HIV/AIDS in urban areas

            The CDC is recommending that four separate populations be targeted for different prevention strategies. These populations are persons unaware of their serostatus, persons aware of their own serostatus and at very low risk for infection, persons aware that they are seronegitive but at high risk for becoming infected, and persons who know that they are seropositive (19). Programs targeting all four groups can be effective in the more densely populated urban areas of New Hampshire.

            Critical to the SAFE (Serostatus Approach to Fighting the Epidemic) program is the identification and treatment of those individuals infected with HIV. New Hampshire need to utilize rapid rest more and make them readily available in health care settings. Rapid tests, which use salvia instead of blood, can be done quickly, without a lab, and the results can be ready in about twenty minutes. These tests are ideal for testing the street population and those without a permanent address. This test eliminates the long waiting period in between taking the test and finding out the results (19). Since the results of this test are available almost immediately, this helps eliminate the problem of individuals not returning to receive their test results.

            Harm reduction programs need to target those who know that they are seronegitive but still at high risk for infection. These groups of individuals include MSM, IDU, at risk heterosexual adults, and sexually active adolescents (20).

            A comparison of a variety of interventions among MSM shows that interventions reduced the percentage of men reporting unprotected anal insertive sex by 26%. Programs in the study ranged from a single three hour session in San Francisco to twelve weekly 75-90 minute meetings in Mississippi. MSM programs should include interpersonal skills training as the programs with such skills training produced the largest reduction in risky behavior (21). Even though the decrease in unprotected anal insertive sex is typically only 26%, this amounts to a tremendous savings in HIV medical cost.

            IDU is the second most common form of transmission in New Hampshire. However, little is known about this population in New Hampshire. New Hampshire isn't thought of as having an IDU problem, but the data suggests otherwise. Before a program can be implemented to reach out to this population, studies need to be done to determine where the highest concentrations of intravenous drug users are and determine if a needle exchange program would be feasible. New Hampshire lacks the public transportation system of the larger cities, so accessing these needle exchange sites will be problematic. The study should also attempt to find out if drug users would be willing to go to local pharmacies to exchange dirty needles. This would allow for a greater number of sites spread around the state. The feasibility of a mobile van needle exchange program should also be studied. A study in Australia showed that although patterns of urban and rural intravenous drug use were similar, injecting drug users in metropolitan areas were more likely to report obtaining needles from needle and syringe exchange programs (80%) than rural areas (36%). Injecting drug users also reported more barriers to access to clean equipment and a longer time period between HIV testing (16). In the meantime, intravenous drug users need to have access to educational harm reduction programs led by peers to help reduce their chance of becoming infected with HIV (16).

            Lastly, young adults in New Hampshire's urban areas need to receive more comprehensive sexual education. This education needs to combine skills based training, including how to use a condom and predict whether or not someone is infected with STDs or HIV. Interpersonal training also helps to increase the use of condoms. Programs should practice role playing in order to prepare individuals with condom negotiation skills. The program should also either provide participants with either condoms information about where they can obtain condoms. While many sexual education programs are based in the classrooms, these programs aren't as effective as community based programs. Programs with 100% racial homogeneity produced significantly higher rates of condom used than heterogeneous programs (22). In order for these programs to be the most effective, fascinators of these programs should also be from the participants racial group (23).