Dont ask, Dont tell

HIV Status In-closure in the OC

He said, he said,

Edwin Ramos-Soto

September 25th, 2008

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Presentation Summary
Overview of Strategic Planning Process
Agency Mission, Vision and Goals Business/Operational Priority: Activities, Evaluation Resources Needed

Overview of Project Initiative

Community Assessment Intervention Evaluation Activities

Budget Closing Thoughts

ASF Mission and Vision

AIDS Services Foundation of OC is dedicated to: Preventing the spread of HIV and improve the lives of men, women, and children affected by HIV/AIDS in Orange County. Preventing the spread of HIV, through education and awareness. Our Vision is to: Promote health until there is a cure A community free of new HIV infections

ASF Goals
Keep client input and needs central to our

decision making process

Stop the spread of HIV and increase

community awareness about the HIV epidemic

Implement medical services Ensure access to the communities impacted

by HIV/AIDS

ASF Goals (cont.)

Commit to cultural competency and diversity

at all agency level

Provide a work environment that respects,

rewards, and values the commitment and expertise of ASF staff

Advocate for public policies and funding

allocation that improve the lives of the HIV impacted community

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Strategic Planning Group

Ty Rose Andrea Coulson Director of Fund Development ASF Staff Outreach Coordinator/Diversity Officer ASF Staff Health Education/Prevention Director ASF Staff Program Coordinator ASF Staff Positive Life Force Core member Member of the priority population
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Martin Salas Mario Gonzalez Albert Soto

Strategic Issue
1. Decreases in agency funding

disproportionately affect prevention programs and services

2. Lack of specific funding for prevention

programs and services

Rationales
1. Achieving program and services stabilization and

ensuring continuation helps ASF achieve its mission of preventing the spread of HIV and improving the lives of men, women, and children affected by HIV/AIDS in Orange County.
2. The loss of funding negatively impacts the agency, the

staff, and most importantly the lives of our clients that are best served in our county through all programs and services we provide in our community.

Strategic Plan Goal

Our goal is to diversify and increase funding sources to make prevention services funding more stable allowing ASF to provide much needed uninterrupted services to Orange County.

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Strategic Plan Objectives

1.

By Jan 30th 2009, AIDS Services Foundations Fund Development Department will establish the Prevention Fund Advancement Group By December 31st 2009, the AIDS Services Foundation Fund Development Department and Prevention Fund Advancement Committee will increase agency funding for prevention services by 20% By June 30th 2010, AIDS Services Foundation of Orange County will pursue three (3) larger ($500K+) grants at the federal and state level to support its prevention programs

2.

3.

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Activities & Timeline

Objective 1
Strategy Hire full time Prevention Fund Advancement manager/create Prevention Fund Advancement portfolio for existing staff Recruit and establish a fund advancement committee of volunteers By Jan 15th 09

By Jan 30th 09

Create the largest possible effective databases of corporate, foundation and individual donors

By Feb 28th 09

Create the largest possible effective databases of corporate, foundation and individual donors

By Feb 28th 09
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Activities & Timeline

Objective 2
Tactics
Institute programs to identify, evaluate and prioritize prospects, who may underwrite or sponsor a specific program, service or department By Mar 31st 09

Assist committee members in developing a By April 30th 09 volunteer network of community leaders and executives who will solicit for the organization

Develop compelling written materials that effectively communicate the organizations funding requirements to the board, other volunteers and the public

By April 30th 09

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Activities & Timeline

Objective 2
Establish and maintain staff development By April 30th 09 and/or train existing employees to help direct and staff all fundraising initiatives Project fund-raising goals Identify, recruit and provide orientation to trustees and other community leaders Package our HIV prevention programs and services in the operational budget, to produce more succinct and compelling proposals By April 30th 09 By May 30th 09 By May 30th 09

Develop/produce donor profiles and contribution records

By May 30th 09

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Activities & Timeline

Objective 2
Initiatives

Plan, initiate and produce an endowment campaign and deferred giving program Institute a communication program to maximize awareness of the organizations value to the community
Institute a recognition program to honor major donors 1st Year Closure Gift acknowledgements and other responses; Recognition of donors via testimonials, credits, honors event Final reports and summaries

By July 31st 09 By Sept 30th 09

By Oct 31st 09

By Dec 1st 09

By Dec 31st 09
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Evaluation
Goal How will you measure achievement?
Formation of a committee to

To diversify and increase funding sources to make prevention services funding more stable allowing ASF to provide much needed uninterrupted services to Orange County

generate funds for prevention programs, services and activities Increased funding for prevention programs Development and implementation of additional prevention services Complete grant proposals New grants awarded
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Evaluation
Objective 1
By Jan 30th 09 ASFs Fund Development Department will establish the Prevention Fund Advancement Group to help increase funding for agencys prevention services and programs

How will you measure achievement?

