Working with Baltimore churches, homeless shelters and food kitchens, Johns Hopkins researchers have proved that community-based testing programs are powerfully effective in reaching people at high risk for HIV. In a report prepared for last week's Eighth Annual Conference on Retroviruses and Opportunistic Infections, Hopkins researchers said tests of nearly 1,000 people at community sites over a year and a half identified 122 who were HIV-positive. Ninety-seven did not know they had the disease or were spreading it.

"Most people at risk for HIV won't go to health departments for testing," says Carol Hilton, lead author of the study. "This study shows that we can get to them in the community if we put some energy into it." Using urine rather than blood tests also helped, she says.

The researchers focused their efforts on 10 ZIP code areas that had high incidences of HIV and were plagued by drug addiction and prostitution. They tested 684 people through one- to two-day events at four churches, a shelter for men, a food kitchen and a health fair. They offered ongoing testing through a church, the Deaf AIDS Project, a hospital, a mobile van and Sisters Together and Reaching, an organization for women, screening 279 more over a year-and-a-half period. Sixty-seven percent of the HIV-positive individuals were continuing to get medical care 1.5 years after diagnosis, thanks to counseling and referrals that are part of community-based efforts.

"Our experience underscores the fact that many people do not know that HIV screening is available, free, confidential and anonymous," Hilton says. "Some fear needles, are not aware that urine screening is an option or lack access to testing sites because of transportation, child care or time issues."

The researchers plan to continue community testing in Baltimore and believe that other areas could benefit from similar programs.

The project was funded by the National Institute of Allergy and Infectious Diseases.