The Centers for Disease Control and Prevention (CDC) estimates that at least half of new HIV infections in the US are among individuals under age 25. Gains in risk reduction for HIV among Men who have Sex with Men and IV Drug Users have been offset by increased transmission among those 25 and under. Among the tools recommended by the CDC for primary and secondary prevention of HIV are voluntary HIV Counseling and Testing (VCT). For most organizations serving at-risk youth--school, vocational, GED, substance use, and recreation programs--the prevention of HIV is not their primary or even secondary service goal. Programs with the greatest access often have the least capacity to engage youth in a process likely to reduce HIV risk and encourage testing where appropriate. The most recent guidelines for adolescent VCT are useful for medical practitioners with a history of high-quality and youth-friendly services. However, for social service providers who do not provide testing, they do not sufficiently address the issues faced by staff when referring or providing follow-up to clients. These structural issues have not been previously attended to in research. The Hunter College Center on AIDS, Drugs and Community Health, in partnership with National Development and Research Institutes, is proposing a two-year research project to examine the broader context and practice of VCT. This project will examine the structural factors that affect the efficacy of HIV VCT as a prevention strategy for medical and non-medical social service providers. Utilizing participatory methodologies and a functionalist approach, the expertise of practitioners, researchers, and youth will be tapped to examine current practice. We propose to: 1. Identify existing policies, protocols, and issues regarding the HIV assessment, referral, counseling, testing and follow-up process for youth at medical and community-based sites, including structural barriers and gaps in understanding and practice that may undermine HIV VCT functioning as an effective prevention strategy for adolescents. 2. Develop """"""""Best Practice"""""""" guidelines for assessment, referral, counseling, testing, and follow-up for HIV VCT at medical and community-based sites that are developmentally appropriate for diverse subpopulations of youth, including those most at risk. This initial research will begin to build a body of knowledge about the barriers to and facilitators of effective assessment, referral and follow-up for adolescent HIV VCT. Changes in technology, e.g., rapid-result testing of finger-stick blood samples, adds to the importance of the current study.
