Date: Tue, 2 May 1995 13:59:40 +0500 From: ghmcleaf{CONTRACTOR/ASPEN/ghmcleaf}%NAC-GATEWAY.ASPEN@ace.aspensys.com Subject: CDC Prevention Newsletter, Spring 1995 CDC HIV/AIDS Prevention Newsletter, Vol. 5, No. 4 (Spring 1995) Quarterly publication for constituents of the Centers for Disease Control and Prevention (CDC), Public Health Service, U.S. Department of Health and Human Services Director, CDC: David Satcher, M.D., Ph.D. Deputy Director, CDC: Claire V. Broome, M.D. Acting Director, National Center for Prevention Services: Helene D. Gayle, M.D., M.P.H. Acting Director, Division of HIV/AIDS Prevention: James W. Curran, M.D., M.P.H. Editorial and Distribution Inquiries to: CDC HIV/AIDS Prevention Newsletter 1600 Clifton Road, MS/E-40 Atlanta, GA 30333 INTERNET: LEC4@ODDHIV1.EM.CDC.GOV Managing Editor: Linda Gauger Elsner Associate Editor: Carol M. O'Connell Production: Barbara J. Benson Renee Maciejewski SPECIAL ISSUE: HIV PREVENTION COMMUNITY PLANNING During fiscal year (FY) 1994, the Centers for Disease Control and Prevention (CDC), the National Alliance of State and Territorial AIDS Directors (NASTAD), and other national partners implemented HIV prevention community planning. In the first year of the HIV prevention community planning process, state and local health departments were asked to hold an open nomination and selection process for membership on their planning groups. The health departments then worked with these planning groups to develop epidemiologic profiles of the current and projected epidemic in their jurisdictions, assess HIV prevention needs, establish priorities among needed HIV prevention strategies and interventions, and develop a comprehensive HIV prevention plan consistent with the high priority needs identified through the planning process. This plan was then used as the basis for the health department's FY 95 funding application. A number of mechanisms were established to monitor the progress made in implementing community planning in year one. In addition to weekly meetings with CDC project officers and teleconferences with NASTAD, sources of information on year one progress included the following: y The November 6-10, 1994, external review of continuation applications for FY 95 HIV prevention cooperative agreement funds y Four subject-specific, in-depth reviews of a randomly selected sample of 16 continuation applications y The observations of 52 external consultants at the December 5-7, 1994, In-Progress Review meeting y The review of FY 95 applications for the five core year-one objectives and the compilation of FY 95 budgetary data, both conducted by the Academy for Educational Development y The United States Conference of Mayors' profiles of community planning in nine jurisdictions y The Batelle profiles of community planning in two cities receiving HIV prevention funds directly from CDC y The AIDS Action Foundation report of interviews with key informants of nine community planning groups As they were completed, these individual reports were sent to the 65 state and local health departments and the community planning co-chairs of record. To assist project areas, community planning groups, and other partners in the synthesis of this large amount of important information regarding year one of HIV prevention community planning, CDC convened a small group of staff to cull from the reports described above the major findings around each of the five core objectives established for year one. The group then prepared a report, which was distributed in March to project areas, co-chairs, community-based organizations, national/regional minority organizations, STD programs, consultants, and others. This summary document does not include all findings, but lists those that CDC believes are especially relevant for successful HIV prevention community planning in year two. Additionally, it is not meant to replace the wealth of specific information available in the sources described above, but rather to assist project areas by highlighting, from CDC's perspective, the important findings of year one. General Observations: While the report's findings of specific strengths and limitations related to each core objective are too lengthy to be included here, some of the general observations noted in the report are listed below: y Leadership of national partners, especially nongovernmental organizations, and designated fiscal resources are important factors in sustaining an open nomination/selection process. y The role of CDC Project Officers, as proactive consultants to health departments during development of nomination/selection procedures, generally helped to identify and solve problems early on. y Health departments' acknowledgement of the benefits of an open and inclusive planning process improves their commitment to achieving inclusion and representation. y Flexibility in interpreting the guidance language (i.e.,"representation reflective of the epidemic") often results in confusion about the appropriate mix of members on the community planning group. y To balance the realistic concern of keeping a community planning group at a "workable" size with the important ongoing concern about increasing representation and inclusion, many areas are using mechanisms such as public hearings and ad hoc committees to ensure representative input. y The task of developing an epidemiologic profile and needs assessment is not a one-time-only event; instead, it is an ongoing, iterative process. y The application of behavioral science to the assessment of unmet needs facilitates and supports the process. y Consideration of the numerous criteria outlined in the guidance document is a necessary, but ambitious, task requiring input from the entire group, using the diversity of their experience. y The ability to prioritize interventions is highly dependent on the accurate assessment of unmet HIV prevention needs. y There is a need for distribution of more straightforward models to prioritize interventions based on multiple criteria. y Improving the ability of planning groups to critically examine the relationship of the funding application to the plan is necessary. y In most instances, it will take more than a single planning and funding cycle to result in significant, widespread changes in allocations of funds at the local level. Cross-cutting Issues: The report also noted the following cross-cutting issues: y Parity is a cross-cutting issue that affects every step in the community planning process. Reciprocal understanding and respect for different competencies are necessary for the success of the community planning process. y It is important to clarify communication roles and responsibilities between and among CDC, health departments, community planning groups, technical assistance providers, other related planning groups, and affected