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HIV Prevention Education
and Risk Reduction
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"Prevention through education" has been a
priority of the Wisconsin AIDS/HIV Program since its inception in the 1980's. This theme
focuses on the central role education plays in addressing the broad range of HIV-related
prevention information and skill-building needs of diverse groups of individuals and
communities.
Prevention education programs supported by the Wisconsin
AIDS/HIV Program have taken many forms, including media campaigns for the general public,
teen peer education, and focused risk reduction programs for men who have sex with men.
While variable in content and approach, HIV prevention programs share a common goal of
supporting and sustaining positive health behaviors in order to limit and ultimately
eliminate HIV-related health risks. Prevention programs accomplish this goal through
methods that effectively address the unique cultural, social, and educational needs of
individuals, groups, and communities.
HIV prevention education programs in Wisconsin
have been directed at the general population and individuals with HIV-related risk
behaviors. Early prevention programs emphasized basic facts about HIV and AIDS, examined
concepts related to infection control, and attempted to address common myths,
misunderstandings, and irrational fears about the epidemic. Prevention education programs
for the general public were usually didactic and frequently held in large group settings
in schools and colleges, at meetings of civic organizations, and in the workplace.
HIV prevention education programs and related activities
supported by the Wisconsin AIDS/HIV Program include:
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Knowledge, attitude and behavior (KAB) surveys of the
general public and ethnic minority communities that evaluated the need for and success of
education initiatives.
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A statewide media campaign that was tailored for
Wisconsin residents and adapted from the national America Responds to AIDS media
campaign.
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Grant supported local and regional prevention
education programs targeted to populations at risk and implemented by AIDS service
organizations and minority community-based organizations.
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A grant supported toll-free statewide information
hotline and resource library serving as an information clearinghouse that collects and
distributes brochures, video and audio tapes, books, posters, and other materials.
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Print and audiovisual resources developed by the
Wisconsin AIDS/HIV Program and provided to local public health agencies, physicians,
community educators, infection control practitioners, and other service providers and
agencies.
2005-2008
Wisconsin Comprehensive HIV Prevention Plan
(PDF, 169 KB) exit DHFS
2006
Addendum to the 2005-2008 Wisconsin Comprehensive HIV Prevention Plan
(PDF, 787 KB) exit DHFS
2007
Addendum to the 2005-2008 Wisconsin Comprehensive HIV Prevention Plan
(PDF, 132 KB) exit DHFS
Prevention services for youth
For five years, the Wisconsin AIDS/HIV Program provided funding to AIDS service
organizations (ASOs) and community-based organizations (CBOs) for general HIV prevention.
The funds were used in communities to increase awareness of HIV and to dispel myths about
HIV/AIDS. A few ASOs and CBOs began to include youth in World AIDS Day activities,
presentations and small volunteer projects. In 1993, the AIDS/HIV Program recognized the
need to develop specific HIV prevention programs for youth. Grants to nine ASOs and six
CBOs enhanced or developed HIV youth peer education programs.
In 1995, the HIV Prevention Planning Council identified
strategies to reach targeted population and the AIDS/HIV Program solicited HIV prevention
grant applications for the following areas:
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pregnant and parenting youth
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runaway youth and youth in the juvenile justice system
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HIV prevention teen peer mentor training
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gay, lesbian, bisexual youth
Grant funds targeted at-risk youth by integrating
HIV prevention messages into existing programs, reaching incarcerated youth, developing a
statewide peer education training center, and coordinating a conference with mini-grants
to assist providers working with gay youth. The result of this targeted funding increased
HIV awareness among youth, developed a network of HIV programs serving gay youth, provided
risk-reduction skills to incarcerated youth, and sponsored regional speak-out forums
statewide. The AIDS/HIV Program continues to target HIV prevention services for at-risk
youth.
Prevention services for men who
have sex with men
Early efforts to reach gay men and other men who have sex with men (MSM) included
distribution of risk reduction kits in gay bars and multi-session workshops with
instruction on safer sex practices.
Prevention efforts for MSM in the late 1990's
included:
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outreach and distribution of risk reduction kits in bars and other
high-risk settings;
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opinion leader interventions in select areas in the state, based on the
diffusion model developed by faculty at the Center for AIDS Intervention Research, Medical
College of Wisconsin;
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community-building efforts, including events, informal discussion groups,
and support groups focused on HIV prevention and critical issues in men’s lives;
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a social marketing campaign encouraging men who have sex with men to
engage in safer behaviors; a social marketing campaign encouraging men who have sex
with men to engage in safer behaviors;
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capacity-building efforts to improve services for gay and bisexual youth;
and
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conference and mini-grants to assist informal groups of African American and Latino gay
and bisexual men to develop their capacity to provide prevention services.
An initiative beginning in 1999 is designed to develop
the capacity of organizations in communities of color to reach men of color who have sex
with other men.
