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HIV/STD Prevention in Rural America

 
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Programs Tailored to Ethnic and Racial Minorities
 

Three racial and ethnic minorities in the U.S. account for a greater proportion of rural HIV/AIDS cases than would be expected for their proportion of the population. OF all new HIV diagnoses in 2008, African American men and women accounted for 53%, Latinos account for 10%, and American Indian/Alaska Natives 2%.[1] This disproportionate infection rate has nothing to do with race or ethnicity, per se, but with other challenges that face these groups such as poverty, poor access to health care, stigmatization of HIV/AIDS, homophobia, higher rates of other STDs, discrimination, and racism. The following interventions show that there are some innovative programs that may work in rural settings that are tailored to reach these groups at heightened risk for infection. Having interventions that honor the cultural values and account for the challenges each group faces will be more likely to be effective. However, it is essential to remember that there is a lot of diversity within each of these minority groups. This makes it necessary to know the community being targeted and adjust the intervention to reflect local culture and social context. The National Native American AIDS Prevention Center (NNAAPC) presents a directory of individual, group, and community level HIV prevention programs for American Indians, Alaskan Natives, and Native Hawaiians.

Target Behaviors and Behavioral Determinants
Early initiation of sexual intercourse and drug and alcohol use; lack of communication between parents and teens about sexual and drug use risk behaviors; lack of social norms to support sexual and drug use abstinence and safer sex behaviors.

Target Audience
African American primary caregivers and their pre-teen children

Description
The 7-week prevention program is designed for rural African American primary caregivers and their 10-12 year old children. The program builds positive parenting skills to promote healthy early adolescent development and help youth gain control over their behavior, form influential friendships, and reduce risky behaviors. This intervention is based on the knowledge that rural African American families exert a significant influence on the choices children make. Thus, the level of skill and involvement the caregiver has in his/her relationship with the child largely determines the risk path a child takes. Evidence shows that parents report an increase in targeted parenting behaviors and youth.

Evidence
After the SAAF intervention, parents engaged in more regulated, communicative parenting than parents in the control group. Youth who participated in the SAAF program reported reduced intentions to engage in risky sexual and drug use behaviors.

Recommendations
Involving the community in modifying the curriculum builds community support and increases participant recruitment and retention.

Where Implemented
Rural Georgia with mothers and their 11 year olds

Contact Information
SAAF

 

Infórmate for Adolescent Migrant and Seasonal Farmworkers

Target Behaviors and Behavioral Determinants
Correct and consistent condom use with causal or non-main partners; increased communal caring behavior as exhibited by peers discussing safer sex, psychosocial issues such as low levels of self esteem, experience of discrimination, and cultural pride; sex under the influence of alcohol or other drugs; self-efficacy to talk to partners about condom use; multiple partners.

 

Description
The Infórmate (inform yourself) Teen Health Program is an adaptation of Migrant Health Promotion’s Promotor(a) de Salud (Community Health Worker) program model serving adolescent migrant and seasonal farmworkers during the agricultural season.  The program recruits, trains and mentors adolescents in rural farmworker communities to work directly with their peers and with partner health center staff. The Infórmate program focuses on culturally competent, accessible and engaging health education, prevention activities and access to services in the key health areas of HIV and mental health. The adolescents trained as peer health educators, or Teen Health Aides, educate their peers through a variety of methods including individual and group education sessions, theater performances highlighting key health information, and organize Teen Health Nights in collaboration with local health providers. 

 

Evidence
Evaluation data are being collected through pre and post-tests and focus groups to measure knowledge gains and changes in attitudes and behaviors related to HIV/AIDS and STDs, mental health, and substance use; increased referrals to and utilization of health and mental health services; and increased numbers of teen farmworkers with an ongoing source of health care.


Recommendations
Success depends on gathering information from farmworker adolescents to understand their health needs, disparities and access issues and from partner health centers and providers to identify cultural and community strengths.

      

Where Implemented
2 rural communities in Michigan


Contact Information

Amy Frank, Program Director

afrank@migranthealth.org

734.944.0244 x 14        

    

 

Keystone Migrant Farmworker Health Outreach

Target Behaviors and Behavioral Determinants
Unprotected sex; multiple sex partners; unknown HIV serostatus; misconceptions about HIV/AIDS; HIV/STD stigma; lack of skills for negotiating consistent and correct use of condoms.

Description
Keystone Migrant Farmworker Health Outreach is a medical outreach program for migrant and seasonal farm-workers which contains an HIV/AIDS/STD risk reduction component that includes HIV testing (using Orasure) and counseling, as well as HIV prevention for positives. Activities are conducted in outreach settings such as farms, labor camps, and farm-worker homes or during transportation to clinic appointments. The program uses a holistic approach where concern for HIV infection is no different then concern for hypertension or diabetes. This is in keeping with the culture of health and healing, and takes advantage of ongoing opportunities to give and enforce risk reduction messages.

Evidence
Farmworkers demonstrated an increase in accurate HIV/STD knowledge and increased use of condoms after the intervention. Substantial numbers of farm workers received voluntary HIV and STD testing and counseling.

Recommendations
This model takes advantage of established trust relationships and ongoing opportunities by integrating it fully into field clinics and other medical outreach activities. Any program that has access to medical information (medical histories or diagnosis) and provides much needed and wanted medical services should use their knowledge and opportunities to provide and reinforce risk reduction messages. Bilingual outreach workers who understand the culture of the workers are essential.