communities. y In year one, technical assistance providers made important contributions by emphasizing national commitment and partnerships and by raising awareness of key issues related to specific planning tasks. y Interactive technical assistance systems in year two should be more regionally/locally oriented so that they are responsive to local need and aware of local context. y The overall community planning process will improve as groups improve and increase their abilities to self-assess progress and diagnose potential difficulties. To obtain a copy of the complete report, please write to Mr. Dalton Steele: Centers for Disease Control and Prevention 1600 Clifton Road, Mail Stop A-24 Atlanta, Georgia 30333. COMMUNITY PLANNERS SHARE EXPERIENCES This issue of the CDC HIV/AIDS Prevention Newsletter presents a special focus on the first year of HIV Prevention Community Planning. In the "spirit of community," the editors invited guest authors involved in the last year's process to contribute to this special issue. CDC is extremely grateful to the individuals and organizations who took time from their busy schedules to share their various perspectives on the community planning process. The opinions expressed herein by guest authors are their own and do not necessarily represent the views of the Centers for Disease Control and Prevention. NEW CENTER FOR HIV/AIDS, STD, AND TB PREVENTION IS ESTABLISHED - -DR. HELENE GAYLE IS NAMED ACTING DIRECTOR Following the announcement of a major reorganization of CDC's HIV/AIDS programs, CDC Director Dr. David Satcher moved quickly to establish a new center for HIV/AIDS, STD, and TB prevention services on February 15, 1995. Dr. Helene Gayle, CDC's Associate Director/Washington, was named Acting Director, and a national search is underway for permanent center leadership. The name of the new center is still under consideration. Dr. Satcher accepted the internal implementation team's recommendation that the new center be organized around disease- specific divisions for HIV/AIDS, STD, and TB. Dr. James Curran, Associate Director for HIV/AIDS, is serving as Acting Director of the Division of HIV/AIDS Prevention, which will incorporate the surveillance, epidemiology, and behavioral science functions of the Division of HIV/AIDS, National Center for Infectious Diseases (NCID); HIV prevention and behavioral science functions of the Division of STD/HIV Prevention, National Center for Prevention Services (NCPS); and activities of the Office of the Associate Director for HIV/AIDS. In addition, Dr. Curran will work with Dr. Gayle to establish a clear matrix of responsibilities for HIV/AIDS prevention efforts in other centers, institutes, and offices at CDC in the following areas: y Policy, internal communications, and clearance procedures y Laboratory and epidemiology coordination y Programs for youth y Programs for women y Prevention of HIV transmission in the workplace y International health y Prevention of opportunistic infections Two divisions from the former NCPS will be merged into the new center. Dr. Judith Wasserheit, Director of the Division of STD/HIV Prevention in NCPS, is serving as Acting Director of the new center's Division of STD Prevention. Dr. Kenneth Castro is continuing as Director of the Division of TB Elimination, which will remain largely intact in the reorganization. The Division of Quarantine, headed by Charles R. McCance, was moved from NCPS to NCID. The organizational location of the NCPS Division of Oral Health, headed by Dr. Donald Marianos, is still under study. Dr. Alan Hinman, previously director of NCPS, has been named a Senior Advisor to the Director, CDC. His broad expertise in public health and longstanding relationship with state health departments will be invaluable to CDC in coordinating the development of performance measures and program standards for block grants to states. He will also assist the agency and the Public Health Service in developing better measures to evaluate public health outcomes. More About New Prevention Center: In addition to the three divisions, the new center is expected to include a Program Support Office that will serve as the key service link for HIV/AIDS, STD, and TB prevention efforts nationwide. It will be the point of initial contact for CDC grantees in state and local health departments and will provide technical assistance to grantees and CDC field staff and support to all divisions with respect to management of field staff. Public health advisors (PHAs) in the field comprise approximately one-half of the staff of the new center and will continue to be a mainstay of center activities. Plans are also being formulated to use cross-divisional teams and other approaches for coordinating behavioral science, research synthesis and translation, surveillance, and other activities throughout the center. CDC believes this approach will improve the science base and evaluation capacity of HIV programs, as well as facilitate integrated approaches to HIV/STD and HIV/TB activities. Additional details about the reorganization will be provided in the next issue of this newsletter. CDC'S DR. ROBIN GORSKY IS HONORED Robin Gorsky, Ph.D., Associate Professor, Department of Health Management and Policy at the University of New Hampshire and part-time Cost Specialist at CDC since 1991, has been awarded the university's 1995 Excellence in Research Award. This annual award recognizes the faculty member whose research represents the highest standards to which others may aspire. Dr. Gorsky will receive her award at the University Honors Convocation on May 8 in Durham, New Hampshire. COMMUNITY CO-CHAIR PERSPECTIVE ON PLANNING FOR HIV PREVENTION By Luoluo Hong Community Co-Chair, Louisiana Region II I think most of our members joined the community planning process motivated by similar ideals of healing our communities, improving the health of our loved ones, and raising the awareness of all citizens. One year later, that idealism has been tested, yet remains true. For the past year, the members of the Louisiana Region II HIV Prevention Community Planning Group (CPG) have struggled with political agendas (some subtle, others overt), territorialism, hot weather, suspicious community leaders, attack dogs, grandmothers with grit, and tension-filled meetings. Along the way, we laughed, cried, fought, and hoped together. The community planning process helped each of us involved to grow as much as it enabled each of us a chance to give back to the people we called friends, teachers, mentors, neighbors, grocery store clerks, cops, and family. When our year one evaluation and year two plan were successfully sent off to the state Office of Public Health, and the state grant applications were reviewed and funded, the group breathed a sigh of relief--our work had paid off. However, in