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HIV/AIDS Education and Risk Reduction Initiative

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The Alliance's HIV Education and Risk Reduction (HERR) program was developed in 1995 to address the prevalence of HIV/AIDS in the African-American community in DeKalb County. Debra Thomas, an HIV positive African-American woman and an avid local and national AIDS activist, was instrumental in its development.

Our conceptual framework for HIV/AIDS prevention is grounded in theory. As we strive to better understand why people expose themselves to risks (i.e., lack of knowledge, ability to make decisions) and the socio-cultural and contextual factors that contribute to risk taking (i.e., racism, poverty, stigma, discrimination, lack of opportunities, low self-esteem, diminished ability to dream, etc) theory helps explain human behavior and suggests ways in which we may better impact attitudes and behaviors.

HIV is preventable. While an incurable and progressive disease, HIVis also treatable. Research has identified three routes of HIV transmission:

1. Blood
2. Sexual
     3. Mother/child during pregnancy or breastfeeding.

However, sexual transmission accounts for more than 75 percent of infections nationally and worldwide. 1 Transmission of HIV from men to their partners is more efficient than from woman to man. 2,3 According to the Centers for Disease Control & Prevention and other scientists, STDs (sexually transmitted diseases) appear to amplify HIV transmission.

Behavior theory is a component of our program planning process that involves:

 · Assessing the risk behaviors and co-factors of the targeted population;
 · Considering the strengths and weaknesses of potential HIV interventions and choosing those that best 
   address the needs of the targeted population; and
 · Working from an awareness of the contexts in which HIV occurs in our organization, community and 
    appropriate culture.

Following are examples of theories used in our program:

Health Belief Model (HBM) proposes that an individual's actions are based on beliefs. It identifies key elements of decision-making such as a person's perception of susceptibility, perceived severity of the problem, and the perceived barriers to prevention. (Rosentock, Strecher, Becker, 1994.)

Theory of Reasoned Action (TRA) provides a construct that links individual beliefs, attitudes, intentions and behavior based on the premise that people are rational and that the behaviors being explored are under their control. (Fishbein, Middlestadt, 1989).

Social Cognitive Theory (SCT) views learning as a social process influenced by interaction with other people. Even more important than learning about HIV prevention methods is placing those messages in the context of the participants' own reality. (Bandura, 1994).

Stages of Change (SOC) is a continuum that provides a framework for understanding a person's readiness to change behavior. This continuum describes a series of steps or stages that includes: (1) Pre-Contemplation, (2) Contemplation, (3) Ready for Action, (4) Action and (5) Maintenance. A person engaged in risky behaviors at the first stage may have no intention of changing the high-risk behavior or adopting a given risk reduction behavior. This is especially true with young men engaged in risky sexual behaviors who do not identify as being gay or bi-sexual. (Prochaska and DiClemente, 1983).

AIDS Risk Reduction Model (ARRM) provides the framework for explaining and predicting the behavior change efforts of individuals specifically in relationship to the sexual transmission of HIV/AIDS. A three-stage model, AARM incorporates constructs from other theories including the Health Belief Model and Social Cognitive Theory. (Catania, Kegeles, Coates, 1990).

Popular Education (PE) is based on the belief that teachers and students have different strengths and should learn reciprocally from each other and speaks to the principles of Freirean empowerment. (Wallerstein, 1992)

In addition, we also use a number of science-based interventions in our program that address the strategies of CDC's Advancing HIV Prevention initiative. Advancing HIV Prevention is aimed at reducing barriers to early diagnosis of HIV infection and increasing access to and utilization of quality medical care, treatment and ongoing prevention services for those living with HIV. These interventions include:

· Popular Opinion Leader (Kelley, Lawrence, Diaz, Stevenson, 1991)
 · Safety Counts (Rhodes and Wood, 1999)
 · Street Smart (Rotheram-Borus, Van Rossem, Gwadz, Koopman and Lee, 1997)
 · Voices/Voces (O'Donnell, San Doval, Duran, Labels, 1998)

The Alliance has an established Program Review Panel to consider the appropriateness of messages to the target population. We have adopted four social marketing messages for community-wide education and awareness. These are:


A Know Your Status - Get Tested!
 A Use a Latex Condom or Barrier Accurately & Consistently!
 A Be Abstinent or Be Monogamous
 A Respect Yourself - Protect Yourself

We offer the following services:

ü HIV/STD Counseling, Testing and Referral
 ü Street Outreach & Community Outreach
 ü Peer-led Support Groups
 ü Barber and Beauty Shop Initiative
 ü Capacity Building and Technical Assistance
 ü Information Dissemination and Awareness Raising
 ü Advocacy

Expected Outcomes
Increased numbers of African-Americans knowing their HIV status
Reductions in acquisition and transmission of the virus
Correct and Consistent Condom Use
Avoidance of Injecting Drug Use or Safer Drug-Injecting Habits
Increased Health Seeking Behaviors
Increased Self-Efficacy

REFERENCES

1 Royce RA, Sena A, Cates W Jr, Cohen MS. Sexual transmission of HIV.
N Engl J Med. 1997. 336:1072-1078.

2 Padian N, Marquis L, Francis DP, et al. Male-to-female transmission of human
immunodeficiency virus. JAMA. 1987. 258:788-790.

