Browsing Category: GENERATIONS

Hurting or Helping? My Story from IAC

by Dafina Ward, Project Manager, Beauty in Knowing
AIDS Alabama

On July 24,  I had the honor of attending the “AIDS in America” forum at The Washington Post.  Sponsored by the Ford Foundation, the event featured some of the nation’s leading experts and decision-makers in the areas of HIV/AIDS and health.  U.S. Surgeon General Regina Benjamin, Black AIDS Institute CEO Phill Wilson and acclaimed physician Dr. Anthony Fauci were among the speakers.  Also among them was my own CEO, Kathie Hiers, who also serves on President Obama’s Advisory Committee on HIV/AIDS (PACHA).  Following the panel discussions, Secretary of U.S. Department of Health and Human Services, Kathleen Sebelius, spoke on the topics during a one-on-one interview with Jonathan Capehart (one of my favorite MSNBC contributors).  Like I said, this event was a big deal.

With all of the acclaimed speakers and experts on hand, I expected to learn more about the future of AIDS in America, to leave reassured that we are moving in the right direction in addressing health disparities, to gain insight into the reality of an actual “cure”.  And I did gain all of those things—and more.  What did I not expect was to leave questioning the way I do my work.  But at the end of the day, I was left with a sense of guilt and a nagging feeling that maybe well-intentioned prevention workers are a part of the problem in communities at greatest risk.

That probably sounds really crazy.  I mean, how could that be?  We “target” populations at “highest risk” and equip them with the tools that should lead to less “risky” behavior.  But through our characterization of the people we serve as “troubled”, are we in essence part of the problem?  Unbeknownst to us, we sometimes approach our work as though there is something inherently wrong with the people we serve, as though they are “less than” and that they are in need of repair.

I came to this thinking as I reflected on my own experiences.  I facilitate an intervention, Beauty in Knowing, which services African-American women who are enrolled in cosmetology school.  The program provides five sessions addressing HIV/STI prevention, condom negotiation, assertiveness, and a host of other topics relevant to our participants.  Several months ago during class a participant posed an interesting question.  She asked why African-American women were always being discussed as though they were “THE” problem when it comes to HIV. Why weren’t the men they were sleeping with being made accountable through programs such as this?  Are prevention programs trying to say that African-American women are more promiscuous than other women?     Now of course I explained to her that our program was about empowering women.  That the HIV rates in our community reflected a need for targeted interventions that empower African-American women (In Alabama, African-American women are becoming HIV positive at a rate of 9.5 to 1 when compared to Caucasian women).  In that moment I thought that I had adequately reflected upon and responded to her question.  But perhaps not.

Dr. Vignetta Charles of AIDS United was also a speaker at the AIDS in America panel, and a point that she made gave me pause as it took me back to my participant’s barrage of questions months ago.  Dr. Charles made the point that African-American women are not becoming infected at higher rates than other women because they sleep around more or take more risks than others.  It is truly about who these women are sleeping with.  An African-American woman is more likely to become HIV positive during one unprotected sexual encounter with an African-American man, than a Caucasian woman who does the same with a Caucasian man.   Of course I haven’t done formal research to support that theory, but it makes complete sense.

In our program women often report being in sexual relationships with men in their communities who have multiple female partners.  They also express being uncomfortable discussing condom use with their partners—let alone making it a requirement.  Imagine if these women felt empowered to establish such a requirement with their partners.  Imagine if these women felt empowered to remove themselves from relationships where they know their partner is sleeping with other women.  Imagine these women being made to feel that they are part of the solution in the fight to end HIV/AIDS and not the problem.

So what I will take away from the International AIDS Conference is the necessity of true community engagement in fighting the spread of HIV in my community.  We often talk of community participatory research and program development.  But what if we truly empowered the communities we serve to see themselves as the key to stopping the virus—rather than problems that we desire to “fix”.   We can end the spread of HIV and turn the tide in our communities, but we must truly do it together.

Dafina works on AIDS Alabama’s “Beauty in Knowing” project as part of AIDS United’s GENERATIONS initiative supported by Johnson & Johnson.

