| |
Highlighted HIV Prevention Programs at Natl Conference
|
| |
| |
2005 National HIV Prevention Conference
June 12-15, 2005, Atlanta, GA.
Summaries of Highlighted Research
Tuesday, June 14, 2005
Using social networks to reach high-risk individuals for HIV infection in communities of color.
[Presentation M3-D0604]
Reducing Risk Behavior in HIV Positive and HIV Negative Populations
SENORITAS: A peer organizing program for reducing HIV/AIDS risk in college-age Hispanic and Caribbean women.
[Presentation TP-047]
The women's health project: The efficacy of an integrated intervention for HIV-positive women with histories of child sexual abuse.
[Presentation TP-046]
Perinatal HIV prevention in a correctional setting: Florida's targeted outreach for pregnant women act (TOPWA) jail program.
[Presentation M3-C0502]
Using social networks to reach high-risk individuals for HIV infection in communities of color
HIV-positive and high-risk individuals of color can play a significant role in encouraging people in their social networks to seek HIV counseling and testing
People of color are at high risk for HIV infection, yet almost half of Latinos and one-third of African Americans report never having been tested for HIV. Lisa Kimbrough and colleagues from the Centers for Disease Control and Prevention (CDC) report on a demonstration project, launched in 2003, involving HIV-positive and high-risk persons in communities of color who reach out through their social, sexual, and drug-using networks to encourage their peers to seek HIV counseling and testing services.
Outreach workers from nine community-based organizations worked to enlist HIV-positive and high-risk individuals to become recruiters. Recruiters were chosen based on their abilities to serve as role models and deliver positive messages about HIV counseling and testing. Because these individuals are regarded as trusted sources of information within their networks, they are able to reach many people who might not otherwise seek testing. In the first year of the program, these recruiters referred more than 800 of their peers who were at risk for HIV infection to HIV testing services.
Program staff help the recruiters determine who in their social, sexual, or drug-using networks may be at high risk for infection, and then coach them on effective ways to discuss and refer them for HIV testing. Once the recruiters have identified people who want to be tested, they refer them to outreach workers for HIV counseling and testing. Recruiters bring in an average of six people before leaving the program, and new recruiters are continually enlisted from those who have come in to be tested, broadening the network of people who can then be reached.
Kimbrough and colleagues report that 133 recruiters in seven cities - Philadelphia, New York City, Boston, Orlando, San Francisco, Washington, DC, and Lafayette, La. - referred 814 high-risk individuals for counseling and testing during the first 12 months of the program. Of those,
46 were newly diagnosed as HIV positive, representing a prevalence of 5.7 percent - almost six times that seen overall in publicly funded HIV counseling and testing sites. The project team believes this demonstrates the value of a targeted approach. To date, outreach workers have linked 51 percent of people testing positive to medical care and prevention services. Based on these promising early results, Kimbrough and colleagues have developed a training curriculum on these effective recruitment strategies and interviewing techniques. They hope to expand this program into other communities, and are working to develop materials to help other organizations integrate this approach into existing counseling and testing services.
Reducing Risk Behavior in HIV Positive and HIV Negative Populations
A range of research on effective prevention programs will be presented at the 2005 National HIV Prevention Conference in Atlanta, GA this week, including the first comprehensive review of prevention interventions specifically for people living with HIV.
CDC researchers found that these programs reduced occurrence of unprotected sex by an estimated 43 percent. Researchers also examined the characteristics of effective interventions and found that programs delivered by health care providers as part of routine medical services were generally most effective (Presentation TP-050).
Similarly, multiple programs for HIV-negative populations will be highlighted, including a group intervention for HIV-negative, African-American MSM. The program, "Many Men, Many Voices (3MV),"has been shown to reduce the frequency of unprotected sex in this population and is being carried out by community organizations across the country.
The 3MV program comprises six weekly facilitated discussion sessions which include HIV prevention information, role-playing, group problem solving, and discussions that address the attitudes and beliefs that impact African-American MSM and their sexual practices (Presentation M1-C1204).
In addition, community organizations and health departments are collaborating with CDC to expand the use of four specific interventions shown to reduce sexual risk behaviors among HIV-positive and HIV-negative African-American women. Through individual and group counseling sessions, these programs improve women's sexual health communications skills, enhance skills in correct condom use, and work to help African-American women build the self-worth and confidence needed to take control of their health.
