Positive Interventions:

Vital to HIV Prevention

Successful HIV Prevention Programming for PLWHA

Edwin Ramos-Soto

March 31st, 2009

Dedicated to:
The HIV-Positive Individuals Of Orange County, CA Who Throughout The Epidemic Have Taken Extraordinary Steps To Protect Others, thereby Preventing The Spread of HIV

Presentation Summary

Positive Preventions Backdrop The Logic of Prevention with PLWHA Community Needs Assessment OCHCA Community Needs Assessment ASF-PLWHA Community Needs Assessment Successful prevention program with (MSM) PLWHA Mpowerment EBI adaptation for (MSM) PLWHA Varying Levels of Prevention Interventions Conducted Measure of success Process/Outcome Evaluation Systematic Steps, Best Measure of Success Closing Thoughts

Objectives
At the completion of this session scholars will: Explain how the needs of PLWHA were assessed Describe how AIDS Services Foundation (ASF) has conducted a successful program with PLWHA Discuss how the success of ASF HIV prevention program with PLWHA is measured

Positive Preventions Backdrop

Prevention efforts focused on HIV-negative

Emphasis on care/support services to PLWHA Many factors point to the need for interventions designed for PLWHA

Positive Preventions Backdrop - Factors

Need for interventions for PLWHA Increasing number of PLWHA High rates of infection in communities of color; resurgence of HIV in some populations The HAART impact

Positive Preventions Backdrop - Factors

Maintenance

challenge HIV transmission prevention environment is increasingly complex Increasing number of PLWHA are living and coping well with disease challenges Occasional lapse into unsafe behaviors

of low-risk behavior

Positive Preventions Backdrop - Factors

Prevention

burnout Depressive symptoms and increased rates of unprotected sex correlation HIV treatment optimism Reinfection/Superinfection confusion Viral undetectability = reduced infectivity confusion

Positive Preventions Logic of Preventions for PLWHA

New

infections involve an HIV-infected individual New infection can be prevented by intensive efforts directed toward population capable of transmission

Positive Preventions Logic of Preventions for PLWHA

Prevention

need to:

efforts directed toward PLWHA

Encourage

healthy sense of responsibility without assigning blame Support a lifestyle that includes a fulfilling sex life Support the enhance of interpersonal and community relationships

Community Needs Assessment

Orange County Health Care Agency (OCHCA)

Objectives: Describe the risk and/or protective behaviors of individuals not receiving HIV preventions services
Describe

knowledge and perceptions regarding HIV and HIV risk HIV prevention needs, met/unmet

Determine

Community Needs Assessment

Orange County Health Care Agency (OCHCA)

Needs Assessment Outcomes Focus: Demographics HIV knowledge Drug risk behaviors Sexual risk behaviors Perceptions about HIV Barriers to service utilization

Community Needs Assessment

Orange County Health Care Agency (OCHCA)

Needs Assessment Results: Particular behaviors pose risk for HIV

MSM

prioritized as high-risk behavioral risk group

misperception of HIV transmission

Continued

Community Needs Assessment

Orange County Health Care Agency (OCHCA)

Needs Assessment Results: Inconsistent condom use with casual partners

Drug-use

prevalence contributing to increased high-risk behaviors risks differences depending on acculturation levels

Perceived

Community Needs Assessment

OCHCA PLWHA Needs Assessment

Prevention efforts for PLWHA need be tailored specifically to their needs: HIV treatment education workshops
Community-building General

activities for specific groups

health and wellness support delivered in individual or small-group settings

Community Needs Assessment

OCHCA PLWHA Needs Assessment
Substance Info

abuse service sensitive to PLWHA need

and support for sero-discordant couples availability of mental health services

Greater

Peer-led

support and information groups

Community Needs Assessment

OCHCA PLWHA Needs Assessment
Skills-building Individual

workshops for positives

and/or group counseling focused on contextual factors that influence risk that focus on relationship dynamics

Interventions Peer

and professional support in dealing with sexual compulsivity/sex addiction

AIDS Services Foundation PLWHA Needs Assessment

Community Needs Assessment

Objectives: Establish appropriate goals, objectives, activities

Define

purpose and scope social and behavioral attitudes

Identify

AIDS Services Foundation PLWHA Needs Assessment

Community Needs Assessment

Objectives: Identify HIV transmission risk/protective factors

Identify

PLWHA perceptions of risk

Establish
Establish

basis for evaluation

community-based support

AIDS Services Foundation PLWHA Needs Assessment

Community Needs Assessment

Sources: PLWHA, Consumers and Gate Keepers

Agency

staff
partners

Community OCHCA

(local DOH)

