Successful HIV Prevention Programming for HIV-Positive MSM

7/28/2019 Successful HIV Prevention Programming for HIV-Positive MSM

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Successful HIV Prevention Programming for PLWHA

Edwin Ramos-Soto March 31st, 2009

Positive Interventions:

Vital to HIV Prevention


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Dedicated to:

The HIV-Positive Individuals

Of Orange County, CAWho Throughout The Epidemic

Have Taken Extraordinary Steps

To Protect Others, thereby

Preventing The Spread of HIV


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Presentation Summary

Positive Preventions Backdrop The Logic of Prevention with PLWHA

Community Needs Assessment

OCHCA Community Needs AssessmentASF-PLWHA Community Needs Assessment

Successful prevention program with (MSM) PLWHA Mpowerment EBI adaptation for (MSM) PLWHAVarying Levels of Prevention Interventions Conducted

Measure of success Process/Outcome Evaluation Systematic Steps, Best Measure of Success

Closing Thoughts


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Objectives

At the completion of this session scholars will:

Explain how the needs of PLWHA were

assessedDescribe how AIDS Services Foundation

(ASF) has conducted a successful program

with PLWHADiscuss how the success of ASF HIV

prevention program with PLWHA is

measured


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Positive PreventionsBackdrop

Prevention efforts focused on HIV-negative

Emphasis on care/support services to PLWHA

Many factors point to the need for

interventions designed for PLWHA


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Positive PreventionsBackdrop - Factors

Need for interventions for PLWHA

Increasing number of PLWHA

High rates of infection in communities ofcolor; resurgence of HIV in somepopulations

The HAART impact


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Maintenance of low-risk behaviorchallenge

HIV transmission prevention environmentis increasingly complex

Increasing number of PLWHA are living

and coping well with disease challengesOccasional lapse into unsafe behaviors


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Prevention burnout

Depressive symptoms and increased rates ofunprotected sex correlation

HIV treatment optimism

Reinfection/Superinfection confusion

Viral undetectability = reduced infectivity

confusion


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Positive PreventionsLogic of Preventions for PLWHA

New infections involve an HIV-infectedindividual

New infection can be prevented byintensive efforts directed toward populationcapable of transmission


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Positive PreventionsLogic of Preventions for PLWHA

Prevention efforts directed toward PLWHAneed to:

Encourage healthy sense of responsibilitywithout assigning blame

Support a lifestyle that includes a fulfilling sexlife

Support the enhance of interpersonal andcommunity relationships


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Community Needs AssessmentOrange County Health Care Agency (OCHCA)

Objectives:

Describe the risk and/or protective behaviors ofindividuals not receiving HIV preventions services

Describe knowledge and perceptions regardingHIV and HIV risk

Determine HIV prevention needs, met/unmet


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Needs Assessment Outcomes Focus:

Demographics

HIV knowledgeDrug risk behaviors

Sexual risk behaviors

Perceptions about HIV

Barriers to service utilization


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Needs Assessment Results:

Particular behaviors pose risk for HIV

MSM prioritized as high-risk behavioral riskgroup

Continued misperception of HIVtransmission


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Needs Assessment Results:

Inconsistent condom use with casualpartners

Drug-use prevalence contributing toincreased high-risk behaviors

Perceived risks differences depending onacculturation levels


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Community Needs AssessmentOCHCA PLWHA Needs Assessment

Prevention efforts for PLWHA need be tailoredspecifically to their needs:

HIV treatment education workshops

Community-building activities for specific groups

General health and wellness support delivered inindividual or small-group settings


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Substance abuse service sensitive to PLWHA need

Info and support for sero-discordant couples

Greater availability of mental health services

Peer-led support and information groups


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Skills-building workshops for positives

Individual and/or group counseling focused oncontextual factors that influence risk

Interventions that focus on relationship dynamics

Peer and professional support in dealing withsexual compulsivity/sex addiction


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Community Needs AssessmentAIDS Services Foundation PLWHA Needs Assessment

Objectives:

Establish appropriate goals, objectives,

activities

Define purpose and scope

Identify social and behavioral attitudes


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Objectives:

Identify HIV transmission risk/protectivefactors

Identify PLWHA perceptions of risk

Establish basis for evaluation

Establish community-based support


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Sources:

PLWHA, Consumers and Gate Keepers

Agency staff

Community partners

OCHCA (local DOH)


