The Afrolatin@ Project: Conversemos HIV/AIDS Initiative Descriptive Summary 6-20-08


Published on

Description of the pilot HIV/AIDS Prevention Initiative conducted by the Afrolatin@ Project in 2008-2009, funded by the Ford Foundation.

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

The Afrolatin@ Project: Conversemos HIV/AIDS Initiative Descriptive Summary 6-20-08

  1. 1. CONVERSEMOSAn HIV/AIDS Prevention ModelDescriptive SummaryGeorge Priestley, PhDMarcia Bayne Smith, PhDThe Afro-Latino ProjectQueens College – CUNYJune, 2008 1
  2. 2. ABOUT CONVERSEMOSIntroduction Introductory information on issues related to prevalence as well as regional andpopulation considerations are provided here as a backdrop against which theConversemos Model is framed. Therefore it is important to first recognize that the UN-AIDS division has assigned a 2% HIV prevalence rate among adults 15-49 for thecircum-Caribbean region1 which is now considered to be second only to AIDS-ravagedsub-Saharan Africa, where the prevalence of HIV among adults ages 15-49 is reported tobe 8.0%.2,3 New trends specify a shift: half of all new cases are now found in youngwomen 15-19. The most prevalent mode of transmission for these young women isheterosexual sex which has implications for their children both living and yet unborn.4The groups most affected by this new trend are Afro-descendant populations such as theGarifuna (living primarily in Honduras, Guatemala and Belize) who have some of thehighest HIV/AIDS (8% to 14% in Honduras) rates in Latin America.5Regional and Population Considerations The circum-Caribbean region includes all of the island states and nations withinand surrounding the Caribbean Sea. Initial Conversemos pilot work will be done in:Honduras, Panama and the Dominican Republic and will focus on Afro-descendantpopulations. A major challenge is the absence of consensus about socio-political identity.Race for example is a politically charged issue in some countries contributing to a dearthof data disaggregated by race. Also, regional poverty presents economic stressors whilerampant HIV/AIDS related stigma, forces some people to forego seeking treatmentand/or related services. The more powerful challenges will come from sociallyprescribed gender roles, one of which is the economically driven, historical practice ofrelationships between very young girls and much older men. Afro-Latin@ populations and Trans-nationalism (circum-Caribbean ~ UnitedStates). A unique characteristic of the HIV/AIDS epidemic among Afro-Latin@population has to do with the practice of circular migration and living on two homefronts: the country of origin and the U.S. Contributing factors to this trans-nationalphenomena include: • geographic proximity and facility of air travel between the two regions, • constant bi-directional flow of people, goods, services, etc., to and from the circum-Caribbean region as a vacation destination hotspot, • the need for migrant farm workers and domestic workers in the U.S. • access to dual citizenship policies shared between the U.S. and many nations of the circum-Caribbean region, • dual social networks in both regions which assures migrants of support systems on both home fronts. • U.S. policy regarding deportation of ex-prisoners. 6 2
  3. 3. The Conversemos InterventionThe Conversemos Intervention, is an interdisciplinary community wide approach toreduce prevalence of HIV/AIDS through prevention and treatment services in accordwith the United Nations goal of Universal Access by 2010. Conversemos aims tointegrate multiple components of health and prevention services into existing publichealth and social services systems in 7selected countries of origin as well as in the U.S. inan effort to expand appropriate and timely access to these systems for Afro-Latin@transnational communities. Key leaders from Afro-Latin@ communities both incountries of origin and in the U.S. will be trained8,9. to work locally with: 1. public health departments to scale up targeted voluntary counseling and testing programs, and encourage compliance with HIV/AIDS medical treatment 2. social service agencies both public and private to expand HIV prevention and social support services around economic, and socio-political issues such as: self esteem, housing, job protection, empowerment, disclosure, confidentiality, etc. 3. media outlets (print, radio/TV, electronic) and cultural entities (dance groups, vocal and instrumental artists) to produce and disseminate (through broad/deep community penetration); culturally and linguistically appropriate, relevant HIV/AIDS prevention messages/images/symbols that encourage protection, prevention as well as compliance with medical care and medication regimen for those already infected. 4. regional and international funding sources to collect and analyze individual and cross-site data that provides evidence of the effectiveness of the Conversemos Initiative.Conversemos goals are to:♦ Increase and sustain effective communication about HIV prevention♦ Reduce stigma♦ Increase (develop) ongoing universal access for residents of targeted communities to high-quality HIV Services such as prevention, medical treatment and social supportsDescription of the Conversemos ComponentsConversemos activities are divided into three major program components: CommunityMapping, Promotoras and Celebrando Salud. As described below, Community Mappinghappens in Phase One, while Promotoras and Celebrando Salud are essential to PhaseTwo of Conversemos implementation. In Phase three the ongoing work of Phases I andII are integrated into the service delivery systems of the major public agencies (health andsocial service departments) serving the targeted communities and those efforts aresupported by local private entities. All three components operate under an overlay offormative and outcomes evaluation activities designed to measure the performance ofeach component and to ultimately determine the nature and extent of any changesresulting from the use of the model. 3