AIDS Services Foundation PLWHA Needs Assessment

Community Needs Assessment

Additional data as resource: Socioeconomic and demographic status; Current statistics and trends involving HIV/STD
Existing Social

gaps in HIV programs and services

indicators that indicate HIV/STD prevalence of program/resources for PLWHA

Identification

AIDS Services Foundation PLWHA Needs Assessment

Community Needs Assessment

Data collection strategies: Informal

Frequent

clients

conversations with colleagues and

Formal
Strategic

Planning meetings Focus Groups

AIDS Services Foundation PLWHA Needs Assessment

Community Needs Assessment

Results: Many HIV-positive persons live with multiple diagnoses

Health

care adherence and HIV transmission prevention are not primary concern

AIDS Services Foundation PLWHA Needs Assessment

Community Needs Assessment

Results: High-risk behaviors are not exclusive to those who struggle with poverty, stigma, mental illness
Some

risk behaviors transcend class, economic status and demographic group

AIDS Services Foundation PLWHA Needs Assessment

A

Community Needs Assessment

comprehensive approach to prevention with positives must include strategies intervene with high-risk behaviors strategies for engaging out-of-care HIVinfected persons into care of limited resources means communities can not provide entire range of possible interventions

Include

Reality

AIDS Services Foundation PLWHA Needs Assessment Factors

Community Needs Assessment

that place any HIV-positive person at risk for transmitting the virus are often highly individualized
simply identifying risk behaviors, it is important to gain understanding of the place these behaviors hold within the context of each individuals life

Beyond

Community Needs Assessment

ASF Characteristics of Effective Programs Structuring

programs around the specific culture, behaviors and circumstances of PLWHA

incremental, achievable steps towards behavior change multiple contacts with clients

Emphasizing

Providing

Community Needs Assessment

ASF Characteristics of Effective Programs Structuring

interventions to provide both individual and small-group work harm reduction based approaches

Using

Maintaining

a dynamic balance between peer support and use of professional staff

Community Needs Assessment

ASF Characteristics of Effective Programs
Focusing

on client-defined motivators as a basis for creating change behavioral objectives that are specific and achievable effects of multiple diagnoses on motivation and behavior change relapse prevention

Using

Factor

Include

ASF Mpowerment EBI adaptation for (MSM) PLWHA

Successful prevention program

Formative research led to the adaptation and implementation of a Mpowerment EBI for (MSM) PLWHA
Mpowerment

intervention

is a peer-led community level

Through

Mpowerment large numbers of PLWHA are reached in a cost-effective manner because it operates on the community level

ASF Mpowerment EBI adaptation for (MSM) PLWHA Mpowerment

Successful prevention program

is designed to be tailored to the characteristics of every community on interrelated Core Elements that each community can adapt

Based

ASF Mpowerment EBI adaptation for (MSM) PLWHA Adapted

to

Successful prevention program

for MSM PLWHA, the Mpowerment intervention mobilizes individuals

shape a healthy community for themselves Build positive social connections Support safer sex

ASF Mpowerment EBI adaptation for (MSM) PLWHA Two

Successful prevention program

programs were implemented:

Life Force
English-speaking HIV-positive MSM

Positive

Hombres

Por La Vida

Spanish-speaking HIV-positive MSM

Successful prevention program with (MSM) PLWHA

English-speaking

Spanish-speaking HIV-Positive MSM Program

HIV-Positive MSM Program

Successful prevention program

Levels of Interventions for (MSM) PLWHA

Various Levels of Interventions

They

provide different opportunities for working with positives and their communities

They

facilitate various types of support and opportunities for growth

Successful prevention program

Levels of Interventions for (MSM) PLWHA Individual
Allow

interventions

the development of a collaborative relationship clients in making plans for individual behavior change and ongoing appraisals of their own behavior

Assist

Successful prevention program

Levels of Interventions for (MSM) PLWHA
Provide

safe space to explore sensitive topics

Enhancing clients self awareness of HIV risk behavior Discussing options for risk and harm reduction Demonstrating and practicing techniques for risk reduction (e.g. barrier demonstration, cleaning needles) Role playing for condom negotiation

Making

appropriate referrals to HIV prevention and other supportive services

Successful prevention program

Levels of Interventions for (MSM) PLWHA

Successful prevention program

Levels of Interventions for (MSM) PLWHA
Group-level
Allow

interventions

for exchange of ideas, experiences, support, resources Enhance communication skills and receive feedback Monthly Positive Voice (Core Group) Meeting where PLWH provide input and direction for the program design and implementation of workshops, social activities and community building events. Positive Voice Group members become empowered as they take part as decision makers, help provide input and feedback and assist the program to remain clientcentered.

Successful prevention program

Levels of Interventions for (MSM) PLWHA

Successful prevention program

Levels of Interventions for (MSM) PLWHA

Successful prevention program

Levels of Interventions for (MSM) PLWHA Health

Communication/Public Information
peer education, support, skills training and reinforce safer behaviors

Provide

Promote

Successful prevention program

Levels of Interventions for (MSM) PLWHA HCPI:
Previous

A Reality Check HIV Disclosure, Who? When? Where? How? Party Smart HIV Meds and Drug Interactions Passionate Living Become your greatest self-advocate Understanding your labs Take all your meds Building Adherence Your new life stage Life after HIV diagnosis, what next? Living Well with HIV Living Happy Managing HIV & Depression

