Transcript Newcomers and HIV

From Evidence to Action
Replicating and Adapting Evidence-Driven Interventions at the
Local Level
Shannon Thomas Ryan
David Lewis-Peart
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Black CAP
Our Mission
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To reduce the spread of HIV infection in the Black
communities.
To enhance the quality of life of Black people living with or
affected by HIV/AIDS.
Founded in 1989, the Black Coalition for AIDS Prevention
(Black CAP) has worked to meet its mission in our Black
communities. Our work is also guided by our motto,
‘Because All Black People’s Lives Are Important’, and it
stands as a reminder of the importance of our commitment
to our community.
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Black CAP Programs
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Support
Community Outreach
Peer Education
Gay Men’s Outreach
Women’s Prevention
MSM Prevention
Roots of Risk
Volunteer Program
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Mate Masie – Kwanzaa Yoga
Youth Program
PHA Settlement
LGBT Settlement
LGBT Peer Education
Anti-homophobia
Prevention for PHAs
PHA Youth
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Why Are We Looking To Evidence Before We
Implement New Programming?
Guided by one of the directions identified
in our Strategic Plan
 Direction 2.1 - Develop systems and
structures for program and service
development, monitoring and evaluation.
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2.1a - Implement new programs and services
to meet emerging needs based on a program
expansion plan and evidence-based program
models
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Why Are We Looking To Evidence Before We
Implement New Programming?
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Black CAP has gone through significant organizational
change over the past three years
Black CAP was an agency that typically considered internal
knowledge and evidence before developing new
programming
Programs were often developed on the fly (i.e. “It sounds
like a good idea so let’s do it!”) and often without the
benefit of external consultation or research
Black CAP had very limited capacity for research and
effective program development
Organizational expectation that we include evidence in
every aspect of program design and delivery
Many benefits to this approach – especially in relation to
program impact and access to new funding
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Gathering Evidence
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In 2006, we initiated two parallel
processes to build on our
understanding of women and BMSM
at risk for HIV
Two reports were produced in mid2007 that helped clarify the scope of
the issue
 Led by stakeholder panels and
Black CAP staff
 A total of 50 semi-structured
stakeholder interviews
 Incorporation of epidemiology
and other data
 Review of best practice
Development of recommendations to
guide program expansion and
implementation
Prepared us to look to external
models prior to developing new
interventions
Stronger sense of local reality
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How Are We Implementing New
Programming?
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Developing internal knowledge and capacity for
research over time
Looking to other organizations to provide
capacity building and technical assistance support
– for instance with GMHC, ACCHO, TPH, etc.
Taking the time to develop models and adequate
time for planning
Recognizing that externally developed
interventions are a starting point
A continued focus on research and evaluation
after implementation
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Interventions
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Popular Opinion Leader (POL) – Implemented in
our Roots of Risk Program
Comprehensive Risk Counselling Services (CRCS)
– Implemented in our Support Program
Many Men, Many Voices (3MV) – Implemented in
prevention programming for gay, bisexual and
straight-identified men who have sex with men
EXPLORE – To be implemented prevention
programming for gay, bisexual and straightidentified men who have sex with men
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Popular Opinion Leader – Social Diffusion
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The POL model is based on the theory of Social Diffusion
and uses opinion leaders within targeted social groups to
disseminate risk reduction information around sexual
health.
This model was initiated at the Center for Disease Control
and was developed specifically for at-risk MSM, but has
since been implemented with various high risk target
groups.
A POL modeled program uses identified target community
leaders trained to deliver accurate sexual health
information to their peers conversationally in informal
settings.
Central in the development and delivery of our Roots of
Risk program – POL model mixed with health marketing
approaches
Implemented in 2008 and continuing into 2010
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Comprehensive Risk Counselling Services (CRCS) – Risk
Reduction Counselling
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The primary goal of CRCS is to help HIV-positive and HIVnegative persons who are at high risk for HIV transmission
or acquisition and struggle with issues such as substance
use and abuse, physical and mental health, and social and
cultural factors that affect HIV risk.
To reduce risk behaviours and address the psychosocial and
medical needs that contribute to risk behaviour or poor
health outcomes.
Included in our support programming through individual
and group supports
CRCS/PCM agency guidelines developed
Implemented in 2009
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Many Men, Many Voices (3MV) - Behavioural SelfManagement and Assertion Skills
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Many Men, Many Voices (3MV) is a 7-session group-level
intervention program to prevent HIV and sexually
transmitted infections among Black gay bisexual,
questioning and straight-identified men who have sex with
men.
The intervention addresses factors that influence the
behavior of Black MSM:
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Cultural, social, and religious norms
Interactions between HIV and other sexually transmitted
infections
Sexual relationship dynamics
The social influences that racism and homophobia have on HIV
risk behaviours
Implemented in our BMSM Prevention Program in 2009
Modified to include other components
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EXPLORE - Information-Motivation-Behaviour
Skill Model /Social Learning Theory
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EXPLORE is a ‘best evidence’ intervention that
consists of 10 core counselling sessions delivered
one-on-one to participants. The first 3 sessions
are intended to establish rapport between the
counsellor and the participant, and to provide
personalized risk assessments. The remaining 7
sessions cover topics such as sexual
communication, knowledge of personal and
others’ HIV serostatus when making sexual
decisions, and the role of alcohol and drug use in
risk behaviour.
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To be implemented in late 2009 in our BMSM
Prevention Program
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The Implementation and Delivery of 3MV
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The 3MV model
Delivery
Program modifications
Initial outcomes
Unintended outcomes
The role of secondary evaluation
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Challenges
Gaps in our capacity to understand and
implement research driven interventions
 Investing in staff capacity
 Identifying staff with appropriate skill sets
– research, program development and
evaluation, facilitation, etc.
 Committing the time for essential planning
and not rushing into programming
 Budgetary
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Questions
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