3 Padian NS, Shiboski, SC, Jewell NP. Female-to-male transmission of human
immunodeficiency virus. JAMA. 1991. 266:1664-1667.

Stats
HIV IN GEORGIA

· There were 29,896 reported AIDS cases in Georgia as of September 2004. Although only 29% of Georgia's population, African-Americans represented 64% of these AIDS cases.

· African-American females are 23 times more likely to be diagnosed with AIDS than their white female counterparts.

· African-American females represented 98 percent of minority female AIDS cases in Georgia from 1981 to 2001.

· AIDS case rates among African-Americans in Georgia are 11 times higher than Asian Pacific Islanders, 9 times higher than their White counterparts, 5 times higher than American Indian/Alaskan Natives, and 3 times higher than Latinos.

· The leading cause of death for African-American men aged 35-44 was HIV/AIDS during 1999-2001, compared to unintentional injuries for White men in the same age group. 1

· Cumulative total of AIDS cases from 1981 through the end of the 1st Quarter 2005 is 28,719. 2

· Georgia is #8 in the nation of the states and territories reporting the most AIDS cases. 2

· African-Americans continue to bear the disproportionate burden of HIV infection in Georgia. The highest frequency is among young MSM of color. 3

· Heterosexual women represent the fastest growing subpopulation of new incidences of HIV infection while Black women representing approximately 70% of women infected. 3

 HIV IN DeKALB
· DeKalb County has the second highest number of cumulative AIDS cases in Georgia (4,052) through the end of the 1st Quarter 2005. 4

· African-Americans account for 66 percent of the cases (2692), Whites 31 percent (1,238) and Hispanics 3 percent (108). 4

· Forty-six percent of AIDS cases are in the 30-39 age group category; 25 percent (1003) in the 40-49 age group category; 19 percent in the 20-29 age group category; and 9 percent (350) over aged 49. 14
· Primary exposure categories for males are MSM (62%), followed by IDU (13%).4

· Primary exposure categories for females are Heterosexual Contact (39%), followed by IDU (22%). Unknown Exposure Category is significant at (36%).4

 STDs IN DeKALB

Research by the Centers for Disease Control & Prevention (CDC) has shown that STD infection, especially recurring infections, increase susceptibility to HIV. The association between HIV and STDs is further complicated by sexual behavior and/or immune suppression in persons with sexually acquired HIV.

· Between 1998 and 2003, 12,563 cases of Gonorrhea were reported in DeKalb County residents. Fifty-four percent of cases were among males, and 45 percent occurred among persons 20-29 years. Gonorrhea cases increased from 449.8 cases per 100,000 in 1998 to 515.5 in 2003.

· Between 1998 and 2003, 21,001 cases of Chlamydia were reported in DeKalb County residents. Eighty percent of cases were among females and 85 percent of cases occurred among persons 10-29 years. Chlamydia cases increased from 449.8 cases per 100,000 in 1998 to 515.5 in 2003.

· Between 1994 and 2003, 657 cases of primary and secondary syphilis were reported in DeKalb County residents. Seventy-five percent of cases were among males and 90 percent of cases occurred among persons 20-49 years.

· Georgia has the highest rate of primary syphilis the country. Metro Atlanta (which includes DeKalb County) has the third highest rate of syphilis for an urban area in the nation. A recent STD diagnosis represents a significant risk exposure for HIV infection regardless of any other population characteristic or risk behavior. (CDC, Nov. 2003).

 REFERENCES
1 Georgia's Minority Health & Health Disparities Report. Georgia Department of
Community Health, Office of Minority Health, 2004.

2 Georgia Department of Human Resources. Division of Public Health. Surveillance
Report for AIDS thru the end of the 1st Quarter 2005.

3 Georgia Department of Human Resources. Community Planning Group 2002
Epidemiologic Profile.
4 Georgia Department of Human Resources. Division of Public Health. Surveillance
Report for AIDS thru the end of the 1st Quarter 2005.
STATISTICS