HIV Impact, JulyAugust 2004 (PDF) by Alex Browne


									                                                                                                                               July/August 2004

                                  IV Impact
                                                                           Positive Results
                                                 Community/Research Partnerships Bear Fruit
     Why Parents Matter
                                                                                                                                 Jennifer L. Rich

             4                                                                              affect health than do researchers, who tend to con-
   From Mother to Daughter

                                             hen Laurell Lasenberg, the former presi-
                                             dent of the Central Harlem HIV/AIDS            duct their studies in a vacuum. With health dispari-
             5                                                                              ties among racial and ethnic minorities becoming an
       De madre a hija
                                             Network, was invited by the New York
                                  Academy of Medicine to join a group of local lead-        increasingly important focus of federal, state and
               6                                                                                                      local public health out-
 National Black HIV/AIDS Day
                                  ers in forming a commu-
                                  nity action board to “It’s important to provide everyone with reach, the research com-
            7                                                                                                         munity has started to turn
 Ask An Expert-Microbicides
                                  address the borough’s
                                                                 flexibility and a sense of control...”               to the community for their
                                  chronic public health
             8                                                                                                        help in developing cultur-
    Maui AIDS Foundation
                                  problems, she thought:
                                  “Sure, why not?” But                                                                ally appropriate programs.
                                                                                   David Vlahov
                                                                                                                           “Things developed
Minority Women’s Health Summit
                                  she, like others at the
                                                                      Center for Urban Epidemiologic Studies
                                  table, was uncertain of                                                             by brilliant minds in ivory
              11                                                                            towers always fail,” said David Vlahov, the director
     Federal Health News
                                  what the relationship would accomplish.
                                       “When we first started, we would all just sit        of the Center for Urban Epidemiologic Studies
              12                                                                            (CUES) at the New York Academy of Medicine.
African Immigrants in Minnesota
                                  there and the principal investigator at the time
                                  would tell us about the research they were doing,”        “When the community is involved, it becomes vest-
             14                                                                             ed, and having that personal stake makes it work.”
                                  she recalls. “Until somebody finally said: ‘Why are
                                  we here’?”                                                     Funders seem to agree. In an August 2003 arti-
             16                                                                             cle in the "American Journal of Public Health,"
                                       The group hasn’t looked back since. After
                                  developing a set of principles and a mission state-       Meredith Minkler, a researcher at University of Cal-
                                  ment, they’ve embarked on a collaboration that has        ifornia, Berkeley, points out that government fund-
                                  already begun to yield positive results.                  ing has played an instrumental role in spurring
                                       Such relationships are beginning to spring up        CBPR in the United States. And philanthropic
                                  around the country as a growing number of govern-         organizations like the W.K. Kellogg Foundation, the
                                  ment and private funders are betting that collabora-      Ford Foundation, the Annie E. Casey Foundation,
                                  tion between researchers and community groups             the California Endowment and the Aspen Institute
                                  can be an effective way to address the nation’s           have also begun throwing significant support
                                  health problems. That’s good news for community-          behind CBPR.
                                  based organizations looking for new revenue                    While the dollar amounts are still low, Minkler
                                  streams in today’s increasingly competitive funding       says that momentum is gathering for what
                                  environment.                                              Lawrence W. Green, director of extramural preven-
     A newsletter of the
                                       The value of community-based participatory           tion research at the Centers for Disease Control and
  Office of Minority Health,      research (CBPR), according to proponents, is that         Prevention (CDC) has called “bootstrap epidemiol-
     U.S. Department of           community organizations have a better understand-         ogy.” For example, she said, the CDC recently
 Health and Human Services        ing of the social and environmental factors that          funded $13 million in three-year CBPR grants. The
CDC also supports three urban research centers, including                  not just dealing with HIV when you are dealing with a person
CUES, that focus strictly on community-based research.                     living with AIDS,” Lasenberg said. “It is important for service
                                                                           providers to have linkages to other service providers and to the
Who’s at the Table?                                                        Academy of Medicine.”

