Why “Change Matters”: Building Economic Self-Sufficiency among People living with and at-risk for HIV Infection
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Why “Change Matters”: Building Economic Self-Sufficiency among People living with and at-risk for HIV Infection

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  • 1. Why “Change Matters”: Building Economic Self-Sufficiencyamong People living with and at-risk for HIV Infection Paula M. Frew, MA, MPH, PhD Emory University
  • 2. Co-Investigators Carlos del Rio, MDEmily McCollum, MPH Takeia Horton, MPH Marcus Bolton, MA Jeffery RomanMary Helen Borck, RN Garcelia Burchell Michael Banner
  • 3. Epidemiology of HIV Infection in Georgia and Louisiana•Georgia: 8th in nation AIDS cases •Louisiana: 4th in nation AIDS cases of•Atlanta: 60% of prevalent HIV cases large metro area•African Americans: 78% newly •Baton Rouge: highest rate of AIDSdiagnosed HIV/AIDS cases (2008) cases in state •African Americans: 72% of newly diagnosed HIV cases (2007)
  • 4. Theorized Socioecological Factors Influencing HIV Risk •Housing issues •Economic policies Structural/Policy •Health disparities •Healthcare access • Socioeconomic challenges • Educational access Community • Environmental issues • Access to resources • Financial dependency • Concurrency Relational • Domestic violence • Condom negotiation •Financial insecurity Individual •Self-esteem issues Denning et al., 2011; Gillies et al., 1996; Schwartz et al., 2011; Behrer, 2007;Sumartojo et al., 2000; Gilbert, 2003; Adimora et al., 2006; Greene et al., 2010; Ezzy et al., 1999
  • 5. Program Aims• Increase opportunities for participants to become financially self-sufficient and improve well-being.• Increase knowledge and skills to negotiate many socioecological factors associated with HIV risk (housing instability , educational attainment, financial dependency, self-esteem issues).
  • 6. Building the “Change Matters” ProgramCurricular Examples: Curricular Aims:• “Hope and Power” • Basic financial (National Coalition management against Domestic • Setting achievable goals Violence) • Self-sufficiency• “Moving On” (Sudie Pollack)• “Will the Dollars Stretch? Teen Parents Living on Their Own” (Sudie Pollack)
  • 7. “Change Matters” Topics• Taking a financial inventory• Finding a job• Paying bills• Managing a household• Building a financial base• Saving for emergencies• Helping with big problems• Looking toward the future
  • 8. Intervention Sites• Baton Rouge, LA (N=48), 2008 - 2009 – Recruited at Family Services of Greater Baton Rouge – Program: 8 week one-hour sessions plus facilitator follow up at 1-, 3-, 6-months• Atlanta, GA (N=15), 2009 – Recruited at Stand, Inc – Program: 1 day class
  • 9. Inclusion Criteria• Persons ≥18 years• Able to read and write English• Reside in designated areas of Baton Rouge or Atlanta with high HIV prevalence and poverty• Clients of designated partner CBOs
  • 10. Data CollectionQuantitative variables: Qualitative topics:• Gender • Knowledge gains related to• Age program topics• Race and ethnicity • Attitudes towards topics• Education • Behavioral impact• Income • Engagement with topic• Employment status • Program pedagogical approach• General well-being • Program impressions• Self-efficacy • Program design feedback• Attitudes towards money
  • 11. Analytic Approach Content Analysis •Interim Reports •Final Reports Quantitative Data Qualitative Data•Baseline and Follow-up Conclusions •In-depth interviews with staffSurveys •Client narratives•Session Questionnaires •Field observations
  • 12. Group Characteristics* Atlanta Baton Rouge (N=15) (N=48)Black/African American 14 (93%) 48 (100%)Gender (Male) 15(100%) 15 (31%)Heterosexual 13 (87%) 40 (83%)Unemployed 15 (100%) 31 (66%)Annual Family Income <$20K 12 (86%) 38 (84%)Educational Attainment 12 (80%) 32 (67%)(HS/GED)
  • 13. Results Improved Navigation of Structural issues Opened Access to Resources Greater FinancialIndependence ImprovedSelf-Efficacy & Self-Esteem
  • 14. Financial Skills Navigating Structural issues Question Pairs Mean– Mean – t df P-value Pre Post (0=No; (0=No; 1=Yes) 1=Yes)Credit Report Assessment (Baton Rouge) 0.58 1.02 -3.57 47 .001Net Worth Calculation (Baton Rouge) 0.31 0.90 -5.27 47 <.001Personal Spending Plan (Baton Rouge) 0.43 0.91 -5.21 45 <.001
  • 15. Addressing Economic Challenges Navigating Structural issues“About the 7 years statute of limitation for Louisiana. Deal with the original creditor instead of collection people. ‘Don’t Settle.’”“That there programs to help me get work. That I don’t need to stop living, because its help out there.”
