Addressing the HIV Prevention Needs of Black Men & Women


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  • In providing capacity building assistance (CBA) services, AACBI uses several CBA best practices, including:   Cultural Competence Intergration Needs-Driven Action Plans Comprehensive Consumer Involvement Integration of CDC-Endorsed Best Practices Continuous Program Improvement   Our goals are aligned with the CDC, which directly funds our program
  • Therefore, in order to address the prevention needs of black/African American heterosexual women with drug using sex partners, it is necessary to address four key issues: The influence of main sex partners on the use of barrier methods (i.e. desire to use condoms) Relationship status with main partner (i.e. monogamy, marriage) History or threat of intimate partner violence The influence of a woman’s drug and alcohol use on their sexual behavior.
  • Based on the responses of focus group participants, the best way to meet the HIV prevention needs of this priority population are: Black/African American women speaking up and out about their needs to decision makers regarding policy, funding and media attention Becoming an integral part in program design and delivery at community based organizations Utilizing an integrated approach to HIV prevention services to include all relevant programs/services, such as domestic violence, shelters, food banks, religious/spiritual organizations, etc. Peers reaching out to women and their partners in nontraditional entities (i.e. beauty salons, barber shops, etc.) Mental health services for women, men and couples Teaching women to self-stimulate when their partners are not around or eroticize condoms in relationships with partners.
  • Other Direct Costs (e.g. educational materials, printing, telephone, postage, etc.
  • Addressing the HIV Prevention Needs of Black Men & Women

    1. 1. Expanding the Reach of HRC:Addressing the HIV PreventionNeeds of Black/African American Men& Women Camille A. Abrahams, MS Harm Reduction Coalition September 2008 CDC/ASPH Institute for HIV Prevention Leadership 1
    2. 2. Summary of PresentationOverview of Strategic Planning Process • Mission, Vision and Goals • Strategic Issue: Activities, Evaluation, Resources NeededOverview of Project Initiative • Community Assessment Process • Intervention Activities • Evaluation ActivitiesBudget 2
    3. 3. Harm Reduction CoalitionMission:The Harm Reduction Coalition (HRC) is a national advocacy and capacity-building organization that promotes the health and human rights of people who use drugs and confronts the adverse effects of drug use, by advocating for effective policy responses to drug-related harms, by serving as an incubator for new ideas, and by promoting best practices for the harm reduction movement.HRC advances policies and programs that help people address the adverse effects of drug use including overdose, HIV, hepatitis C, addiction, and incarceration.VisionWe recognize that the structures of social inequality impact the lives and options of affected communities differently, and work to uphold every individuals right to health and well-being, as well as in their competence to protect themselves, their loved ones, and their communities. 3
    4. 4. HRC’s National GoalsLead national advocacy campaigns on the following issues: • Lifting the federal ban on syringe exchange funding, increased • Increase government funding for community-based hepatitis C programs • Developing a comprehensive plan on the federal level to reduce overdose mortality • Improve federal policy/prescribing guidelines to increase access to BuprenophrineHRC will accomplish these goals as a national capacity builder for programs addressing the harm reduction, prevention, and treatment needs of people who use drugs. HRC will also develop and promote minimum standards for harm reduction service provision . 4
    5. 5. African American Capacity Building InitiativeThe African American Capacity Building Capacity Building Initiative (AACBI) is a CDC-funded program that was founded in 2004 to assist community based organizations (CBOs), health departments (HDs) and other community stakeholders serving the African American community in the CDC’s North Region.Goals:• To strengthen the capacity of CBOs & HDs to develop and implement effective HIV prevention interventions.• To decrease the number of people at risk of acquiring or transmitting HIV infection. 5
    6. 6. Strategic Planning GroupHarm Reduction Coalition• Jagadisa-devasri Dacus, MSW, Senior Director of Training & Capacity Building Programs• Dorcey Jones, MPH, Capacity Building Assistance SpecialistHunter College School of Social Work• Darrell Wheeler, PhD. Associate Dean for Research/Associate Professor and AACBI Behavioral and Social Science Consultant• Bernadette Hadden, PhD, Assistant Professor and AACBI Evaluation ConsultantBrick Rebuilding• Allen Frimpong, Founder and Program Coordinator 6
    7. 7. Strategic IssueStabilizing the program staff by addressing recent staff turnover and challenges filling the positions.Rationale for Issue:• AACBI recently experienced a long-term period of instability as a result of a vital program position being vacant for seven months.• The Program Director had to juggle both administrative and programmatic work, which was overwhelming both personally and professionally.• The Program Director views that period as a lesson learned, and wants to be prepared when staff turnover occurs. 7
