HIV Testing and Prevention: Identifying and Reaching At-Risk and Hidden Populations

Rutgers scholar Henry Raymond, an expert in HIV/LGBT populations, is researching HIV prevalence and behaviors among hard to reach LGBT communities in order to monitor the epidemic and provide data to design appropriate education and intervention strategies in HIV prevention.

While there has been great progress in the prevention and treatment of HIV over the last decade, the disease is still a persistent problem around the world, according to the Centers for Disease Control and Prevention,

Raymond, an associate professor at Rutgers School of Public Health, discusses some of his recent research – which took place in San Francisco – into hidden, hard to reach, populations in order to identify trends and behaviors of LGBT populations that vary by geography, race, and ethnicity.

“While some preventative interventions, such as the use of pre-exposure prophylaxis (PrEP) are increasing, there is still a need for targeted strategies that will continue to increase access to HIV testing, prevention and care, and treatment, without making disparities in HIV worse,” said Raymond. “PrEP is ‘the thing’ in HIV prevention today – statewide and nationally, but there are disparities in uptake and adherence.”

What is the significance of “hidden populations” in your research?

Raymond: The reason they are considered hidden is that they are not usually included as a special population in typical data collection activities. We might want to know about the HIV prevalence among female sex workers, for instance, but in household surveys women are unlikely to admit they engage in sex work and often are not even asked about it. This means we have to use epidemiologic methods to study the incidence, location, and management of the disease. Because of stigma or illegality, hidden populations may also not be involved in prevention planning or other programs, making it difficult to determine exactly how many are being overlooked and neglected. Being able to access these populations and collect data on size and conditions of health will help ensure they are included.

What trends are you finding related to behaviors associated with HIV testing and prevalence?

Raymond: It really depends on where and what population. For example, in San Francisco the trend in new HIV infections among men who have sex with men is going down across all race and ethnic groups, while at the same time the trend in new infection among adult transwomen is high and stable. In contrast to that, New Jersey is seeing more new HIV diagnoses among Black / African American and Latino men who have sex with men compared to white men who have sex with men.

What are the implications of your research findings?

Raymond: That all epidemics are local, and locally obtained data is part of the best practice toolbox that will help to develop policy and adopt programming to address it.

Is there anything from your research that you have found personally surprising?

Raymond: How much these communities appreciate the chance to have their concerns illustrated and communicated by participating in research.

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