addition to mastering the nuances of prevalence versus incidence data, we learned a few other crucial lessons that we will be sure to carry into year two planning efforts. First and foremost, it was reinforced for our group just how challenging it is to confront HIV and other issues of sexual health and substance abuse, particularly for a Southern, conservative culture such as ours. We had to proactively build support every step of the way from key leaders in the local community. We had to be flexible and open-minded to all viewpoints. Second, we found that community-based organizations (CBOs) are proud and therefore protective of the work they are conducting around HIV prevention. It was imperative that CBOs felt ownership of the tasks at hand, and that they did not regard CPG efforts as a threat to the very beneficial and identifying niche they had carved out for themselves. This required us to be collaborative, communicative, and willing to compromise. Unfortunately, in our need to meet tight deadlines, I don't think we were effective in achieving this goal; we will definitely attend more fully to this task in upcoming months. Third, we realized that the community is a resilient, dynamic resource in and of itself. Again, our desire to be task-oriented and efficient somewhat obscured our ability to take advantage of the street-smarts and skills that our community offers. Our society has trained us to value formal education, oftentimes to the exclusion of informal learning; the latter can be just as insightful or relevant--at times even more so. Channeling and utilizing the expertise of individuals from the various walks of life takes time and patience, both of which we should have in greater supply next year. In community planning, HIV prevention implies so much more than talking about condoms and clean needles. It means incorporating the meaning of violence, crime, homelessness, poverty, racism, teen pregnancy, media, barbershops, public schools, churches, and discount stores in our lives. I have been privileged to work with the members of the community planning group. Their willingness to commit energy, time, feeling, and creativity to such a daunting project has motivated me and brought out the best in myself. This job has been largely a thankless one, but the small rewards, though intangible, have been worth the labor and heartache. Continued good luck to all you fellow CPG-ers. Love, laughter, and peace.  BETTER PARTICIPATION . . . BETTER SCIENCE . . . BETTER PREVENTION by William A. Smith Academy for Educational Development The first year of HIV Prevention Community Planning has been complex, demanding, exciting, rewarding, even inspiring . . . and, yes, frustrating too. Health departments and communities have shared responsibilities, embraced a broad range of interested and affected populations, and begun to improve the scientific and technical quality of local prevention efforts. As one of the network of technical assistance providers assembled by the CDC, the Academy for Educational Development (AED) has been privileged to work with health department staff and community planning group members from project areas around the country. We are witness to the creativity, dedication, and commitment of individuals at all levels, and to the openness and genuine sense of partnership that has been created and supported. Have there been problems? You bet. We all complained about the time line, but ultimately it didn't stop any of us from getting the job done. We lost members and friends to fatigue and illness, and we dealt with conflicts over scheduling and values. But in many areas, HIV/AIDS community planning was the first community- wide HIV prevention planning effort undertaken. New working relationships were created, and new prevention needs were identified, documented, and incorporated in community-driven prevention plans. There remains much to do. The goal of community planning is to improve the quality of prevention programs by putting planning into the hands of those most invested in the epidemic and by giving them the organizational and scientific tools they need to do the job. The organizational demands of the first year often left little time for the scientific issues. Many groups attempted for the first time to struggle with the epidemiology of HIV and understand how the virus was moving through their populations. Effects of the epidemic on new communities were identified, and new voices were heard at the planning table. At the same time, many of the communities historically impacted by AIDS were facing tough new challenges--recidivism and growing apathy in the face of a stubborn, intransigent epidemic. No two communities in America were identical, but many shared common problems. In a world of stable or shrinking resources, effective prevention requires communities to make sound, but tough, decisions which employ techniques and knowledge that good science is essential for providing. In December 1994, scientists, managers, and community members came together with CDC in Atlanta to examine and discuss current and future efforts. Along with praise for progress achieved came recommendations for improving the quality and comprehensiveness of community planning efforts, including identification of the following needs: y A shared logical framework for decision-making--a framework that explicitly links our analysis of problems with our selection of solutions. y Epidemiology and behavioral science to play a greater role in decision-making and priority-setting. y A technical assistance network that is closer to home and brings together lessons being learned in communities across the country. The old notion of "technology transfer" has given way to a strong sense that scientists, public health program managers, and community members, together, are creating the expertise needed to improve prevention efforts. But this expertise has to be shared. y Planning groups to upgrade skills in acquiring and using behavioral data as a way to improve the quality of specific prevention programs. Substantial progress was made during the first year in building strong partnerships. We still need to remind ourselves that improving prevention and reducing HIV transmission are really the ultimate goals. Community involvement and better use of available science through community planning are important means to achieving that end more quickly and more effectively. HIV PREVENTION COMMUNITY PLANNING: YEAR ONE OBSERVATIONS, YEAR TWO CHALLENGES by Julie Scofield National Alliance of State and Territorial AIDS Directors The National Alliance of State and Territorial AIDS Directors (NASTAD) was founded 2 years ago, in large measure due to the concern and frustration of state health department AIDS program managers over a perceived decline in support for HIV