SENORITAS: A peer organizing program for reducing HIV/AIDS risk in college-age Hispanic and Caribbean women
Student peer educators offer HIV prevention education tailored to at-risk college-age Hispanic and Caribbean women
To help address the unique prevention needs of Latinas, Dr. Sande Gracia Jones and colleagues at Florida International University (FIU) created a peer education program that provides culturally specific HIV/AIDS information to female Hispanic and Caribbean FIU students. The program is called "SENORITAS"(Student Education Needed in Order to Reduce Infection and Transmission of AIDS/HIV and STDs) and is funded by the Office on Women's Health, Department of Health and Human Services.
The program was developed based on formative research on the specific information needs and barriers to HIV and STD prevention among FIU students. While originally conceived as an intervention for Hispanic women, the curriculum was expanded to address the needs of a broad range of Caribbean women in response to substantial student interest.
SENORITAS was implemented last year by 32 senior nursing students who volunteered to be trained as HIV prevention peer educators. The program consists of a single, three-hour group session led by a pair of peer educators. The session begins with a story based in south Florida and grounded in Hispanic culture and the importance of amigas (friends). The story relays a discussion between several female college students about how gender, ethnicity, misperceptions, and HIV risk collide in the context of the college experience.
Details of the story introduce topics later addressed in group discussions, including the impact of gender on safer sex (for example, the pressure for women to remain virgins until marriage, while men of the same age may be expected to be sexually active and not monogamous); why fidelity may not protect you from HIV or STDs if your partner is not monogamous or is infected; the risk of misperceptions about who can be HIV positive ("Oh, he could not have HIV because....he is so cute....he drives a nice car....he goes to college,"etc.); deciding not to have sex at certain times or in certain situations; and HIV risk associated with various sexual behaviors, including oral and anal sex, which are sometimes practiced by young women who identify as virgins. Peer educators provide information on building support networks and strategies for empowerment within relationships, including negotiating condom use.
Program participants were asked to complete HIV knowledge and attitude assessments prior to and immediately following the intervention, and at three months follow-up. Among the 169 students who completed pre- and post-tests during the first year of the program, researchers documented significant improvements in knowledge related to HIV risks and prevention strategies. This increase was sustained at three months among the 95 students completing the follow-up assessment. Self-reported condom-use skills were also assessed among a subgroup of 60 students who participated in the program, and participants reported significant improvements following the sessions.
Follow-up with the peer educator nursing students also demonstrated significant increases in their comfort level in teaching HIV prevention. Jones and colleagues hope to expand the SENORITAS program for use by other ethnic groups, young men, and couples. This year they are targeting sororities and have developed a pilot session for fraternities.
The women's health project: The efficacy of an integrated intervention for HIV-positive women with histories of child sexual abuse
First prevention intervention focusing on HIV-positive women with histories of childhood sexual abuse effectively helps participants maintain risk-reduction behavior over time, clinical research shows
Women who have a history of childhood sexual abuse (CSA) are significantly more likely to engage in unprotected sex and other HIV risk behaviors than other women. In some studies, as many as half of HIV-positive women report a history of CSA, compared to one-third of HIV- negative women. To address the unique challenges faced by these women, Dr. Gail Wyatt and colleagues from the University of California, Los Angeles, and the Centers for Disease Control and Prevention developed and evaluated the first program specifically designed for HIV-positive women with a history of CSA. Results from a phase I efficacy study of the intervention demonstrate that the program resulted in significant reductions in sexual risk behavior.
Because of the disproportionate impact of HIV/AIDS on women of color, Dr. Wyatt and colleagues chose to tailor their intervention, called the Enhanced Sexual Health Intervention (ESHI), to address the needs of African-American women and Latinas. ESHI comprises small groups (six to eight women each) that meet weekly for 11 two-and-a-half hour sessions. Trained facilitators and peer mentors who are HIV-positive CSA survivors lead the sessions, offered in both English and Spanish, which address HIV risk behaviors, interpersonal skills, general health behaviors, and psychological symptoms of CSA. Participants are taught strategies for self-esteem building and risk reduction, and for decision-making about issues such as partner selection, negotiating condom use, drug and alcohol use, accessing appropriate health care, and improving adherence to antiretroviral therapy.
To evaluate the program, researchers conducted a randomized phase I efficacy trial, which enrolled 147 HIV-positive women with a history of CSA (54% African-American, 40% Latina, and 6% white). Trial participants were randomized into two arms - 67 women received ESHI, while the other 80 were assigned to a control group, which received basic brochures on HIV prevention and CSA and participated in a single-session group meeting.
