Targeted STD/HIV Outreach Services to High Risk Populations in Guam: Lessons Learned

Background: 

On Guam, Gonorrhea and Chlamydia screening rates demonstrated over a 20% positivity rate among STD/HIV Program (SHP) clients.  SHP initiated a CBA Request Information System (CRIS) with CDC.  An integrated STD/HIV Targeted Testing strategy was developed and implemented in January 2016 to reach the most at risk populations.  Based on client interviews, targeted testing efforts were expanded to include the local migrant population who are engaging in risky behaviors with MSM.  

Methods:  From January through April 22, 2016 several key informants from the MSM and local migrant populations were contacted to promote testing services and recruit individuals for screening during SHP's weekly outreach testing efforts.  During each outreach, HIV rapid testing was offered.

Results: 

Of the people encountered between January 1 through April 22, 2016, 31 clients were tested for HIV during outreach testing efforts: over 75% reported having unprotected sex in the past 12 months; 10% reported having sex in exchange for drugs, money or gifts; nearly 50% reported having sex while using drugs, alcohol or both; and, less than 1/3 of clients tested ever had a HIV test in the past.  Also, some clients tested reported possibly coming into contact with a known HIV positive individual and having been “picked up” for sex by other male individuals in exchange for drugs or alcohol.

Conclusions: 

Although Guam’s HIV rates among migrants is low, there is an increased likelihood that HIV can be transmitted among the migrant population due to: High STD rates among migrant populations and, the notion that migrants are engaging in risky behaviors with the MSM population.  In resource-constrained jurisdictions, targeted testing employs a combination of strategies to include the integration of HIV and STD prevention and control efforts.  Syphilis testing should be offered since it has an increased burden among both MSM and migrant populations.