HIVinterventionstrategy

Intervention strategy, Final 1
Intervention Strategy: Final
Addressing the High Prevalence of Human Immunodeficiency Virus in Alexandria, Virginia
Kelly Garcia

Introduction
According to the Health Profile I released by the Alexandria Health Department in 2015,
there is an increased prevalence of sexually transmitted disease in residents of Alexandria.
Particularly, there is a significant increase in the prevalence of human immunodeficiency virus
(HIV). The continued prevalence of HIV in the United States is considered a major public health
crisis, because it affects a wide range of people from different backgrounds, and there is
currently no cure. The virus family that causes HIV, called retrovirus, is extremely virulent and
attacks the T-cells in the immune system, causing a slow erosion of a person’s immune system.
In addition, HIV also poses economic distress to patients and health care providers.
Population Demographics
The intervention proposed in this paper will focus on a population of young men who
have sex with men (MSM) who live in Alexandria, Virginia. This specific population was
selected because of the increased risk that young MSM have in getting HIV.
According to the Centers for Disease Control and Prevention (2015b), in 2010 MSM
accounted for 63% of estimated new cases of HIV in the United States. In many cases, men
infected with HIV may be unaware that they have it (Centers for Disease Control Prevention,
2015b). Where this is the case, it is impossible for the man to get the medicine he needs and he
may be more likely to infect others. This leads to an increased contraction rate between MSM
who may be having unprotected sex with someone unknowingly infected with HIV.
In addition, according to the Centers for Disease Control and Prevention (2015b), anal
sex is the riskiest type of sex for contracting HIV. In particular, the act of receiving anal sex is
the most risky.
Disease Prevalence

As discussed in the previous section, MSM are most at risk for contracting HIV.
According to the Centers for Disease Control and Prevention (2015a), African American men
who are between 13-24 are the most at risk, with white males behind them. In a 2013 Gallup
survey, about 10% of people in the District of Columbia identified themselves as homosexual.
This percentage is highest of anywhere in the country, with Hawaii next at 5%. Because of
Alexandria’s proximity to Washington, DC, it can be assumed that this trend carries over and
there is a higher population of MSM in Alexandria then elsewhere in Virginia. According to the
same Gallup poll, Virginia’s percent of the population who is homosexual is 2.9%.
In Alexandria, the rate per 100,000 people with HIV is 1078.7 (Alexandria Health
Department, 2015). This is much higher than the national average of 105.5. According to the
District of Columbia’s Department of Health (2013), the rate per 100,000 people with HIV in
DC is 2541.7. This is higher than anywhere else in the country. Because many people who live in
Alexandria spend time socially in Washington, DC bars and nightclubs, it is safe to assume that
the number from DC is a more accurate representation of the population then elsewhere in
Virginia.
Consequences
HIV causes a number of short-term and long-term consequences. Perhaps the most severe
consequence of HIV is its eventual progression into AIDS. HIV is considered AIDS when the
number of CD4 in a patient’s body dips below 200 cells/mm3 (Health and Human Services,
2015a). CD4 is a glycoprotein that is found on the surface of helper T cells, a type of immune
cell (Health and Human Services, 2015b). Once progressed to AIDS, if untreated this disease
yields an average life expectancy of three years.

Because HIV lowers the body’s immune response, someone with HIV is at a higher risk
of developing respiratory infections such as the flu and pneumonia. Someone with HIV may also
experience aches and pains, mouth ulcers, hypertension, kidney damage, fatigue, dementia,
seizures, shingles, and itchiness (United States Department of Veterans Affairs, n.d.). HIV can
also lead to neuropathy, which is numbness of the extremities due to nerve damage. In addition,
HIV may lead to metabolic changes in the body, and changes how the body uses, stores and
excretes fats and sugars (United States Department of Veterans Affairs, n.d.). This may lead an
increased risk of developing diabetes mellitus or heart disease. People with HIV may also
experience a loss of nutrients because of consistent diarrhea.
Finally, a diagnosis of HIV or AIDS may be accompanied by increased stress, anxiety,
and depression. According to a 2010 study, 22% of patients with HIV experience depression
(HIV Clinical Resources, 2010). And although the number is declining, investigators found in
2008 that people living with HIV were three times more likely to commit suicide than the
general population (HIV Clinical Resources, 2010).
Risk Factors
There are two primary transmissions of HIV. The most common way HIV is contracted is
through unprotected sex. Another common way it is transmitted is by sharing infected needles
and syringes. Through the analysis of scientific journals, the CDC discovered that receiving
unprotected anal sex with someone who has HIV was a major risk factor, although unprotected
sex of any kind increased a person’s risk of contracting the virus (Patel et al., 2014). In addition,
sharing needles or injection equipment with someone with HIV is a risk factor (Patel, et al.).

