Session
Community Engagement and HIV
APHA 2022 Annual Meeting and Expo
Abstract
Community engagement strategies to advance health equity: experiences from the Black Women First Initiative
APHA 2022 Annual Meeting and Expo
Human-centered design approaches and community engagement place individuals and communities at the center of the solution, which is particularly critical for advancing health equity (National Academies of Sciences, Engineering, and Medicine et. al, 2017). The Black Women First (BWF) Initiative aims to implement culturally responsive and evidence-informed bundled interventions to meet the unique health needs of Black women living with HIV. Funded by the Health Resources and Services Administration (HRSA) under the Special Projects of National Significance (SPNS), BWF is being carried out by 12 demonstration sites around the USA. BWF demonstration sites utilize a variety of strategies to engage their client, peer, and partner communities to inform implementation and quality of care. Site staff have incorporated questionnaires and motivational interviewing techniques into provision of care to strengthen engagement and solicit feedback from clients in every appointment. All sites have established or are establishing community or client advisory boards, founded on the principles of Meaningful Involvement, that meet regularly to incorporate the leadership of Black women with HIV in their own care. Some sites have also established or reinvigorated their involvement in community partnerships and community advisory boards consisting of local multi-sectoral providers where they can provide implementation, recruitment, and training support. In this workshop, participants will hear about the importance of community engagement and, through the example of BWF, learn how to build community engagement and buy-in, and hear some of the successes and challenges these 12 sites have experienced.
Abstract
The Role of Community Engagement in Increasing Health Equity to End the HIV Epidemic in the Ryan White HIV/AIDS Program
APHA 2022 Annual Meeting and Expo
Issues:
Since the beginning, community engagement has been a core value for HRSA’s Ryan White HIV/AIDS Program (RWHAP) and is a critical element to ending the HIV epidemic. In 2020, the Ending the HIV Epidemic in the U.S. (EHE) initiative launched to reduce new HIV infections in the U.S. by 90% by 2030. To achieve this EHE goal, HRSA’s Ryan White HIV/AIDS Program has developed a framework to support community engagement with a whole of society focus that supports health equity across RWHAP priority population.
Description:
In 2021, HRSA conducted 16 community listening sessions, and feedback synthesized from the community is informing HRSA’s EHE efforts moving forward. Crosscutting themes including stigma as a barrier to care, increasing health equity, and providing meaningful roles for the HIV community. In this presentation, HRSA will provide an overview of EHE’s qualitative and quantitative data and the role of community engagement in ending the epidemic.
Lessons Learned:
To promote health equity while ending the HIV epidemic, HRSA developed a health equity approach focusing on: 1) Data utilization and Implementation Science 2) Community Engagement and Partners 3) Organizational Culture and Personnel and 4) Service Delivery. Attendees will better understand this approach for ending the HIV epidemic.
Recommendations:
HRSA RWHAP’s approach to health equity in addition to the community engagement tools and resources are key contributors to ending the HIV epidemic. Understanding the factors that influence health disparities and engaging with people with lived experience is critical for public health leaders to ending the HIV epidemic.
Abstract
Peer engagement health equity considerations in adapting an evidence-based HIV/STI intervention for Black women in community corrections.
APHA 2022 Annual Meeting and Expo
Background: U.S.’ health equity goals of “reducing—and, ultimately, eliminating HIV disparities and its determinants among marginalized Black and Indigenous People of Color remain largely unrealized and the need for culturally tailored prevention interventions remains paramount. Cis-Black women who use drugs and alcohol (C-BWUDA) and complete criminal legal sentences while living in the community have long been identified as an especially vulnerable sub-group but to date there are no HIV evidence-based intervention adaptation models that describe how to equitably share power with at-risk BIPOC individuals as a whole, or this group in particular.
Methods: Guided by an integrated ADAPT-ITT health equity framework, we culturally tailored the only group-based, computer-assisted, HIV/STI intervention working with C-BWUDA with criminal legal system backgrounds and Black, female, community re-entry providers slated to deliver the adapted intervention as health equity partners. Focus groups and a pilot were held.
Results: The resulting intervention, E-WORTH, features HIV/STI-specific Afrocentric themes of risk and resiliency and a psychoeducation component that raises awareness of how racialized drug laws and policing have impacted Black women. Evaluation of an E-WORTH RCT confirms its cultural resonance. Participants assigned to the E-WORTH arm had a 54% lowered odds of testing positive for any STI and reported 38% fewer acts of condomless vaginal or anal intercourse at 12-month follow-up.
Conclusions: Findings highlight strengths and health equity gaps in available HIV intervention adaptation models and underscore the need to develop an adaptation model that explicitly provides guidance on how to equitably partner with criminal legal system involved peers.
Abstract
Meaningful Involvement of People with HIV in Leadership and Stigma Reduction Activities
APHA 2022 Annual Meeting and Expo
Issues: Since the beginning, meaningful involvement of people with HIV is a core tenet in the Ryan White HIV/AIDS Program authorizing legislation. People with HIV are experts in identifying and understanding their needs and experience and are essential in designing and implementing policies, strategies, and services.
Description: The Health Resources and Services Administration implemented two initiatives focused on building capacity of and opportunities for people with HIV. Engage Leadership through Employment, Validation, and Advancing Transformation and Equity for persons with HIV (ELEVATE) builds the capacity of people with HIV to be meaningfully involved in planning, delivering, and improving client services. ESCALATE (Ending Stigma through Collaboration and Lifting All To Empowerment) is a training and capacity-building initiative designed to address HIV stigma that creates HIV care continuum barriers. ESCALATE requires organizations to assemble a stigma reduction team that includes people with HIV.
Lessons Learned: ELEVATE trainings are offered in English, Spanish, virtual, in-person, and specialized to priority communities, including Indian Country, transgender/gender diverse, Latinx, and cisgender women. Evaluations show high rates of satisfaction and usability. ESCALATE guides teams through training and capacity building exercises using an organization self-assessment (OSA). OSA respondents noted an awareness of stigma and took steps with staff and community to build supportive and affirming environments. Respondents stated they would benefit from formalized responses to HIV stigma at an organizational level.
Recommendations: ELEVATE added a post-training coaching component to support participants seeking opportunities to become community involved. ESCALTE aims to validate and use OSA to measure organization progress.