HIV Prevention Evaluation Initiative

Front row (from right to left): Olga Grinstead, Sandi Galvez, Carrie Bancroft, Ellen Goldstein. Middle row, standing: Mike Kennedy, Barry Zack, Maria Ekstrand, Bill Woods, Eugene Beronilla, Carolyn Laub. Back row: Drew Feraios, Mike Acree, Ron Stall, John Dunn-Mortimer, Lindsey Phillips, Bonnie Faigeles, Coleen Hoff, Rafeal Diaz, Oliver Saunders. Not pictured: Henry Raymond, Jose Hernandez, Gabe Lew, Marvin Williams, Tom Calvanese, Donnovan Somera.

Background

In 1997, the Center for AIDS Prevention Studies (CAPS), University of California San Francisco, AIDS Research Institute and Northern California Grantmakers AIDS Task Force (NCG), an association of philanthropic organizations, joined forces to launch the HIV Prevention Evaluation Initiative. The two-year project sought to bridge the skills of HIV prevention science and HIV prevention service by bringing together a consortium of Bay Area community-based organizations (CBOs), trained HIV prevention researchers from CAPS, CAPS program administrators, and Bay Area philanthropists to implement HIV prevention intervention research.

Project Goals

The project sought to pilot novel prevention programs, evaluate their success, and disseminate the results so that effective programs can be replicated, and ineffective programs can be modified. Our goals were:

to evaluate programs for at-risk populations;
to develop evaluation skills among CBO staff participants;
to bring university researchers new insights on populations at risk for HIV;
to gain insight into real-world conditions that affect model program designs;
to evaluate the process of community-based research.

Program Design

In order to successfully carry out the goals, we designed a model program for community-based collaborative research that included:

a consortium consisting of 7 CBOs, 7 researchers, 2 statisticians, a program manager, and administrative support staff;
CBO staff person/scientist dyads where each agency was teamed with a dedicated scientist;
up to $45,000 in program and $10,000 evaluation funding per year for each CBO;
a 4-day workshop which provided CBO participants extensive training in research design, data collection and analysis;
monthly meetings where participants received additional research training, collective problem solving, and support;
a working partnership with funders;
a program manager to support the scientist-CBO pairs, facilitate training and assistance, and remove obstacles to project implementation;
on-going technical assistance, including scientist and statistical consultation, data entry and statistical analysis;
additional funding to disseminate findings to colleagues and community members.

The Players

Seven CBOs from various parts in the Bay Area who served a diverse group of clients were chosen to participate in the 1996-1999 HIV Prevention Evaluation Initiative. Following is summary of the agencies, the contact person at each agency, the scientist at CAPS who collaborated on each project and a brief description of the research project each carried out.

AIDS Project of the East Bay
Drew Feraios; Oliver Saunders; Diane Binson -- CAPS

The goal of the research was to better understand the population of substance users in Alameda County and their prevention needs. For several months in 1998, 200 individuals attending APEB's HIV prevention programs at 35 different venues (e.g., SROs, recovery centers, homeless shelters) and 234 individuals from street venues (e.g., parks, sex industry strip) completed surveys. In addition, from October, 1997, to September, 1998, we conducted life history interviewers with 30 people from these venues.

AIDS Resources, Information and Services of Santa Clara County (ARIS)
Eugene Beronilla, Cecile Cummings; Colleen Hoff-- CAPS

With the goal of creating effective HIV prevention interventions for gay Asian/Pacific Islander (A/PI) Men in Santa Clara County, ARIS, created a community level intervention emphasizing community involvement and mobilization. The study began with intensive formative work with focus groups, key informant interviews, and the formation of a community advisory board. The interventions included a website and events.

Centerforce
Barry Zack; Olga Grinstead -- CAPS

Centerforce developed and implemented a multi-dimensional peer education program targeting women who are the sexual and needle-sharing partners of incarcerated men at San Quentin State Prison. The program contacted the women directly at The House, a center for visitors outside San Quentin's main gate. The intervention involved the following components: 1) recruitment, training, and evaluation of peer educators; 2) peer facilitation of a variety of risk reduction activities, including HIV/AIDS education classes and one-on-one support. Cross-sectional surveys to describe the visitor population over time and to assess program utilization were also conducted in 1997 and 1998.