While the risk is the same for all people, some groups are more affected by HIV than
others. These disparities are discussed previously in this paper. In general, MSM males are most
at risk for HIV, the reasons being discussed previously.

Goals and Objectives
Evidence Based Intervention:
In previous interventions that have sought to reduce sexual risk behaviors or increase
protective behaviors to prevent MSM from contracting HIV, several approaches have been found
to be successful by the Community Guide. Interventions at the individual level provide people
with relevant information, training, or support through a one-on-one interaction. Interventions at
the group level promote individuals to change their behavior through guided activities and
discussions with a trained facilitator, and are reinforced by support from other members. Both
the individual level and group interventions have been supported by strong evidence. Finally,
interventions at the community level attempt to change individual behaviors by providing
education and changing attitudes. Community-level interventions have been supported by
sufficient evidence.
In the population of MSM who live in Alexandria, Virginia, we will employ the use of a
group-level intervention. The Community Guide recommends this type of intervention. The
intentions of this intervention are outlined more specifically below:
1. Overall goal: To decrease the number of young MSM who contract HIV in the
community of Alexandria, Virginia
2. Process Objective: Between January 2017 and May 2017, staff will lead ten bi-monthly
support groups with at least seven MSM men (ages 25-44) in Alexandria, Virginia
3. Impact Objective: After ten group sessions, 60% of young MSM will correctly be able to
identify methods of sexually transmitted disease prevention and the dangers of binge
drinking on a quiz

4. Outcome Objective: By December 2017, there will be a 5% decrease in new HIV cases in
young MSM men in Alexandria, Virginia
Because of the young age of the targeted population, a community-based program was
employed. Members of this age group have an extrinsic sense of self, so I believe a community-
based intervention would be most effective in achieving goals. A likely predisposing factor that
exists in this population is the tendency of young adults in this area to binge drink. I considered
this when drafting one outcome objective because binge drinking may lead to having more
unprotected sex. Consequently, there will be elements in the program that will address the
dangers of binge drinking. An enabling factor of this population is their easy availability of
resources. Reinforcing factors in this population would include social support and increased life
longevity.
Narrative
I. Participants
The primary population of those who will be used in this intervention will be young (ages
25-44) men who have sex with men (MSM). These men will be residents of Alexandria,
Virginia. Participants will be recruited for this study in a number of ways. First, participants will
be recruited through posters, which will be posted throughout of the county in grocery stores,
coffee shops, recreation centers, metro stops, gyms, public libraries, nightclubs, and bars. In
addition, participants will be recruited through centers from which they are receiving treatment
for HIV or another sexual transmitted disease through a nurse. To encourage participants to
continue to come to classes, there will be incentives (discussed below) rewarded to those who
attend the most sessions and demonstrate excellent knowledge of the material.
II. Facilitators

A part-time facilitator will be hired with the funds gained from this grant. The hired
employee will work for approximately 8-10 hours a week. The primary responsibilities of this
position will be to lead the bi-monthly group sessions to provide beneficial information to the
target population. The facilitator will also provide support outside of the classes to the
participants by planning and preparing for each session.
III. Location
A room at the Patrick Henry Recreation Center will be rented out to provide a space for
the sessions to take place. The Patrick Henry Recreation Center is located at 4625 Taney Ave.
We have discussed the rates with the Alexandria Department of Parks and Recreation, who have
agreed to rent us one of their small rooms for a discounted price.
IV. Incentives
Snacks and refreshments will be included with participation in each class. In addition,
participation in the intervention strategy will be incentivized with prizes for the people who
attend the classes most frequently. The participant who attends all ten classes and can
demonstrate their learned knowledge most effectively will receive a $100 gift certificate to the
Wharf, an upscale restaurant in Old Town Alexandria. The runner up will receive a $25 gift
certificate to the Wharf, and the third place winner will receive a $15 gift certificate to iTunes.
Every participant will receive a t-shirt. Finally, in partnership with Health and Human Services,
the participants will receive access to an smart phone application that locates nearby testing
centers.
V. Objectives and Action Plan
The theory used when planning this intervention is the transtheoretical model. The
transtheoretical model utilizes stages of change to move a participant to a more positive normal