prevention. States felt hampered in their prevention efforts by a lack of adequate resources and by what they viewed as micromanagement of their programs. At the same time, a clear message was being sent from the community of organizations and individuals concerned about prevention--too many resources were being spent on counseling and testing, inadequate resources were being invested in targeted community-based interventions, and too little was known about effective interventions for changing the behaviors that continued to put people at risk for HIV in communities across the nation. We all collectively recognized that without stronger partnerships and grassroots support for HIV prevention, programs could not be effective and increased resources would not be forthcoming. HIV prevention community planning is the path we have taken to reach these two goals. The challenge of implementing community planning in one year was daunting. Health departments dedicated enormous amounts of staff time and resources to put a sound community planning process in place. Other initiatives were set aside, and government bureaucracy was challenged from within to respond to the demands of an inclusive, representative planning process. The demands on community participants were equally challenging. Individuals, many of whom are also living with HIV, were asked to volunteer many hours of their time toward this process. Monthly meetings, weekend retreats, community hearings, focus groups, committee work, and numerous other activities were organized and conducted by the hundreds of community participants. The achievements of year one are magnificent. Representative planning groups have been convened across the country, inroads have been made in reaching disenfranchised communities and bringing them to the table, historical barriers between government and people have begun to erode, and the energy of these new prevention partnerships has been felt in communities across the country and in our nation's capitol. Year two presents many opportunities to build on year one successes. Along with the opportunities, however, are hazards to be avoided. Given the uncertainty regarding various national proposals that would impact on this process, it is critically important that we respect the partnerships that have been established and ensure that our collective efforts nurture and sustain the process rather than overwhelm and smother it. Clearly, we must continue to be proactive in identifying technical assistance needs and making sure that project areas that had a rough start are provided needed attention and help. In the vast majority of project areas, however, we must trust that the process has taken hold and that community planning groups are setting their goals and objectives for year two. Indeed, anecdotal evidence suggests that many groups are well into year two activities--priority activities that they have determined for the coming year. Finally, as we work together to strengthen HIV prevention, we must carefully consider how strong community planning processes strengthen our HIV prevention programs. Translating what we learn from each other into more effective HIV prevention programs across the country is essential and must continue to be the ultimate goal of the HIV prevention community planning initiative. NATIONAL ASSOCIATION OF PEOPLE WITH AIDS HELPS INCLUDE PERSONS LIVING WITH HIV IN THE PLANNING PROCESS by William Freeman National Association of People With AIDS Collaboration and diversity are key aspects of any successful planning process. The National Association of People With AIDS (NAPWA) believes that CDC's HIV prevention community planning efforts recognize that importance. NAPWA was pleased, in the past year, to be a provider of technical assistance to state and local health departments and community planning groups to ensure that people with HIV/AIDS were an integral part of HIV prevention community planning. Through our newsletter, regional workshops, guidance manual on community planning, and on-site technical assistance, NAPWA actively participated in the launching of this effort. Inclusion and active involvement of those who are living with HIV disease is the most important part of HIV prevention community planning. Without their perspective, prevention will have limited success in addressing the real causes and effects of HIV. Participatory community planning by those for whom the services are intended is an essential component of effective HIV prevention programs. In the past, major resources have sometimes been misdirected to prevention strategies for low-risk populations, while critical issues related to the prevention needs of high-risk communities and those already infected have been ignored. This has occurred for several reasons, chief among them being planning decisions that have failed to effectively include the input of individuals from those communities. During the provision of technical assistance, NAPWA observed that some jurisdictions and health officials were still unwilling to include people with HIV disease or were uncertain as to why their input is necessary to the prevention planning process. Additionally, there is neither a full appreciation for the unique role of people living with HIV disease in primary prevention strategies nor a clear understanding of the secondary prevention needs of people living with HIV disease. The HIV prevention community planning model works to match prevention activities with the communities where services are provided, and thereby depends on the input of individuals from these communities in the design of effective prevention programs. Individuals with HIV are often essential "experts" on the prevention of HIV infection, as they are intricately familiar with their behavioral patterns and those of their own communities. They are also in need of HIV prevention services to guard against infecting others and to sustain optimal health. People living with HIV offer strategic contributions to community planning groups, providing insight into variables tied to risk behavior that cannot be charted with national surveillance strategies. The past year's community planning process made great strides in emphasizing the importance of participation by HIV-positive people. As year two of community planning begins, NAPWA will be encouraging the continual identification, recruitment, and training of HIV-positive people as active participants and increased education of health department officials and community co-chairs on the importance of that participation. NAPWA will also be advocating for, and working to develop, successful primary and secondary prevention interventions for people living with HIV disease. CDC HELPS BUILD BETTER EPIDEMIOLOGIC PROFILES FOR PREVENTION PLANNING Adapted from a speech by CDC epidemiologist