Prevention and Support Services

Anonymous HIV Counseling & Testing Program in Community & Criminal Justice Settings

Program Description

The Anonymous HIV Counseling and Testing (ACT) Program, managed by the Bureau of Direct Program Operations, was established in 1985 to provide free, anonymous, HIV pre- and post-test counseling and HIV antibody testing to individuals at risk for HIV infection. The program's client-centered behavioral counseling sessions are tailored to address individual client needs. Counseling sessions include an assessment of the client's HIV risk, assisting clients to understand their risk for HIV, and assisting the client to develop a risk reduction plan and skills for negotiating safer sex and safer drug use behavior. Testing method options include rapid HIV testing with confirmatory testing offered immediately to clients that have a reactive screening result. Confirmatory testing is expedited to ensure the client receives confirmed results as soon as possible to alleviate the stressful waiting period. In addition, other support services are offered until results are delivered, to assist clients and enhance access to care.

Individuals who test HIV positive are provided with partner notification assistance and based on client preference are either directly linked, or referred, to medical and ancillary services. Since 1996, the program has offered those who test HIV positive the opportunity to change their test result from anonymous to confidential status. This option facilitates access to medical and social services without the need to retest. Follow-up appointments are scheduled for all HIV positive clients to ascertain the client's success in accessing services to which they were referred, to develop strategies that overcome barriers to care, to make additional referrals to needed services, and to review partner notification and risk reduction strategies.

The program utilizes a community-based strategy specifically designed to reach individuals at high risk. To increase the availability and accessibility of services, walk-in and evening clinics operate in high seroprevalence areas. In addition, special initiatives targeting high risk populations, and the use of regional referral arrangements with community-based providers, increase the potential for those at risk to receive information about testing options and be encouraged to test. Clients can easily access information about HIV/AIDS and the availability of local testing by calling the program's statewide toll-free hotlines.

Since 1989, the NYS DOH AIDS Institute has provided HIV/STD prevention education and HIV counseling and testing to inmates in state facilities with the goal of reducing HIV transmission in the correctional system. Through a Memorandum of Understanding (MOU) between the NYS DOH and Department of Correctional Services, services are provided to encourage early HIV identification and entry into medical care for those with HIV. All inmates can request program services, including voluntary, anonymous HIV counseling and testing, assistance in risk identification, harm reduction and skill development to avoid HIV acquisition and transmission, and partner notification services.

The Anonymous Counseling and Testing Program currently provides services at 53 community clinic sites and 41 correctional facilities throughout New York State, including 19 county jails. From the inception of the program through December 2004, 316,517 individuals in the community and 73,592 incarcerated individuals have received HIV counseling and testing services.

Funding

The Anonymous Counseling and Testing Program is supported by combined State and Federal funding.

Contact:

Bureau of Direct Program Operations
Division of HIV Prevention
(518) 474-3671

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Criminal Justice Initiative

Program Description

The Criminal Justice Initiative (CJI) was developed in response to the emerging prevention and service needs of HIV infected and at risk detainees, inmates and ex-offenders in New York State. Its goal is to provide a comprehensive, seamless continuum of quality HIV prevention and supportive services to individuals in a correctional setting and ex-offenders returning to their home communities. These services are designed to diminish HIV transmission and improve the health and well-being of individuals living with HIV and AIDS. The CJI uses multiple strategies to ensure effective service delivery.

The services provided in correctional settings may include HIV prevention interventions, peer educator training, anonymous HIV counseling and testing (with the option to convert to confidential), HIV supportive services and transitional planning. One or more of these services may also be provided to incarcerated or detained individuals in select youth facilities and local county correctional facilities.

In state correctional facilities the CJI supports the Prison HIV Hotline. This hotline offers state inmates the opportunity to call collect for HIV information and counseling. The hotline is also a clearinghouse for HIV-related information and provides referral services for HIV positive inmates upon release.

This initiative also funds community-based organizations to provide re-entry assistance for ex-offenders living with HIV/AIDS. Services include transportation, supportive service, risk reduction counseling, coordination of health and human services and referral to community case management.

Funding

A total of $3,301,737 in combined state and federal funds supports CJI contractors. An additional $150,000 in state funds is given to the New York State Office of Children and Family Services under a Memorandum of Understanding with the Department of Health for detained and adjudicated youth.

Contact:

Bureau of Community Based Services
Division of HIV Prevention
(518) 486-1412

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Lesbian, Gay, Bisexual and Transgender HIV Initiative

Program Description

In 1994, the AIDS Institute developed the Lesbian, Gay, Bisexual, and Transgender HIV Initiative. This initiative is to support organizational capacity-building within the lesbian, gay, bisexual, and transgender (LGBT) communities of New York State, and to strengthen the ability of existing HIV service providers to improve access to and deliver effective HIV prevention interventions for gay men/men who have sex with men (MSM), lesbians/women who have sex with women (WSW), bisexuals, and transgender individuals.