Where Implemented
Pennsylvania - Berkshires, Lehigh, Lancaster and Schuylkill Counties
at labor camps, farms and orchards during adult immunization clinics, as well as in farm workers’ homes

Contact Information
Selina Zygmunt, Regional Manager
Keystone Farm-worker Health
Program, 145 N6th ST. Suite 102
St. Joseph Community Campus, Reading, PA 19601
khcberks@pa.net
610-372-5001


 

 

Target Behaviors and Behavioral Determinants
Lack of cultural pride

Description
Native Women Speaking, an HIV prevention project that targets American Indian and Alaska Native women, consists of three components: capacity building for partner organizations; community mobilization through the implementation of a community assessment, and diffusion of social marketing materials. The intervention was adapted from Native Voices Speaking, an HIV prevention intervention developed by NNAAPC that targets Native people living with HIV/AIDS.

The primary goals of Native Women Speaking are for participants to reclaim a sense of pride in their identities as Native women that will allow them to maintain their health and the health of their community;

create a framework for maintaining a sense of holistic balance in their lives, and create a realistic HIV risk reduction goal. Participants work towards these goals through small group discussions and teachings all held during a three-day retreat where the women can bond with other Native women, connect with Mother Earth, and practice their spirituality.

A Spiritual Advisor is available throughout the retreat and leads several activities.

Evidence
A pre-post knowledge survey showed that women increased their knowledge on HIV topics from 59.18% to 75.51%.

Recommendations
Community assessment and establishing community partners facilitate development of a culturally relevant program.

Where Implemented

Sand Hill Lake, MN
Hummingbird Living School, Cleveland, NM

Contact Information

     National Native American AIDS Prevention Center

     (720) 382-2244

 

Target Behaviors and Behavioral Determinants
Unprotected sex; multiple partners; HIV/STD stigma; use of drugs and alcohol before sex; misconceptions about HIV/AIDS/STD; lack of skills for condom negotiation and correct use; lack of access to care; unknown HIV serostatus.

Target Audience
American Indian/Alaska Native Community, Families, Individuals

Description
This multi-component long-term project is designed to provide tribal communities in Idaho, Oregon, and Washington with education, training, and technical assistance for the prevention and treatment of HIV/AIDS and other STDs through community collaboration. Community outreach includes: media campaigns especially on local radio to increase community awareness and decrease stigma; training IHS and tribal health care providers to detect STDs and HIV early and provide appropriate treatment; condom distribution; testing events like area basketball games to normalize testing; women’s peer education.

Evidence
Together, the Red Talon STD/HIV Coalition and Project Red Talon have shown improvements in reducing the prevalence of STDs among American Indians and Alaska Natives in the Pacific Northwest. Among the Project’s successes are increased:

    STD/HIV networking and regional partnerships,

    knowledge about STD/HIV among tribal staff,

    STD screening and use of recommended treatment protocols at tribal and IHS clinics,

    STD/HIV surveillance for American Indians in the Pacific NW,

    tribal community awareness about STDs and HIV, and

    inter-agency collaboration in grant writing and receipt of awards

Recommendations
Working as an inter-tribal coalition decreases stigma and normalizes STD and HIV testing and treatment. Culturally appropriate outreach, education, training, and technical assistance are keys to success.

Where Implemented
among 43 federally recognized American Indiana and Alaska Native tribes in the Pacific Northwest; Idaho, Oregon, Washington

Contact Information
Stephanie Craig Rushing, MPH - Project Director scraig@npaihb.org
Northwest Portland Area Indian Health Board
527 SW Hall, Suite 300,
Portland, Oregon 97201
Phone (503) 228-4185
Fax (503) 228-8182
Project Red Talon

 

 

The Shawl Circle - Hokvke Yekce (Creek for "strong women")

Target Behaviors and Behavioral Determinants
Lack of knowledge about how to prevent HIV and other STDs; lack of knowledge about early detection of STDs, HIV, cervical cancer, and breast cancer; distrust of public health.

Description

Respectful of our American Indian communities sovereignty and understanding that health department staff may be viewed with fear and distrust when taking educational and preventive messages to the community, this intervention brings together respected women from the tribes, bands and/or clans, provides them with accurate HIV/STD prevention education and materials, and lets them present the information in the correct cultural and traditional context for their community. Women are nominated by their tribal councils to attend a one-day training covering HIV/STD prevention, and ways to detect breast and cervical cancer early.  Following training, these women become Community Health Advocates, sharing the information they learned with other women in their tribal communities.  The Community Health Advocates have as much flexibility as possible to teach the information correctly with respect to each tribe’s cultural beliefs and traditions.  At the conclusion of each Shawl Circle class, participants are presented with a specially-designed shawl to signify their commitment to keep themselves and their community healthy.

 

Evidence
On-going evaluation of the project includes pr and post tests to measure changes in knowledge and attitudes.  At the end of the project, the health department plans to follow-up with all the participants to determine if women obtained a screening test to detect HIV, STD, breast cancer, and/or cervical cancer.

 

Recommendations
Start with a community assessment to determine the basic knowledge of HIV transmission and breast and cervical cancer symptoms. 

 

Where Implemented
Rural Florida

 

Contact Information
Karen Simons, Special Projects Coordinator
Karen_Simons@doh.state.fl.us
(850) 245-4444, ext. 2625   

 

Mara Michniewicz, Interventions Team Supervisor
Mara_Micnhniewicz@doh.state.fl.us
(850) 245-4444, ext. 2597  

 

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