.” (12) It could be assumed that since this proposed clinic would be in a school, that the people who would use the facilities would be more likely to return for their results (assuming that they are at school regularly and have fewer obstacles in returning to the testing site). However, schools must consider the findings of one study which indicated that, if negative, an HIV test would not impact a person’s sexual activity or other risk behaviors. (13) In other words, centers in schools where students would almost always test negative would be extremely cost-ineffective. While expensive, these school-based clinics might be cost-effective when compared to the cost of treating an AIDS patient.

II. Injection Drug Use

            The plan to stem off AIDS rates among injection drug use is quite simple, considering the services and legislation Connecticut and Fairfield County already have in place. One addition that can be made to ameliorate the situation is a needle exchange, condom distribution and HIV-testing van modeled after San Francisco’s “Late Night Breakfast Buffet”. (14) This van would operate during non-working hours, especially on the weekends and target those populations highly at risk for contracting HIV. For that reason, there are several areas in Bridgeport that might be plausible stops for this van.

            To start, Fairfield Avenue would be a potential stop, as it is home to both the Bridgeport Rescue Mission, a local homeless shelter, and Family Services Woodfield (mentioned earlier in this paper). Drug rehabilitation centers might also be logical places to stop, as IDU users are an extremely high risk group, particularly in Bridgeport. One such center is the Guenster Rehabilitation Center located on Union Avenue. Many bars are also located on Main Street in Bridgeport; perhaps this would also be a logical place to stop. However, as was stressed earlier, decisions as to where the van should run should be made on a community basis. For example, the YMCA is located on Central Avenue, which is very close to the Guenster Rehab Center on Union. Perhaps parents would feel uncomfortable having such a van operating near a building that hosts many programs for children.

            Again, the cost for such an endeavor is rather expensive, though not in comparison to the cost of an AIDS patient. The cost of running the van in San Francisco was $100,000, which again, is cost ineffective in towns with low AIDS rates (14). The study concerning the LNBB also recommended having more volunteers to reduce the burden on staff in its conclusions. Perhaps this program could be run in conjunction with Family Services Woodfield.

            One concern in neighborhoods where a needle exchange runs is the risk of discarded needles. While this may not be a problem in Connecticut, as IDU users are allowed to carry syringes on the and therefore feel less frightened of the police, communities nearby the van’s route may be interested in a study conducted concerning a syringe drop box program in Baltimore. This study found HIV positive needles in their drop boxes that might have been a risk where they throw elsewhere. Moreover, members of the community sighted fewer needles in the streets around their homes.

            Unfortunately, this study did not cite a price for the project, but said that drop boxes were made from converted US mail collection boxes (which one must assume are rather cheap in the face of AIDS costs). Should community members feel at risk of increased discarded needles, perhaps this program would be an appropriate solution.

III. Conclusion

            To reiterate, Connecticut has already taken great strides in their effort to stem off AIDS. Hopefully, with these proposed solutions to address stigma and IDU users, the process will be accelerated.

WORKS CITED

1)      “Fairfield Co. AIDS Data by Year of Report, Sex, Race, and Risk/Mode of Transmission in Percent Total for the Category through December 31, 2006.”  Packet distributed by Professor Yoshino, in class.

2)      “Impact of New Legislation on Needle and Syringe Purchase and Possession—Connecticut 1992”. MMWR weekly. 5 March 1993. 18 November 2007. http://www.cdc.gov/mmwR/preview/mmwrhtml/00019810.htm.

3)      “Case Study: Family Services Woodfield, Bridgeport, Connecticut.” Health & Disability Working Group: Boston University School of Public Health. 18 November 2007.

4)      “Basic Statistics”. Centers For Disease Control. 20 November 2007. http://www.cdc.gov/hiv/topics/surveillance/basic.htm

5)      Hamilton, Robert A. “Two Cities Get Funds  to Cut School Dropout Rate”. The New York Times. 6 December 2007. http://query.nytimes.com/gst/fullpage.html?res=9B0DE3DF163CF93BA25752C0A961948260

6)      “Connecticut received $1,251,800 in federal funds for abstinence-only-until-marriage programs in Fiscal Year 2006.” Siecus Public Policy Office. 6 December 2007. http://www.siecus.org/policy/states/2006/mandates/CT.html  

7)      Kirby, Douglas. “School-based programs to reduce sexual risk-taking behaviors.” Journal of School Health. Health and Wellness Resource Center. September 1992.

8)      Schilling, Robert F. “Predictors of Changes in Sexual Behavior among women on methadone.” American Journal of Drug and Alcohol Abuse. December, 1993. 5 December 2007. http://finadarticles.com/p/articles/mi_m0978/is_n4_v19_ai_14732773/print

9)      Rao. “Stigma and Social Barriers to medication adherence with urban youth living with HIV”.  AIDS Care. Jan 2007; 19 (1): 28-33.

10)   “HIV/AIDS Among Hispanics—United States, 2001-2005”. MMWR. 12 Oct 2007. Medline. Ebsco. 13 November 2007.

11)  Sidebottom, Abbey. “Decreasing Barriers for Teens: Evaluation of a New Teenage Pregnancy Prevention Strategy in School-Based Clinics”. American Journal of Public Health. November 2003, Vol 93, No. 11.

12)  “Voluntary HIV Testing as Part of  Routine Medical Care—Massachusetts, 2002.” MMWR. 25 June, 2004. 20 November 2007. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5324a2.htm

13)  Weinhardt, Lance S. “Effects of HIV Counseling and Testing on Sexual Risk Behavior: A Meta-Analytic Review of Published Research, 1985-1997” American Journal of Public Health. September 1999, Vol 89, No9.

14)  Rose, Valerie. “Assessing the feasibility of harm reduction services for MSM: the late night breakfast buffet study”. Harm Reduction Journal. 03 October 2006.

15)  Riley, Elise. “Operation Red Box: A Pilot Project of Needle and Syringe Drop Boxes for Injection Drug Users in East Baltimore”.  Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology. Vol 18 (Supplement 1) 1998.

16)  Data derived using American Fact Finder. www.census.gov