A mobile HIV education and testing program: Bringing services to hard-to-reach populations

Few programs exist that offer a range of human immunodeficiency virus (HIV) services to multiple populations (i.e., substance abusers, individuals on probation, sex workers and their clients, court-mandated perpetrators of do mestic violence) in multiple settings (i.e., courts, methadone maintenance clinics, residential and outpatient substance abuse treatment programs). Th e purpose of this article is to describe a model mobile HIV program, highli ghting its flexibility in providing services to clients who infrequently pr esent to traditional clinic-based testing sites. This mobile HIV program wa s developed to provide on-site HIV testing and counseling, education, and l inkages to primary care services. The implementation of the program begins with training of agency staff, who then provide preliminary orientation wit h clients regarding HIV testing. Approximately 3 weeks later, the mobile pr ogram staff (HIV nurse specialist and HIV counselors) provide standardized group pretest counseling and education. Clients who decide to be tested mee t with mobile program staff for individualized risk assessment and specimen collection. Two weeks later, clients meet with mobile program staff to obt ain results and receive posttest counseling; risk reduction strategies are reemphasized at that time. Unique to this program is the provision of refer rals for a wide range of primary care services for both seropositive and se ronegative clients. Since 1994, the mobile program has been implemented at six sites, and over 1100 clients have been served. Two major outcomes from the program have been observed: 1. With adequate preparation and psychological support, 40% of hard-to-reac h populations will elect to be HIV tested. 2. Through social networks of program participants, HIV-positive individual s not previously engaged in care have been referred to a comprehensive HIV primary care program.