Community Prevention Planning 101

1. Community Prevention Planning 101

3. Agenda 10:00-11:30am - Chapter: Introduction Getting to know each other and working together Objectives and agenda Elements of community planning Prevention plan format 11:30am-12: 00pm – Chapter 1: Community needs assessment Importance of data for planning Types and uses of data for community needs assessment 12:00pm-1:00pm: Working Lunch Community needs assessment findings (PowerPoint) 1:00pm-2: 30pm: Chapter 2: Resource inventory Why a resource inventory? Identification of resources and resource disparities 2:30pm-5:00pm Chapter 3: Audience Prioritization Importance of audience prioritization Steps to audience prioritization Setting your priorities

4. ELEMENTS OF COMMUNITY PREVENTION PLANNING • COMMUNITY ASSESSMENT • Epi profile • Community needs assessment • Resource inventory • AUDIENCE PRIORITIZATION • HIV prevalence • Disproportionate Impact • Resource disparities • Service and Behavioral gaps • PRIORITIZATION OF INTERVENTIONS

5. Prevention plan format • Audience: • Barriers identified: • Cultural: • Socio-economic • Behavioral: • Access to services: • Specific Audience Intervention identified • Current resources available: • Community support interventions needed

6. PREVENTION IS A SOCIAL VACCINE In the absence of medical vaccine to prevent HIV, we have to use sexuality education as a ‘social vaccine’, Thoraya Ahmed Obaid, Executive Director of UNFPA, the United Nations Population Fund

7. Prevention works at different levels • Individual • Family/household • Community • Institutional systems • Policy makers

8. Community Access to services Availability of services Policy Provider Skills Social values and norms Leadership support Information Equity Lack of exposure to HIV/AIDS information Collective Self-Efficacy Sense Of Ownership Participation Equity Social Norms Social Capital Individual Knowledge Risk appraisal Risk reducing and promoting behaviors Subjective Norms Self efficacy Perceived social norms Attitudes and beliefs Intentions What did we look at:

9. Stages of Change – IndividualBehavior change can only take place in the context of an enabling or supportive environment. SOCIAL FEATURES - nature of personal relationships; expectations of class, position, age, gender; access to knowledge, information. CULTURAL FEATURES - the behaviors and attitudes considered acceptable in given contexts - e.g.. relating to sex, gender, drugs, leisure, participation. ETHICAL & SPIRITUAL FEATURES - influence of personal and shared values and discussion about moral systems from which those are derived – can include rituals, religion and rights of passage. LEGAL FEATURES - laws determining what people can do and activities to encourage observance of those laws . POLITICAL FEATURES - systems of governance in which change will have to take place - can, for example, limit access to information and involvement in social action. RESOURCE FEATURES - affect what is required to make things happen - covers human, financial and material resources; community knowledge and Skills.

10. Behavior change The Innovators 10% The majority in advance 40% The majority that Is behind 40% 10% The Conservatives

11. STEPS TO BEHAVIOR CHANGE COMMUNITY COMMUNITY Action Decision Persuasion Knowledge Awareness INDIVIDUAL

12. THE SMOKER WHO QUITS! Reason-emotional THE SMOKER WHO QUITS Reason- Structural THE SMOKER WHO QUITS Reason-Physical THE SMOKER WHO QUITS Reason-Interpersonal Impossible to smoke! THE SMOKER WHO QUITS! Reason- Rational or Practical Please Daddy Stop smoking, it stinks! Ah! Yes cigarettes give you cancer. I don’t smoke any more and I am proud of it! NO SMOKING I don’t feel good! I don’t smoke any more and I am proud of it! Factors that influence individual behavior

13. Breaking the Silence 2 FINDINGS

14. INDIVIDUAL RISK FACTORS • Heterosexual Unprotected sex • Complacency • Fear of test • Delay getting tested • Multiple partners • Heterosexual • Drugs and alcohol

15. Demographic indicators • Level of education • People with little or no education have more difficulty understand concepts tied to the transmission and prevention of HIV AIDS and STDs. • They also are more susceptible to external influences. • Sex • Women are more vulnerable to HIV because their socio economic status. • Age • Low income • Poverty aggravates an individual’s capacity to address HIV Source: Breaking the silence 1, United Way