behavior. These stages include pre-contemplation, contemplation, decision, action, and
maintenance. The information that supports the use of this model in this program was gathered
from the U.S Department of Health and Human Service’s “Theory at a Glance: A Guide for
Health Promotion Practice” (2005). This intervention will seek to identify where participants lie
on this stages of change initially and promote them to progressive levels through education about
HIV/AIDS and safe sex. In the beginning of the program, a questionnaire will be administered
that measures where a participant lies in the stages of change (*****). It will also be given at the
mid-program evaluation after five sessions. The end of a 20-week timeframe will be
benchmarked by the same survey to assess the effectiveness of the program and to support the
impact objective. The materials used in this questionnaire will be purchased with funds obtained
from the grant.
During the 20-week time period, there will be ten class sessions, supporting the process
objective. Each session will focus on a specific way to educate participants on methods of safe
sex, as well as providing them a safe place to learn about and discuss HIV/AIDs. Some topics
will include: a condom demonstration, the financial cost of HIV/AIDs, locations of nearby
testing centers, and dangers of binge drinking for unsafe sexual behaviors. Each class will
provide materials for the participant’s use outside of the class, supporting the idea that learning
happens both inside and outside of the classroom. The materials that will be administered will
include brochures, condoms, and posters. In addition, we will partner with the United States
Department of Health and Human Services, in order to provide an application to our participants
that locates nearby testing centers and is accessible anywhere by cell phone.
VI. Benefits and Conclusion

The city of Alexandria, Virginia has a higher rate of HIV/AIDs in young, homosexual
males as compared to the national average, and therefore the funds of this grant would have an
obvious benefit here. In a successful program of this kind, the rate of contraction of HIV in a
population of at-risk, young, homosexual males would decrease. If there were a lower incidence
of contraction of HIV, then subsequently the rate of AIDs would decrease as well. If a young
adult can avoid the contraction of HIV and then the development of AIDs, they can increase their
overall health and longevity. This program would provide an at-risk population with the
education they need to help complete the primary objective.

Gantt Chart
Tasks
Person(s)
Responsible
Projected Dates
Apr-161-MayJun-16 Jul-16Aug-16Sep-16 Oct-16 Nov-16 Dec-16Jan-17 Feb-17 Mar-17 Apr-17May-17Jun-17 Jul-17 Aug-17 Sep-17Oct-17 Nov-17 Dec-17
Contact HHSin
regards to partnership
Kelly Garcia
Hire and train part-
time class instructor
Kelly Garcia
Design marketing
campaign to recruit
MSM
Kelly Garcia
Implement marketing
campaign
Kelly Garcia
Secure location Kelly Garcia
Design program
contentswith class
instructor
Kelly Garcia
Secure materials to be
used in classes
Kelly Garcia
Finalize terms of
HHS partnership
Kelly Garcia
Prepare for program
kick-off
Kelly Garcia
Finalize any
recruitment needed
Kelly Garcia
Administerpre-
programsurvey
Conduct program Kelly Garcia
Mid-programsurvey Kelly Garcia
Amend program
based on mid-
evaluation
Kelly Garcia
Programevaluation
after20 weeks
(survey)
Kelly Garcia
Secure prizes for
participants
Kelly Garcia
Tally up winners and
reward participants
Kelly Garcia
Conduct final
programevaluation Kelly Garcia
Make changesfor
future implementationKelly Garcia
Write final report Kelly Garcia

