A Program of CIFAL Atlanta
Hosted by Emory Rollins School of Public Health
Atlanta, GA, June 19-23, 2005
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Session 1: Discussion about Self Assessment Process in Cities

Delegations: San Juan, San Pedro Sula, Atlanta, Seattle, Houston

What worked about the process?

San Juan

• Met with major professions for first time to discuss AIDS response; learned what they each contribute
• Assessment chart was a great tool to use as a starting point
• Group made a plan and has made a commitment to meet quarterly to implement the plan and reassess needs

Atlanta, GA

• Used the chart to articulate ways in which AIDS organization responses and the city’s governmental level of recognition and response would differ 30 – 40 % of the people attending the meeting were consumers

Seattle and Houston

• Didn’t meet – the letter got stuck in the mayor’s office

Changes for next time:

• Do additional homework to establish who needs to be point of first contact about the meeting (not necessarily the mayor’s office)
• Have each point of first contact identify who needs to be at the meeting (Need a strong HIV advocate from local government, consumers)
• Send information out six months in advance
• Enlarge the meetings to include a greater range of government, CBO, and consumers as needed (e.g. in Georgia, of the 23 counties in Metro Atlanta only Fulton County was represented – need more govt. representation.  San Juan wants more consumer involvement)

Adapting our response

Atlanta

Concern: Programmatic issues of prevention based on limited opinion leader involvement and limited capacity to foresee the future] How do we, as a community, keep our finger on the pulse of where the epidemic is going (e.g. moving into crystal meth. population) and adapt our response accordingly in a timely manner? We are good about educating people but less good about turning education into widespread policy and practice. We also have a persistent problem with gathering input and buy-in of locally important opinion leaders. 

Suggestion: Environmental Scan to spot emerging trends.

San Juan

Concern: Clinical issues of treatment based on limited financial resources. Adapting clinical treatment program to new trends in prevention and treatment because it brings good results from consumers but have to make cost-benefit decisions because don’t have large budget. Employees are in training all the time on the new trends. Policy is done by the state.  That can be slow so we act before it is a policy, as soon as we receive notification. Health department receives funds from HRSA, state, managed care etc. Are involved in clinical trials, go to conferences, search internet. Our health department faculty meet and discuss the new protocols and present to the administration (executive director of HD), who makes decisions based on money and impact (cost / benefit). Are spending $12M / year in medications? Need better utilization reviews.

Suggestion: Approach pharmaceutical companies for patient assistance programs

Honduras

Concern: Programmatic issues of prevention based on limited access to target audience. Currently offer a two day education program (funded by Global Fund and United Nations): Youth without boundaries. Purpose: Dissemination of information. Target people ages 12-24. Reach out to youth via schoolteachers, in three different regions. Use health educators to teach several seminars, for example about self esteem, discrimination, how to use a condom.  Work with both infected and uninfected. For infected, emphasis on teaching about disclosure. Have limited resources to offer infected people and resources are far away from where the training is offered. Do a post-test at 6 months of a participant sample (10%) to check for changes in behavior attributable to the intervention. Use teachers (who are locally important opinion leaders) for input and as liaisons. Need way to get more directly to children and via venues other than just schools.

Suggestion: Peer education. E.g. in San Juan -- work with three schools each year. One each: wealthy, middle, poor. Get popular kids (opinion leaders) to act as peer educators to go monthly to give seminar about different topics. At end of year they arrange for a talent show, drama, comedy on HIV prevention. Effective because of peer education.

Houston

Concern: Case management issues based on fragmentation of needed information and services. Problem accessing needed information; no central database of available services.  Need new strategies for case management.

Suggestion: Aggressive preventive case management (e.g. AID Atlanta); Houston version of Key Contacts.