First Annual Workshop and Conference

A Program of CIFAL Atlanta
Hosted by Emory Rollins School of Public Health
Atlanta, GA, June 19-23, 2005
• Workshop Home

Session 3: Best Practices Sharing: Peer assist reviews

Topic: Linking Care and Prevention

What would be the possibility of doing the computer risk assessment program in Mexico?

• There is currently work being done to translate the program into Spanish. The director of the program is willing to give away the software; the only thing necessary would be to buy the computers.

• Brazil doesn’t think the computer program would be replicable in her country because of people’s lack of education and familiarity with computers.

• Guyana thinks that such a program would be beneficial especially for the youth. In her health centers now, they try to attract youth (ages 6–18) by having computers and books in the waiting areas. She thinks it would be very successful to have the computer self assessment in the waiting areas for the youth to come in and do it themselves.

For Seattle, what types of human resources are necessary to ensure the counseling program for MSM?

• The requirement for sustainability would be both federal and private funding. Part of their money comes from federal organizations like the CDC.

How do other cities assess risk?

• Denver: has a sophisticated tool to assess risk which consists of a paper questionnaire of about 25 questions. They input this information into a database to help the patient keep plan/goals. They then create outcome measures specifically for the risk level of each patient.

• Trinidad & Tobago: Doesn’t feel they have the luxury to follow up with the issues that the poor with HIV face. For example, they have programs to aid with food, but they cannot address housing issues of a homeless patient. So the problem is that people could have access to the food, but nowhere to prepare it or cook it.

• Denver has an HIV specific food bank and a nutritionist which can meet one-on-one with a client. They also offer food classes to help the HIV patient dietary needs. Clients have choices for what foods they want. Houston also had a similar program, but had to discontinue offering patients with so many choices because of cost and now only offer a food box program plus one food voucher per month. The patient can take the voucher and buy food at a local grocery store. Houston spends almost $20,000 per month on this program.

• Seattle has a commercial kitchen offering 11 meals per week for 1,000 people.

• Haiti lacks funding for sustaining such programs. They have about 5 or 6 pilot programs, but they do not seem to be successful because these programs are not enough to sustain the patient plus their families i.e. although only one person in the family may be infected with HIV and receives assistance, they will share the food with their family and the end result is that patient still does not get enough food. They are thinking about trying a micro credit program to assist families in generating their own money.

• Trinidad & Tobago has a huge problem HIV-infected people with the mentality that if they’re sick, they are entitled to everything. They want the government to provide everything without working for it. Seattle responds that this is a universal problem. The number of HIV infected people is increasing but the staff in their programs is not growing. Therefore, to get around this they are devising ways to have the HIV patients do more on their own. For example, they find housing for the HIV-infected patients. If the patient does not like what is being offered, they have the choice to find something on their own. If they are given too many choices it is never enough.

• In Mexico there are no large scale food programs. They have a pilot program in which they offer a box of food staples weekly, and this is not yet a federally funded program.

Linking care and treatment, how does Seattle do it?

• Seattle has a specific committee which focuses on linking care and treatment. They had a person trained at the CDC specifically in linking these two areas, who then took this information back to Seattle. They made a new council by getting people from both the existing treatment and care councils. They did county wide training to link people together and also to focus on standards of care on how to implement the prevention into care and implement the care into prevention. For example, one of the things the committee came up with was a keychain which the prevention/peer educators would carry and this keychain had all kinds of information embedded into it. So, if they came across a client with a particular need, the peer educator could refer them to a number of different agencies by looking at what information they had on their keychain. This was a way for the prevention workers to have a list of other resources literally at their fingertips, which increased referrals of clients to other resources. Also, care workers (nursing staff for example) were trained on prevention risk assessment, and tried to incorporate this into their standard of care. Seattle has a $13 million budget for their HIV/AIDS county program. Of this, $6 million goes towards providing health insurance for the patients, $3 million is for care, and $3 million is for prevention.

Is the linkage model in Seattle applicable to other countries?

• Trinidad & Tobago does have a system of referrals to housing and other resources when their patients go into the STI and HIV treatment clinics. But they do think that if they trained volunteers that go out and give this information it would be better for getting this info to the people early before they are too sick. But how can the volunteers be retained for extended periods of time without being overworked or frustrated by what they are experiencing?

• Seattle says that they are constantly training new volunteers. Therefore you must have the mindset of training volunteers constantly. Every six months they are training new volunteers. Also they recruit volunteers from the communities they are trying to reach, for example they recruit people who frequent the bath houses who will then go and volunteer in the bath house. And they try to offer incentives, for example the people who work in the food centers; they get a meal every time they come volunteering.

• Seattle also tries to get higher level volunteers by involving students in graduate studies, such as social work or dietician students who can intern with currently working social workers and dieticians which can oversee the student. This multiplies the number of people working in those areas while also involving people with higher levels of education. Also, Seattle will get volunteers from churches in exchange for donations that they will make to the church from their non-federal funding.

• In Mexico, they have a sexual health library with a cyber café so that people can look up information anonymously and print what they need.

How can the stigmatization associated with HIV/AIDS be decreased because this is a huge problem in developing countries because it prevents people from seeking treatment?

• In Seattle there are various ways that they try to normalize the disease. There is a radio show where they talk to many different audiences to increase awareness about AIDS. On the radio show they will have different types of guests on the show to address the different audiences (for example church leaders, transgender community, etc). Seattle also has an internet ‘counselor’ which goes into chat rooms to have conversations where anybody can log on and ask questions anonymously.

• In Rio, Mexico, and Houston, rather than internet chat counselors, they have hotlines where people can call in anonymously. They think this is beneficial but needs to be more widely used. However, they like the idea of having cyber counselors.