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UCLA Civic Engagement 105 H.A.R.R.P. PROGRAM EVAULATION

UCLA Civic Engagement 105 H.A.R.R.P. PROGRAM EVAULATION. Presented By: Yesenia Guzman JWHC Institute Jennifer McGee Anthropology/Women’s Double Major Civic Engagement Minor. MISSION STATEMENT.

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UCLA Civic Engagement 105 H.A.R.R.P. PROGRAM EVAULATION

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  1. UCLACivic Engagement 105H.A.R.R.P.PROGRAM EVAULATION Presented By:Yesenia GuzmanJWHC Institute Jennifer McGee Anthropology/Women’s Double MajorCivic Engagement Minor

  2. MISSION STATEMENT • JWCH Institute's mission is to improve the health status and well being of underserved segments of the population of Los Angeles County through the direct provision or coordination of health care, health education services and research.

  3. HISTORY • JWCH Institute Inc. is a private non-profit health agency that was established the John Wesley County Hospital in 1960. • After 1979 the Hospital was brought down but JWCH evolved into a health care organization with a focus on community-based health education and social support programs.

  4. CLIENTS/PEOPLE SERVED • Adult Homeless and Medically Indigent Individuals. • Adolescents Practicing High Risk Behaviors. • Individuals at risk of HIV. • HIV+ individuals. • Anybody that is in need of our services.

  5. LITERATURE REVIEW • Characteristics of Successful Program • Funding • Well-Structured Evaluations • Cultural Relevance • Harm Reduction Model • Women and HIV

  6. Healthy Alternatives for Reducing the Risk of HIV Infection Program(H.A.R.R.P.) • Voluntary four session educational and skills building intervention intended to reduce the incidence of HIV. • Prevention program aimed at reducing risk. Target population: Men who have sex with men and Women at sexual risk in the SKID Row Downtown area.

  7. Downtown SKID Row SKID ROW “The Nickel” JWCH Weingart Clinic

  8. DOWNTOWN SKID ROW • Estimated 10,000 people living in Skid Row. • Los Angeles County -50% are African American-30% Latino-14% White • 1/3-1/2 of homeless are Women. • 1/3-2/3 are substance users • 10%-25% are “chronic” homeless SKID ROW = human service non profits

  9. HIV TESTING ACROSS GENDER: SPA 4 Individuals in SPA 4 that have never been tested for HIV.

  10. HARM REDUCTION MODEL:“Meet them where they are…” • The first priority of harm reduction is to decrease the negative consequences of drug use. By contrast, drug policy in North American has traditionally focused on reducing prevalence of drug use. Harm reduction establishes a hierarchy of goals, with the more immediate and realistic ones to be achieved as first steps toward risk-free use or, if appropriate, abstinence. • The Harm reduction approach to education focuses on non-judgmental information about different drugs, their properties and effects, about the law and legal rights, about how to reduce risk, and where to get help if needed. It helps youth to develop a wide range of skills in assessment, judgment, communication, assertiveness, conflict resolution, decision-making and safer use. • Harm reduction education is based on humanitarianism, pragmatism and a scientific public health approach. The principles of harm reduction drug education are that drug use is normal; it is associated with benefits as well as risks; it cannot be eliminated altogether, but the harms can be reduced; many young people grow out of drug use; education should be non-judgmental; it requires an open dialogue with the young and respect for people’s right to make their own decisions; and it emphasizes positive peer support, not divisiveness.

  11. PROGRAM OVERVIEW • Curriculum is based on Transtheoretical Model of Behavior Change, “Harm Reduction Model.” by Prochaska and colleagues. • The Transtheoretical Model is a model of intentional change that focuses on the decision making of the individual. • Processes of Change includes 5 stages: • Precontemplation • Contemplation • Preparation • Action • Maintenance

  12. PROGRAM OVERVIEW • HARRP participants are required to complete a minimum of four sessions. • Each cohort of H.A.R.R.P is gender specific with 10-15 participants. • HARRP sessions are scheduled throughout a one month time period. • Participants who complete the 4th and final session receive an incentive in the form of a meal coupon.

  13. A TYPICAL CLASS:Curriculum • SESSION 1 – HIV/AIDS EDUCATION AND PREVENTION • SESSION 2 - ASSESSING PERSONAL RISK AND COMMITING TO BEHAVIOR CHANGE • SESSION 3 - UNDERSTANDING VALUES AND DECISION MAKING • SESSION 4 - COMMUNICATION AND NEGOTIATION SKILLS

  14. RESEARCH QUESTION How successful is Healthy Alternatives for Reducing the Risk of HIV Program(HARRP) at increasing the HIV related knowledge of women at sexual risk(WSR) and men who have sex with men (MSM)?