Eighteen organizations are funded under the following three components of the initiative to provide the following services:

Component #1 - Outreach and HIV prevention services to the targeted populations to:

  • improve access to HIV prevention services for at-risk LGBT individuals through the provision of outreach, supportive counseling, HIV prevention education, substance use relapse prevention, reinforcement of risk-reducing behaviors, and HIV counseling and testing;
  • increase awareness and knowledge among LGBT communities of HIV transmission factors and risk-reduction strategies;
  • eliminate or reduce high-risk behaviors through the development of necessary skills, such as communication and negotiation of safer behaviors;
  • develop skills and offer supportive reinforcement to sustain behavior change; and
  • provide HIV prevention services within a supportive environment and relevant to the concerns of LGBT communities.

Component #2 - Substance use-related services for gay men/MSM, lesbians/WSW, bisexuals and transgender individuals to:

  • improve access to HIV-related services for LGBT individuals who are active substance users and those preparing to enter recovery, currently in treatment, and at risk of relapse;
  • empower LGBT individuals who are active alcohol and/or other drug users and are living with HIV/AIDS or at high-risk for HIV infection, to consider the effects of alcohol and drug use and to take specific, achievable steps to reduce risk behaviors; and
  • integrate HIV prevention, harm reduction, recovery readiness, and relapse prevention activities within Community-Based Organizations (CBOs) serving LGBT individuals.

Component #3 - Outreach and HIV prevention services to gay/MSM, lesbian/WSW, bisexual, and transgender young people to:

  • increase the number of community-based HIV prevention education programs serving young gay/MSM, lesbian/WSW, bisexual, and transgender individuals;
  • promote the development of innovative outreach strategies and prevention program models to reach and effectively engage LGBT youth;
  • train youth to conduct outreach and serve as peer educators;
  • increase awareness and knowledge among LGBT youth of HIV transmission factors and risk reduction strategies;
  • incorporate self-esteem building and skills development (communication, negotiating safer behaviors, etc.) into HIV prevention programs targeting LGBT youth and provide supportive reinforcement to sustain behavior change;
  • develop linkages between CBOs and health care providers, including mental health and drug treatment service providers, where HIV counseling, testing, and care are provided in a sensitive manner to LGBT youth; and
  • create program models that can be replicated by other organizations committed to serving LGBT youth.

In addition to the programs funded under the Lesbian, Gay, Bisexual and Transgender HIV Initiative, the AIDS Institute contracts with various community-based HIV service organizations throughout New York State to provide a broad range of HIV prevention and supportive services to LGBT communities. These programs are supported with funds awarded under the CDC Minority Peer Initiative, the Community Service Programs Initiative, the Multiple Service Agencies Initiative, as well as with Ryan White Title II funds.

Funding

The Lesbian, Gay, Bisexual and Transgender HIV Initiative is supported by approximately $5 million in combined State and federal funds.

Contact:

LGBT Unit
Bureau of Special Populations
Division of HIV Prevention
(212) 417-4667

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Harm Reduction Initiative

Program Description

Injection drug use is a primary risk factor for new AIDS cases in New York State. To date, the number of injecting drug users with AIDS is reported to be more than 65,000. The AIDS Institute recognizes that harm reduction strategies are needed to prevent the transmission of HIV to substance users, their sexual partners, and children.

The Harm Reduction Initiative supports comprehensive and complementary services with funds from the Centers for Disease Control and Prevention (CDC), the Ryan White CARE Act Titles I and II, and the New York State Department of Health (NYSDOH). Harm Reduction Initiative contractors receive funding from a combination of these sources to provide an array of services to substance users, their families, and communities. The CDC funds HIV prevention services to substance users including outreach, individual and group level interventions, and support groups. Ryan White Title I funds harm reduction/recovery readiness/relapse prevention services, to HIV positive substance users. They support intakes and assessment, individual and group counseling, support groups, acupuncture, referrals to health care, supportive services, and substance use treatment. The Mental Health Services in Harm Reduction Settings Initiative, funded by Ryan White Title 1, provides mental health services including psychiatric intakes and assessments, and individual and group interventions. Ryan White Title II funds counseling and supportive services targeted to special populations to address regional priorities. The New York State Department of Health budget funds comprehensive harm reduction/syringe exchange programs as described below.

