142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

Doing Prevention in the ACA Era: CBOs in the Midwest Finding Their Way

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Wednesday, November 19, 2014 : 1:15 PM - 1:30 PM

Keith R. Green, MSW , School of Social Service Administration, University of Chicago, Chicago, IL
Alida Bouris, PhD, MSW , School of Social Service Administration, University of Chicago, Chicago, IL
Harold A. Pollack, PhD , School of Social Service Administration, University of Chicago, Chicago, IL
Background: Implementation of the Affordable Care Act (ACA) creates new opportunities for engaging HIV-positive and high-risk negative persons into evidence-based prevention and treatment strategies.  Community-based organizations (CBOs) are well positioned to reach individuals whom these interventions might benefit most.  Many structural and philosophical barriers confront CBOs in the rapidly evolving world of HIV-prevention and sexual health politics.

Methods: In-depth interviews were conducted with executive administrators of 11 different CBOs in the Midwest.  Interviews explored how each CBO has integrated behavioral and biomedical prevention methods, as well as the challenges and opportunities presented by the ACA.  Thematic transcript analysis was conducted to identify common insights and challenges experienced by respondents.

Results: Most interviewees indicated that their prevention efforts were not directly facilitated by ACA.  Many identified challenges with integrating biomedical interventions. Cited challenges included lack of frontline staff knowledge and ethical concerns regarding PrEP and PEP.  Interviewees also described a prevention environment where acceptable interventions are prescribed by funders, who place heavy emphasis on “test and treat” strategies over other behavioral and biomedical approaches.

Conclusions: The ACA offers a potential opportunity to curb the tide of HIV within high-risk populations.  To be successful, new frameworks must be developed for strategically integrating interventions and for evaluating their combined effect. Future research in this area should explore how expanded access to healthcare provided by the ACA will impact acceptability and uptake of biomedical prevention strategies, and work with CBOs to determine effective strategies for engaging and retaining high-risk individuals in these interventions.

Learning Areas:

Chronic disease management and prevention
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Public health administration or related administration

Learning Objectives:
Identify and describe the challenges and opportunities facing community-based organizations conducting HIV-prevention activities in the Affordable Care Act era.

Keyword(s): Community-Based Health, HIV Interventions

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Prior to my pursuit of a PhD, I served as program director for a federally funded study designed to explore the acceptability and feasibility of pre-exposure prophylaxis among young MSM. I also served as director of federal affairs for the AIDS Foundation of Chicago, where I worked on implementation of the National AIDS Strategy in Illinois. My primary focus as a doctoral student is on the integration of behavioral and biomedical HIV prevention strategies.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.