    8. 8. Goal and ObjectivesThe goal is to develop and maintain program sustainability for the AACBI program in the event of staff turnover.Objective 1• By April 30, 2009, AACBI/HRC will expand its cadre of trainers/technical assistance providers by recruiting, hiring and training new consultants.Objective 2• By May 30, 2009, AACBI/HRC will develop a staff recruitment and retention plan that will address, among other things, monetary and non-monetary incentives. 8
    9. 9. Objective #1: Recruit, Hire & Train New Consultants OCT NOV DEC JAN FEB1. Develop job descriptions2. Post job description3. Develop selection criteria4. Identify candidates5. Invite candidates for interview6. Interview candidates7. Observe candidates train 9
    10. 10. Objective #1: Recruit, Hire & Train New Consultants NOV DEC JAN FEB MAR APR8. Plan orientation9. Develop orientation manual10. Host consultant orientation11. Hire qualified candidates12. Train new consultants – HR13. Train new consultants – CD 10
    11. 11. Objective #2: Develop a Staff Recruitment and Retention Plan OCT NOV DEC JAN1. Determine staffing needs2. Evaluate cause of staff turnover3. Sr. Management Mtg4. Learn best practices from partners5. Link R&R plan w/strategic plan6. Develop R&R plan (short/long term)7. Develop selection criteria 11
    12. 12. Objective #2: Develop a Staff Recruitment and Retention Plan DEC JAN FEB MAR APR MAY8. Train/coach managers - perf/change mgmt9. Draft R&R manual10. Seek feedback11. Finalize R&R manual12. Develop QA plan13. Plan to review R&R plan annually 12
    13. 13. EvaluationGoal How Will You Measure Achievement?To develop and maintain program Tracking and examining:sustainability for the AACBI program in • the staff’s length of tenurethe event of staff turnover • job satisfaction • the quality of staff job performance This data will be collected through: • Observation • Staff supervision • Program evaluation (i.e. training evaluation) This data will be reviewed every trimester. 13
    14. 14. EvaluationObjectives How Will Your Measure Achievement?1. By April 30, 2009, AACBI/HRC will After each recruitment cycle, monitor and expand its cadre of trainers/technical analyze the number of trainers/TA assistance providers by recruiting, providers: hiring and training new consultants. • Recruited • Added to the consultant pool and compare to the baseline number (pre- recruitment) • Completed trainings2. By May 30, 2009, AACBI/HRC will Monitoring and analyzing the following: develop a staff recruitment and • Length of time it takes to recruit new staff retention plan that will address, among • Length of staff tenure other things, monetary and non- • Staff job satisfaction monetary incentives. • Staff job performance14
    15. 15. Safety CountsA Behavioral HIV Intervention For Black Men Who Use Drugs and Have Sex With Women 15
    16. 16. Priority Population Black/African American adult women (ages 20-49) ofunknown or HIV-negative status, engaged in heterosexualcontact with men who use drugs and live in New York City. Why this population? • In NYS, over 42% of African Americans don’t know how they were infected. • In NYC, 54% of black women acquired HIV from heterosexual contact. Another 27% do not know how they were exposed to HIV.Therefore, the focus of our prevention efforts needs to be on the sexual partners of these women. 16
    17. 17. HRC’s Capacity To Work With Priority PopulationHarm Reduction Coalition is not a direct service agency. Therefore, our capacity to work with this priority population is limited.However, the Board of Directors is open to supporting a program for black women who are partners of drug users (our target population).HRC is a culturally competent organization with experience working with the African American community. Furthermore, HRC has extensive knowledge about drug use and the adverse effects of drug use (e.g. overdose, viral hepatitis, HIV/AIDS, etc.) 17
    18. 18. Assessment & The Theory Behind ItIndividual Assessment: Web-based Survey questionnaire• Target pop - Black/African American women (ages 20-49) of unknown or HIV negative status, engaged in heterosexual contact with men who use drugsCommunity Assessment: Focus Groups• Target Pop - Key Informants and Community Leaders – individuals who understand the influence and connection between poverty, incarceration and sexual networks within Black/African American communities that lead to HIV infection among heterosexual womenBehavioral Theory :The Theory of Gender and Power• The theory argues that self-protection by women is often swayed by economic factors, abusive partnerships, and the socialization of women to be sexually passive or ignorant.• The theory incorporates the structure of gender relations, societal definitions of masculinity and femininity, and economic power. 18
    19. 19. Key Findings From Individual AssessmentThe top two reasons why women did not use condoms all the time with their drug using main partners were: • Their partner doesn’t like to use condoms • They are in a monogamous relationshipThe main reason why women did not use condoms all the time with their drug using casual partners was a history or potential for partner violence.Although the majority of women surveyed think they are at risk for HIV, that does not always lead to using a condom each and every time with their partner. 19