     The key to organizing an effective community-based                    Building Trust
research program, according to Vlahov, is to include a wide
variety of organizations at the table. CUES invited the leader-                 The first few successes also helped to build trust among
ship from health-related organizations, such as HIV/AIDS                   groups that often compete for resources.
groups and city and state health departments, multi-service                     Part of the way the Academy compensates its board mem-
clinics, substance abuse treatment centers, homeless shelters              bers is through free grant writing seminars. The organization
and correctional facilities. The only prerequisite was that the            also provides meeting space. And it has a small amount of
groups have a firm stake in the community.                                 money available for grants within the community.
     Though most of the community leadership responded pos-                     One of the more important aspects of the relationship,
itively to the invitations, they often were too busy to participate        Lasenberg said, is that it gives community-based organizations
themselves, sending midlevel management instead. The lack of               the access to researchers who can provide data for grant pro-
decision-making power at the table was CUES’ first challenge.              posals.
     “You get a number of people who can communicate infor-                     “You cannot send an RFP or an RFA without statistics,
mation back and forth but there is still some higher level of              without data, without some type of the research to show that
integration that is missing,” Vlahov said. “The people that we             your program is going to work for a certain population,” Lasen-
got were terrific, but learning what we have learned, we would             burg said. “So now we call up the Academy and say, ‘Listen, I
go for the executive directors.”                                           have this program that I want to do and I need this informa-
                                                                           tion.’ And they say, ‘Fine, no problem.’”
Starting Simple                                                                 Ultimately, though, the community action group will be
                                                                           competing for funding that everyone can share in some way.
     One of the early challenges of CBPR, according to partic-                  Vlahov said he explained the premise to the group in this
ipants, is to find common ground among the varied interests,               way: “Some grants are just going to make sense for us to do.
which can begin only as the groups start to understand each                But then there are going to be times where we sit down and do
other’s vocabularies. The extended ramping-up time can be                  something as a joint venture. You will get half the funding.
worrisome to results-oriented funders, so Vlahov recommends                Your names will be on the papers. You’ll get to go to national
pushing for some quick successes.                                          meetings.”
     On the CUES community action board, for example, the                       “It’s important to provide everyone with flexibility and a
group ultimately decided to work toward the goal of making it              sense of control,” Vlahov said. “What is it that we can get out
easier to get treatment for injection drug use in Harlem than to           of it? What is it that the other side can get out of it? Everyone
get the drugs themselves. That broad goal has allowed them to              needs to feel that it is fair and equitable.”
focus on related problems such as HIV and Hepatitis C, hous-
ing, treatment and health disparities.                                     How Does It Work Now?
     Their first quick effort was to develop a “Survival Guide”
of support services for drug users and their families. In order to              After a year, the CUES group has moved on to bigger proj-
increase communication between the providers themselves, the               ects that have begun through simple brainstorming. Eventually,
group also created an Internet-based resource guide                        questions boil down to: Who might the project serve and what
( where local community-based                  can it do? Is it something that can be done in a reasonable
organizations can both search for services and update their own            amount of time? Do they have the right kinds of people? Is
program information.                                                       there interest all the way around? And finally, do they feel com-
     The two successes brought the group members closer                    fortable going forward?
together, Lasenberg said, and reinforced the ties between their
organizations.                                                                                                         CUES continued on 3
     “What we are trying to get across to people is that you are

     HIV Impact is a free newsletter of the Office of Minority Health, Office of                       HIV Impact Staff
Public Health and Science, U.S. Department of Health and Human Services.
     The Office of Minority Health Resource Center provides free information on                Blake Crawford Jennifer L. Rich
various health issues affecting U.S. minorities.                                               Executive Editor Senior Editor/Writer
                      Send an e-mail to to join our mailing list
                 or to update your address. Or, write to OMHRC, P.O.Box 37337,                      John I. West Isabel Estrada-Portales, M.S.
                 Washington, D.C., 20013-7337.                                      Editor/Production Coordinator Bilingual Editor/Writer
                      To submit story ideas or to comment on HIV Impact articles,
                                                                                    Brigette Settles Scott, M.A. Stephanie L. Singleton
                 address above or e-mail bscott@omhrc.govN
                 contact Brigette Settles Scott, M.A., managing editor at the
                                                                                                Managing Editor Graphics/Layout Design

July/August 2004                                                       2                                                          HIV Impact
CUES continued from 2

     The community action board
recently gave the go-ahead to an influen-
za immunization project.
                                               Why Parents Matter
     Vlahov explains: “We picked
influenza because it’s an easy one. If
you have a pandemic, it is going to be
awful for everyone, but 40 percent of
these people have never seen a doctor          Jennifer L. Rich
and they won’t go to a clinic, so how do
                                                                                             a series of sessions that focused on three