Budget
ORGANIZATION NAME: Champion for a Healthy City Foundation
BUDGET YEAR: 2016-2017
A. PERSONNEL: Staff salary & benefits. Cost for the Supervisor's salary of projectstaff cannot exceed 5% of Supervisor's salary.
Position Title Annual Salary Request from FUNDER Match Contributions
(If Applicable)
Totals
Supervisor $30/hour at 40 hours/week $0 $62,400 $62,400
Fringe Benefits for Personnel (FICA, Health, etc.) Fringes cannot exceed 30%
of the salary amount.
$4,775 $0 $4,775
Totals $4,775 $62,400 $67,175
NARRATIVE DESCRIPTION FOR SECTION A. PERSONNEL
Total cost: $4,775
Supervisor will help implement the plan and conduct the evaluation techniques.The Supervisor will work 40 hours per week, which will bematched contributions.The fringe
benefits are being requested from the program.
NOTE FOR THIS PROJECT: Fringe Benefits for Personnel is calculated using a FICA rate of $0.0765.
Fringe Benefits for Personnel:
FICA rate= $0.0765
[$0.0765 x $62,400 annual salary]=$4,773.6
Total Fringe $4,775
B. CONSULTANTS: Cost to utilizetrainer,artist,evaluators or other contractor(s) for short-term work.
Type of Expense
Rate/ Unit of Reimbursement Request from FUNDER
Match Contributions
(If Applicable)
Totals
Classroomfacilitator (part-time) $25/hour at 10 hours/week for 52
weeks
$6,000 $7,000 $13,000
Totals $6,000 $7,000 $13,000
NARRATIVE DESCRIPTION FOR SECTION B. CONSULTANTS
Classroomfacilitator Total=$13,000
The Classroomfacilitator will plan and conductthe program. They will work for 10 hours a week (not to exceed 12 hours) for the duration of the program52 weeks.

Classroomfacilitator Rate=$25 per hour
[10 hours x $25/hour]= $250
[$250 x 52 weeks]= $13,000
We arerequesting that $6,000 be covered by grant funds.
D. RENTAL SPACE/EQUIPMENT: With clear justification,onecomputer system with peripherals may be purchased,not to exceed $1,000. Other equipment MUST be unavailable
in the organization,related to the projectand clearly justified.
Type of Expense Request from FUNDER Match Contributions
(If Applicable)
Totals
Rental Space at Patrick Henry Recreation Center $590 $590
Totals $590 $0 $590
NARRATIVE DESCRIPTION FOR SECTION D. RENTAL SPACE/EQUIPMENT
Equipment and Space Total= $590
The rental spacewill be used to conduct the bi-monthly intervention sessions.Itwill berented from the Patrick Henry Recreation Center in Alexandria,Virginia.Computer use is
included in the costof the room.
Rental Space (small room):Total $590
Rental Space (small room) fee- $59/hour
[$59.00 x 10 hours]=$590
E. MATERIALS: Educational materials,products,supplies.
Type of Expense Request from FUNDER Match Contributions/
If Applicable
Totals
Flyers (150) $207 $207
Posters (25) $900 $900
Brochures (250) $300 $300
Condoms (200) $72 $72
Wooden Penis Demonstrator (10) $90 $90
Totals $1,569 $0 $1,569
NARRATIVE DESCRIPTION FOR SECTION E. MATERIALS
Flyers fee- $1.38/per at Kinkos
[$1.38 x 150]= $207.00
Poster fee- $36.00/per 16"x20" atKinkos
[$36.00 x 25] = $900
Brochure Fee- $299.99/per 250 at Kinkos
[$299.99 x 1]= $299.99
Condoms fee- $35.99/100-pack

[$35.99 x 2 boxes]= $72.00
Wooden Penis Demonstrator- $9/per unit
[$9.00 x 10]= $90.00
F. OTHER COSTS: Printing,copying,postage
(If Applicable)
Totals
Printed pre- and post-assessmentquiz(50) $40 $40
Snacks and refreshments ($20/class) $200 $200
Firstplacegiftcard to the Wharf $100 $100
Second placegiftcard to the Wharf $25 $25
Third placegiftcard to iTunes $15 $15
Participation T-shirts $0
Totals $380 $0 $380
NARRATIVE DESCRIPTION FOR SECTION F. OTHER COSTS
Quizzes fee- $0.08/per at Kinkos
[$0.08 x 50]= $40.00
Snacks and refreshments- $20/class
[$20.00 x 10]= $200.00
G. INDIRECT Indirectcosts cannotexceed 10% of the personnel costs charged to the grant.
(If Applicable)
Totals
IndirectCosts $8,271 $8,271
Totals $8,271 $0 $8,271
NARRATIVE DESCRIPTION FOR SECTION G. INDIRECT COSTS
FOR THIS PROJECT: Indirect cost rate is 10%. No additional narrative needed.
H. TOTAL BUDGET
Amount Requested From
FUNDER
Match Contributions
(If Applicable)
Totals
Total Amount of Funds $21,585 $69,400 $90,985