    20. 20. Key Findings From Community AssessmentHIV prevention education does not effectively incorporated drug education, especially understanding how a partner’s use of drugs can place them at risk for HIVBlack/African American women need to find their voice in the fight against HIV. • Lack of self- empowerment to protect and defend their needs with their sexual partnersRelationship dynamics between men and women need to be functional, balanced and healthy. • Economic disparities, unemployment/underemployment for either partner, especially the man, can cause distress in the relationship leading to high-risk behaviorsThere are stigmas that are specific to the black community (e.g. faith-based homophobia). 20
    21. 21. Safety Counts• Safety Counts is an HIV prevention intervention for out-of-treatment active injection and non-injection drug users aimed at reducing both high-risk drug use and sexual behaviors. It is a behaviorally focused, seven-session intervention, which includes both structured and unstructured psycho- educational activities in group and individual settings.• The goal of the intervention is to reduce the HIV acquisition and/or transmission incidence for adult men who use drugs and have sex with African American women.• Harm Reduction Coalition is in the pre-implementation stage with Safety Counts. In partnership with a direct service provider, Safety Counts can be implemented with fidelity, because two HRC staff members are Safety Counts master trainers and have extensive knowledge of the intervention. 21
    22. 22. Adaptation of Intervention• Safety Counts would have to be adapted to serve African American male clients who use drugs and their primary goal behavior is to use a condom.• Since the ultimate goal is to effect the risk of African American women who are having sex with men who use drugs, it is important and necessary to link Safety Counts to another intervention for women, SISTA, for their female partners.• Both sexual partners will be receiving the same risk reduction messages simultaneously.• Safety Counts social events will be open to female sex partner who are also SISTA participants. In addition, another group session will be added to Safety Counts to include information on healthy relationships between black men and black women. 22
    23. 23. Intervention Implementation StakeholdersStakeholder Name Resources and/or Rationale for InclusionAdam Viera Serves as program staff, therefore he would beCBA Specialist implementing the intervention.Harm Reduction CoalitionDorcey Jones Serves as program staff, therefore she would beCBA Specialist implementing the intervention.Harm Reduction CoalitionDarrell Wheeler, PhD Supports the program with expertise aroundBehavioral & Social Science Consultant behavioral theory, interventions and the targetHunter College School of Social Work populationBernadette Hadden, PhD Expertise in formative, program and outcomeEvaluation Consultant evaluationHunter College School of Social Work 23
    24. 24. Process Outcome or Behavioral or Goal Objectives Immediate Intermediate Statement Objectives ObjectiveProcess Monitoring Outcome Monitoring and Impact and Evaluation Evaluation Evaluation 24
    25. 25. Behavioral or Intermediate Outcome Objective By the completion of the intervention(4 months), each client will have the knowledge and skill to reduce the transmission risks associated with unprotected vaginal and/or anal sexual intercourse. 25
    26. 26. Evaluation of Behavioral ObjectiveObjective Indicator Source of EvidenceBy the completion of Increase in awareness # of participants thatthe intervention, 100% of the link between increased theirof participants will internalized awareness of the linkincrease their homophobia and HIV between internalizedawareness of the link risk behavior among homophobia and HIVbetween internalized participants who risk behaviorhomophobia and HIV completed therisk behavior leading interventionto rising HIV ratesamong AfricanAmerican women. 26
    27. 27. Outcome or Immediate Outcome Objectives• By the completion of the intervention, 75% participants will bring their AA female sex partners to at least one social event, where they will discuss the risk of HIV infection due to drug/alcohol use.• By the completion of the intervention, 75% of the Safety Counts participants will receive at least one referral to a job training program .• By the completion of the intervention, 100% of participants will increase their awareness of the link between internalized homophobia and HIV.• By the completion of the intervention, 75% of Safety Counts participants will state an intention to use condoms with their female sex partners. 27
    28. 28. Evaluation of Outcome ObjectivesBY THECOMPLETION OF INDICATORS SOURCE(S) OFTHE EVIDENCEINTERVENTION: Number of A/ABring AA female sex partners attending Sign-in sheetfemale sex Head count atpartners to at social event Social Eventleast one social Programevent Number of Social Events Monitoring FormReceive at least Number of jobone referral to a training programs injob training List of referrals, referral networkprogram MOAs with job Number of training programs participants referred in referral network to job training , Client Records 28 programs
