Communities Empowered To Address HIV/AIDS
In the United States, as elsewhere, AIDS is an epidemic composed of multiple sub-epidemics. These diverse sub-epidemics, that vary by region and community, combine to create the larger picture of AIDS in America.
Recognizing that unique local situations require unique local solutions, in 1993 the Centers for Disease Control and Prevention completely revamped its approach to HIV prevention activities. In December of that year, CDC issued HIV Prevention Community Planning guidance to all state, territorial, and local health departments receiving HIV prevention funds. The guidance required that health departments share responsibility for identifying high priority HIV prevention needs with representatives of communities for whom prevention services are intended. HIV Prevention Community Planning also embraces the notion that behavioral, epidemiologic, and social sciences must act synergistically in the development, implementation, and evaluation of HIV prevention programs within a community.
HIV Prevention Community Planning represents a significant step forward in the planning of culturally competent and scientifically sound HIV prevention programs that specifically address unique community needs.
The Community Planning Cycle
The community planning process begins with the development of an epidemiologic profile of the present and future extent of HIV/AIDS in the jurisdiction. A needs assessment is then conducted to identify unmet HIV prevention needs within defined populations. The Community Planning Group takes this information to identify priority HIV prevention strategies and interventions for specific populations. They then develop goals and measurable objectives for specific populations. Once this step is completed, a comprehensive HIV prevention plan is developed that is consistent with the identified high priority HIV prevention needs. Then the local and/or state health department implements priority activities of the plan. Periodically, the HIV prevention plan is updated. The Community Planning Group evaluates the effectiveness of the planning process before the cycle begins again.
Technical Assistance Helps Communities Continually Refine Planning
CDC works a network of governmental, nongovernmental, and private providers to deliver technical assistance and training to health departments and community planning groups. This technical assistance includes several content areas:
- Orientation to the Community Planning Process
- Process Management
- Parity, Inclusion, and Representation
- Using Data to Support Decision Making
- Needs Assessment
- Priority Setting
- Intervention Effectiveness/What Works
Community Planning Has Strengthened HIV Prevention
Presently, there are 176 community planning groups--128 regional and 48 project-area wide. Virtually all 65 state, territory, and city HIV prevention grantees have formed and sustained a community planning group; developed or strengthened epidemiologic profiles; conducted needs assessments; developed a comprehensive plan; and begun to implement priorities. The community planning process has seen other positive effects as well, including:
- Improved relations between communities and health departments
- The infusion of diverse individuals and perspectives to address the problems of HIV prevention
- Enhanced data collection and use
- Shifts in funding allocations and strategies
- Strong interest in evaluation
- System for identifying national prevention research needs
- Dissemination of innovative practices and program models
Challenges for the Future
Evaluation of this innovative HIV prevention planning process yielded high positives for the new way of working. But it also indicated that the community planning process continues to face many challenges. These include the need for priority-setting models; defining and addressing data gaps; sustaining diverse membership; delivering ever-more complex technical assistance. Evaluation in year 2 will assess the impact of the process on HIV prevention programs, monitor progress and costs, and serve as the basis for program improvement. These Vancouver presentations offer more information on HIV Prevention Community Planning.
The AIDS Community Demonstration Projects(ACDP): A Successful Multi-Site Community-Level Behavioral Intervention, Martin Fishbein.
Case Study Methods for Process Evaluation of Participatory Social Marketing, Lauretta Pinckney, Martha Hare.
Social Capital Among Community Volunteers: Its Relationship To Community-level HIV Prevention Programs, Donna L. Higgins.
Project Area-Specific Technical Assistance for HIV Prevention Community Planning, Dennis Jarvis.
Focus Group Themes That Will Shape Participatory Social Marketing Interventions in 5 Cities, May Kennedy.
Reaching And Involving Youth: A Prevention Marketing Approach, Chad Martin.
Designing Evaluations of Community-Level HIV Prevention Plans, Glen Nowak.
Involving the Community: A Model for Community-level HIV Prevention Activities, Bobbie Person.
Evaluating the Contributions of Social Marketing to HIV Prevention in Five U.S. Communities, Deborah L. Rugg.
HIV Prevention Programs: A Decade of American Experience, Gary R. West.
Rapid Assessment of Prevalence Surveys: Prevalence Data for Use in Local HIV Prevention Community Planning, David G. Withum.