Dr. Jim Buehler Epidemiologists at CDC and colleagues from the Council of State and Territorial Epidemiologists have been involved in promoting and supporting the use of epidemiologic information in community planning for HIV prevention. Epidemiologists who have shared in this process have two goals: y To use epidemiologic data appropriately in shaping HIV prevention community planning y To use our collective experience with community planning to improve our data collection systems Epidemiologists work in a quantitative, numeric, analytic environment, often constrained by the logistic realities of collecting data. Community representatives base their advocacy on their direct experience in confronting the real-life, day-to-day problems that they or their constituents face. To maximize the benefits that can arise from the combination of these varying perspectives, epidemiologists must explain not only their terminology, but also how the data are collected, the constraints imposed on the information collection process, the strengths and limitations of the information, and strategies for effective and appropriate use of the data. Community advocates must make sure that the right questions are asked of the data, and their experience must be used to fill the gaps. As they become increasingly familiar with the array of possible data collection methods, they can play a key role in shaping future information collection strategies--not only asking the right questions, but asking them in a way that can ultimately lead to attainable answers. These things were done in a number of states, establishing a good foundation for collaboration between the planning groups and the epidemiologists and enabling the planning group members to put the data in proper perspective and use them appropriately. Future Directions: Concerns have been expressed about the limitations of AIDS surveillance, HIV seroprevalence surveys, and HIV counseling and testing data in providing a sensitive and timely marker of trends in HIV risk behaviors and HIV infections. These give us a grasp of the number of new AIDS cases that occur annually, but not the number of new HIV infections that are occurring each year, since new infections are much less visible to the health care system. Similarly, we have a much weaker understanding of trends in the often very private behaviors that place individuals at risk for HIV. These concerns have led to wide interest in the role of various surrogate markers for HIV risk, ranging from markers of sexual behavior such as rates of sexually transmissible diseases (STDs), to measures of community vulnerability such as poverty or homelessness. As we think about the role of these surrogate markers, we also have to think about our priorities for HIV prevention. How should we balance our prevention resources between groups or areas where HIV is currently a problem and groups or areas where HIV is a potential problem? For example, high STD rates are clearly a reflection of unsafe sexual behavior. But two communities with comparable syphilis or gonorrhea rates may have very different levels of HIV risk because HIV may or may not be widespread within the communities. Therefore, these surrogate markers reflect behaviors that can be associated with HIV infection and clearly reflect the potential for HIV transmission, but do not necessarily predict HIV trends or levels. Additionally, we would all agree that having more direct information on risk behaviors would be useful, but we need to think very carefully about what our information needs are and how they can be practically met. For example, we can survey people and ask if they used a condom the last time they had sexual intercourse, but is the answer to that question really going to tell us what we need to know? To whom should we address these questions? How can this be done feasibly in local areas, in a way that truly represents trends in behaviors among at-risk populations, in a way that provides a consistent measure over time in our communities, and in a way that provides insights into the success or failure of our community planning efforts? Clearly, we need to be sure that whatever new efforts we undertake to monitor behaviors are supportive of community planning. Finally, the advent of recent changes means that individuals with different perspectives on epidemiology and community planning, public health officials and community advocates alike, must really listen to each other. CDC was encouraged to see this happening in a number of areas as the planning groups took their first steps toward defining a community HIV profile. In the second year of community planning, there will be a need to reexamine and update the epidemiologic profiles and to build on this progress. THE PREVENTION SUMMIT IN ATLANTA -- COMMUNITIES "BUILDING A WORLD WITHOUT AIDS" More than 580 HIV prevention community planning co-chairs and other involved partners gathered in Atlanta March 12-15 for The Prevention Summit. The purpose of this national conference, with the theme of "Building A World Without AIDS," was to recognize the tremendous efforts made by hundreds of people at the local, state, and national level to implement year one of community planning. The meeting was co-sponsored by the Centers for Disease Control and Prevention, the National Alliance of State and Territorial AIDS Directors, and the National Minority AIDS Council. The opening plenary session featured a welcoming speech by CDC's Dr. Helene Gayle, Acting Director of the National Center for Prevention Services, and a presentation on the status of the epidemic by Dr. James Curran, Acting Director of the new center's Division of HIV/AIDS Prevention. In addition, Mr. Paul Kawata, Executive Director, National Minority AIDS Council, made a spirited presentation on the importance of continuing our nationwide HIV prevention efforts. More than 50 workshops at the Prevention Summit offered tools, skills-building sessions, and networking opportunities to assist co-chairs as they move through year two of community planning. Brett Lykins, 15, of Duluth, Georgia; CDC's Chad Martin; Ms. Patsy Fleming, Director, National AIDS Policy Office; Sean Sasser, Health Initiative for Youth's "Yes Center"; Pamela Ling of MTV's "Real World;" and CDC's Dr. Ronald O. Valdiserri participated in a panel discussion on HIV infection and youth. LOCAL DEMONSTRATION PROJECTS PUT PREVENTION MARKETING IN SYNC WITH COMMUNITY PLANNING The Prevention Marketing Initiative (PMI) is being undertaken at CDC to combine the forces of community action, social marketing, and behavioral science to reduce the sexual transmission of HIV among America's youth. Several communities involved in both PMI and CDC's HIV prevention community planning have experienced some natural links between these two initiatives. The