  15. DATA INSTRUMENTS 1. PRE & POST TEST • Knowledge test on HIV/AIDS -Infection -Transmission -Risk behaviors. • 12 questions -True/False -Multiple choice -Matching questions.

  16. DATA INSTRUMENTS 2. Sign In sheets • For the budget period of July 2006-December 2006 3. Risk Assessment • 15 item Questionnaire • Demographic Information • Sexual History • Drug History

  17. KEY INFORMANT INTERVIEWSALUMNI Overall theme of the Alumni interview was very positive. Key Points: • He would recommend one of his friends to participate in HARRP, “because these tools save lives.” • He believes that not all participants complete HARRP because, “there are a lot of things to compete with, one being drug addiction and two being people trying to find or keep a roof over their heads” which might prevent class attendance. • If incentive amounts were increased or if snacks were provided during the sessions retention rates might improve.

  18. KEY INFORMANT INTERVIEWFACILITATOR Overall theme of the Facilitator interview was very positive.Key Points: • Felt the program has strengths in outreaching to the clientele, but they needed to stabilize the workshop sites since some clientele are located at transitional site. • Felt that if there were incentives that were more appropriate for their lifestyle, clients would return. • Felt that a strength of the program was the “client-centered approach.” • Felt they needed more staff in order to assign tasks equally. • Staff needs to be provided more training and opportunities for involvement in the development of the program curriculum. • Feels that there should be a minimum of 5 staff members since the program ran better when there were more staff.

  19. Client Demographics • N= 102 • Mean age 39 years • Range of 19-62 years • 30% MALES • 69% FEMALES • 1% TRANSGENDERED

  20. DEMOGRAPHICS OF PARTICIPANTS

  21. HOMELESSNESS • 78% of participants identify as homeless. • 54% have been homeless more than once in their life. • 70% of the females identified as homeless. • 97% of the males identified as homeless

  22. RISK FACTORS Number of sex partners • Average # of Sex Partners: 2 • Men have sex with: • Men: 4 • Men and Women:6 • Women:19 • Women have sex with: • Men: 47 • Men and Women:19 • Women:3

  23. RISK FACTORS INCLUDE: • Traded sex for drugs or money • Engaged in anal sex • Sex while high or intoxicated • Injection drug use • Had sex with a prostitute • Had sex with a married man • Had sex with a stranger

  24. Number of Risk Factors Engaged in within the Last 3 Months 56 participants' identified with having at least one risk factor.

  25. Men Most Common Risk Factor: Sex while under the influence: 43% Traded sex for drugs or money: 20% Least Common Risk Factor: Sex with a prostitute: 0% Receptive anal sex: 10% Injection drug use: 10% Forced to have sex against will: 10% Women Most Common Risk Factor: Sex while under the influence: 27% Sex with more than one person: 20% Least Common Risk Factor: Sex with a prostitute: 5% Receptive anal sex: 8% Injection drug use: 8% RISK FACTORS

  26. RISK FACTORS ACROSS GENDER

  27. KNOWLEDGE TEST • Average Pretest score: 94/120 • Range: 10-120 • Average Post Test score: 106/120 • Range: 0-120 11.3% increase in knowledge.

  28. Knowledge Test • N= 61 Completed the pre and post test. 49% of Males 69% of Women 0% of Transgendered

  29. GENDER & KNOWLEDGE TESTAVERAGE INCREASE IN SCORE FROM PRE AND POST TEST ****Transgender participants did not complete the post test

  30. RACE AND KNOWLEDGE TEST:Average increase/decrease in pre/post test scores.

  31. PRE/POST TEST SCORES ACROSS ETHINICITY

  32. ATTENDANCE & KNOWELEDGE INCREASE? Average increase/decrease in pre/post test scores

  33. WHO IS NOT COMPLETING H.A.R.R.P.? Mean Age: 38 Male: 42% Females: 53% Transgendered: 5%

  34. IMPLICATIONS • On average those participants that attended all four of the HARRP sessions had the most increase in HIV related knowledge. • Recruitment efforts need to be aimed at targeting more at risk populations. This change in demographics might cause more of an increase in knowledge from post to pre test. • Female participants reported engaging in riskier behaviors and at higher frequencies than the male participants. • Increase/change incentives.

  35. POLICY IMPLICATIONS • Female HARRP participants reported having more risk factors for HIV than male participants. • Currently the majority of HIV prevention funding is focused on MSM. • Funding policies need to be revised to provide funding for HIV prevention programs that meet the specific issues that women face in relation to HIV (self-esteem, empowerment, cultural issues). • Staff needs to be involved in program curriculum, outreach and undergo a comprehensive training.

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