you reach them?”                                        y looking at him, you wouldn’t
     The community action group decid-                  suspect that James Austin makes      major topics: risk awareness, positive
ed to address the problem by mobilizing                 people nervous. He’s not a big       parenting and sexual communication
HIV groups that have extensive contact         man. He speaks in a calm, college pro-        skills.
with the community. Through an “Adopt          fessor-like voice. It’s what he says that          Scyatta Wallace, a research fellow
a Block” approach, the outreach workers        causes the anxiety. Because when he           at the CDC, said that risk awareness is
are going to go door to door to talk to        walks into a room, people know he is          the cornerstone of the program. Even
people directly about the influenza vac-       going to talk to them about sex.              though half of all HIV infections occur
cine.                                                Austin is one of a handful of facili-   in people under 25, she said, “Many par-
     “We’re taking an infrastructure that      tators for Georgia State University’s         ents are unaware of the early initiation
was set up for HIV and expanding it to         Parents Matter program who go into            of sexual intercourse among many youth
other pre-primary care outreach for pub-       communities around Atlanta to teach           and of the consequences from sexual
lic health prevention,” Vlahov said.           African American parents how to talk to       risk behaviors.”
     “The ultimate goal here is to get         their children about sexual risk and HIV           In the positive parenting section,
immunizations up in general,” he added.        prevention.                                   parents talk about how to build strong
“In East Harlem, only seven percent of               “They know you come from a uni-         lines of communication with their chil-
people have gotten a Hepatitis B vac-          versity setting and you are dressed in        dren.
cine, despite the fact that the vaccine has    nice clothes and they figure you must be           “Sometimes parents don’t commu-
been available for more than 20 years.         a doctor or something,” Austin said. “I       nicate with their kids,”Austin said.
There is eventually going to be an HIV         tell them no, I’m not a doctor, I’m not a     “Sometimes whole weeks can go by, and
vaccine. How are you going to distribute       health worker, I’m a parent, like you.”       the parents don’t know about the things
it?”                                                 The Parents Matter program was          that happen in their child’s life.”
     If vaccines work, he said, they can       founded at the Institute of Behavioral             To reinforce the idea of positive
expand the outreach to other health            Research at the University of Georgia         communications skills, Austin says that
issues, while keeping the core HIV mes-        after years of research showing the ben-      they ask parents to discuss what they
sage.                                          efit of early parental involvement in         like about their supervisors at work.
                                               shaping the decisions of children.            Answers usually include: someone
Where to look?                                       “Parents can provide accurate infor-    who’s understanding, someone who lis-
                                               mation and teach values and skills need-      tens, and someone who considers all the
     Though not many areas have CBPR           ed to make responsible decisions about        facts before making a decision. Then
programs like CUES in New York, Vla-           health early, before risk behaviors are       Austin asks them how they treat their
hov says that CBOs can look for com-           established,” said Kim Miller of the          own children.
munity/research partnerships in a variety      Centers for Disease Control and Preven-            “It stops them in their tracks,”
of locations. The first, he said, is through   tion (CDC). “And compared to other            Austin said. “Because a lot of times all
schools of public health at local univer-      sources of information, parents hold the      of the relationship is directed at the
sities. The proportion of faculty that         reputable distinction of having an audi-      child: ‘You do exactly what I tell you to
does research in the local area is small,      ence that wants to hear from them.”           do, when I tell you to do it.’”
he said, but there are those that are com-           In collaboration with researchers at         “What we try to make the parents
mitted to community health issues.             Georgia State and the University of           realize is that as high as the stakes are,
     He also suggests contacting local         Arkansas for Medical Sciences, the            communication is essential,” he added.
health departments, which are more and         CDC-funded study recruited 1,200                   Once the facilitators have worked
more interested in building links with the     African American families that included       on general communication skills, they
community for joint problem-solving.           a parent, co-parent, and child in the         turn their focus to increasing the par-
     For more information, call 212-           fourth or fifth grade. To qualify for the     ents’ ability to talk about sex.
822-7200 or go to         study, the primary caregiver had to be
initiatives/cues.shtmlN                        living with the child for the previous
                                               three years. Parents were asked to attend                      Parents continued on 13

HIV Impact                                                         3                                                 July/August 2004
From Mother to Daughter
Project Teaches Latinas that HIV Education Starts at Home
Jennifer L. Rich