Prevention services for injection drug
users
For many years, the majority of HIV prevention services for injection drug users (IDUs)
and their partners was limited to street outreach workers providing leaflets and health
promotion materials. Historically, the drug using population was approached individually
to increase knowledge of detrimental effects of drugs. Most programs focused on changing
beliefs and behavior. Many IDUs face enormous challenges such as low literacy skills,
cultural, language, stigmatization, poverty, and social acceptance.
The AIDS/HIV Program supports prevention programs
targeting IDUs and their partners. Street outreach services for drug using populations
occur in jails, crack houses, shelters, meal programs, and group homes. AIDS service
organizations in the metropolitan areas of Milwaukee, Madison, and Kenosha have utilized
HIV prevention funds to support effective outreach to IDUs, including outreach counseling
and testing services. These efforts are coordinated with prevention services promoting
harm reduction and treatment interventions for IDUs. While needle exchange programs (NEP)
are not supported by state or federal funds, they are coordinated with other HIV
prevention programs serving IDUs.
Prevention services for women
Since nearly the beginning of the epidemic, efforts aimed at women have included a focus
on preventing transmission from mother to infant. In 1994, the federal 076 trial found
that zidovudine (AZT) provided to pregnant women during pregnancy and delivery resulted in
a dramatic reduction in risk of transmission from an infected pregnant woman to her fetus.
The AIDS/HIV Program has collaborated closely with the
Wisconsin Association for Perinatal Care, members of the Wisconsin Chapter of the American
College of Obstetric and Gynecology, the Wisconsin Chapter of the American Academy of
Pediatrics, and other professional groups in promoting routine prenatal counseling and
voluntary testing for HIV. The Wisconsin AIDS/HIV Program developed advisory materials for
prenatal care providers as well as consumer education materials for pregnant women. In
1995-96, the AIDS/HIV Program contracted with the Medical College of Wisconsin to provide
in-service training to physicians and other medical providers to ensure that pregnant
women were offered HIV counseling and testing and if identified as HIV-infected, offered
AZT and other appropriate treatment.
Efforts to prevent HIV transmission in women
focus on those in the sex industry, those
currently in or recently released from correctional facilities, women who abuse alcohol
and drugs, and pregnant and parenting adolescents. Strategies to reach women at risk
include facilitator- and peer-led group sessions, street and community outreach, and
individual risk-reduction counseling.
Prevention services for HIV
positive persons
Since early in the epidemic, two strategies have been critical to reaching HIV-infected
persons--HIV counseling and testing, and partner counseling and referral services.
Recently, prevention case management is being provided to reach HIV-infected persons
continuing to engage in risky behaviors.
HIV counseling and testing offers individuals an
opportunity to know their serostatus. As part of counseling and testing services,
individuals who learn they are HIV-infected can access timely medical and support services
and can change behavior in order to reduce the risk of infecting others.
Partner counseling and referral services,
formerly known as partner notification, has been the primary HIV prevention strategy aimed
at reducing transmission from persons who know they are HIV-infected. Sexual and
needle-sharing partners of HIV-infected persons are contacted, without revealing the
identity of the source patient, and advised that they may have been infected. They are
encouraged to seek HIV counseling and testing services.
In 1998, the AIDS/HIV Program received federal
funding to begin two initiatives focused on HIV-infected persons. The first expands
outreach counseling and testing in communities of color in southeastern Wisconsin. The
second provides prevention case management services to HIV-infected persons who continue
to engage in risk behaviors after they are aware of their HIV status. Prevention case
management services are intensive and focus on sexual and drug-use risk behaviors and the
barriers that individuals face in changing these risk behaviors.
Prevention services for
communities of color
Reaching minority populations through public information alone has limited effectiveness.
To reduce HIV infection in communities of color, prevention programs should address the
cultural and linguistic needs of these populations.
In 1989, the Wisconsin AIDS/HIV Program received funds
to provide direct funding to minority community-based organizations (CBOs) for HIV
prevention. A competitive grant application process identified five CBOs from the African
American, Hispanic, and Native American target populations. CBOs spent the first few years
conducting HIV prevention presentations and risk reduction programs led by social workers,
nurses, teen peers and indigenous outreach workers. These programs dispel the myths of
HIV/AIDS, increase HIV community awareness and promote risk reduction. CBOs were
identified as the best agent to deliver these prevention messages because of established
trust among community leaders and track records in working with minorities.
In 1996, CBOs were encouraged to redirect prevention
strategies to reach at-risk populations. HIV prevention programs were developed targeting
men of color who have sex with men (MCSM); injection drug users and their partners;
pregnant and parenting teens; homeless and incarcerated youth; and gay, lesbian, and
bisexual youth. The targeted programs promoted counseling and testing and risk reduction
for high risk youth, identified a leadership task force for MCSM, provided direct funding
for culturally-specific case management services in minority CBOs, and increased
collaborations with ASOs.