16. Individual and Community Awareness and knowledge • COMMUNITY • Lack of Exposure to HIV/AIDS information • Leadership not speaking out • Messages on services • Cultural issues • Outreach services limited • Education INDIVIDUAL • Many misconceptions about HIV transmission (contributes to stigma and denial) • Unfamiliar with the location of HIV/AIDS services and what they offer • Incomplete information on safe sex practices • Beliefs about PLWHA and prevention methods • Lack of information about services • Incomplete information about safe sex practices • Need for more outreach Source: Breaking the Silence 2 Community LACK OF EXPOSURE TO HIV/AIDS INFORMATION

17. Myths and Misconceptions Fear of people living with HIV Take risks Deny I have a problem Throw the blame on others

18. Individual and communityBeliefs and attitudes • COMMUNITY • Small town mentality feeds the fear and silence • HIV is shameful • Religious beliefs influence a community members decision to address HIV • Hide the fact that we have HIV in our community • The test has a bad image because it is perceived as an admission of guilt for immoral behavior • Conservative values that restrict talking about HIV • Head in the sand mentality, because of the fear and shame not one wants to be associated with HIV INDIVIDUAL • Beliefs about PLWHA and prevention methods • Fear of being labeled HIV • Fear of PLWHA • Fear of going to services for fear of being considered promiscuous. • Do not like the condom • Certain groups are responsible for HIV Source: Breaking the Silence 2 Community Social influence

19. TEST HAS BAD IMAGE

20. Our RECIPEE FOR STIGMA • Insufficient knowledge, misbeliefs and fears about a) how HIV is transmitted; and b) the life potential/capacity of PLWHAs (no immediate death); • Moral judgments about people who we assume have been sexually promiscuous • Fears about death and disease • Lack of recognition of stigma

21. I FEAR, I DON’T TELL

22. Living with HIV inFearof loved ones finding outof friends abandoning youof never being held again- I don’t go in the front door of servicesI watch who I talk tooI don’t try and get a job for fear of disclosureI sometimes don’t want to tell

23. Living without HIV in Ignorancefor FEARof being labeled HIVof family knowing that I am having sexof someone knowing my businessI don’t inform myself, talk about it,take the test or use prevention

24. Risk appraisal INDIVIDUAL • Most member underestimate their risk of HIV with the exception MSM, younger women and professional women. • Blame others for HIV/AIDS • Stereotypes and typecasting • Put more emphasis on other social issues • Low perceived severity of HIV • Illusion of invulnerability • Misconceptions on HIV transmission • COMMUNITY • Stigma • Lack of Exposure • Social Determinants • Moral values • Cultural disparities

25. Perceived Severity Community Low priority for leaders Other issues more important

26. Perceived Severity BUT HIV AID IS NO PICNIC Individual Complacency among youth EVEN WITH MEDS

27. Understand we are at risk Granddad’s chin. Dad’s eyes. Mom’s HIV.”

28. Risk promoting and reducing behaviors NO PROTECTION IT DOES NOT HAPPEN TO TRUST

29. Poverty and powerlessness render women vulnerable to infection. Disempowerment of women makes it more difficult for them to protect themselves from being infected by their partners, exposes them to sexual abuse and rape, limits their access to knowledge about how to protect themselves, and increases the incidence of other STDs that raise susceptibility to HIV infection. This vicious circle of gender inequality, poverty and voicelessness is at the core of the relentless spread of the epidemic.

