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Objectives. We evaluated the use of social networks to reach persons with undiagnosed HIV infection in ethnic minority communities and link them to medical care and HIV prevention services. Methods. Nine community-based organizations in 7 cities received funding from the Centers for Disease Control and Prevention to enlist HIV-positive persons to refer others from their social, sexual, or drug-using networks for HIV testing; to provide HIV counseling, testing, and referral services; and to link HIV-positive and high-risk HIV-negative persons to appropriate medical care and prevention services. Results. From October 1, 2003, to December 31, 2005, 422 recruiters referred 3172 of their peers for HIV services, of whom 177 were determined to be HIV positive; 63% of those who were HIV-positive were successfully linked to medical care and prevention services. The HIV prevalence of 5.6% among those recruited in this project was significantly higher than the approximately 1% identified in other counseling, testing, and referral sites funded by the Centers for Disease Control and Prevention. Conclusions. This peer-driven approach is highly effective and can help programs identify persons with undiagnosed HIV infection in high-risk networks.

To accurately account for previously undiagnosed infections, it is critical that community-based organizations conducting the social networks strategy in their HIV counseling and testing programs verify each identified case with their local or state health department.

As part of a cultural competence needs assessment study at a large academic health care system, we conducted a survey among 1,220 practicing physicians to assess their perceptions of the organization's cultural competence climate and their skills and behaviors targeting patient-centered care for culturally and socially diverse patients. Less than half of providers reported engaging in behaviors to address cultural and social barriers more than 75% of the time. In multivariable logistic regression models, providers who reported moderate or major structural problems were more likely to report low skillfulness in identifying patient mistrust (aOR: 2.01; 95% CI: 1.23-3.28, p<0.01), how well patients read and write English (aOR: 1.63; 95% CI: 1.03-2.57, p=0.03), and socioeconomic barriers (aOR: 2.14; 95% CI: 1.14-4.01, p=0.01), than providers who reported only small or no structural problems. Improved structural support for socially and culturally complex medical encounters is needed to enhance care for socially at-risk patients.