                                                                        expectations to their teens and preteens and teaching them that

           hat do 80 Latinas from the gritty Mission district of
           San Francisco and the sleepy agricultural communi-           waiting to have sex until they are married or in a committed,
           ty of Watsonville 90 miles to the south have in com-         long term adult relationship is the healthiest choice they can
mon?                                                                    make," said Dr. Alma Golden, the deputy assistant secretary for
     All have daughters between the ages of 11 and 18. All want         Population Affairs. "Young people who are abstinent do not
their daughters to have a better life than they did. And all took       have to worry about pregnancy or sexually transmitted dis-
part in a four-day curriculum all in Spanish to teach                             eases, including HIV/AIDS. Condoms may reduce the
them how to better communicate with their daugh-                                    chances of infection or pregnancy, but they do not
ters about sexual health and HIV prevention.                                        reduce the emotional and social impact of sex on
     Called “From Mother to Daughter: Protecting                                    teens. Only abstinence works 100 percent of the
Our Health,” this intergenerational pilot initiative                                time, and parents are important partners to provide
developed by a team of researchers from the Univer-                                 support for abstinence.”
sity of California, San Francisco (UCSF) highlights                                      After several hours of in-depth discussion on the
a fact that is often overlooked in HIV prevention                                   anatomy of sexuality, Gomez said the women were
programs directed at the Hispanic community: the                                    already starting to feel more confident. “They left
positive role parents can play in helping guide their                               the session saying ‘Now I’m going to know more
children’s sexual development.                                                      than my daughter,’” she said.
     “Parents recognize that their kids are vulnerable                                   But that’s just the tip of the iceberg. In pre-proj-
and they want to be good teachers of sexuality to                                   ect focus groups, girls surprised the researchers by
them,” said Cynthia Gómez, principal investigator                                   saying that they were actually much more interested
for the project and interim director of the Center for                              in emotional guidance than a lecture on the birds and
AIDS Prevention Studies (CAPS) at UCSF. “I don’t                                    the bees.
think that is a surprise, but Latinos aren’t usually                                     “They feel like they know about sex ed from
viewed that way.”                                                                   school, but they want to know about relationships
     Indeed, many people think that religiosity keeps                               with boys,” said Angelica Martinez, field coordinator
Latinos from talking about sexual health. But Gómez said that           for the study in San Francisco. “How to have a healthy relation-
data from large-scale studies have failed to find a connection.         ship is not talked about so if they are being abused, they think
Instead, she says that gender role traditions and a lack of             it’s normal.”
knowledge are much more influential, a fact that became obvi-                 Part of the problem, Martinez said, is that the mothers were
ous to the UCSF team from pre-study focus groups.                       too overcommitted with work and other responsibilities to talk
     “What was fairly amazing for us is the degree to which             to their daughters much at all.
women did not know the basic anatomy of men and women,”                       “One girl told me that she had a friend whose mom takes
Gómez said. “If women don’t even know how their bodies, and             her out to lunch every week so that they can be alone to talk,”
particularly their genital areas, function, how will they under-        Martinez said. “She said her mom was always working, she
stand why they are making certain decisions around precau-              was always busy.”
tions for HIV or STDs?”                                                       In response, a segment of the curriculum asks mothers to
     And how, she asks, are they supposed to communicate that           set goals for creating time to talk to their daughters alone.
information to their daughters, who may already know more                     The curriculum also includes a section on fostering con-
than they do through sex education classes at school.                   versation. Instead of communication-stoppers like “You can’t
     “These women were embarrassed to talk to their daugh-              have a boyfriend until you are 21,” mothers were instructed to
ters,” she said. “And justifiably so, because their daughters           soften their language to “Although I’d like you to wait, if you
could say: ‘You don’t know this? How can you possibly help              do decide to have a boyfriend, I’d prefer to know about it.”
me?’”                                                                         As part of an exercise on intergenerational values, women
     In response, Gómez and her colleagues created a curricu-           were also asked to explore their families’ feelings about sexual
lum that focused heavily on anatomy, as well as sexual health           topics. The message, Martinez said, was: “We definitely want
and risk, communications skills, and intergenerational issues.
     “Parents need to feel confident in communicating their                                                         Mother continued on 15

July/August 2004                                                    4                                                           HIV Impact
De madre a hija
Enseñando a las latinas que la educación sobre el VIH comienza en casa
Jennifer L. Rich
Translation by Isabel Estrada-Portales, M.S.

