Module 4: Foundation of a Prevention Program

Goal of Module 4: To provide methods, examples, and tools with which to carry out your HIV/AIDS prevention program.

In order to provide an effective HIV prevention intervention for Native people, you will need to lay a strong community foundation and apply intervention programs in a culturally meaningful way. One option is to tailor existing interventions to fit the unique needs of your Native community. This module includes an overview of program components, information on CDC’s Advancing HIV Prevention Initiative, descriptions of evidence-based interventions, and an introduction to storytelling as a prevention strategy.
Contents 1b Community Involvement
1. Components of a Comprehensive Prevention Program:

2. Advancing HIV Prevention Initiative:
3. Evidence-Based Interventions:
4. Introduction to Storytelling as a Prevention Strategy:

Many developing programs face the same challenges: too little money, resources, and materials available for prevention of HIV/AIDS and sexually transmitted infections (STIs). Another challenge to Native HIV/AIDS prevention efforts is diversity among Native people in the same community. Not all community members have had the same exposure to cultural values and resources. Also, some Native people may be more comfortable with and aware of the topic of HIV/AIDS than others. Because of this, your program should address various languages, beliefs, and comfort levels, especially if you work in an intertribal community.

In order to get your community involved in your HIV/AIDS intervention in a positive way, you need to build trust and acceptance. Train your outreach and prevention workers to respect people “just as they are.” Try to create a safe and understanding environment so that people will communicate more openly. For information on cultural competency, you can consult the National Center for Cultural Competency or HRSA’s Cultural Competence Resources for Health Providers.

In Towards a Culturally Competent System of Care, Volume I, the authors identify positive attributes, knowledge, and skills that are necessary to achieve cultural competency.2

ATTRIBUTES:
Genuineness. Be honest and real. Show people that you truly care about the work you’re doing. Show sympathy for the problems and concerns of others.
Open-mindedness. Welcome new ideas and different opinions. Accept differences between people. Try not to assume things about people before you act or communicate.
Flexibility. Be willing to change. Always keep your community’s needs in mind; adjust your behavior to suit those needs.
Realistic self-image. Think about how community members might perceive you or your organization. If you are Native and work in a Native health facility, then you might already have the trust of Native community members. If you are non-Native, you might have to win the trust of Native community members. Think about this in advance; be cautious in your actions and communications.

KNOWLEDGE OF:
Culture. Learn about the history, values, traditions, art, and family ways of your community members. Remember that different people come from different backgrounds. Try to learn as much as you can about your community members’ backgrounds.
Help-seeking behaviors. Your community members might not directly ask for your help. Find out what Native people might do to show that they need help (without directly asking).
Role of language, speech patterns, and communication styles. Remember that different people have different ways of communicating. Many Native people do not openly talk about health problems. Learn as much as you can about the way that Native people in your community talk about health. Remember that they might communicate differently with you than with family or other community members (if you are non-Native or come across as an authority figure).
Available resources. Learn about Native and non-Native health facilities in the area. Think about the other ways that people can get help. Find out what helpful services are available in your community and also what services are missing.

SKILLS:
Have methods for learning about culture. Establish different ways to find out information about Native culture in your community. Talk to people, observe their behavior, do research, conduct surveys, perform assessments, etc.
Communicate accurately. Use words that everyone can understand. State and write things clearly. Do not use sarcasm or assume that the meaning of something is obvious.
Recognize and combat racism, stereotypes, and myths. Be aware of racism and stereotypes in your community. Show that you do not make negative assumptions about people. Make sure that everyone in your program, organization, or facility does this too.


CASE IN POINT:
As part of HRSA’s Special Projects of National Significance (SPNS), the South Puget Intertribal Planning Agency (SPIPA) carried out an HIV intervention program within sovereign American Indian communities. The program, Expanding the Circle of Care, provided outreach and rapid testing services to the Nisqually, the Shoalwater Bay, and the Squaxin Island Tribes.3 The project evaluated the changes in tribal community knowledge, attitudes, beliefs, and behaviors over time.4

CASE IN POINT:
CDC’s Division of Adolescent and School Health (DASH) funds education and health agencies that perform HIV prevention work in schools. CDC/DASH partners carry out policies and strategies that reduce HIV risk behaviors among youth. They focus on subpopulations of youth that are more greatly affected by HIV and other health problems. They also evaluate their prevention strategies so that they can continuously improve them.

Recommendations to keep your program community-based:

  • Recruit and train leaders from within your focus community. Community leaders will understand local language, leadership, beliefs, past relations with non-Native societies, and current social and health problems. Think about training other community health professionals, including health educators and mental health, domestic violence, and substance abuse counselors.
  • Invest in training and leadership development. NNAAPC offers executive coaching—tailored for HIV prevention work—through its Capacity Building Assistance program. Consult the Indian Health Service (IHS) Executive Leadership Development Program, the National Indian Women’s Health Resource Center (NIWHRC) Mentoring Program, or the Women Executive Directors of Color (WEDOC) Professional Development Coaching Project.
  • Improve testing at local tribal clinics AND train outreach workers in the field. Some Native people prefer to visit non-Native facilities for confidentiality reasons; others prefer to receive counseling and testing from Native-serving providers. Your program should work to improve HIV/AIDS testing and treatment in both Native and non-Native heath facilities.
  • Provide training for front-line staff to make sure that your program goes as planned. Front-line employees are the first interaction a client has with a clinic or program. Staff must have diversity training and be culturally competent in order to interact with all clients in a fair and unbiased manner regardless of race, class, gender, sexual orientation, drug use, and/or HIV status.
  • Build public, family, and community support for HIV-positive individuals. This improves long-term prevention for other community members.
  • Use family, small group, and community-based social education activities. Social learning allows community members to share common challenges and receive peer-to-peer support.
  • Evaluate, adjust, and improve your program whenever you can. Contact NNAAPC or consult Module 6: Evaluation of the Online Toolkit for Native Communities to help you evaluate and improve your program. Ensure that you have an evaluation plan in place before you begin your prevention program.

    Prevention Interventions and Strategies

    Peer education                                              
    Mentorship                                                    
    Outreach                                                      
    Counseling and testing                                    
    Skills-building sessions                                     
    Support groups                                              
    Prevention case management

    Drop-in centers
    Cultural retreats
    Needle exchange
    Newsletters/Chatlines
    Elder/Grandparent education
    Media campaigns/PSAs
    Theater/Video/Storytelling

2Cross T, Bazron B, Dennis K, Isaacs M. Towards a Culturally Competent System of Care: Volume I. Washington DC: CASSP Technical Assistance Center, Georgetown University Child Development Center; 1989. Available at: http://www.d.umn.edu/sw/culturalcomp/culcomp.html. Accessed February 19, 2007.

3Fulwyler T, Uldall KK, Riediger J, Kalama C, Tiam A. Expanding the Circle of Care: An analysis of an HIV intervention in Indian Country. HIV among American Indians and Alaska Natives: Culturally Appropriate Programmatic Approaches. Center for Applied Social Research, University of Oklahoma; April 2006:88-110.

4Health Resources and Services Administration. Special Projects of National Significance, American Indian/Alaska Native Initiative: 2005 Report to CARE Act Grantees; 2005.