On Wednesday evening in Washington, D.C., International AIDS Foundation Pangaea hosted a reception for Oakland/East Bay conference goers.

Researchers, advocates and persons living with HIV/AIDS shared conversation over drinks and a light buffet. 

"As an organization that works on the forefront of global HIV research, we're also very committed to what it means to bring that dialogue back home" Dr. Ifeoma Udoh said. "How do we take the lessons learned from both the domestic response and the global response and bridge the gap there and bridge that divide? We wanted to show our commitment to our Oakland partners." 

Udoh is the research director for the Oakland Late Testing Study - Pangeae's only current project in the U.S. This study comes from a partnership between Pangaea, Clinica de la Raza, Cal-PEP, University of California, Berkeley, School of Public Health and the Alameda County Public Health Department. 

In April 2011, the county released data showing that more than 50 percent of African-Americans, Asians and Latinos who tested positive for HIV developed AIDS within one year of their test results. 

"Essentially what that means is that we've caught them too late for the medicines to be as effective as they can be," Udoh said. In other words, getting everyone to test more often can help get people who are HIV positive into treatment earlier and to live longer. 

Dr. Julie Lifshay is the Health and special projects manager at Centerforce, an agency that helps inmates prepare for release and reentry.

"We link people who are HIV positive with care in the community, as well as working with people who are at risk for HIV, trying to get some testing and HIV prevention goals set before they leave prison,"  Lifshay said.

She also cautions that the vulnerable populations she works with have pressing needs for food, housing and jobs. Former inmates may not qualify for needed government safety nets like public housing. Many of her clients also are trying to reconnect with family: Children that have been placed in foster care or girlfriends/boyfriends. Although they know testing is important, it can be low on their list of priorities. 

"We're a little skeptical of the push to test and treat," Carla Dillard Smith, community principal investigator at Cal-PEP, said. Smith said she feels that case management is an essential part of the process.

"People need to be linked to services and the government has been taking away the money to do that," she said.

The research has confirmed these concerns. Researchers met with individuals and conducted focus groups with people who weren't getting tested to help understand the challenges faced by African Americans and Latinos in Oakland. Although the full study results won't be ready until next year, Udoh said, "What we heard is that it's not a priority.

"Our priorities are to feed our families, taking care of our children," Udoh added. "Our priorities are not about being sick because unless I've gotten shot in the leg and have to go to Highland, I'm really not going to go there to get an HIV test." 

Structural issues of poverty are affecting both testing and access to care. Highland Hospital is Oakland's only public hospital, yet it can only be reached by a couple of bus lines and has no BART service. Publicly-funded HIV test sites exist in certain areas of the city, but not others. For example, a search of the National HIV/STD database reveals no testing sites in East Oakland between Allen Temple on International at 85th and Fairmont HIV Clinic near 150th in San Leandro.

Oakland itself is considered a "Shadow City" - many regional resources are directed towards San Francisco, where infection numbers are higher, yet percentages of the population that are living with HIV infection are similar in both cities. And until universal health care comes into effect, more Oakland residents are trying to access prevention and treatment services without insurance. 

Based on the research so far, the partner agencies will begin pilot projects this fall. The goal is to "scale up" testing with men as they are released from jail and prison and low wage immigrant migrant workers. In this way, the partner organizations hope to get more Oaklanders to see regular HIV testing as routine as any other health screening. 

"They're showing up at the emergency rooms," Smith said. "We're not just doing advocacy because that doesn't work. We are researching and crafting a response together ... responding to why African Americans and Latinos are getting into care late. There's no silver bullet."