In May 1992, the Department of Health filed emergency regulations for authorization to conduct hypodermic syringe and needle exchange programs. Section 80.135 of Title 10 of the State of New York Official Codes, Rules and Regulations provides the regulatory authority by which community-based, not-for-profit organizations, and government entities may be granted a waiver to obtain, possess, and furnish hypodermic syringes and needles without a prescription in programs designed to reduce the transmission of HIV. The target population are injection drug users (IDUs) who are not ready, willing, or able to abstain from drug use or enter substance use treatment programs. The regulations require that syringe exchange services be provided within a comprehensive harm reduction model, where clients can learn methods risk reduction measures for themselves and their partners. Programs must elicit and obtain community support in order to receive approval for their waiver applications.

In addition to the provision of clean injection equipment, harm reduction services include:

  • outreach and education on risk reduction practices related to sexual and drug-using behaviors;
  • distribution and demonstration of male and female condoms and dental dams;
  • distribution and demonstration of bleach kits and safer injection techniques;
  • distribution of other harm reduction supplies and literature;
  • provision of supportive services, HIV counseling and testing, partner notification assistance, case management, health care, legal, and housing services. Programs must provide referrals for these services if they are unable to provide them directly.

There are currently fifteen approved harm reduction/syringe exchange programs in New York State: eleven in New York City, and one each in Buffalo, Rochester, Ithaca, and Mount Vernon. To date, approved programs have collectively enrolled more than 114,500 injection drug users (1DUs), 73% male and 27% female. Approximately 44% have been Latino, 26% African-American, 27% Caucasian, .28% Asian/Pacific Islander and .07% Native American and 2% more than one race. Ninety percent of participants are over 30 years of age.

Program models include street-side services, mobile vans, storefront centers, walking teams, hospital-based programs, and visits to single room occupancy hotels. Syringe exchange programs (SEPs) have shown a rapid and remarkable rate of growth along with strong evidence of effectiveness.

Researchers from the Baron Edmond de Rothschild Chemical Dependency Institute of Beth Israel Medical Center have conducted evaluations of New York State's syringe exchange programs. Following are some of the findings from its research:

  • comparison of HIV transmission rates among SEP participants and non-participants show a significant decrease in transmission in IDUs enrolled in syringe exchange. Only 2% of syringe exchange program participants are infected per year versus a 4-8% rate in non-syringe exchange IDUs;
  • there is a 76% decrease in the buying or renting of syringes among SEP participants; and
  • there is a 50% decrease in borrowing or sharing of used syringes.

The Beth Israel study also demonstrated that syringe exchange does not attract people to drug use. In fact, among SEP participants the frequency of injecting declined by 8%. Further, the findings show a threefold increase in the number of participants who use alcohol pads as a disinfectant before injecting. This practice results in a decrease in the number of injection-related infections.

The number of referrals provided by syringe exchange programs continues to increase. Over 123,000 referrals have been made to detoxification and substance use treatment programs, health care services, HIV counseling and testing, and social services.

Funding

The Harm Reduction Initiative is supported by approximately $5.4 million in combined State and federal funds.

Contact:

Harm Reduction Unit
Division of HIV Prevention
(212) 268-6987

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Expanded Syringe Access Demonstration Program (ESAP)

Program Description

In May 2000, the New York State Legislature enacted Chapter 56 of the Laws of 2000 creating the Expanded Syringe Access Demonstration Project (ESAP). The purpose of this program is to reduce the transmission of blood borne diseases, including HIV and hepatitis, by enhancing access to clean (new) syringes. Under this program, up to ten syringes may be sold or furnished to a person 18 years of age or older without a prescription by pharmacists, health care facilities, and health care practitioners who have registered with the New York State Department of Health.

As of October 31, 2005, there were 2,882 registered ESAP providers. Of registered providers, 1,138 (38.8%) are located in the five boroughs of New York City (NYC). The remainder of the ESAP providers were located outside of NYC. There are ESAP-registered providers in every New York State County except Hamilton.

Of all registered providers, 2,819 (97.8%) are pharmacies. Major pharmacy chains account for 2,042 (72.4%) of all registered pharmacies. Approximately 71 percent of all community pharmacies in NYS are registered. In addition to pharmacies, there are 63 other providers enrolled including 14 hospitals, 9 nursing homes, 24 clinics (Diagnostic and Treatment Centers), and 16 private practitioners.

A listing of registered ESAP providers by county, as well as sharps collection sites, are available at the NYS Department of Health website. A printed directory of registered ESAP providers and sharps disposal sites, by county, is also available. The website provides ESAP-related material including an overview of the law and regulations, information on ESAP for providers and consumers, guidelines to sell or furnish syringes without prescription, guidelines for health care facilities, and the application to register for ESAP. It also contains information on how to dispose of household sharps properly, the application for sites interested in accepting syringes for disposal outside a health care setting, and some additional resources. In New York State, all hospitals (251 facilities) and nursing homes (679 facilities) must, by law, accept household-generated sharps for safe disposal. There are sharps disposal sites in every county except Hamilton. Nearly one-third of sharps disposal sites (n=258, 28%) are located in the five boroughs of NYC; the rest are located outside of NYC. In addition to the hospital and nursing home disposal sites, there are 62 other sharps collection sites developed by ESAP community demonstration projects in regions throughout New York State. Of these 62 new sites, 24 are at local pharmacies, 19 are at community-based organizations, 7 are at health centers, 3 are at housing authorities, 1 is at a county landfill site, 3 are at county solid waste transfer stations, 2 are at a community college and 3 are at sites visited by a mobile van.

