Findings from an Outreach Strategy By the Monroe County Health Department, Rochester, New York

Background:  Between 2005 and 2007, the city of Rochester accounted for over 70% of all incident Chlamydia, Gonorrhea, early syphilis and HIV infections in Monroe county. To better allocate resources, and understand possible social determinants of disease morbidity, we conducted a targeted outreach.

Methods:  Neighborhood was selected using incidence surveillance data. Five Public Health Representatives and 1 data analyst conducted random interviews. The semi-structured questionnaire collected:

• Demographics  
• Insurance status and interactions with medical systems
• STD/HIV knowledge and risk

Data were analyzed using inductive qualitative techniques.

Results:  Sixty-nine residents were interviewed (53.6% males, 69.6% black, 26.1% white, average age 25). Themes: 1) Age and insurance status- Almost 50% of the “Teens” group had coverage through their parents. About half of the “Mid 20’s” group had aged out of parental coverage, and used emergency rooms (ERs) and publicly-funded resources (i.e. walk-in centers) for care. Eight out of every 10 in the “30’s” group had insurance coverage.  2) Interactions with medical systems- Younger, insured interviewees (<24) were more likely to use private providers. Conversely, older, insured participants (>=24yr) were less likely to have a PCP, and utilized ERs and walk-in centers for intermittent, need-based sexual health and preventive services. 3) Neighborhood context and  risk of STI’s- Participants used the term “contaminated groceries” to describe their perceived susceptibility to STI’s. Over half were screened for STDs/HIV within the past year. Many were eager to receive condoms the teams were distributing.  

Conclusions:  Participants are aware of their risks for STIs, yet are limited by restricted interactions with medical systems. For older individuals, these interactions are not mediated by their health insurance status, but by need and accessibility. To reduce increasing burdens on publicly-funded resources, findings could be used to plan ongoing outreach activities that address utilization of public and private medical resources, preventive versus emergent care, and condom distribution.