Helping Latinas in San Diego Prevent HIV

by Veronica Tovar,  MPA
HIV Research and Education
Chicano Federation

For the past five years, Chicano Federation has been conducting the National HIV Behavioral Surveillance (NHBS) in San Diego. NHBS is a Center for Disease Control and Prevention (CDC) program that interviews populations at risk for HIV to track behavioral trends in twenty-one cities in the U.S. with the highest HIV prevalence.

During counseling and testing sessions through this project, Chicano Federation found that many Latinas had never been tested for HIV.  Furthermore, many shared that their male partners were engaged in extramarital affairs, but continued to have unprotected intercourse.  Quite a few others shared that they did not know whether their partner was monogamous.  Both Latinos and Latinas, usually the older, lower-economic status couples, revealed not knowing how HIV is transmitted or how to use a condom.

According to the CDC, Latinas represent nearly one quarter (24%) of new HIV infections in the U.S. (CDC, 2010).  When compared to the United States, California and San Diego County had the largest proportion of Hispanic HIV cases (Epidemiology Report, 2010). In 2003-2007, the most common mode of HIV transmission in females was heterosexual contact (75% of all cases). Additionally, according to the CDC, high HIV risk in heterosexuals is linked to regions of high poverty and high STI rates.

In response to these overwhelming findings, with the financial and technical support of AIDS United and Johnson & Johnson, Chicano Federation created the De Mujer a Mujer curriculum (From Woman to Woman).  This unique health curriculum specifically aimed at educating traditional, mono-lingual, migrant Latinas living in one of five high-risk zip codes in San Diego, structured to cover a wide spectrum of health issues with the end goal being to de-stigmatize HIV and empower women to take control of their sexual relationships, get tested for HIV, and start making better decisions related to their own overall health and their children’s health.

AIDS United and Johnson & Johnson provided the opportunity to create an innovative program by allowing a formative and pilot phase prior to implementation.  Staff found that in order to address HIV, some basic needs and issues must first be acknowledged.  The curriculum was designed to address the overall encompassing needs of women, and gain trust and confidence before indulging in the taboo subjects of sex, HIV, and communicating with partners and children. The model consists of seven sessions, as follows: 1.Information/Introduction, 2. Gender empowerment, 3. Healthy relationships, 4. Reproductive anatomy, 5. HIV/STI 101, 6. Communication, and 7. Graduation. The three main objectives are 1. Increase self-efficacy and a personal sense of empowerment 2. Improve inter-personal communication skills, and 3. Improve safe sex practices through sexual health knowledge.

In 12 months Chicano Federation has held 63 weekly sessions for 128 women.  Of those 128 Latinas who participated, 112 graduated with 88% having attended all of the seven weekly sessions.  The comparisons of pre- and post- evaluations show statistically significant, positive improvements in all three areas.  More Latinas are getting tested for HIV and using condoms as a result of this intervention. But perhaps the most interesting results come from personal testaments to the impact that this program has had on the individuals.  Many participants have shared stories of how their participation in De Mujer a Mujer has acted as a catalyst for healthier choices in their lives.  The participants start showing positive improvements in their appearances, they share stories of terminating unhealthy relationships, have fun explaining the creative ways they have introduced condoms in their sex lives, and their experiences of communicating about safe sex with their children, to name a few.  The letter below from a De Mujer a Mujer participant explains both the impact and the continued need for this intervention in our community.

“I want to thank the instructors in the De Mujer a Mujer for giving me the opportunity to attend their class…The exercises we did in class were fun and smartly put together and I found myself laughing but at the same time really thinking about the impact it could make in my everyday life.  I was surprised that the Latinas in our community are still not informed about HIV and the myths they still hear.  I believe our culture has a lot to do with it.  I hope De Mujer a Mujer continues and more Latinas are aware of it because it is greatly needed in the Latina community.  I’m definitely telling every Latina in the community I come across about De Mujer a Mujer.” –Adriana Lopez

Two years ago, Chicano Federation went through a change in leadership, something that had not happened in 20 years.  This change, along with the support from AIDS United, has allowed Chicano Federation to invest in innovative projects like De Mujer a Mujer; it has provided the opportunity to bridge the gap between HIV research and the social services it provides to the community.  The creation of the program, not only brought new energy to the organization, but also to the community at large.  Stakeholders and media alike welcome the opportunity to learn more about De Mujer a Mujer, despite the difficult subject, and they are eager to help make this program succeed.  Chicano Federation and this program are being viewed as a model to delivering mission driven services in a relevant and effective way. Chicano Federation now has social services for HIV prevention and has demonstrated success implementing an innovative project.  Thank you AIDS United and Johnson & Johnson for this wonderful journey!