Interviews were conducted immediately following the conclusion of the intervention, and again three and six months later. Results indicate that women in the ESHI group were about 1.5 times more likely to report sexual risk reduction - including increased or 100 percent condom use - than women in the control arm. Follow-up interviews revealed that 83 percent of participants in the ESHI arm had maintained sexual risk-reduction behaviors at 3 months and 78 percent at 6 months. Control group participants were also offered the intervention at study's end.
Contrary to expectations, ESHI did not significantly improve medication adherence overall. Women who attended at least eight of the total 11 sessions were significantly more likely to report adherence immediately following the intervention, but not at the three- and six-month follow-up.
Study authors believe the findings clearly demonstrate the effectiveness of the intervention in helping HIV-positive women with histories of CSA maintain sexual risk reduction. However, it appears that additional ongoing support may be needed to assist these women with long-term treatment adherence. Wyatt and colleagues have developed materials and a training program on the intervention, which they hope to disseminate to community groups providing services to HIV-positive women. They are also testing a comparable intervention designed to promote sexual risk reduction among HIV-positive African-American and Latino men who have sex men with a history of CSA.
Perinatal HIV prevention in a correctional setting: Florida's targeted outreach for pregnant women act (TOPWA) jail program
Florida program links incarcerated women with prenatal care to improve pregnancy outcomes and reduce perinatal HIV transmission
Most incarcerated women are of childbearing age, and data from the U.S. Department of Justice indicate that approximately six percent are pregnant at the time of their incarceration.1 These women are often at increased risk for HIV infection, and may be unable or unwilling to seek prenatal care when pregnant. Frances Walker and colleagues at the Florida Department of Health, Bureau of HIV/AIDS, report that a newly launched program in Florida jails is successfully linking incarcerated women in four counties with needed prenatal care, contributing to a significant reduction in mother-to-child HIV transmission and improved pregnancy outcomes in this population.
The jail program is part of a larger effort mandated by Florida's Targeted Outreach for Pregnant Women Act (TOPWA) of 1999, which seeks to link the estimated 2,000 pregnant women statewide who do not receive prenatal care and are at risk for delivering an HIV-infected or substance-exposed infant, to needed services. Through the jail program, TOPWA outreach workers screen female inmates for program eligibility; provide free, voluntary HIV and pregnancy testing; assess each woman's needs for health and social services; and provide education about HIV/AIDS prevention, sexually transmitted diseases, substance abuse and domestic violence. The program follows all pregnant women until the time of birth and links participants to any post-release services needed, including ongoing prenatal care, the AIDS Drug Assistance Program, Medicaid, immigration assistance, housing assistance programs, substance abuse treatment, and domestic violence services. HIV-positive women are followed until confirmation of the infant's HIV status.
According to Walker, the TOPWA jail program screened more than 5,100 women for eligibility between February 2002 and December 2004, all of whom were provided with basic HIV prevention information. Of these, over 2,500 (pregnant and non-pregnant) women were tested for HIV, 75 (3.1%) of whom were HIV-positive. Overall, 515 pregnant women were enrolled in the program, including nineteen known HIV-positive women. Almost 40 percent of the pregnant women enrolled had never previously accessed prenatal care.
In addition to linking all pregnant women to prenatal care, the TOPWA program works to ensure that HIV-positive participants are educated about the use of antiretroviral drugs (ARVs) to reduce the risk of transmitting the virus to their infants. HIV-infected women are then linked to healthcare programs that can provide treatment before and at the time of delivery. As of April 2005, 16 of the 19 HIV-positive women in the program had delivered their babies, with only one infant (6%) reported to be HIV-infected.
Routine HIV testing and counseling has been recommended for pregnant women in the U.S. for more than a decade, and the use of antiretroviral drugs has contributed to significant reductions in perinatal HIV transmission. The estimated number of children born with HIV has declined from 1,000-2,000 cases per year in the early 1990s to an estimated 280-370 cases today.2,3 Study authors believe the program has helped many HIV-positive and substance-abusing women overcome prior barriers to seeking prenatal care, including a lack of health insurance and a fear of losing their infant to social services. The first TOPWA-funded jail program was piloted in Palm Beach County in 2002, followed by the implementation of jail programs in Orange (Orlando), Hillsborough (Tampa), and Miami-Dade (Miami) counties. In counties with a TOPWA outreach program but without a funded jail program, outreach staff work with jail administrators to receive referrals of and link pregnant women to needed services upon their release. The Florida Department of Health hopes to expand the TOPWA program to other communities in the future, and plans to incorporate rapid HIV testing into current jail programs to increase the number of women who receive test results and necessary referrals prior to release.
|
|
| |
| |
|
|
|
