"Houston Hits Home" With Youth and HIV/STD Testing

Houston Hits Home, the Houston Health Department-led effort to increase HIV and STDs awareness and testing, is rooted in a vibrant collaboration of partners. The health department, the Houston Astros, KRBE-104.1, Planned Parenthood Gulf Coast, Memorial Hermann, and Harris County Public Health & Environmental Services are just a few of the entities that have rallied to implement a personalized HIV/STD prevention and intervention strategy and to standardize service delivery.

“It’s only because of our partners that we are able to reach the numbers of people we do each year,” says Marlene McNeese, Bureau Chief of the department’s Bureau of HIV/STD and Viral Hepatitis Prevention.

The partnership approach grew out of the department’s efforts at teaming up with public schools and other entities during the emergency preparedness efforts in the face of Hurricanes Ike and Katrina a decade ago. “We took that experience in developing our Houston Hits Home model,” says McNeese.

The Houston Health Department truly understands that if you want to affect behavior you must reach out to those whose behavior you want to change, not wait for them to come to you. Otherwise, you may never reach them. That’s the motivation behind Houston Hits Home, a public health initiative targeting some of the highest risk groups for HIV—youth of color—to get them tested so they know their status. 

How do you do that? Put on hip hop concerts and invite the city’s youth to sporting events, where the only price of admission is getting tested for HIV and other sexually transmitted diseases (STD). Listen to some basic education about the diseases, and enjoy yourself. 

The innovative approach seems to be working. Since 2007, 57,000 HIV tests have been administered at the annual events, with most of those concertgoers also getting screened for Gonorrhea, Chlamydia, Hepatitis C and other sexually transmitted diseases (STD). Age-appropriate immunizations are also provided. Each concertgoer receives about one hour of education on HIV and STDs—and information on seeking care should they need to do so—while their tests are processed onsite. Thirty percent of concertgoers report it’s the first time they’ve been tested.  

“HIV is getting to be a younger epidemic,” says Marlene McNeese, Bureau Chief of the department’s Bureau of HIV/STD and Viral Hepatitis Prevention. In Houston, rates of HIV among those aged 20 and 24 are about double that of Houstonians in their 30s and 40s, while rates for those in their late 20s run about 1.5 times higher than their older peers. In Houston, nearly 80 percent of transmission risk for males is among men who have sex with men, and the epidemic is largely concentrated among those with low-incomes.  

Moreover, the epidemic has become one disproportionately impacting communities of color. There are 1 million Americans living with AIDS, and nearly half are black, says McNeese. In Houston, 60 percent of new HIV cases annually are concentrated among blacks. Meanwhile, one in five people living with HIV in the metro area don’t know they have it, while only 73 percent of the nearly 23,000 Houstonians diagnosed with HIV are receiving medical care. 

“One of our initial goals, or aims, was to destigmatize HIV in these communities,” says McNeese. Several years of events seem to have made an impact. In recent years, each annual event has attracted about 15,000 people. “We have young people who look forward to this each year.” Several cities have since rolled out similar events, including the Chicago, Dallas, New York (the Bronx), Oakland and Philadelphia.     

Houston’s event got its start in 2007 with a local radio station initially developing the Hip Hop for HIV intervention, offering a free concert to attract black youth in exchange for a free screening test. The event drew 7,500 people, but “they quickly realized they needed more capability,” says McNeese. “They didn’t know how to provide care.” After the department got involved, it took the lessons learned from the first summer concert and applied them to the second year’s event. “We needed the ability to offer more types of testing and we needed more staff,” says McNeese. 

In 2008, it applied those lessons and added a 60–minute HIV/STD education class, while staff processed test results. The event was also smaller so that that the department and its multiple sponsors (see box) could successfully apply the first year’s lessons. When participants register, they provide consent to testing and get a confidential code, and volunteer staff from state and local health departments, hospitals, phlebotomy schools and elsewhere collect and process specimens. Skilled youth facilitators conduct a 1-hour education class while tests are processed. On-site treatment also is available. 

Of the 57,000 tests, one in 193 people have tested positive for HIV, one in 48 have tested positive for Gonorrhea, while one in nine have tested positive for Chlamydia. Pre- and post-assessments have found significant positive changes in knowledge level and beliefs about the diseases. “We haven’t reached the point of saturation to see a decline in new incidence,” says McNeese. “[but] I’m hoping we’re at a tipping point.” 

More recently, it’s become harder to draw artists to do free standalone shows and there has been a rise in HIV rates in Houston’s Latino community. “We’ve had to be more creative,” notes McNeese. In 2014, the city’s health department rebranded the effort, calling it Houston Hits Home in recognition of a new partner, the Houston Astros baseball team, and the department’s attempt to reach a broader population, especially the Latino community. “Baseball is pretty incentivizing,” McNeese says. 

On July 26, 2014, thousands of Houston’s youth were provided free admission to the ballpark to see the Astros play the Miami Marlins, which was followed immediately by a Jason Derulo concert. “We had a pretty good success,” says McNeese, who is busy planning the 2015 event.