The 2011 GEN III Grantee Convening Helps Bolster Skills, Invigorate Staff

by Veronica Tovar MPA
HIV Research & Education,
Chicano Federation

We at the Chicano Federation of San Diego, Inc. have been thrilled to be part of AIDS United’s groundbreaking program called GENERATIONS:  Strengthening Women and Families Affected by HIV/AIDS.  The GENERATIONS program supports new evidence-based interventions or adaptations of existing prevention models for specific populations of women and girls at high-risk for infection, utilizing a combination of cash grants, technical assistance, grantee convenings and evaluation support.  Chicano Federation is one of six grantees in the third cohort of GENERATIONS (GEN III)  grantees, all of whom gathered in Washington, D.C. November 2-3 to discuss the progress of each grantee’s project, support each other with input and ideas, and to rejuvenate.

Chicano Federation’s GENERATIONS grant helped us create the De Mujer a Mujer Project (From Woman to Woman) in response to the need for HIV prevention targeting primarily monolingual Spanish speaking, migrant, Latinas from traditional backgrounds.  To target the most at risk Latinas in San Diego, demographic maps demonstrating the areas with the highest STI and poverty rates, created by the California Department of Public Health, Office of AIDS, were utilized. Participants must be Latina, ages 18 and over, sexually active (had unprotected vaginal or anal sex with a man in the past 6 months), must be HIV negative, or not know HIV serostatus, and live in one of five zip codes in the central region.  The project was piloted for four months, and then began implementation in January, 2011.  To date, over 100 women have participated.

At the convening, GEN III grantees were given tips on how to write abstracts, a task that Chicano Federation really needed some help in doing so we could better  present our success to the community.  We were then assigned to begin writing an abstract, on the spot, with our team.  This activity was incredibly helpful.  Since Chicano Federation had not previously had an HIV prevention project, it also lacked the experience of writing competitive abstracts.  We left the conference feeling capable and better prepared.

The AIDS United staff also gave us tips on funding sustainability.  During a time when funding is scarce, it is very important to have a realistic discussion about the next steps.  AIDS United Victor Barnes, Angela Von Croft, and Maura Riordan, took the time with the program managers to have candid discussions about funding possibilities.  For me, it helped to give greater clarity on what the best options are for my agency.  Having little experience in generating funding, I left the convening with a plan of action.  The technical assistance team conducted another important and final activity, addressing each grantee’s project individually, and explaining what portion of the GEN III proposals caught the attention of funders, and what almost took us out of the running.  Having funders tell you exactly what was good and not so good about your proposal is rare but unbelievably beneficial to us!  This type of interaction is a perfect reflection of how much the funders truly care about the grantees and their work.

Moreover, just being with a group of people who are all implementing wonderful projects to better the lives of underserved women is inspiring in and of itself.  Chicano Federation was striving to create a prevention project for Latinas; GEN III made our dream come true.  It is incredibly fulfilling to have participants share how this project has positively impacted their lives.  They get out of abusive relationships, they learn how to use a condom for the first time, and they feel better about themselves.  Thank you GEN III for making such a huge difference in our community!

What Makes AIDS United’s GENERATIONS Program Unique?

Stephanie By Stephanie Cruse
Program Officer

I will be presenting a poster today focusing on GENERATIONS: Strengthening Women and Families Affected by HIV/AIDS. It is a capacity-building program for community-based organizations to create or adapt evidence-based interventions for at-risk populations of women, primarily women of color. Since 2005, Johnson & Johnson has supported GENERATIONS, and our latest cohort (GEN III) includes six grantees, funded for a period of 28 months.

So what makes GENERATIONS unique? GEN is an innovative prevention program because in addition to cash grants, we provide a technical assistance component, led by a team of HIV prevention scientists from the Health Equity Institute at San Francisco State University, and we also provide a local evaluator to create an evaluation plan and measurement tools, and to analyze progress towards key outcomes.