                                                                            “Estas mujeres sentían vergüenza de hablar con sus hijas”,

      Qué tienen en común 80 latinas del árido distrito Mission
      de San Francisco y la adormecida comunidad agrícola de           dijo ella. “Y con razón, porque sus hijas podían decirles: ‘¿Tú
      Watsonville, que queda 140 km (90 millas) al sur?                no sabes eso? ¿Cómo puedes ayudarme, entonces?’”
     Todas tienen hijas entre las edades de 11 y 18 años. Todas             Como respuesta, Gómez y sus colegas crearon un curricu-
quieren que sus hijas tengan una vida mejor que la que ellas           lum con énfasis principalmente en anatomía, así como salud
han tenido. Y todas participaron en un seminario en español de         sexual y riesgo, habilidades de comunicación y problemas gen-
cuatro días, para enseñarles a comunicarse con sus hijas sobre         eracionales.
salud sexual y prevención del VIH.                                          "Los padres necesitan comunicar, con seguridad, sus
     Con el título “De madre a hija:                                                              expectativas a sus hijos adolescentes
Protegiendo nuestra salud”, esta ini-                                                              y enseñarles que la opción más
ciativa intergeneracional piloto                                                                   saludable es esperar a casarse o a
desarrollada por un equipo de inves-                                                               estar en una relación amorosa
tigadores de la Universidad de Cali-                                                               estable y adulta para comenzar las
fornia, San Francisco (UCSF)                                                                       relaciones sexuales", dijo la Dra.
subraya un aspecto a menudo igno-                                                                  Alma Golden, la secretaria asistente
rado en los programas de preven-                                                                   de Asuntos de la Población. "Los
ción del VIH dirigidos a la                                                                        jóvenes que se abstienen no tienen
comunidad hispana: el papel positivo                                                              que preocuparse del embarazo o de
que los padres pueden jugar en la guía del desarrollo sexual de        las enfermedades de transmisión sexual, incluido el VIH/SIDA.
sus hijos.                                                             Los condones pueden reducir las probabilidades de infección o
     “Los padres reconocen que sus hijos son vulnerables y             embarazo, pero no reducen el impacto emocional y social del
quieren ser buenos maestros de sexualidad para ellos”, dijo            sexo en los adolescentes. Sólo la abstinencia es 100 por ciento
Cynthia Gómez, investigadora principal del proyecto y directo-         efectiva y los padres son importantes en el apoyo a la abstinen-
ra interina del Centro de Estudios para Prevención del SIDA            cia".
(CAPS, por sus siglas en inglés) en la UCSF. “No creo que sea               Después de varias horas de profunda discusión sobre la
una sorpresa, pero los latinos no son vistos de esa forma usual-       anatomía de la sexualidad, Gómez dijo que las mujeres comen-
mente”.                                                                zaron a sentirse con más confianza. “Ahora yo voy a saber más
     De hecho, muchas personas piensan que la religiosidad             que mi hija”, dijo.
hace que los latinos eviten hablar sobre salud sexual. Pero                 Pero eso es sólo la punta del iceberg. En los grupos de foco
Gómez dijo que los datos de estudios a gran escala no han              previos al proyecto, las muchachas sorprendieron a los investi-
encontrado ninguna conexión entre ambos aspectos. En lugar             gadores al decirles que ellas estaban mucho más interesadas en
de esto, ella dice que las tradiciones de los roles de géneros y       guía o acompañamiento emocional que en una conferencia
la falta de conocimiento tienen mucha más influencia, algo que         sobre las cigüeñas.
se manifestó abiertamente al equipo de UCSF en los grupos de                “Ellas sienten que saben sobre educación sexual por la
foco previos al estudio.                                               escuela, pero quieren saber más sobre las relaciones con los
     “Lo que nos resultó realmente sorprendente fue el grado de        muchachos”, dijo Angelica Martínez, coordinadora de campo
desconocimiento de las mujeres con respecto a la anatomía              del estudio en San Francisco. “No se habla sobre cómo tener
básica de mujeres y hombres”, dijo Gómez. “Si las mujeres ni           una relación saludable, por tanto, si ellas están siendo abu-
siquiera saben cómo funcionan sus cuerpos, y en particular sus         sadas, ellas creen que es normal”.
genitales, ¿cómo van a comprender por qué toman determi-                    Parte del problema, dice Martínez, tenían demasiadas
nadas decisiones relativas a las precauciones contra el VIH o          responsabilidades con trabajo y otras cosas y no tenían oportu-
las enfermedades de transmisión sexual (ETS)?                          nidad dehablar con sus hijas sobre nada.
     Y cómo, pregunta Gómez, pueden ellas comunicar esa                     “Una muchacha me dijo que ella tenía una amiga a quien
información a sus hijas, quienes pueden saber ya más que sus           su mamá la llevaba a almorzar todas las semanas para tener
madres a través de las clases de educación sexual recibidas en         tiempo de estar solas y conversar”, dijo Martínez.
la escuela.
                                                                                                                 Madre continued on 15

HIV Impact                                                         5                                                  July/August 2004
Creating Awareness One Day at a Time
National Black HIV/AIDS Awareness and Information Day
Jennifer L. Rich