Documentation including: Job description Hiring paperwork HR personnel file Credentials Volunteers recruitment materials Volunteers response Letters of acceptance to volunteers Volunteers contact database Meeting Minutes

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Evaluation
Objective 2
By Dec 31st 09 ASFs

How will you measure achievement?

List of fundraising activities Rating forms for prospective sponsors Promotional materials Orientation manuals Recruitment letters Revised budget Donor profiles

Prevention Fund Advancement Group will increase funding for agencys services by 20%

Project fundraising goals

Press releases Contribution records Gift acknowledgement lists and testimonials

Recognition program brochure

Final report

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Positive Connections
A Healthy Relationships Intervention

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Priority Population
HIV+ MSM of Orange County
Ages 20-49 years
Rationale for choosing this population: Stigma, discrimination, shame and fear drive people into social isolation and high-risk sexual behaviors that increase their probability of HIV/STI exposure and transmission to their sero-discordant sex partners.

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ASF Capacity
AIDS Services Foundation has: Has access to the priority and target population Continues to implement and support prevention programs for PLWHA and MSM populations in our service area Has staff from the target population and professional individuals with vast experience Can implement intervention with funding Can develop necessary evaluation methods and tools

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Key Findings
Quantitative Cross-sectional Assessment (n=44) How open with other people (or out of the closet) are you about your HIV status? Answer options Response Percent

Not out to anyone Out to a few people Out to half the people I know Out to most people I know Out to almost everyone Refused to answer

2% 43% 23% 7% 16% 9%

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Key Findings
Quantitative Cross-sectional Assessment (n=44) 36% lacked the self-efficacy to disclose their HIVpositive status before having sex if they did not know their sex partners HIV status 32% lacked the self-efficacy to discuss being HIV positive with a new sex partner 29% lacked the self-efficacy to tell someone they were dating that they were HIV positive 43% lacked the self-efficacy to disclose their HIVpositive status even if they had been drinking 49% would rather not have sex than deal with decisions to disclose their HIV-positive status to a new sex partner 23

Key Findings
Qualitative Assessment
Status disclosure is a complex process
PLWHA are confronted with multiple questions related

to HIV-positive status disclosure:

Who should I disclose this to? When? Under what circumstances do I tell? How do I disclose HIV-positive serostatus to others?

Self-efficacy is a critical co-factor that greatly enables

or prevents PLWH to disclose or conceal their HIV status

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Key Findings
Qualitative Assessment Lack of skills on the how-to disclose affects the ability and decision making process to disclose HIV status Low self-efficacy results in ineffective coping with highrisk situations Rejection resulting from disclosure episodes leads to negative outcome expectancy every time an individual chooses to disclosure Intentions to disclose may be high or low depending on the cost/benefit of the disclosure Perceived risk of HIV transmission affects disclosure
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Positive Connections

Healthy Relationships

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Positive Connections
Goal of Healthy Relationships is to promote intentions

to change risk behaviors and encourage self-evaluation to increase condom use and develop strategies for behavioral change Five-session, small-group intervention for PLWHA Based on Social Cognitive Theory Focuses on developing skills and building self-efficacy and positive expectations about new behaviors through modeling behaviors and practicing new skills. Decision-making and problem-solving skills are developed to enable participants to make informed and safe decisions about disclosure and behavior.

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Positive Connections
ASF will utilize the HR intervention to help OC HIV+ MSM to build skills that assist in reducing stress in three life areas of influence:
1. 2. 3.

Disclosure of HIV status to family and friends Disclosure to sex or needle sharing partners Safer sexual behaviors

ASF is currently in a pre-implementation stage of development

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Adaptation of Intervention
Healthy Relationships will be delivered with complete fidelity to the core elements; no adaptation will be required.