community action and social marketing processes occurring in each of the five Prevention Marketing Local Demonstration Sites (one of PMI's four components) affords a common understanding of this connection. The five demonstration sites are Sacramento, California; Phoenix, Arizona; Nashville, Tennessee; Northern Virginia; and Newark, New Jersey. The most common vehicle for interacting has been the sharing of data. Both community planning groups and the demonstration sites have been dedicated to learning as much as possible about critical populations for HIV prevention. Data gathering and sharing during the needs assessment and situation analysis phases of both initiatives has been a mutually beneficial exchange. As both efforts continue to set priorities for target audiences and interventions, opportunities to exchange information and experiences will grow. In 1994, two demonstration sites, Phoenix and Newark, have had greater opportunities to collaborate with local community planning groups because of location and a related focus on critical high-risk populations. In New Jersey, the state health department's AIDS office has actively participated in the Newark prevention marketing planning committee. This involvement has fostered not only data sharing, but also a common focus on the need to involve youth in the planning process of both the prevention marketing and community planning efforts. Ongoing exchanges of ideas and experiences relating to technical assistance have been an additional benefit. In Phoenix, both of the regional community planning co-chairs were involved with the local prevention marketing planning committee. The local prevention marketing coordinator is a member of the regional community planning group. This arrangement alone has bolstered opportunities to share experiences across the two initiatives. A common need to reach and involve Phoenix-area youth in both initiatives has stimulated a collaborative effort to explore the formation of a joint youth advisory committee. Community planning group members' exposure to the prevention marketing process underway in the Phoenix demonstration site further cemented their methods of segmentation, such as focusing on priority populations based on behaviors rather than on traditional demographics. CDC is committed to increasing the synergy between prevention marketing demonstration sites and community planning groups. This collaboration is required for an effective, efficient, and united front against AIDS. For information about the Prevention Marketing Initiative, call 1-800-447-4784, then 329-1659. DECENTRALIZED PLAN FOR TECHNICAL ASSISTANCE IN SECOND YEAR OF HIV PREVENTION COMMUNITY PLANNING To assist in the year one implementation of community planning, CDC worked with its prevention partners to provide technical assistance and training to health departments and community planning groups in the following areas: y Parity, inclusion, and representation of affected populations y The use of epidemiologic and needs assessment data in the planning process y Community planning processes and models y Access to behavioral and social science expertise, including information on effective and cost-effective HIV prevention efforts y Conflict of interest and dispute resolution This technical assistance was delivered through a network of governmental, nongovernmental, and private providers, including the Academy for Educational Development, the Council of State and Territorial Epidemiologists, the National Alliance of State and Territorial AIDS Directors, the National Association of People with AIDS, the National Council of La Raza, the National Minority AIDS Council, the National Native American AIDS Prevention Center, the National Organization of Black County Officials, Inc., and the United States-Mexico Border Health Association. Based on experiences in the first year and input from project areas, technical assistance providers, and community consultants, CDC has determined that for year two, a decentralized technical assistance network will help in meeting the needs of project areas and community planning groups. While maintaining technical assistance providers at the national level, CDC will also implement a decentralized technical assistance program that encourages linkages with, and the development of, local resources. Planned enhancements of technical assistance in year two include providing tools and consultation to project areas to help assess technical assistance needs and priorities, accessing and building the capacity of local and regional organizations to provide technical assistance, implementing processes to establish common objectives and expectations for technical assistance, and improving the follow-up after technical assistance visits. With these enhancements, community planning groups and health departments will be more directly involved in the assessment, selection, and provision of technical assistance in their areas. COMMUNITY PLANNING -- WHAT TO EXPECT IN YEAR TWO The first year of community planning involved many new activities and the formulation of new and enhanced partnerships for HIV prevention across the country. Now that the program is established, we must heighten our focus and understanding of specific prevention needs and interventions. The following is a list of CDC's general expectations for planning groups in year two of HIV prevention community planning: y HIV prevention community planning groups should continue to meet on a regular basis to refine, as necessary, needs assessment data, epidemiologic profiles, and prevention program priorities. y Procedures should be developed for orienting new planning group members about their roles and responsibilities. This should include a thorough review of all written CDC guidance as well as the jurisdiction's year one comprehensive plan. y After reviewing (1) perspectives and experiences of planning group members and community constituents, (2) the reports from the external reviewers and the in-depth reviewers, and (3) any other pertinent information, planning groups should develop two or three major goals and objectives to improve the planning process in year two. y Groups must continue to evaluate the planning process by (1) monitoring planning objectives, including those newly developed for year two, (2) assessing the impact of the planning process, and (3) estimating the cost of the process. y Incorporating results from the activities listed above, planning groups should refine, revise, or expand--as appropriate- -the year one HIV prevention comprehensive plan. CDC expects health departments to submit in the fall of 1995 a continuation application for FY 96 HIV prevention funds. Although specific guidance for these applications will not be available until early summer, a report of progress in the community