                                                                         including prayer breakfasts, rallies, music and dance presenta-

       he freezing rain that fell most of the day didn’t stop 400
       people from coming to the Frank D. Reeves Municipal               tions, workshops and health fairs, to mobilize African Ameri-
       Building in downtown Washington, D.C., on Friday,                 cans from all communities and walks of life to address the
February 6, 2004, to get tested for the virus that causes AIDS.          disease.
The event, which included a health fair, was just one of hun-                 “If we are to end the HIV pandemic in African Americans,
dreds of activities across the country organized in recognition          African Americans must continue to be part of the solution, as
of the Fourth Annual National Black HIV/AIDS Awareness and               clinicians, prevention providers, treatment advocates,
Information Day on February 7.                                           researchers and as HIV therapeutic and preventive vaccine
     “National Black HIV/AIDS Awareness and Information                  clinical trial volunteers,” said Dr. Anthony Fauci, director of
Day is an important opportunity to understand and educate peo-           the National Institute of Allergy and Infectious Diseases at the
ple nationwide about mobilizing in the fight against                     National Institutes of Health.
HIV/AIDS,” said Tommy G. Thompson, secretary of the                           National Black HIV/AIDS Awareness and Information
Department of Health and Human Services.                                 Day was created by the Community Capacity Building Coali-
     The need for the day is more compelling than ever, sup-             tion, a group made up of Concerned Black Men, Inc. of
porters say. Though African Americans make up 12 percent of              Philadelphia, the Mississippi Urban Research Center at Jack-
the U.S. population, they comprised 51.7 percent of all estimat-         son State University, Health Watch Information and Promotion
ed AIDS cases diagnosed in 2002. HIV/AIDS is one of the top              Service, the National Black Alcoholism & Addiction Council
three leading causes of death for both African American men              and the National Black Leadership Commission on AIDS.
and women ages 25-44.                                                    Besides organizing National Black HIV/AIDS Awareness and
     “The thing about HIV is that it wreaks havoc on our eco-            Information Day, the Coalition receives funds from the Centers
nomics as well as our social structures,” said LaMont Evans,             for Disease Control and Prevention to provide HIV/AIDS pre-
executive director of Concerned Black Men, Inc. of Philadel-             vention capacity-building assistance to community-based
phia, one of the groups that founded the day. “Once we get peo-          organizations in African American neighborhoods.
ple educated about the disease, everything gets better.”                      “If one person walks away from today knowing more
     Around 215 events took place throughout the country,                about HIV, we would consider the day a success,” Evans said.N

                                               Hundreds visit the Frank D. Reeves Municipal
                                                  Building in downtown Washington, D.C.,
                                             in recognition of the Fourth Annual National Black
                                                 HIV/AIDS Awareness and Information Day.

                              For more information on National Black HIV/AIDS Awareness and Information Day,
                         visit the HHS Web page dedicated to the initiative at
July/August 2004                                                     6                                                       HIV Impact
Ask An Expert
Roberta Black, Ph.D.

    n the United States, 20 African            •   Blocking the dissemination of HIV         microbicide research and development
    American women are infected with               from initial target cells to other sus-   is to prove clinical efficacy. Six microbi-
    HIV every day. A surge in new infec-           ceptible cells by interrupting the        cide candidates should enter advanced
tions among U.S. Latinas means that                attachment to specific cellular recep-    clinical trials by the second quarter of
they are seven times more likely than              tors; and                                 2005.
White women to contract HIV. And it                                                                Despite progress, though, chal-
doesn’t stop there. Worldwide, women           •   Inhibiting sexually transmitted infec-    lenges still remain. Certain elements of
represented almost half of the estimated           tions (STIs), which create abrasions      the clinical trial design still need to be
42 million people infected with HIV at             in the lining of the vagina and/or        hammered out. For example, researchers
the end of 2002.                                   cervix that can help HIV gain access      have not decided on the best placebo.
      Most disturbing about these statis-          to susceptible cells.                     And limited international clinical trial
tics is that minority women acquire HIV                                                      infrastructure raises issues about capaci-
predominantly through unprotected sex-         Based on what we know about optimiz-          ty and feasibility.
ual intercourse. Yet, for protection, sex-     ing HIV therapeutics, it is likely that the         We also need to have a better under-
ually active women largely have only           most effective topical microbicide will       standing of what makes a product
one recourse: the consistent and correct       contain a cocktail of active ingredients      acceptable to the culturally diverse
use of male condoms. The catch, of             with diverse mechanisms to act against        group of women it is being developed to
course, is that men must agree to use          HIV and other STIs. In addition to hav-       serve. The most potent microbicide is no
them. Such cooperation may be unrealis-        ing potent inhibitory activity, an ideal      good if women refuse to use it correctly
tic, however. Even when one partner            microbicide would have to:                    and consistently.
thinks a relationship is monogamous, the                                                           It will probably take five to seven
risky sexual practices of the other may        •   Be safe for multiple daily applica-       years for one or more of these first can-
remain undisclosed. The vulnerability of           tions over long periods of time;          didates to make it to market, assuming
women of all ages drives the develop-                                                        clinical trials prove they are safe and at
ment of safe, effective and acceptable         •   Act rapidly and be long lasting;          least partially effective. While less than
female-controlled methods for prevent-                                                       ideal, an initial success would provide
ing the sexual transmission of HIV.            •   Either be acceptable to both sexual       an important springboard for the rapid
Microbicides may provide an answer.                partners or be completely unobtru-        development of highly improved second
      Topical microbicides are prepara-            sive;                                     and third generation products.
tions for intravaginal or intrarectal appli-                                                       Roberta Black, Ph.D., is Team
cation that contain chemical and/or            •   Be inexpensive and available over         Leader for Topical Microbicides at the
                                                                                             National Institute of Allergy and Infec-
biological mediators to prevent infection          the counter;                              tious Diseases.
by HIV and other sexually transmitted                                                              For more information, go to the
pathogens. Topical microbicides could,         •   Remain where applied while distrib-       National Institutes of Health Office of
in theory, act at multiple levels to repel         uting appropriately to cover all rele-    AIDS Research at
HIV infection by:                                  vant tissues, without leaking or          od/oar/about/research/microbicides/oar
                                                   being absorbed systemically; and
• Directly inactivating the virus by (i)                                                                Clinical Trial Candidate
  enhancing or stimulating the natural         •   Be compatible with the body’s                              Mechanism
  acidity of the vagina, or (ii) disrupt-          microbial ecology.                                         BufferGel™
  ing a viral membrane;                                                                                  maintains vaginal acidity
                                               There are approximately 70 candidates              PRO 2000/5™ , Dextrin-2-sulfate™,
                                                                                                  Carraguard™, Cellulose sulfate™
                                                                                                 prevents the entry of HIV or other STIs
•   Preventing the infection of suscepti-      at various stages in the microbicide
    ble cells with HIV reverse transcrip-      development pathway. Although ample                        into initial target cells
    tase inhibitors or by impeding the         precedent suggests that topical agents
    binding and entry of the virus;            could possibly protect against HIV and        disrupts the cell membranes of HIV or other STIs
                                               other STIs, the most urgent priority in