  4. 4. Phase One: Resident Recruitment and Information GatheringI. Community MappingCommunity Mapping is composed of a clear-cut set of activities that collect data aboutthe community at large. Community Mapping is used to determine which neighborhoodswould be best for the program, and which agencies would be best suited to implement itsuccessfully. The Community Mapping process then collects information on thecommunity’s attitudes, knowledge, beliefs and behaviors, regarding HIV/AIDS, and ituses this information to recruit and involve residents in formulating locally developedsolutions. To accomplish these objectives, Community Mapping is divided into thefollowing six activities:1. Choosing an Implementing Agency2. Choosing the Target Area/Community3. Recruiting Community Members/Residents4. Physical Mapping of the Target Area5. Survey Mapping of the Target Area6. Survey Analysis and Results Preparation7. Developing Conversemos messagesPhase Two: Community Outreach and Mobilization -PromotorasPromotoras, the term used here are also known as community health workers,capacitadoras, neighborhood health messengers and a variety of other terms. Essentiallythey are community residents who undergo training to go into their community toinitially do mapping, then to recruit fellow residents to participate in the ConversemosInitiative while simultaneously and continuously spreading and saturating theircommunity with Conversemos messages and helping residents to access needed services.Training is provided through the eight session Conversemos Curriculum that is designedto address: 1. HIV (101): Increase factual knowledge, dispel myth, treatment options 2. Explore attitudes, Unpack stigma 3. Improve stigma-free communication skills 4. Development of Positive HIV/AIDS Prevention Messages 5. Celebrando Salud - Dissemination plan for spreading HIV/AIDS Prevention Messages 6. Adopting Personal risk reduction behaviors, modeling, getting tested 7. Building – strengthening family/community/social network bonds, to provide stigma-free social and emotional supports 8. Partnering with local public and private health and social support agencies to increase access to and use of HIV/AIDS prevention and treatment services 4
  5. 5. The Promotoras de Salud go door-to-door, into homes, schools, community centers,businesses, and just about anywhere they could find an audience to listen. Their primaryfunction is to inform and engage community residents, recruit hosts for Celebrando Saludhome health parties and to facilitate the Celebrando Salud parties sessions throughout thecommunity.Celebrando SaludThe purpose of a home health party is to educate adults and parents on sexual issues andto teach them the importance of communicating this knowledge to their children andother adolescents in the community. The goal of the Celebrando Salud Home Parties is tohelp recruit more residents, adults and youth, in the community, which in turn willincrease the accuracy and frequency of community wide communication about risktaking and HIV/AIDS prevention issues.Celebrando Salud home party events give adults and youth correct information on thecontraction and prevention of STDs and HIV/AIDS, reproductive health issues,pregnancy, pregnancy prevention, and transmission of HIV from mother to child. Theseevents also give parents, community adults and young people the communication skills, anew language if you will that is needed to become educated, and to forego stigmaattitudes and behaviors in order to protect adults and young people in their community,from HIV/AIDS disease.Phase Three: Community – Services IntegrationDeveloping Partnerships with local health and social service agenciesDevelopment of effective partnership relationships between community resident groups,community agencies, private physicians, public service agencies and other health careproviders are vitally significant to the Conversemos model for the following reasons: 1. Outreach and community mobilization activities of the Conversemos intervention must be coordinated with the goals/objectives of public service (health, social services) agencies 2. Promotoras de salud must be trained regarding the local systems, policies and services available in order to properly refer residents and otherwise collaborate with local public systems. 3. Evaluation is integral to the Conversemos Model and the ongoing input and assistance from all providers, public and private is critical. 4. Private physicians as well as Public agencies have to be integrated into the outreach and mobilization efforts in two concrete ways: these health care providers must become part of the larger social network of the community and they must also provide an anchor and location of operation of the ongoing Conversemos Intervention by utilizing the Conversemos curriculum and holding Celebrando Salud sessions. 5. Public agencies must also serve as a resource for the comprehensive evaluation of the ongoing Conversemos work and a link to internal and external support systems: ie. attract additional funding, create policy change, etc. 5
  6. 6. Expected Benefits of the Conversemos Model A. Community wide benefit 1. Empowered and mobilized communities prepared to protect themselves from HIV/AIDS disease 2. Social / emotional support available through community wide social networks and resources 3. Enhancement of local evaluation capabilities and efforts B. Benefits for Promotoras 1. Development of local leadership skills 2. Agents of change: Transcending myth and stigma barriers to HIV/AIDS prevention 3. Obtain training and education that can be exchanged elsewhere in the market place C. All stakeholders (professional providers and residents) 1. Development of strong partnership relationships between community residents, providers and public health and social service agencies. 2. Connection of adults, youth, families to HIV/AIDS prevention and treatment services 3. Improved community health status 4. Long term sustainability of HIV/AIDS prevention strategies 5. Policy change???? Is that a stretch???1 Leu-Bent, ibid.2 Human Development Sector Management Unit, Latin America and the Caribbean Region, The WorldBank. Report No. 20491-LAC, June 20003 UNAIDS/WHO, 20054 UNAIDS/WHO, 20055 Leu-Bent, M. Preliminary Assessment of the Impact of HIV/AIDS on Afro-descendant populations of heAmericas, Submitted to Dr. Jacob Gayle, Ford Foundation.6 New York State Correctional Systems Report 2006 Data on repatriation of prisoners from New York State indicates that 11.3%of the 62,732 (99% males) prisoners in the state are foreign born of which 65.5% are from the circum-Caribbean region including 9.1% from Central America. Upon their release either to their local U.S. communities or deported back to their country of origin, the majority of these men will resume their former heterosexual lifestyle without alerting their partners of any violence or other incidents that occurred while incarcerated.7. Bayne-Smith, Marcia “Daughters of the Diaspora” An Intergenerational Model for HIV/AIDSPrevention. A Curriculum and Intervention Program Proposal funded by The Office of Women’s Health(OWH) in the Department of Health and Human Services (DHHS), Sept. 2006.8. Bayne-Smith, Marcia, HIV/AIDS Prevention program based on modifications to CDC’s DEBI – Sistaprogram, implemented by the Caribbean Women’s Health Association, Inc. and funded by New York CityDepartment of Health/Mental Health, March 2006 6