The structure of GENERATIONS is also unique. In GEN III, grantees began with a four-month Formative Phase, which allowed program staff to work intensively with their TA providers and evaluators in adapting or creating their interventions, run focus groups, and refined their target populations and projects. The final product at the end of the Formative Phase is their intervention’s curriculum. A four-month Pilot Phase followed, in which organizations conducted two pilot cohorts to test out their intervention, and to receive any feedback around any changes to be made. The curriculum is finalized at the end of this phase, setting the stage for a full 20 months of implementation during the Implementation Phase.

AIDS United’s poster at the National HIV Prevention Conference focuses on this unique model and the benefits of technical assistance to community-based organizations. I’ve personally seen our TA providers in action during grantee site visits, and the amount and quality of work that happens during the visits is inspiring. It’s not your typical funder site visit – it’s intensive, roll up your sleeves kind of work, to conduct problem solving, and offering real-time problem solving to these common and inevitable challenges. GEN is a very intensive grant, and our 6 funded organizations have truly stepped up to the task of putting in long hours creating or adapting an intervention, and working closely with both TA and evaluators to make the program successful.

Not only has the provision of technical assistance around the GEN program been invaluable to project staff, we have seen through all of the GEN cohorts that the programmatic technical assistance goes far beyond the individual GEN program. Through this grant, organizations and staff have gained knowledge and skills that can be used across prevention programming such as: basics of curriculum development; understanding adaptation of effective behavioral interventions; recruitment and retention of participants; implementation of evidence-based programs with fidelity; increased skills in dissemination, and program evaluation basics.

For more information, please come visit me today, Tuesday, August 16th from 12-1:30pm in the Poster/Exhibit Hall, space 142T!
 

Turning HIV Prevention for Girls “Inside Out!”

by Traci Callender
Bronx AIDS Services

Known as one of the epicenters for the HIV virus, New York City is home to more than 40,000 women living with HIV/AIDS (New York City Department of Health 2010).  Bronx AIDS Services (BAS) is located in the Bronx, New York, where the impact of HIV/AIDS has been disproportionate and deadly. Twenty three percent of all black female PLWHA’s in NYC who died in 2008 were from the Bronx and 43.8% of all NYC Latina PLWHA deaths were among Bronx female residents (NYCHOHMH 2008).

Since 1998, BAS’ GO GIRL program has provided sexual health-related services to adolescent girls and young women (ages 12-24) including community outreach; HIV/ STI prevention; HIV counseling and testing; substance abuse prevention counseling; peer leadership and education training and a youth prevention theater program. While the existing GO GIRL curricula more than adequately educated participants on HIV transmission and safer sex strategies, program staff recognizes that participants deal with additional risk factors that are not covered by the interventions, more specifically: lack of self-esteem, low familial expectations, depression, low self-efficacy, insufficient support systems, and a wide range of mental health issues. Armed with a clear gap in community needs versus resources and a grant from AIDS United’s GENERATIONS program, BAS has developed the Inside Out intervention which aims to address the needs of urban adolescent girls who are facing personal risk factors that are beyond the scope of our existing HIV/AIDS prevention curricula.

Inside Out is an eight week, 16 session HIV prevention intervention designed to take young women (ages 14-18) who already possess a basic level of knowledge about HIV risk factors and prevention strategies and provide them with a second level intervention that delves into their personal risk factors and triggers for risky sexual behaviors. The curriculum, developed by BAS with the assistance of the AIDS United TA team, consists of eight group sessions and eight individual sessions. The eight group sessions focus on maintaining optimal sexual health: assertive communication, sexual readiness, sexual coercion, healthy relationships, coping skills/resiliency, self-esteem building, goal setting, and gender roles and expectations. The general structure of each session includes an icebreaker, 2 or more activities followed by a discussion, journal writing, and a Facebook note. Participants also meet individually with a licensed clinical social worker, or Adolescent Wellness Coordinator, to reinforce concepts from group but also to discuss ongoing personal issues that may affect their ability to implement safer sex strategies into their lives.