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Intervention Stakeholders
Edwin Ramos-Soto Martin Salas OC Health Care Agency TBD TBD Health Education & Prevention Programs Supervisor Health Education Department Director Office of HIV Planning and Coordination Programs Monitor HR Program Coordinator HR Mental Health Facilitator

TBD
TBD

Peer Facilitator Member of the Targeted Population

Funder
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Process Objectives
By 07/17/2009 Health Education and Prevention services supervisor will secure all human resources By 08/14/2009 all HR staff will be trained in HR intervention, Agency Policies and Procedures. By 08/28/2009 a private, centrally located site will be secured By 08/28/2009 HR infrastructure will be established and all resources needed for the HR intervention implementation will be secured. By 09/11/2009 staff will develop and operationalize all client recruitment strategies and materials.

Outcome or Immediate Objectives

By the end of the last intervention session, 90% of the HIV-positive MSM ages 20-49 will demonstrate increased awareness and correct knowledge of HIV sexual transmission risk. After completing the Healthy Relationships intervention, 90% of participants will demonstrate an increase in perceived HIV transmission risk. After completing the Healthy Relationships intervention, 90% of participants will report increased confidence in: making informed and safe decisions about disclosure and behaviors After completing the Healthy Relationships intervention, 90% of participants will report acquisition of social and self-management skills that allow for effective action implementation, i.e. serostatus disclosure. After completing the Healthy Relationships intervention, 90% of participants will report increased and developed decision-making and problem solving skills that enable participants to make informed decisions about disclosure and sex behaviors.

Behavioral or Intermediate Objective

Goal Statement

By 09/25/2009 staff will establish a network of service providers to create a referral network system within the service area.
By 10/16/2009 staff will recruit and screen participants for pilot test of the HR intervention, report and revise recruitment protocols if needed. Between 11/06/2009 and 12/11/2009 staff will implement and evaluate Core Element #1-5 of the HR intervention. By 01/15/2010 staff will evaluate HR intervention. By 01/29/2010 staff will begin dissemination of evaluation results to all key stakeholders with final report by 02/12/2010.

By June 30, 2010, six months post intervention, 60% of the HIV-positive MSM ages 20-49 exposed to the ASF intervention will report an increase in their serostatus disclosure.

To reduce risky sexual behaviors thereby, increasing by 15% the number of MSM ages 20-49 diagnosed with HIV who report adopting and maintaining behaviors that reduce the risk of HIV and STI transmission, including serostatus disclosure in OC over the next three (3) years.

Process Monitoring and Evaluation

Outcome Monitoring and Evaluation

Impact 31 Evaluation

Behavioral/Intermediate Outcome Objective

By June 30th 2010, six months post intervention, 60% of the HIV-positive MSM ages 20-49 exposed to the HR intervention will report an increase in their serostatus disclosure.

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Evaluation of Behavioral Objective

Objective Indicator Source of Evidence
Cross-sectional follow-up questionnaires

By June 30th 2010, Increase in six months post serostatus intervention, 60% of disclosure the HIV-positive MSM ages 20-49 exposed to the HR intervention will report an increase in their serostatus disclosure.

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Immediate Outcome Objective

1. Six months after completing the Healthy Relationships

intervention, 60% of the HIV-positive MSM ages 20-49 exposed to the HR intervention will report an increase in their serostatus disclosure.
2. After completing the Healthy Relationships intervention,

90% of participants will demonstrate an increase in perceived HIV transmission risk.

3. After completing the Healthy Relationships intervention,

90% of participants will report increased confidence in making informed and safe decisions about disclosure and behaviors.