HIV Impact                                                         7                                                     July/August 2004
Serving the Few and Far Between
Maui AIDS Foundation
Jennifer L. Rich

                                                                             “The neighbor islands have always felt that we are forgot-

             ith the shockingly blue ocean lapping softly on the
             rocks below, more than a hundred Native Hawai-             ten or not considered as much because we have such small pop-
             ians, Asians and Pacific Islanders recently gathered       ulation bases,” said Jon Berliner, the executive director of Maui
at a YMCA camp on the                                                                                              AIDS since 1994. “One by
tip of Maui’s Keanae                                                                                               one, each neighbor island
Peninsula* for a weekend                                                                                           county developed its own
of HIV prevention and                                                                                              AIDS organization and they
cultural activities organ-                                                                                         had to do a lot of educating
ized by the Maui AIDS                                                                                              to get the state to see that
Foundation.         Speakers                                                                                       there was an important need
from local and national                                                                                            in each place.”
minority health groups                                                                                                  Hawaii is made up of
addressed the diverse                                                                                              eight major islands. Maui
crowd of at-risk gay,                                                                                              County, which has a popu-
straight or transgendered                                                                                          lation of around 120,000,
men and women in a spot                                                                                            oversees three of them: the
where Native Hawaiians                                                                                             largest, Maui itself, as well
still fish and farm the soil                                                                                       as neighboring Molokai
for taro root.                                                                                                     with 7,000 people and
      “Keanae is spiritually                                                                                       Lanai with around 3,000.
significant because no                                                                      Map courtesy of Hawaii Kahoolawe, unpopulated, is
                                                                                           Department of Business,
blood was ever shed                                                              Economic Development and Tourism
                                                                                                                   usually treated as a district
there,” said Dean Wong,                                                                                            of Maui for statistical pur-
the director of education and prevention at the Maui AIDS               poses. All are largely rural, and have significant populations of
Foundation. “Native people immediately feel like they are in a          Native Hawaiians and other Asian and Pacific Islanders, which
safe place there, so we don’t have to spend a lot of time break-        makes HIV interventions challenging.
ing down walls.”                                                             “Models around prevention that are usually tested and
      Sponsored in part by the Office of Minority Health, the           tried in urban centers and rolled out across the United States
second annual Native Hawaiian, Asian and Pacific Islander               don’t really address our cultural issues,” Wong said. “We have
Retreat to Paradise is one of a number of creative ways the             to readapt them to bring them into our culture in a way that is
Maui AIDS Foundation is adapting urban interventions to serve           not threatening.”
a culturally unique mix of Native Hawaiians, Asians and Pacif-               For example, he said that group-level interventions for
ic Islanders.                                                           people who are HIV positive don’t work in Maui’s rural setting,
      “It’s because so many communities are out of sight and out        where those with the virus fear revealing their serostatus. A typ-
of mind that HIV and AIDS are able to survive so well,” said            ical one-on-one risk assessment for an HIV negative individual
Jay Blackwell, director of HIV education and training at the            is also spurned by the locals for being threatening and cold.
Office of Minority Health Resource Center. “Maui AIDS is tak-                “We have an expression about how you get to know peo-
ing a leadership role in serving underserved and unrecognized           ple here in Hawaii called ‘talk story,’ which means that you talk
communities at high risk for an HIV and AIDS explosion.”                about their family, you talk about their kids, you talk about
      The Maui AIDS Foundation was founded in 1986 by a                 their aunts and uncles and nieces and nephews and what school
group of concerned citizens soon after the first known AIDS             they went to,” Wong said. “Once you’ve shared all that infor-
case was diagnosed on the island. The group received its first          mation, you can start exchanging other information, but it has
government funding three years later, after struggling to con-          to come from a place of brotherhood, not ‘I’m the White mis-
vince the state that the residents of Maui were not being effec-        sionary who has come to your island to teach you something.’”
tively served by organizations from the island of Oahu, which                Wong said that Asian and Pacific Islander men who have
has 80 percent of Hawaii’s population but lies nearly 100 miles         sex with men (MSM) also have a very different way of
away.                                                                   responding to interventions than the White gay community.