  • 16. Accessing Educational Resources Navigating Opening Structural Access to issues Resources Question Pairs Mean Mean t df P value Baseline Follow Up (1=Fair; (1=Fair; 3=Excellent) 3=Excellent)Overall Impression of the Change 2.32 2.79 -3.64 46 .001Matters Program (Baton Rouge)Overall Impression of Change Matters 2.07 2.73 -3.57 14 .003(Atlanta)
  • 17. Accessing Educational Resources Navigating Opening Structural Access to issues Resources “They need many more like this class”“I like to come back to see or talk about using what I learned. And how it better my living arrangements.” “This is such a helpful experience”
  • 18. Fostering Economic Empowerment Navigating Opening Greater Structural Access to Financial issues Resources Independence Question Pairs Mean Mean t df P value Baseline Follow-Up (1=SA;6=SD) (1=SA;6=SD)I am skilled at money management 3.74 2.76 3.72 41 .001(Baton Rouge)I am skilled at money management 4.00 3.27 2.58 14 .022(Atlanta)I am skilled at keeping my family’s money 4.07 2.49 5.96 44 <.001records (Baton Rouge)I feel that I lack education to manage my 3.85 4.79 -3.35 46 .002money
  • 19. Improving Self-Worth Improved Navigating Opening Greater Self-Esteem Structural Access to Financial and Self- issues Resources Independence Efficacy Question Pairs Mean Mean t df P value Baseline Follow -UpFeelings in general over the past month 2.94 2.36 2.99 46 .004(Baton Rouge)My major accomplishments are entirely 2.05 1.52 2.56 43 .014due to hard work and intelligence (BatonRouge)Happy, satisfied, or pleased with personal 3.33 2.73 3.67 14 .003life (Atlanta)Anxious, worried, or upset during the past 3.91 4.45 -3.15 46 .003month (Baton Rouge)
  • 20. Self-Empowerment and Self-Efficacy Improved Navigating Opening Greater Self-Esteem Structural Access to Financial and Self- issues Resources Independence Efficacy“I’ve learned not to just settle less & continue to strive for higher goals.”“I learned that it is good idea if go back to school”“I can accomplish anything I put my mind to”
  • 21. “Know that What You Do Can & Does Change Lives”• -Barry reentered the workforce and has a monthly savings plan• -Ary enrolled in community college and saved $500 for emergencies• Norman saved up enough money to purchase a weed eater and provides lawn services
  • 22. Study & Programmatic Considerations • Small samples • Selection bias • Social desirability bias • Format length• Additional content needs
  • 23. What Did We Learn?• Participants recognize their need for improvement in financial areas• Improved financial skills corresponded with improved emotional well-being• Future economic interventions could be paired with HIV prevention programs
  • 24. Thanks! Program Participants AIDS United (Formerly National AIDS Fund)Emory University Office of University Community Partnerships(OUCP)Emory Center for AIDS Research (P30AI050409)