30. Risk promoting behavior • Among women – regardless of ethnicity • Trust issues • Capacity to negotiate protection • Need for love • Dependency on men • Depression • Ignorance • Control issues

31. Risk reducing behavior • Among women – regardless of ethnicity • Generally monogamous with exceptions • Aware of HIV/AIDS • Would propose the condom • Dependency on men • Depression • Ignorance • Control issues

32. Empowerment of women Stress the importance of knowing one’s status and the status of one’s partner. The necessity to protect self and family. Encourage development of self-esteem and self-efficacy: issues of intimate partner/ domestic violence and gender norms. Knowledge of risk that actually exists for all women. PREVENTION FOR WOMEN

33. Risk Promoting and reducing behaviors It’s them not me Talk to kids not me I know what I am doing Superman syndrome

34. Risk promoting behavior Among Heterosexual Men • have multiple partners • Drugs and alcohol a cause • Weak health seeking behaviors • Feeling of invisibility • Do not use condoms consistently • Do not discuss prevention in initial relationship • For young men condoms kill the moment • Notches in the belt • Need to have sex with a woman or man without complications

35. Prevention and testing where men play, socialize and work Target clubs and bars Distribute informational materials in bars, workplace etc. Group level interventions for both men and women Encourage development of self-esteem and self-efficacy: issues of intimate partner/ domestic violence and gender norms. Use sporting events to reach men Peer approaches – (Homeboy approach) Women to pull in men Use credible male spokespersons to reach men Use media (place advertisements in men’s magazines Radio to reach certain hard to reach men (religious radio stations, cultural stations etc.) PREVENTION FOR HETEROSUAL MEN

36. Talking about HIV/AIDS to your partner Women should initiate more Say the men Men will use protection if a women requests it Women prefer that the man initiates Men believe it kills the moment

37. Address the needs of specific groups tailored - Group level interventions

38. GAY COMMUNITY AND HIV

39. Risk promoting behavior • Among MSM – regardless of ethnicity • Fatalism might as well get it since they don’t care • Battle fatigue • Discouraged by lack of interventions in gay community • Lack of comfort with HIV/AIDS services • Complacency among the young • Non committed relationships, anonymous sex • Ignorance on safe sex practices outside the condom • “Bare backing preferences”

40. Risk promoting behavior • Down low man – • Needs for anonymous sex • Bad relationship • MSM reach down low with other men

41. Reach out separately to White and black MSM More GLBT programs around social and greet Give resources to conduct interventions Materials on safe sex to gay businesses MSM center Use peer approaches Target local chat sites for HIV and MSM internet sites Give information to MSM businesses PREVENTION FOR MEN HAVING SEX WITH MEN

42. Community Typecast Moral judgment Lack of services Provider attitude

44. Risk promoting behavior • Among substance abusers – • Don’t care about protection, trying to feet their addiction • Condoms and testing are secondary to the addiction • Discrimination against substance abusers • Problem with clean works for IDU users • Sharing works is a problem

45. Continue and expand prevention with existing groups and other hard to reach groups(Group level, Counseling)

47. AND Community Level Prevention Interventions Support initiatives with the faith-based community (churches, synagogues, spiritual groups, etc.) Mobilize community businesses Provide and extend counseling, testing and linkages address issues of empowerment, involvement, and dispelling threat HIV/AIDS may have on the community at large.

48. WHAT CDC recommends? PREVENTION EXPAND TESTING SERVICES TACKLE STIGMA SOCIAL DETERMINANTS Kevin Fenton, Director, National Center for HIV/AIDS (CDC)

49. CREATING A BETTER ENVIRONMENT • Through community level, and PR interventions • Correct Misconceptions about HV • Fight stigma • Promote collaboration • Make HIV a household name • Everyone Speak out against HIV • More media involvement

50. RecommendationsPolicy makers • Integrate HIV/AIDS issues and responses into all aspects of the Municipality’s activities. • Encourage staff to be tested and inform themselves • Create an enabling environment to fight stigma and myths and misconceptions • Allocate funds to HIV/AIDS prevention for other members of the family aside from youth • Support and fund interventions targeting certain high risk audiences (substance abuse users, MSM). • Speak out on HIV/AIDS and become a role model by getting tested • Display or distribute information on HIV/AIDS and services • Mobilize community resources, private sector, development partners, donors, etc. to support local projects • Promote directory of HIV/AIDS Referral Services for the city, town, and county to increase knowledge of services • Provide short term technical assistance, funds and capacity building to emerging CBOS to assist them to develop their infrastructure and capacity to provide outreach in their respective communities.