Prevention efforts in communities of color are
most successful when HIV is addressed as a community health issue. The 1999 federal and congressional focus on addressing
HIV/AIDS as state of emergency in minority populations provided an opportunity to initiate
and reinvigorate HIV prevention efforts among communities of color. Many of these are
under the rubric of capacity-building.
Capacity building
Since the 1980s, the AIDS/HIV Program has provided targeted
trainings and sponsored statewide AIDS/HIV conferences. In the early years, training was
directed at provider skill-building, increasing community awareness, and sponsoring
training-of-trainer workshops. In 1996, funds were distributed to grantees to address
staff training needs and upgrade computer and information systems. The AIDS/HIV Programs
continues to sponsor the biennial AIDS/HIV Program conference, minority conferences,
grantee administrative meetings, youth peer education conferences, grant-writing
workshops, regional teleconferences, and program-specific work group training.
Major capacity-building efforts focus on communities of color and include:
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leadership summits in American American and Latino
communities to identify stakeholders and leaders, and to increase awareness and mobilize
communities to reduce the spread of HIV;
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capacity-building efforts aimed at enhancing the
ability of agencies in communities of color to reach men of color who have sex with men;
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coalition-building efforts to utilize faith-based
institutions in communities of color to disseminate HIV prevention messages; and
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technical assistance regarding program development,
evaluation, and agency infrastructure to enhance the capacity of ethnic minority
community-based organizations to provide targeted HIV prevention services.
Prevention evaluation
The AIDS/HIV Program is committed to improving the effectiveness and quality of HIV
prevention programs in Wisconsin through comprehensive evaluation efforts.
The AIDS/HIV Program believes that:
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evaluation helps agencies improve their services;
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evaluation is essential in program planning and
resource allocation;
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process evaluation is critical to ensure effective
outcome evaluation;
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whenever possible, evaluation should be conducted by
grantee agencies, with support and technical assistance from outside resources; and
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evaluation activities should be developed by a broad
range of stakeholders.
Towards these goals, the AIDS/HIV Program has developed
a statewide prevention evaluation system to implement and monitor evaluation activities
and provide high quality, accessible training, and technical assistance to local grantee
agencies.
In October 1995, the AIDS/HIV Program initiated its
first formal efforts to offer evaluation technical assistance to grantee agencies through
the development of a contract with the Center for AIDS Intervention Research (CAIR) at the
Medical College of Wisconsin. CAIR conducted grantee needs assessments, facilitated
regional workshops, and provided individualized on-site and telephone technical assistance
to local organizations.
In 1996, the AIDS/HIV Program convened an evaluation
work group to provide input on evaluation activities and instruments. The group is
comprised of AIDS/HIV Program staff, members of the HIV Prevention Community Planning
Council, staff from grantee agencies, and local and regional evaluation consultants.
In 1997, the Centers for Disease Control identified
Wisconsin as one of five sites to participate in a national demonstration project to
evaluate the impact of community planning on statewide prevention activities. This project
was critical in identifying the strengths and weaknesses of Wisconsin's HIV prevention
evaluation efforts up to that time.
As part of current contracts with HIV prevention
grantees, the AIDS/HIV Program requires that at least 10% of HIV prevention funds
allocated to grantee agencies be designated towards evaluation. For some agencies, this
represents their first formal efforts to systematically conduct needs assessment and
process and outcome evaluation activities, in addition to traditional work plan monitoring
activities.
In 1997, the AIDS/HIV Program, in collaboration with the
Evaluation Work Group, developed and pilot tested an Annual Report Form, the program's
first uniform data collection instrument that collects demographic data about program
participants served through grantee agencies and includes grantees' assessments of their
projects.
In September 1998, the AIDS/HIV Program added a
full-time HIV prevention evaluator position to the staff. The position is responsible for
coordinating a statewide evaluation system, collecting and analyzing contract performance
indicator data, providing technical assistance and training to local agencies, and
advising the AIDS/HIV Program on future evaluation initiatives.
The AIDS/HIV Program, in conjunction with the work
group, has developed a comprehensive five-year work plan to assist in the design and
implementation of future evaluation activities. This is part of a larger national
initiative to create a core evaluation system that assesses and improves state health
department and CDC prevention programs.
In early 2000, the AIDS/HIV Program issued new
evaluation guidance to grantees which includes a revised data collection system.
The AIDS/HIV Program continues working collaboratively with grantee agencies and other
public and private organizations to implement comprehensive evaluation activities in order
to deliver the highest quality, most effective HIV prevention services possible.
For further information regarding the following areas, contact the staff
listed below:
Overall HIV prevention programming:
Timothy Pilcher: 608-264-6514
HIV prevention programs for communities of color:
Karen Johnson: 608-266-1808
HIV prevention evaluation activities:
Timothy Pilcher: 608-264-6514
Last Revised: December 17, 2007 |
