Megan Comfort, Olga Grinstead, Torsten Neilands, Kathleen McCartney. HIV Prevention for Women Visiting Incarcerated Men: The HOME Project [see slides]
Background: Making HIV prevention interventions relevant, accessible and feasible within the contexts in which women live their daily lives may be an effective approach to reducing the disproportionate impact of HIV on low-income women and women of color. One important context of risk is having an incarcerated male partner. We designed the Health Options Mean Empowerment (HOME) Project as a population-specific intervention to reduce HIV risk among women with male partners being released from prison.
We implemented and evaluated The HOME Project at the visitors’ center at a state prison in northern California from February 2005 through January 2006. The HOME intervention trained women visitors to be peer health educators both for other women visiting men at the prison and for women in the peer educators’ home communities. The HOME invention also included community-building activities; workshops focused on general and sexual health promotion; and facilitated community referrals and support services geared specifically to the needs of women who visit men in prison.
Methods: We used two longitudinal surveys to evaluate intervention effectiveness. One survey was conducted prior to intervention implementation (N=117) and one was conducted during the intervention period (N=202). Each set of surveys consisted of interviews during the partner’s incarceration and again 30 days after the partner’s release from custody. Intervention outcome was assessed by comparing the follow-up findings from the pre-intervention and intervention surveys.
We also conducted 2 cross-sectional surveys, one immediately prior to the launch of the intervention (N=205) and one immediately after the intervention ended (N=207). Finally, we conducted longitudinal qualitative interviews with HOME Project peer educators (N=11).
Results: Longitudinal survey participants interviewed during the intervention period engaged in a lower frequency of unprotected intercourse, were more likely to communicate with partners about HIV, and were more likely to have had a recent HIV test despite cross-sectional respondents reporting high levels of stress in their lives. In qualitative interviews, peer educators identified HOME as being feasible given the many constraints on their time, sensitive to the issues affecting prison visitors, and responsive to women visitors’ various needs.
Discussion: Our results support the feasibility and effectiveness of a multi-component community-focused intervention for women with incarcerated partners. Providing interventions in this unique setting has the potential to reach large numbers of at-risk women with HIV-prevention information that addresses the specific context of having an incarcerated partner.
Jae Sevelius, Susan Kegeles, JoAnne Keatley, Paul Cotten. Capacity Building Assistance for HIV Prevention with Transgender Communities: The Transitions Project [see poster]
The Transitions Project provides capacity building assistance and technical assistance to community based organizations and health departments throughout the U.S. to promote knowledgeable, sensitive, and effective HIV/AIDS prevention for transgender communities of color and HIV+ transgender people. This CDC-funded capacity building project is the first of its kind to address the HIV prevention needs of transgender communities.
The goals of the Transitions Project are: 1) to improve healthcare providers’ awareness around issues that impact transgender health and access to healthcare; 2) to expand the capacities of HIV/AIDS prevention organizations in order to serve transgender clients more effectively; 3) to increase transgender-specific resources in community-based health promotion programs; 4) to promote community building and networking among transgender and gender-variant persons and allied service providers and advocates.
Jae Sevelius, JoAnne Keatley, Lydia Sausa, James Rouse, E. Michael Reyes. Center of Excellence for Transgender HIV Prevention in California [see poster]
There is a prevailing lack of medical and cultural competence among providers regarding HIV prevention and care for transgender people. Existing research needs to be consolidated and analyzed to determine what additional research and programming would benefit our understanding of the needs of diverse transgender communities around HIV prevention. The Center of Excellence (CoE) for Transgender HIV Prevention synthesizes California HIV prevention science as it relates to transgender communities and makes it accessible to HIV prevention providers, clinicians, consumers, and other appropriate individuals and organizations. The CoE creates and evaluates mechanisms to expediently and effectively disseminate and translate transgender HIV prevention science to public health practitioners in California and to integrate community-based priorities into the statewide research agenda. The CoE serves as a vital bridge between research and service and is the statewide avenue through which cutting edge community-based transgender HIV prevention science is disseminated to local communities via marketing, materials development, publications, an interactive website and educational activities.
Scott Stumbo, Mallory Johnson, Judith Wrubel. Social Support for HIV Medication Adherence in Gay Couples: The Primacy of the Partner [see poster]
Background: Prevention of complications from HIV disease is highly dependent on accessing and adhering to available treatments. The aim of this qualitative study is to describe, among gay men, the support for medication adherence received from relationship partners and others in maintaining adherence to their HIV antiretroviral (ART) regimen.
Methods: Twenty couples in which at least one partner was HIV-positive and on ART were interviewed separately about their involvement in their partners’ ART adherence. Participants were additionally asked about support received from elsewhere in their social support network (family, friends, co-workers, 12-step program members etc.) The interview elicited narratives of specific recent events around taking medication, as well as typical accounts of what partners and others did to support adherence. Three members of the qualitative team coded and verified the interviews for adherence support practices.
Results: While partners offered a wide range of kinds of support (including reminding, instrumental helping and coaching) around medication adherence, men did not report receiving much practical support from other social network members. In particular, almost every man reported some form of instrumental support (reminding, rides to doctors, help organizing medications etc.) from their partners. In contrast, only ten (25%) men report receiving similar forms of instrumental help from others in their social network. The most common form of support received from others (63%) was basic friendship (e.g. “I know that they care about me”). Indeed, four men (10%) reported a strong belief that medication information shared outside the partnership was too personal or private.
Conclusions: In our sample of gay couples who have lived together for longer than three months, we found that men with partners regularly seek and secure support from their partners, or are offered support by their partners, for HIV medication adherence, but do not routinely receive support from other sources. Understanding how partners foster adherence to ART is an important step towards guiding health care providers in reinforcing current good adherence or in developing interventions for improving adherence in people with HIV who are in relationships. Though some studies of HIV medication adherence posit that all social support may be equal when it comes to help with adherence, our findings demonstrate that for HIV+ gay men with partners, the best place to look for social support is within the partnership. These findings provide guidance for interventions to promote support for adherence, and thereby offer strategies for the prevention of HIV morbidity and mortality.
Pamela DeCarlo, José Ramón Fernández-Peña, Carolyn Hunt, Ellen Goldstein, Daniel Bao, Hank Wilson. Making sure research is used: Community-generated recommendations for disseminating research via non-traditional venues [see poster]
Academic research, no matter how innovative, will never make a difference in the lives of people unless it is disseminated in an appropriate and timely manner to providers and organizations serving the public. Yet many researchers are not trained, rewarded or supported to disseminate research findings. The Community Advisory Board (CAB) of the University of California, San Francisco, Center for AIDS Prevention Studies (CAPS) developed a set guidelines to support researchers’ intentions to disseminate their findings through non-traditional venues. These guidelines are unique because community members, many of whom have struggled with accessing research in a timely way, generated them. In addition to developing the guidelines, the CAB also conceived and implemented a dissemination strategy for the guidelines. The guidelines are available online atcaps.ucsf.edu/uploads/projects/collaboration/dissemination.php.
Last modified: November 2, 2012