Evaluation
As a result of this intervention, the following deliverables will be developed:
1. A report written analyzing the differences in the pre-survey, mid-survey, and post-survey answers
regarding safe sex and binge drinking behaviors
2. A 60% increase in participant knowledge about methods of safe sex and dangers of binge drinking
3. A 60% increase in stages of change progression into the contemplation stage (understand the
dangers of unsafe sex, and are thinking of making changes)
4. A five percent decrease in new cases of HIV by the end of 2017, as reported by the Health Profile I
5. A increase in young, MSM who utilize HIV testing centers in Alexandria, Virginia
There will be two evaluation periods for this initiative. One will be mid-program, after the
completion of five group sessions. The second will be at the end of the program, after the completion
of ten, bi-monthly group sessions. The primary aim of the evaluation will be to determine the impact
of the program in decreasing the number of young MSM who contract HIV in the community of
Alexandria, Virginia.
Both the mid-program evaluation and the final evaluation will be looking to evaluate the
knowledge gained from attending the group sessions provided by the program. There will be a
baseline survey administered at the beginning of the program to gauge where participants are
knowledge-wise. The same survey will be administered after five sessions (ten weeks) to see if
attitudes have improved. The survey will finally be given again after ten sessions (twenty weeks), to
determine knowledge gained from the program. The incentives will be distributed to the person who
has attended the most sessions, and who can demonstrate an excellent knowledge of safe sex
practices.

References
Alexandria Health Department. (2015). Health profile I: health behaviors, morbidity, and mortality.
Alexandria Health Department. Retrieved from
https://www.alexandriava.gov/uploadedFiles/health/WebBoxes/Health%20Profile%20I.pdf
Centers for Disease Control and Prevention. (2015a). HIV in the United States: At a Glance.
Retrieved from http://www.cdc.gov/hiv/statistics/overview/ataglance.html
Centers for Disease Control and Prevention. (2015b). HIV among gay and bisexual men. Retrieved
from http://www.cdc.gov/hiv/group/msm/index.html
Centers for Disease Control and Prevention. (2014). NCHHSTP Atlas. Retrieved from
http://gis.cdc.gov/grasp/nchhstpatlas/main.html?value=atlas
District of Columbia’s Department of Health. (2013). Annual Epidemiology & Surveillance Report.
Retrieved from
http://doh.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/2013%20Annual%20
Report%20FINAL-2.pdf
Gates, G., & Newport, F. (2013, February 15). LGBT percentage highest in D.C., lowest in North
Dakota. Gallup. Retrieved from http://www.gallup.com/poll/160517/lgbt-percentage-highest-lowest-
north-dakota.aspx
HIV Clinical Resources. (2010, October). Depression and mania in patients with HIV/AIDS.
Retrieved from http://www.hivguidelines.org/clinical-guidelines/hiv-and-mental-
health/depression-and-mania-in-patients-with-hivaids/
Patel, P., Borkowf, C., Brooks, J., Lasry, A., Lansky, A., & Mermin J. (2014). Estimating per-act HIV
transmission risk: a systematic review: AIDS. AIDS: Official Journal of the International AIDS
Society, 28(10), 1509–1519. doi: 10.1097/QAD.0000000000000298

United States Department of Health and Human Services. (2015a). Stages of HIV infection. Retrieved
from https://www.aids.gov/hiv-aids-basics/just-diagnosed-with-hiv-aids/hiv-in-your-
body/stages-of-hiv/
United States Department of Health and Human Services. (2015b). CD4 count. Retrieved from
https://www.aids.gov/hiv-aids-basics/just-diagnosed-with-hiv-aids/understand-your-test-
results/cd4-count/
United States Department of Health and Human Service (2005). Theory at a glance: a guide for health
promotion practice. Retrieved from
http://www.sneb.org/2014/Theory%20at%20a%20Glance.pdf.
United States Department of Veterans Affairs. (n.d.). Are there long-term effects?: HIV/AIDS.
Retrieved from http://www.hiv.va.gov/patient/basics/long-term-effects.asp.

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