Since the start of the grant, BAS has completed the curriculum and implemented services with 28 young women. By adding the Inside Out intervention to the services that BAS already renders to the targeted population, we have been able to retain some of the higher risk (and harder to reach) participants and engage them in discussions and activities that aim to guide them in maintaining optimal sexual health. Participants have reported looking forward to Inside Out as the next step in their HIV prevention education at BAS. After successfully completing Inside Out, 17 year old Tayanna commented “This is information that I can use, not just stuff to know.” Shawna, a 16 year old graduate of the program, stated “They should teach us this kinda stuff in school instead of Geometry. Maybe so many girls wouldn’t get pregnant or catch something even worse.”

The AIDS United grant has absolutely increased BAS’s ability to provide a more comprehensive HIV prevention program for one of the most vulnerable populations. Simply put, condom distribution and demonstrations does not begin to scratch the surface of HIV prevention with young women of color. Giving information does little when a person is not empowered to use it. Inside Out has afforded BAS the opportunity to have those difficult conversations with young people and aid them in identifying their personal barriers to protecting their greatest resource… their health.

For more information about the Inside Out program. please contact: Traci Callender at tcallender@basnyc.org.

GEN III Convening Informs and Inspires: A Grantee Perspective

by Dafina Ward,
Project Coordinator, Alabama Community AIDS Fund and Beauty in Knowing
AIDS Alabama

AIDS Alabama received a GENERATIONS III grant to support Beauty in Knowing, an HIV prevention intervention originally created to target African-American women in a beauty salon setting.  Due to key research funded during the Formative Phase of the grant, the intervention has since transformed.  In its current incarnation Beauty in Knowing is a five session intervention targeting African-American women studying cosmetology.  Research revealed a number of potential challenges that could hinder the impact of a salon based intervention.  Key informant interviews with salon owners, staff and clients guided this transition to a program that targets stylists-in-training before they actually enter the profession.  Data collected through a survey of cosmetology students and focus groups at area cosmetology schools revealed that students were anxious to learn accurate information pertaining to sexual health and HIV that they could share with their clients—and also utilize in their personal decision making.

Prior to arriving at the convening in Boston, we were nervous about having to present our program to the other grantees, National AIDS Fund (now AIDS United) and Johnson & Johnson.  AIDS United provided us with a great template to utilize in developing our presentation, but we were still uncertain of what the response would be to this change in our program.  We could not identify any prior HIV prevention interventions that had been focused in a cosmetology school setting.  We were concerned that the funder might not be enthusiastic about funding an intervention that could be perceived as a “risk.”  However, we were pleasantly surprised when AIDS United and Johnson & Johnson reacted very positively to the changes.  The positive feedback and suggestions provided by both funders, as well as the other grantees, was invaluable.  We learned once again that GENERATIONS is not your typical funding opportunity.  The funders are not focused on replication of the same old programs, with little concern for innovation.  Rather we (i.e., grantees and funders collectively) are engaged in a team effort to reach women of color in new ways with consideration given to the unique needs and cultures of our respective communities.

The significant amount of time spent discussing each of the grantees’ programs was the highpoint of the convening.  It was a unique opportunity to attend a convening and become immersed in the work being done by other grantees.  It not only gave us insight into what is happening in HIV in other parts of the country, but also provided us with fresh ideas and approaches for implementation of our own intervention.  We also benefited greatly from the sessions that addressed the specific roles of the project managers and facilitators of our programs.  By dividing programs staff in this manner it allowed for each person to gain new perspective on their role during implementation.  I gained a new appreciation for my role as a program manager as it pertains to supporting program facilitators and making strategic decisions regarding program staffing.  Our program facilitator stated that the facilitator training at the convening reinforced the “ingredients” needed for facilitating sessions effectively, including being prepared for unforeseeable issues during sessions.

As we move forward, Beauty in Knowing will benefit greatly from everything gained at the convening.  We are currently developing Procedures and Protocol for program facilitators to assist them with issues that arise during sessions.  We are also adjusting some of our exercises to incorporate some of the creative approaches shared by other grantees.

GENERATIONS III is a unique opportunity that not only benefits the program funded, but greatly influences an organization’s approach to HIV prevention.  As a result of the standard set by GENERATIONS, our prevention staff is planning to implement regular facilitator trainings for all of our interventions.