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Additional data as resource:

Socioeconomic and demographic status; Currentstatistics and trends involving HIV/STD

Existing gaps in HIV programs and services

Social indicators that indicate HIV/STD prevalence

Identification of program/resources for PLWHA


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Data collection strategies:

Informal

Frequent conversations with colleagues andclients

FormalStrategic Planning meetings

Focus Groups


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Results:

Many HIV-positive persons live with

multiple diagnoses

Health care adherence and HIV

transmission prevention are not primaryconcern


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Results:

High-risk behaviors are not exclusive to

those who struggle with poverty, stigma,mental illness

Some risk behaviors transcend class,economic status and demographic group


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A comprehensive approach to prevention withpositives must include strategies intervene withhigh-risk behaviors

Include strategies for engaging out-of-care HIV-infected persons into care

Reality of limited resources means communitiescan not provide entire range of possibleinterventions


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Factors that place any HIV-positive personat risk for transmitting the virus are often

highly individualized

Beyond simply identifying risk behaviors, it

is important to gain understanding of theplace these behaviors hold within thecontext of each individuals life


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Community Needs AssessmentASF Characteristics of Effective Programs

Structuring programs around the specificculture, behaviors and circumstances of

PLWHA

Emphasizing incremental, achievable steps

towards behavior change

Providing multiple contacts with clients


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Structuring interventions to provide bothindividual and small-group work

Using harm reduction based approaches

Maintaining a dynamic balance betweenpeer support and use of professional staff


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Focusing on client-defined motivators as a basisfor creating change

Using behavioral objectives that are specific andachievable

Factor effects of multiple diagnoses on motivationand behavior change

Include relapse prevention


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Successful prevention programASF Mpowerment EBI adaptation for (MSM) PLWHA

Formative research led to the adaptation andimplementation of a Mpowerment EBI for (MSM)PLWHA

Mpowerment is a peer-led community levelintervention

Through Mpowerment large numbers of PLWHAare reached in a cost-effective manner because itoperates on the community level


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Mpowerment is designed to be tailored tothe characteristics of every community

Based on interrelated Core Elements thateach community can adapt


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Adapted for MSM PLWHA, the Mpowermentintervention mobilizes individuals

to shape a healthy community for themselvesBuild positive social connections

Support safer sex


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Two programs were implemented:

Positive Life Force

English-speaking HIV-positive MSM

Hombres Por La Vida

Spanish-speaking HIV-positive MSM

S f l h


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Successful prevention program with

(MSM) PLWHA

Spanish-speaking

HIV-Positive MSM Program

English-speaking

HIV-Positive MSM Program


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Successful prevention programLevels of Interventions for (MSM) PLWHA

Various Levels of Interventions

They provide different opportunities forworking with positives and theircommunities

They facilitate various types of support andopportunities for growth


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Individual interventions

Allow the development of a collaborativerelationship

Assist clients in making plans for individualbehavior change and ongoing appraisals oftheir own behavior


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Provide safe space to explore sensitive topics

Enhancing clients self awareness of HIV riskbehavior

Discussing options for risk and harm reduction Demonstrating and practicing techniques for risk

reduction (e.g. barrier demonstration, cleaningneedles)

Role playing for condom negotiation

Making appropriate referrals to HIV preventionand other supportive services


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Group-level interventionsAllow for exchange of ideas, experiences, support,

resources

Enhance communication skills and receive feedbackMonthly Positive Voice (Core Group) Meeting where

PLWH provide input and direction for the programdesign and implementation of workshops, socialactivities and community building events.

Positive Voice Group members become empowered asthey take part as decision makers, help provide inputand feedback and assist the program to remain client-centered.

f l


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S f l


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Health Communication/Public Information

Provide peer education, support, skills training

Promote and reinforce safer behaviors


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Previous HCPI:

A Reality Check HIV Disclosure, Who? When? Where? How?

Party Smart HIV Meds and Drug Interactions Passionate Living Become your greatest self-advocate

Understanding your labs

Take all your meds Building Adherence

Your new life stage Life after HIV diagnosis, what next?