Successful prevention program

Levels of Interventions for (MSM) PLWHA

Successful prevention program

Levels of Interventions for (MSM) PLWHA

Successful prevention program

Levels of Interventions for (MSM) PLWHA Community-level
Allow

intervention

for community-wide events, which serve as an effective compliment to individual and group-level interventions to change normative community attitudes and behaviors, providing opportunity for the diffusion and support of lower risk behavior

Seek

Successful prevention program

Levels of Interventions for (MSM) PLWHA

Individual-Level Intervention Program Evaluation By

Measure of Success

June 30, 2009, the HIV-positive MSM programs will conduct a minimum of ninety (90) risk reduction counseling sessions, and make referrals when appropriate, to a minimum of thirty (30) unduplicated English-speaking individuals and a minimum of thirty (30) unduplicated Spanish-speaking individuals
Evaluation

indicator: Health Education/Risk

Group-Level Intervention Program Evaluation

By

Measure of Success

June 30, 2009, the HIV-positive MSM programs will conduct ten (10) English Core Group meetings and ten (10) Spanish Core Group meetings, will recruit five (5) English speaking and five (5) Spanish speaking members for the core group to obtain input and direction for the program design and implementation of community building activities

Evaluation indicator: Meeting Logs, Sign-in sheets and core group meeting agendas

After

participating in core group meetings, eighty-percent (80%) of individuals will report a decrease in social isolation due to HIV disease

Evaluation indicator: meeting evaluation reports

Health Communication Public Info Program Evaluation

By

Measure of Success

June 30, 2009, the HIV-positive MSM programs will conduct fourteen (14) workshops to increase prevention behavior, improve personal attitudes toward HIV and prevention and increase a sense of personal responsibility.

After

participating in the workshop, eighty-percent (80%) of individuals will demonstrate competency in utilizing items in safe sex kits

Evaluation indicator: Sign-in sheets, curriculum, prevention materials, pre/post assessment scores

After

participating in the workshop, eighty-percent (80%) of individuals will identify risk factors for HIV transmission and appropriate risk reduction techniques

Evaluation indicator: safer sex competency check sheets

Evaluation indicator: Pre/post test scores, skills competency check sheets

Health Communication Public Info Program Evaluation

By

Measure of Success

June 30, 2009, the HIV-positive MSM programs will conduct ten (10) English Core Group meetings and ten (10) Spanish Core Group meetings, will recruit five (5) English speaking and five (5) Spanish speaking members for the core group to obtain input and direction for the program design and implementation of community building activities

Evaluation indicator: Meeting Logs, Sign-in sheets and core group meeting agendas

After

participating in core group meetings, eighty-percent (80%) of individuals will report a decrease in social isolation due to HIV disease

Evaluation indicator: meeting evaluation reports

Community-Level Intervention Program Evaluation

By

Measure of Success

June 30, 2009, the HIV-positive MSM programs will conduct two (2) community events, one in English and one in Spanish, to empower a a minimum of thirty (30) HIV-positive MSM individuals per event, and to increase their awareness of HIV support services and related health issues

Evaluation indicator: meeting evaluation reports and sign-in sheets

After

participating in core group meetings, eighty-percent (80%) of individuals will report a decrease in social isolation due to HIV disease

Evaluation indicator: meeting evaluation reports

Measure of Success
PLWHA Programs Evaluation Describing

the process of behavior change is more than counting units of services delivered
whether or not an HIVpositive individual ultimately uses a condom may represent endpoint of an intervention; Such documentation does not fully represent an interventions effectiveness

Documenting

Measure of Success
PLWHA Programs Evaluation
The

path to behavior change is complex and often elusive single evaluation strategy can capture the elements involved focused on producing behavior change require a wide range of evaluation strategies, embracing both quantitative/qualitative methods of evaluation

No

Programs

Measure of Success
PLWHA Programs Evaluation It

is important to have an evaluation plan in place as prevention with positives are designed and implemented
evaluating prevention with positives programs will be very challenging.

Effectively

Measure of Success
PLWHA Programs Evaluation Carefully

evaluating a program affords opportunities to improve, redesign, or even eliminate, aspects of the program
of a program can be determined by an effective, objective evaluation combined with a willingness to modify and improve based on community need, participant feedback, and scientific merit.

Success

Measure of Success
PLWHA Programs Evaluation

To best measure the success or our programs we have developed program evaluations that require systematic steps:
1.

Formulating evaluation questions

i. ii. iii.

To what extent did the program achieve its goals and objectives? Were the activities implemented as planned? Which features were most/least effective

Measure of Success
PLWHA Programs Evaluation 2.

Setting standards of effectiveness

i.

ii.

Deciding on info needed to provide convincing evidence of a programs effectiveness Must be purposeful, Realistic and Measurable How many/when measurements should be made? How many groups or persons should be included in the evaluation?

3.

Designing the evaluation

i. ii.

Measure of Success
PLWHA Programs Evaluation 4. 5.

Collecting data
Analyzing data Reporting the results

6.

Closing Thoughts
Focus on the HIV-positive community as a crucial player in the prevention of HIV is key.
Without programming for PLWHA HIV prevention would be incomplete.