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Immediate Outcome Objective

4. After completing the Healthy Relationships intervention,

90% of participants will report acquisition of social and self-management skills that allow for effective action implementation, i.e. serostatus disclosure.
5. After completing the Healthy Relationships intervention,

90% of participants will report increased intentions to engage in safer sex and disclose HIV-positive serostatus to sex partners.
6. After completing the Healthy Relationships intervention,

90% of participants will report increased decision-making and problem solving skills that relate to making informed decisions about disclosure and sex behaviors.
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Evaluation of Immediate Objectives

Objective 60% of the HIV-positive MSM ages 20-49 exposed to the HR intervention will report an increase in their serostatus disclosure Indicator Increase in their status disclosure Source of Evidence Pre and post assessment of serostatus disclosure

90% of participants will demonstrate an increase in perceived HIV transmission risk

Increase in perceived HIV transmission risk

Pre and post test assessing increased perceptions of HIV transmission risk

90% of participants will Increased selfPre and post test report increased confidence efficacy in making assessing selfin making informed and safe informed decisions efficacy reports decisions about disclosure and behaviors
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Evaluation of Immediate Objectives

Objective 90% of participants will report acquisition of social and selfmanagement skills that allow for effective HIV disclosure 90% of participants will report increased intentions to engage in safer sex with partners of HIV unknown status and disclose status to new sex partners Indicator Acquisition of social and self-management skills Source of Evidence Pre and post test assessing social and self-management skills Pre and post test assessing disclosure intent

Increased intentions to engage in safer sex and serostatus disclosure

90% of participants will report increased decision-making and problem-solving skills that enable participants to make informed decisions about disclosure and sex behaviors

Increased decisionmaking and problemsolving skills

Pre and post test assessing increased decision-making and problem solving skills

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Process Objectives
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.

Secure funding Hire and train staff Develop curricula, assessment and knowledge surveys Establish monitoring protocol Establish referral network Establish formal mandates Provide five, two hour sessions over a eight weeks Formalized the curriculum, all movie clips Ensure active coordination of services with follow-up Provide intervention to 24 participants in first year

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Evaluation of Process Objectives

Objective By 07/17/2009 Health Education and Prevention services supervisor will secure all human resources By 08/14/2009 all HR staff will be trained in HR intervention, Agency Policies and Procedures. By 08/28/2009 a private, centrally located site will be secured By 08/28/2009 HR infrastructure will be established and all resources needed for the HR intervention implementation will be secured. Indicator Staff hired Source of Evidence Licenses/certifications resumes for FTE VOD for HIV + facilitator Certificates, sign-in sheets

Staff trained

Easily accessible location Reviewer observations Adequate space Sufficient seating Working electronic equipment Video clips for sessions Reviewer observation Equipment log HR sessions materials

By 09/11/2009 staff will develop and operationalize all client recruitment strategies and materials.

Recruitment strategies

Recruitment plan
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Evaluation of Process Objectives

Objective By 09/25/2009 staff will establish a network of service providers to create a referral network system within the service area By 10/16/2009 staff will recruit and screen participants for pilot test of the HR intervention Indicator Number of providers in referral network system Recruitment plan developed Participants VOD Source of Evidence Database of providers in referral network system Recruitment database Screening database Session evaluations Facilitators Session Outline Debriefing notes Quality assurance reports Dissemination list
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Between 11/06/2009 and 12/11/2009 staff will Facilitation and implement and evaluate Core Element #1-5 coordination sessions of the HR intervention conducted Debriefings held By 01/15/2010 staff will evaluate HR intervention By 01/29/2010 staff will begin dissemination of evaluation results to all key stakeholders with final report by 02/12/2010 Implementation plans Debriefing notes Evaluation report developed

Resources Needed
Facilities Supplies Staffing

Program Manager Mental Health Co-facilitator HIV + Peer facilitator Equipment Television DVD Player Movie Clips Software

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Year 1 Budget
Strategic Plan Personnel Facilities Equipment Travel Supplies Indirect Costs Total 111,875 10,500 24,200 3,000 11,000 19,269 179,844 Intervention Plan 126,875 21,000 24,200 4,560 12,700 22,720 212,055 Total

238,750 31,500 48,400 7,560 23,700 41,989 391,899

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Final Thoughts
Disclosure of HIV-positive status is a complex,

difficult and a very personal matter Some HIV-positive persons report several negative emotional consequences that have followed the HIVpositive status disclosure, including rejection, abandonment, and isolation In HIV prevention, there is a need for a greater understanding of the complex factors of influence that impact an individuals HIV positive status disclosure We need to focus on the HIV-positive community as a key player in the prevention of HIV through HIVpositive status disclosure
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Final Thought

HIV-positive status disclosure IS HIV prevention

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Questions?

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