Living Well with HIV

Living Happy Managing HIV & Depression


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Community-level intervention

Allow for community-wide events, which serveas an effective compliment to individual andgroup-level interventions

Seek to change normative community attitudesand behaviors, providing opportunity for thediffusion and support of lower risk behavior


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Measure of SuccessIndividual-Level Intervention Program Evaluation

By June 30, 2009, the HIV-positive MSMprograms will conduct a minimum of ninety(90) risk reduction counseling sessions, andmake referrals when appropriate, to aminimum of thirty (30) unduplicatedEnglish-speaking individuals and a

minimum of thirty (30) unduplicatedSpanish-speaking individuals

Evaluation indicator: Health Education/Risk


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Measure of SuccessGroup-Level Intervention Program Evaluation

By June 30, 2009, the HIV-positive MSM programs willconduct ten (10) English Core Group meetings and ten(10) Spanish Core Group meetings, will recruit five (5)English speaking and five (5) Spanish speaking members

for the core group to obtain input and direction for theprogram design and implementation of communitybuilding activities Evaluation indicator: Meeting Logs, Sign-in sheets and core group

meeting agendas

After participating in core group meetings, eighty-percent(80%) of individuals will report a decrease in socialisolation due to HIV disease Evaluation indicator: meeting evaluation reports

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Measure of SuccessHealth Communication Public Info Program Evaluation

By June 30, 2009, the HIV-positive MSM programs willconduct fourteen (14) workshops to increase preventionbehavior, improve personal attitudes toward HIV andprevention and increase a sense of personal responsibility. Evaluation indicator: Sign-in sheets, curriculum, prevention

materials, pre/post assessment scores

After participating in the workshop, eighty-percent (80%)of individuals will demonstrate competency in utilizingitems in safe sex kits Evaluation indicator: safer sex competency check sheets

After participating in the workshop, eighty-percent (80%)of individuals will identify risk factors for HIV transmissionand appropriate risk reduction techniques Evaluation indicator: Pre/post test scores, skills competency check

sheets

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Measure of SuccessHealth Communication Public Info Program Evaluation

By June 30, 2009, the HIV-positive MSM programs willconduct ten (10) English Core Group meetings and ten(10) Spanish Core Group meetings, will recruit five (5)English speaking and five (5) Spanish speaking members

for the core group to obtain input and direction for theprogram design and implementation of communitybuilding activities Evaluation indicator: Meeting Logs, Sign-in sheets and core group

meeting agendas


M f S


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Measure of SuccessCommunity-Level Intervention Program Evaluation

By June 30, 2009, the HIV-positive MSM programs willconduct two (2) community events, one in English andone in Spanish, to empower a a minimum of thirty (30)HIV-positive MSM individuals per event, and to increase

their awareness of HIV support services and related healthissues Evaluation indicator: meeting evaluation reports and sign-in sheets


M f S


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Measure of SuccessPLWHA Programs Evaluation

Describing the process of behavior changeis more than counting units of servicesdelivered

Documenting whether or not an HIV-

positive individual ultimately uses a condommay represent endpoint of an intervention;Such documentation does not fullyrepresent an interventions effectiveness

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The path to behavior change is complex and oftenelusive

No single evaluation strategy can capture theelements involved

Programs focused on producing behavior changerequire a wide range of evaluation strategies,embracing both quantitative/qualitative methodsof evaluation

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It is important to have an evaluation plan inplace as prevention with positives aredesigned and implemented

Effectively evaluating prevention withpositives programs will be very challenging.

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Carefully evaluating a program affordsopportunities to improve, redesign, or eveneliminate, aspects of the program

Success of a program can be determinedby an effective, objective evaluationcombined with a willingness to modify andimprove based on community need,participant feedback, and scientific merit.

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To best measure the success or ourprograms we have developed programevaluations that require systematic steps:

1. Formulating evaluation questions

i.

To what extent did the program achieve itsgoals and objectives?

ii. Were the activities implemented as planned?

iii. Which features were most/least effective

M f S


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2. Setting standards of effectiveness

i. Deciding on info needed to provideconvincing evidence of a programs

effectiveness

ii. Must be purposeful, Realistic and Measurable

3. Designing the evaluation

i. How many/when measurements should bemade?

ii. How many groups or persons should be

included in the evaluation?

M f S


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4. Collecting data

5. Analyzing data

6. Reporting the results


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Closing Thoughts

Focus onthe HIV-positive community

as a crucial playerin the prevention of HIV

is key.

Without programming for PLWHAHIV prevention would be incomplete.

Successful HIV Prevention Programming for HIV-Positive MSM

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