For over a decade, for over a decade, the U.S. Virgin Islands (USVI) has consistently had one of the highest prevalence rates of HIV infection in the nation. The USVI had the highest rate of adults and adolescents (per capita) living with a diagnosis of HIV in 2005, the second highest rate from 2006 through 2009, and currently has the third highest rate (685.1), since 2010 (667.1). According to the President’s National HIV/AIDS Strategy (NHAS), the USVI is a geographic hot spot for increased HIV risk (White House Office of AIDS Policy, 2013). The USVI also has the 3rdhighest rate (365.5/100,000) of adults/adolescents living with an AIDS diagnosis in the U.S. However, only a handful of studies have been published about HIV in the USVI. The project was guided by a number of important documents and frameworks, including the National HIV/AIDS Strategy, the HIV Care Continuum Initiative, the USVI Comprehensive HIV/AIDS Prevention Plan (FY 2012-2016), the Health Belief Model (Stretcher & Rosenstock, 1997; Rosenstock, Strecher, & Becker, 1988), and the Social Ecological Framework (Bronfenbrenner, 2005). The aims/objectives of this project were to:
1. Identify HIV-specific and STI-related: a) perspectives and practices; b) educational and testing needs, and c) community resources
Methods included an HIV-focused community needs assessment (CNA) with key informants, stakeholders and community members, health departments, faith-based organizations, medical professionals, educators (i.e. teachers, nursing faculty), business and community leaders in the USVI and other key informants and members in select communities to identify key HIV-specific concerns and expressed needs related to HIV/STIs and sexual health. We also simultaneously assessed HIV-related community strengths and resources. Our team used VI Department of Health (DoH) HIV surveillance data & data from the CNA to analyze gaps in: (a) HIV and STI knowledge; (b) HIV testing rates/ frequency (lifetime, annually); (c) barriers to HIV testing. Participants completed the following computerized surveys: HIV Knowledge Questionnaire, AIDS Risk Behavior Assessment, HIV/AIDS Questionnaire for Health Care Providers and Staff, and/or the Comprehensive HIV Needs Assessment Survey. Individual interviews were conducted in person using an interview guide by a primary interviewer and a note taker. Interviews were recorded and lasted between 30 to 90 minutes.
Review of USVI surveillance data showed that there were 1061 cumulative cases of people living with HIV/AIDS (PLWHA), at end of 2013 (CDC, 2014). Majority of PLWHA in the USVI are: AA/Black (56.9%), age 25-54 years (75.6%) and exposed through heterosexual contact (34.6%) or unknown (40.2%). Half are male. Local USVI data show that the HIV epidemic in the USVI is primarily among African Americans, heterosexual men and women, and people between the ages of 25 to 54 years old. Review of 2004-2008 USVI data, showed that the USVI DoH conducted a total of 3975 tests in 2008, across all three Virgin Islands. The majority of tests were conducted among females, Blacks, and people ages 19-24 years. For the community needs assessment, a total of 52 participants completed the study and were from the following categories: Community Members/Leaders (n=24), Health-care Providers (n=12), PLWHA (n=7). Participants resided on St. Croix or St. Thomas. Average HIV knowledge scores on ranged from 32.3 to 39.5 (possible range 0-45), with PLWH having the lowest scores. Substance use and risky sexual practices were reported by community members and PLWHA. The main identified factors that contribute to high HIV rates in the US Virgin Islands were stigma, lack of education, and unknown HIV Status. The main identified practices that contribute to high HIV transmission and high HIV rates in the US Virgin Islands were unprotected sex and multiple partners and drug use. The main barriers identified regarding accessing HIV resources were confidentiality concerns, discomfort accessing resources, finances and transportation. The main educational needs identified were regarding HIV transmission, prevention, and treatment, and also general about HIV/AIDS. Participants were mostly familiar with the available HIV-related health resources.
Local surveillance data showed that majority of PLWHA in the USVI are minorities, age 25 – 54 years and acquired HIV through unknown source or heterosexual contact. Overall, significant progress was being made locally on the USVI HIV prevention plan in terms of testing, but there are also opportunities for improvement. The HIV community needs assessment identified that many Virgin Islanders believe that risky sexual behavior, substance use, stigma and are among the main contributors to high rates of HIV in the USVI. Several barriers to treatment were identified, including confidentiality issues. There is a need for expanded HIV testing, HIV education, further examination of HIV-associated risk factors and practices among high risk groups and development of appropriate HIV prevention interventions in the USVI. Additionally, additional attention needs to be paid to addressing educational and secondary HIV prevention needs of PLWHA.