    29. 29. Evaluation of Outcome Objectives BY THE COMPLETION OF INDICATORS SOURCE(S) OF THE EVIDENCE Increase in awareness of INTERVENTION: the link betweenawareness of the link internalizedbetween internalized homophobia & HIV Pre and Posthomophobia and HIV risk behavior Risk Reduction among participants Interview who completed the interventionstate an intention # of participants who Program Monitoring to use condoms completed the intervention Formwith their female Client Recordsex partners # of participants who Risk Reduction completed the intervention Interview who stated an intention to use condoms with female 29 sex partners
    30. 30. Process Objectives1. By November 2008, a formal collaborative agreement -- for the purposes of running Safety Counts in conjunction with their SISTA program, recruiting clients, utilizing office space and sharing staff -- with Diaspora Community Services, a direct service provider, will be established via a Memorandum of Agreement (MOA).2. By January 2009, the Safety Counts staff at HRC and Diaspora (also referred to as “The Safety Counts Team”) will be hired.3. By February 2009, a client recruitment and retention plan will be developed by the Safety Counts Team.4. By February 2009, all Safety Count Team members will have completed a CDC-sanctioned Safety Counts training. 30
    31. 31. Process Objectives5. By February 2009, all Safety Count Team members will have received an Overview of SISTA by a CDC-funded CBA provider.6. By March 2009, the Safety Counts Team will pilot-test a new curriculum for a third group session to address the issue of healthy relationships between black men and black women7. By March 2009, the first cycle of Safety Counts for African American/Black male drug users whose primary goal is to use condoms with their African American female sex partners will begin8. By April 2009, at least one Social Event will be open to SISTA participants who are receiving the same risk reduction messages simultaneously9. By September 2009, the Safety Counts Team will evaluate the first completed cycle of the intervention. 31
    32. 32. Evaluation of Process Objectives PROCESS OBJECTIVES INDICATORS SOURCE(S) OF EVIDENCE (due date) # of roles and responsibilities for the implementation of theFormal intervention detailed in theAgreement MOA MOAthrough MOA # of signatures from Executive(by Nov. 08) Directors of partner organizations Number of Proposed Grant ProposalHire Safety Staff Hiring Letter,Counts Team Employee Records(by Jan. 09) Number of Staff Actually Hired 32
    33. 33. Evaluation of Process Objectives PROCESS OBJECTIVES INDICATORS SOURCE(S) OF EVIDENCE Number of clients identified to beRecruitment recruited and Grant& Retention retained ApplicationPlan (by Feb Client09) Records SC Team # of people completing completes the Safety Counts training Certificates of CDC SC completion Increase in knowledge of Training (by Sign-in sheets Safety Counts Feb 09) intervention procedures and policies 33
    34. 34. Evaluation of Process Objectives PROCESS OBJECTIVES INDICATORS SOURCE(S) OF EVIDENCE Number of people completing the SISTASC Team Overview training Certificates ofcompletes attendance Increase in knowledgeCDC SISTA Sign-in sheets of SISTA interventionTraining (by procedures andFeb 09) policies #of priority populationPilot 3rd participating in pilot test Sign-in sheetGroup Sessionre: healthy Increase in participant’s Pre-Post Testblack knowledge about healthy One-on-onerelationships relationships interviews with(by Mar 09) participants 34
    35. 35. Evaluation of Process Objectives PROCESS OBJECTIVES INDICATORS SOURCE(S) OF EVIDENCE Number of participants whoBegin the 1st attended Group Sign-in sheetscycle of Session 1 ClientSafety Counts Records Number of Group Program(by Mar 09) Sessions that occur Monitoring Form Number of SISTAAt least one SC participants invited to List of invitedSocial Event the Social Events guestsopen to SISTAparticipants (by Number of Social InvitationsApr 09) Events Program Monitoring Form 35
    36. 36. Evaluation of Process Objectives PROCESS OBJECTIVES INDICATORS SOURCE(S) OF EVIDENCEEvaluate the Number of core Programfirst elements implemented Monitoring Formcompleted Pre and post Risk Increase in knowledgecycle of SC Reduction Interview and skills of the(by Sep 09) Client Participation participants Record 36
    37. 37. Resources NeededPersonnel Other Direct Costs• Program Manager • Travel• Counselor/Facilitator I • Consultants• Outreach • Office Supplies Worker/Facilitator II • Educational Materials• Program Assistant • Stipends • Printing • Telephone/Internet • Postage/Delivery • Equipment • Furniture 37
    38. 38. Year 1 Budget Strategic Plan Intervention Plan TotalPersonnel $52,800 $96,600 $149,400Consultants $5,000 $10,000 $15,000Stipends $2,000 $7,000 $9,000Equipment $0 $12,000 $12,000Travel $0 $5,000 $5,000Supplies $1,000 $5,000 $6,000Other Direct Costs $7,500 $17,500 $25,000Indirect Costs 10,245 $22,965 $33,210Total $78,545 $176,065 38 $254,610
    39. 39. Closing RemarksSafety Counts, in partnership with SISTA, is an effective intervention that will reduce the transmission of HIV among Black/African American adult men who use drugs and have unprotected sex with Black/African American women.This unique partnership between two behavioral interventions will be cost-effective while meeting its goal to increase the knowledge and skills of clients and their partners. AACBI/HRC is a culturally competent program that has an excellent performance record as well as strong relationships in the community to make this initiative a success! 39