Huckleberry Youth Programs (formerly Youth Advocates, Inc.)
Lindsey Phillips, Jose Hernandez; Maria Ekstrand -- CAPS

The Latino/a Peer Education Project addressed the HIV Prevention and education needs of the growing population of Spanish-speaking immigrant youth. The Project utilized peer health and peer-led HIV prevention workshops for youth in the Canal, a predominantly newcomer Latino/a community in San Rafael. The approach was to provide HIV prevention services in the context of broader issues facing newcomer youth - issues related to immigration status, language differences, and discrimination; information on reproductive health and contraceptives; and access to health services.

Larkin Street Youth Center
Mike Kennedy; Ron Stall -- CAPS

This project addressed the co-factors affecting homeless youth's need for survival while working towards reducing the behaviors that put homeless youth at risk of HIV infection. It focused on introducing an innovative small group multiple session intervention. The intervention focused on learning skills in negotiating or refusing sexual behavior and in cleaning needles. Additionally the importance of differentiating types of street youth (i.e. skaters, ravers, punks, hippies) for different risk behaviors was explored.

Tenderloin AIDS Resource Center (TARC)
Tom Calvanese; Bill Woods -- CAPS

This project implemented a behavioral risk assessment of its transgendered clients and residents of the Tenderloin area in San Francisco. Areas explored included living situations, access to health care, and sexual and needle sharing risk behaviors.

YWCA of the Mid-Peninsula
Carolyn Laub; Rafael Diaz -- CAPS

This project implemented and evaluated a classroom-based, 5-day HIV prevention education workshop with teenagers in Santa Clara County public high schools. In addition to covering basic information about HIV transmission, compassion for people living with HIV/AIDS, and skills for the prevention of HIV, the curriculum addressed the "cultural scripts" that regulate their sexual behavior. By focusing on "cultural scripts," the program helped teenagers identify, evaluate, and resist the barriers that prevent them from choosing HIV prevention practices. Measures of cultural scripts and their correlation with risk taking was a focus of the research.

Lessons Learned

Over the past two years, we have learned many lessons about the process of conducting collabo-rative community-based research.

Collaborations are both taxing and rewarding. They require both researchers and service providers to see things from an outside point of view which, while frustrating, can be mutually beneficial to all parties;
Invest time in building and maintaining collaborative relationships. The two parties need time to establish trust, give up some control, and learn to speak the language of the other's world.
Provide common ground. Providing regular meetings between all the project participants helped create a language researchers and service providers could share as well as enabling service providers to collaborate on the research rather than cooperate with it.
Invest money in supporting collaborative research. Money pays not only to deliver prevention services and evaluate them, but also to foster strong, collaborative relationships.
Ensure that all participants are committed to the services being offered, to the evaluation project, and to the consortium. It is invaluable that the agency staff, at all levels, have buy-in to the project. Involve researchers with knowledge of HIV prevention and history of community-based work whenever possible.
Set appropriate expectations for research efforts and fund accordingly. Collaborative research is very labor intensive and expensive. Be sure to fund at a level appropriate to this effort.
Actively involve funders whenever possible. Having the funder involved can facilitate midcourse corrections or major changes in research and/or program design.
Be flexible in designing and fielding collaborative studies. The researcher's job in the collaboration is to help the CBO researchers adapt and apply the most appropriate scientific tools while respecting the integrity of the intervention.
Learn from difficulties you encounter in implementing research. Learning what doesn't work in AIDS prevention is also important; don't be afraid of getting negative results.

Bibliography

Please see the list of articles generated by this project.

For more information about the project please contact:

Ellen Goldstein
Center for AIDS Prevention Studies
74 New Montgomery Street, Suite 600
San Francisco, CA 94105
(415) 597-9396

John Dunn Mortimer
Northern California Grantmakers, AIDS Task Force
116 New Montgomery Street, Suite 742
San Francisco, CA 94105
(415) 777-5761.

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