The document discusses standards for non-medical community workers to competently conduct HIV testing. It reviewed literature on community health workers and conducted focus groups. The focus groups identified six categories of standards needed: client-centered care; HIV testing skills; responsibility for competent testing; relationship to community and agency; cultural competence; and monitoring and regulation. Community workers felt they could provide testing with proper training and oversight, though establishing standards and monitoring is challenging without a regulatory framework.

1. Is it time for the community to take a stronger role in HIV testing? How would that look? James Tigchelaar

4. Background: UCSF AIDS Health Project

9. What is the best environment for HIV testing to be offered? Regulatory Process Standards and Scope of Practice Employer Policies Worker Controls on Health Care Practice Competence

10. Themes and Categories Responsibility to the Client Client Centered Care Responsibility for competent HIV testing Responsibility for the Environment

11. Themes and Categories: Client-centered Care “ Our [CHW] success goes back to the strength of the relationship that we have with the individual, because [with HIV testing] if we know the person well, then some strain of pretest counseling would have to be released in there, right?” “ It’s one of the few strengths where the CHW has an advantage over the medical model because they’re able, and set up to, respect... differences in people. So there is a big benefit to the community health worker doing this work... chances are a lot better that [the client is] going to get culturally competent... or culturally sensitive care. ” Relational Practice: A little less enthusiastic:

12. Themes and Categories Responsibility to the Client Client Centered Care HIV testing Skills Responsibility for competent HIV testing Responsibility for the Environment Service design and delivery

13. Themes and Categories: Skills re: HIV testing “ We get info-line calls that are pre and post-test counseling. People are constantly calling or dropping in because they don’t know what they want, and that’s a pretty good argument - we do pre and post test routinely, we just don’t offer the test. ” “ We have to keep in mind that [positive] diagnosis creates trauma – this is an already traumatized population, and the CHW must be able to work with a re-traumatized person in the event of a positive result.” We’re already doing it: But be cautious – it’s not that simple:

14. Themes and Categories Responsibility to the Client Client Centered Care HIV testing Skills The Community The Agency (NGO,CBO) Responsibility for competent HIV testing Responsibility for the Environment Service design and delivery

15. Themes and Categories: Relationship to Service Design and Delivery Participant 7: “ You have to educate yourselves about the cultures within your communities and stay culturally attuned. It may mean participating in cultural events in the community” Participant 16: “ I’d like to broaden that... what about the influences of 25 years of substance abuse, or if they’ve lived in 40 different foster homes, or spent 28 years in jail... there is a prison culture as well. We [have to] tailor our approach depending on what their culture is like.” “ I would argue that there’s a barrier to access within the current system design... maybe there are people who want to hook into the system in a lower barrier way, and the uniqueness of the CHW is that they can offer that. So why would we re-create mini versions of [the medical system] in the CHW, because that’s what not working.... ” Don’t repeat mistakes: Cultural Competence:

16. Themes and Categories Responsibility to the Client Client Centered Care HIV testing Skills The Community Monitoring and Regulation The Agency (NGO,CBO) Responsibility for competent HIV testing Responsibility for the Environment Service design and delivery