Contact:

Expanded Syringe Access Demonstration Program
(212) 417-4746

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Peer Delivered Services

Program Description

Peer education and support are highly effective means of providing HIV prevention education and personal empowerment to individuals at high risk and those who may not be engaged by traditional methods of outreach and education. Peer-delivered services recognize that prevention messages and service delivery are strengthened when delivered by those who share common characteristics with the priority population. These characteristics may include race/ethnicity, cultural background, language, age, gender, HIV status, risk behavior, or similar histories (e.g., individuals who have a history of substance use). The AIDS Institute supports peer-delivered services through the Peer Initiative as well as through other initiatives serving hard-to-reach and underserved populations. The AIDS Institute's Peer Initiative was first funded in 1994 and is supported by both state and federal funding.

Peer Initiative providers recruit members of target communities and provide them with training to become peer educators. Peer training activities vary somewhat by provider agency, but in general include: basic information on HIV/AIDS, sexually transmitted diseases (STDs), hepatitis and tuberculosis (TB); and HIV transmission prevention, and treatment. In addition, programs work closely with peers to continue the development of techniques to engage individuals at risk. Many programs also work with peers on presentation skills, so that the material presented is accurate, culturally sensitive, and keeps the audience engaged and actively listening. All programs provide ongoing support and training for peers to reinforce healthy behaviors and programs ensure that they continue to feel comfortable in their role as peer educators.

Once trained, peer educators conduct outreach, education interventions, and on-going support in a variety of settings and to a variety of priority populations. Examples of Peer Initiative programs funded by the AIDS Institute include: a theater project that has adolescent peers conduct street outreach and interactive theater as a method to deliver HIV prevention education; an Hispanic agency that has adolescents, women and substance users provide HIV prevention education; a multi-service AIDS-specific agency that employs gay men who were former substance users to reach those actively using; a program that recruits and trains individuals who are deaf to reach out and provide HIV prevention education to other deaf individuals; a peer program for those within the correctional system; a prevention program that recruits Caribbean-born women to provide HIV prevention workshops; and a program that has peers who find and educate injection substance users.

In addition to agencies funded under the Peer Initiative, many other providers incorporate the use of peer models in service delivery.

Funding

The Peer Initiative is supported by approximately $4 million in combined state and federal funds.

Contact:

Bureau of Community Based Services
Divison of HIV Prevention
(518) 486-1412

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Specialty Targeted Contracts

Program Description

Fourteen contracts are funded through a variety of initiatives and are categorized under the umbrella group, Specialty Targeted Contracts. These contracts are limited in scope and focus on specific populations and/or geographic areas. Populations reached through these contracts include women, adolescents, persons living with HIV and AIDS, and select racial or ethnic minorities. The intent of these contracts is to implement programs designed to reduce the spread of HIV and AIDS through the delivery of interventions that increase HIV/AIDS awareness, support long-term behavior change, and assist with effective service coordination. Among others, specialty targeted programs include the New York State SIDA Hotline which provides HIV information and referrals to Spanish-speaking individuals.

Funding

Specialty targeted contracts are supported by approximately $1.5 million in funding from New York State.

Contact:

Bureau of Community Based Services
Divison of HIV Prevention
(518) 486-1412

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General Legal Services

Program Description

The General Legal Services initiative was established in 1990 to enable low income, HIV-infected persons to gain access to legal professionals for assistance in writing wills, making child custody arrangements, combating discrimination, receiving health care services and entitlements, developing advance directives, and maintaining or acquiring housing. In addition, the initiative's six contracts support the provision of standard legal services such as settling insurance disputes, bankruptcy proceedings, and other civil matters that many individuals with HIV-related disease could not otherwise manage or afford. Providers are successful in enlisting the services of attorneys to do pro bono work for individuals and families affected by HIV, greatly expanding access to legal services for those in need. Legal service agencies are also active in providing training and technical assistance about HIV-related legal matters to staff and clients of health and human services agencies.

Funding

The General Legal services initiative is supported by $540,000 in State funds.

Contact:

General Legal Services Director
Bureau of Community Support Services
Division of HIV Health Care
(518) 486-1323

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