HIV antibody testing and client retention in the therapeutic community. A preliminary report of Phoenix House.

This report describes the current approach to testing for the human immunodeficiency virus (HIV) antibody at Phoenix House, a large therapeutic community (TC) in the northeastern United States, and presents findings on retention of clients who have been tested for HIV antibodies and notified of their HIV serostatus. A total of 240 clients were tested while in treatment at Phoenix House between April 1988 and July 1992. Of these, 51 tested HIV positive. An additional 76 clients had tested positive for HIV antibodies prior to entering treatment. The difference in length of treatment stay between those who tested negative while in treatment and those who tested positive while at Phoenix House was not significant (t = 0.41, df = 238, p > .683). Although clients who tested seronegative during treatment were found to remain in treatment a significantly longer amount of time than the total population of seropositive clients (t = 4.54, df = 314, p < .001), those who learned of their seropositive status while in treatment remained in the program longer than clients who entered treatment aware of their seropositivity (t = 4.08, df = 125, p < .001). These findings suggest that acute reactions to the knowledge of seropositivity did not determine most premature terminations. The use of a small group, a core technical element of the TC, may have provided a favorable context for the task of HIV counseling and testing.

Three models to promote syphilis screening and treatment in a high risk population.

Three syphilis control models targeted at a high incidence area were implemented and evaluated over a 31-month period. These models consisted of (1) street-based outreach and referral to community health clinics for free sexually transmitted disease screening and treatment, (2) off-site syphilis screening at high risk locations and referral for free treatment, and (3) off-site syphilis screening and referral at high risk locations with monetary incentives offered for obtaining test results and seeking treatment if required. Off-site screening--conducted at homeless shelters, soup kitchens, drug treatment centers, and community fairs--was found to be significantly more effective in promoting syphilis screening than outreach and referral to community health centers. For the off-site screening models, monetary incentives were related to an increase in the proportion of individuals at homeless shelters and soup kitchens who agreed to be tested, and to an increase in the proportion of people at homeless shelters, soup kitchens and drug treatment centers who sought their test results and obtained treatment, if required.