planning process and in implementing HIV prevention programs will likely be requested. A current comprehensive HIV prevention plan also is likely to be requested. As in FY 95, the community planning group will be asked to submit a letter of concurrence or nonconcurrence with the content of the application. Refined core objectives for year two of HIV prevention community planning are as follows: y Foster the openness and participatory nature of the community planning process. y Ensure that the community planning group reflects the diversity of the epidemic in its jurisdiction, and that areas of expertise as outlined in the guidance (e.g., epidemiology, behavioral science, health planning, evaluation) are included in the process. y Ensure that priority HIV prevention needs are determined based on an epidemiologic profile and a needs assessment (including community sources of information). y In the prioritization of interventions, ensure that explicit consideration is given to priority needs, outcome effectiveness, cost effectiveness, theory, and community norms and values. y Strive to foster strong, logical linkages between the community planning process, plans, applications for funding, and allocation of CDC HIV prevention resources. NUMEROUS RESOURCES FOR COMMUNITY PLANNERS AVAILABLE FROM CDC, OTHERS A number of resource materials have been developed during the first year of HIV prevention community planning to assist health departments and community planning groups in understanding and implementing the planning process. The following is a listing of the resources that have been developed by CDC or made available by others. Unless otherwise noted, copies of these documents are available from the CDC National AIDS Clearinghouse, 1-800-458-5231. y HIV Prevention Community Planning: Puzzled Over Getting Started? (January 1994, CDC) y Supplemental Guidance on HIV Prevention Community Planning for Noncompeting Continuation of Cooperative Agreements for HIV Prevention Projects (December 1993, CDC) y Handbook for HIV Prevention Community Planning (April 1994, The Academy for Educational Development [AED] for CDC) y Example Format for Comprehensive HIV Prevention Plan (1994, CDC) y Positive Input: Your Guide to HIV Prevention Community Planning (July 1994, National Association of People With AIDS) Call (202)898-0414 for a copy. y Sample Models and Tools for Conducting Needs Assessment for HIV Prevention Community Planning (August 1994, National Alliance of State and Territorial AIDS Directors [NASTAD], AED, and CDC) y Do's and Don'ts for an Inclusive HIV Prevention Community Planning Process: A Self-Help Guide (October 1994, National Council of La Raza and The Center for Nonprofit Development and Pluralism, for CDC) Call (202)289-1380 for a copy. y Summary Report, Review of Core Objectives: The First Year of HIV Prevention Community Planning (March 1995, AED for CDC) y Networking Directory: Strategies and Practices for HIV Prevention Community Planning (March 1995, written by Community Planning Group members and Health Department staff; compiled by CDC and NASTAD) y External Review of FY 1995 Continuation Applications for HIV Prevention Projects Program Announcement #300, Summary of Process and Findings (December 20, 1994, CDC) y HIV Prevention Community Planning, Year One Progress: In-Depth Review Reports (January 1995, compilation of in-depth reviews of a randomly selected sample of 16 applications, CDC) y Summary of Major Findings from Year One of HIV Prevention Community Planning (February 20, 1995, CDC) y HIV Prevention Community Planning Profiles: Assessing Year One (March 1995, The United States Conference of Mayors for CDC) For a copy, FAX request to (202)887-0652. y A Guide to HIV/AIDS Prevention Interventions: A Special Look at Effectiveness (Draft, March 1995, AED for CDC) y HIV Prevention Community Planning: Self Assessment Tool (Draft, March 1995, AED for CDC) y Selected Papers on "What Works in HIV Prevention" (July 1994, CDC) y Priority Setting in HIV Prevention Community Planning (July 1994, AED for CDC) To order copies of resource materials listed above, contact: CDC National AIDS Clearinghouse Post Office Box 6003 Rockville, MD 20849-6003 1-800-458-5231 For additional information about HIV Prevention Community Planning, write to: Community Planning Coordinator Centers for Disease Control and Prevention 1600 Clifton Road, Mail Stop A-24 Atlanta, Georgia 30333 NEW HANDBOOK ON PREVENTING HIV INFECTION AMONG DRUG USERS Approximately one-third of AIDS cases reported to CDC through December 1994 were directly or indirectly associated with injection drug use. The use of "crack" cocaine has also been found to contribute to HIV transmission, particularly through the practice of trading of sex for drugs or for money to purchase drugs. Health departments, community-based organizations (CBOs), and other HIV prevention partners can be helped by having clear guidance on conducting comprehensive programs to prevent HIV transmission associated with drug use. To address this need, CDC has engaged the Academy for Educational Development (AED) to prepare a "Handbook on HIV Prevention Among Drug Users." This handbook will provide valuable assistance in prioritizing, developing, and implementing HIV prevention programs for drug users and their sex partners. The proposed handbook, expected to be available in fall 1995, is intended for use primarily by persons who make decisions on the use of HIV prevention resources in their communities. However, it is also targeted toward those who know and understand HIV prevention programs, but may be less familiar with drug use issues and programs to reach drug users. It will focus on social (including policy) issues and behavioral interventions for primary prevention of HIV transmission. The handbook will serve as a companion to AED's "Handbook for HIV Prevention Community Planning," prepared in April 1994 with CDC collaboration and funding. It will contain, but is not limited to, the following: y Background information about drug use and HIV (nature of the drug-use associated epidemic, epidemiology, addiction, description of drugs, drug preparation and use, sexual behaviors) y Program elements of existing interventions (outreach/inreach, access to sterile syringes, HIV counseling and testing, policy issues, criminal justice, drug treatment, access to risk- reduction materials) y Linkages among programs and agencies for a comprehensive prevention strategy (development, implementation, and maintenance of linkages; case studies) y Effectiveness (demonstrated or probable) y Strategies and messages y References To develop these materials, CDC convened a 10-member consultant advisory panel co-chaired by Beth Weinstein, M.P.H., chief of the AIDS Section of the Connecticut Department of Health Services, and Richard Elovich, Director of Substance Abuse Counseling and Education at the Gay Men's Health Crisis, New York City. (See below for a listing of additional panel members.) This group met March 23-24 in Atlanta to work on preparation of the handbook, and will also review drafts in various stages of development. The panel and three additional field reviewers, also listed below, will examine the final draft of the handbook prior to publication. For more information, please contact John Miles at CDC; 1600 Clifton Road, Mail Stop E-27; Atlanta, Georgia 30333; telephone (404) 639-8315. CDC Consultant Advisory Panel on Preparation of Handbook: Co-chairs: Beth Weinstein, M.P.H., and Richard Elovich Panel Members: Rosa Lewis, Ed.D. Project Director, AIDS Evaluation of Street Outreach Project, Philadelphia Health Management Corporation Rev. Margaret R. Reinfield Director of Social and Behavioral Research, AmFAR Robert Trotter, Ph.D. Chairman, Department of Anthropology, NAU/Flagstaff Multicultural AIDS Prevention Project Nan Corby, Ph.D. Community Research and Services Program, California State University, Long Beach Imani Woods, M.P.A. Director, Street Outreach Services, Seattle Victor Hunter, B.A. Deputy Assistant Director, New York City Department of Health, HIV Education, Outreach and Community Development Joyce Perkins, M.S. Instructor/Counselor, Meharry Medical College, Nashville Alma Candelas, M.P.H. Director of Substance Abuse and Women's Services, New York State AIDS Institute Mark Colomb, M.A., Ed.S. HIV/AIDS Education Specialist, Mississippi State Department of Health Rick Talley, B.S. Director for Drug Treatment, Neighborhood Services Department, Michigan Outside Reviewers: Mindy Thompson Fullilove, M.D. Columbia University School of Public Health, Office of Community & Minority Affairs Don C. Des Jarlais, Ph.D. Director of Research, Beth Israel Medical Center, Chemical Dependency Institute, Grants Management and Research Support David Holtgrave, Ph.D. Associate Professor and Director of AIDS Policy Studies, Medical College of Wisconsin HIV PREVENTION COMMUNITY PLANNING SIGNIFICANT EVENTS, 1993-1995 1993: September 17 Meeting of governmental and nongovernmental consultants to discuss draft Supplemental Guidance on HIV Prevention Community Planning November 15 Public meeting on draft Supplemental Guidance December 30 CDC Director sends Supplemental Guidance on HIV Prevention Community Planning to health officials 1994: January 1 Planning funds, with restrictions, are awarded to health departments January 6-7 CDC and the National Alliance of State and Territorial AIDS Directors (NASTAD) co-sponsor training meeting for state, local, and territorial AIDS Directors January 14 Supplemental Guidance is mailed to all CDC HIV prevention grantees February 28 Grantees submit planning applications ("plan for the plan") March Announcement of supplemental funds for the Council of State and Territorial Epidemiologists (CSTE) to provide technical assistance on analyzing surveillance data March 1 Supplemental funding awarded to the National Associationof People With AIDS (NAPWA) to provide technical assistance March 1-2 Division of STD/HIV Prevention (DSTD/HIVP), Program Operations Branch (POB), Project Office Training, "Orientation to Community Planning," presented by the Academy for Educational Development (AED) March 4 Task order for the AED to provide interactive technical assistance March 9 Five national/regional minority organizations are funded under Program Announcement 305A to deliver technical assistance March 23-24 DSTD/HIVP POB Project Office Training, "Orientation to Needs Assessments," presented by AED April 6 Supplemental funding awarded to the Association of State and Territorial Health Officials (ASTHO) for providing peer-to-peer technical assistance April 7-8 Meeting of technical assistance provider organizations and others to discuss coordination of technical assistance services April 19 Briefing for Secretary Donna Shalala on HIV Prevention Community Planning, the Prevention Marketing Initiative, and CDC's External Review of HIV prevention programs April 22 AED issues the Handbook for HIV Prevention Community Planning April 25-26 NASTAD conducts "Spring Training" in Washington, D.C. June 6-7 First meeting of HIV Prevention Community Planning Group co-chairs, sponsored by CDC and NASTAD July 11 Second meeting of technical assistance provider organizations July 11, 22 DSTD/HIVP POB Project Office Training, "Priority Setting for HIV Prevention Community Planning," presented by AED August 22-26 DSTD/HIV Prevention Grantees meeting, Washington, D.C. October 3 HIV Prevention Program Announcement #300 continuation application for FY 95 funds due to CDC November 6-10 External review of HIV prevention continuation applications for FY 95 funds December 5-7 Technical assistance providers and governmental and nongovernmental representatives, including co- chairs, meet to review progress toward achieving the five core objectives of HIV Prevention Community Planning Late December FY 95 HIV prevention funds are awarded to 65 project areas 1995: February 15 Supplemental FY 95 applications due to CDC February 28 Meeting of co-chair representatives, NASTAD, and CDC to discuss technical assistance needs in year two March 1 Wide distribution of major findings from year one of HIV Prevention Community Planning March 12-15 HIV Prevention Community Planning co-chairs meeting, sponsored by CDC, NASTAD, and the National Minority AIDS Council (NMAC) NAPWA AND FEDERAL AGENCIES WORKING ON HIV/VIOLENCE ISSUES Living with HIV infection or being diagnosed with AIDS means dealing with both health problems and other people's fears, misinformation, and prejudices. Sometimes these fears and misperceptions result in violent reactions, ranging from verbal harassment to physical assault to homicide. Because the violence is based on the abuser's perception that the victim has HIV or AIDS, people who are HIV negative are potentially just as likely to be victims as people who are HIV positive. To help find solutions to these kinds of problems, CDC will support the National Association of People With AIDS (NAPWA) in convening a group of experts on HIV-related violence. CDC expects to contribute to the NAPWA meeting in discussions involving suicide, violence, gay and high-risk youth, and the prevention of violence associated with HIV testing. In addition to CDC, other federal agencies expected to send representatives include the Department of Justice, the Office of Civil Rights, the Substance Abuse and Mental Health Services Administration, and the National Institutes of Health. Using a "think tank" strategy, the meeting will be held in New York in June. For further information, please contact Mr. David Brownell at CDC; 1600 Clifton Road, Mail Stop E-40; Atlanta, Georgia 30333.