July/August 2004                                                    8                                                              HIV Impact
Photo/Jay Blackwell

                      Overlooking the Keanae Peninsula, a men's group learns how to communicate HIV prevention.

     “The White gay men who come to Hawaii come as cou-                 two weeks to live,” he said. “Testing is an invasive concept to
ples, buy a house together and socialize in that capacity,” Wong        them, and it is only when families feel like they can’t do any-
said. In contrast, he said that Asians, Pacific Islanders and           thing else that they are taken to the hospital.”
Native Hawaiians seldom reveal that they are gay. They usual-                The agency is currently serving 160 HIV-positive clients.
ly remain at home with their families, and they might still get         According to Berliner, around 60 percent are ‘haole,’ a local
married and have children.                                              term that refers to people not originally from Hawaii. A large
     As a result, Maui AIDS has had to devise radically differ-         number of those are White gay men who moved to the islands
ent interventions for each group. For the Native Hawaiians,             in the early years of the AIDS epidemic to live out their lives in
Wong says that outreach workers often evoke memories of the             “paradise.” An additional 30 percent of clients are Native
leprosy epidemic that swept through the islands in the 19th and         Hawaiians, who have the fastest growing infection rate in the
early 20th centuries, after colonizers exposed the nonresilient         state. The remainder is a mix of Japanese, Chinese, Koreans
natives to the disease.                                                 and other Pacific Islanders.
     “AIDS and leprosy are really interchangeable here because               “We know that there are some people out there who decide
native people feel like it came on them in the same way,” Wong          that they don’t need our services for whatever reason,” Berlin-
said. “In our education efforts, we remind people about that by         er said. “But we are out in the community trying to bring down
saying ‘It’s already here, it’s too late. But the difference            any barriers that might exist so that individuals are comfortable
between leprosy and AIDS is that we can prevent you from get-           accessing our services.”
ting it because it is transferred based on what your behaviors               Often, that means meeting clients at their homes or in pub-
are.’”                                                                  lic parks.
     For native people, as well as the Asian and Pacific Islander            “Having HIV/AIDS can be a stigma and being identified
communities, Wong and his team also draw on the tenets of               as gay or bisexual can be a stigma,” Berliner said. “Since
eastern medicine in their prevention efforts.                           everybody knows everybody here, clients are afraid that people
     “Eastern medicine is all about prevention, not about cur-          will see them walking in our door.”
ing,” he said. “If you wait to get acupuncture until you have a              Maui AIDS has been able to step up its client services over
pain in your neck, you’ve waited too long.”                             the past five years or so by focusing heavily on outside
     Instead, adherents are supposed to continually work to             fundraising. In 1998, the group convinced AIDS organizations
keep themselves in harmony and balance, whether through                 on the neighboring Big Island and Kawai to form a coalition to
meditation, Tai Chi or regular acupuncture. Illness, if it hap-         help identify financial resources for all of the partners.
pens, means that energy is no longer flowing.                                In 1999, that partnership lead them to apply for a Housing
     It is that same focus on prevention and traditional reme-          Opportunities for Persons with AIDS (HOPWA) Special Pro-
dies, though, that stymies efforts to diagnose and treat those          jects of National Significance (SPNS) grant, which targets
already infected with HIV.
     “When Native Hawaiians find out that they have HIV, it is
usually at the late stages of AIDS and they usually have one or                                                     Maui continued on 10

HIV Impact                                                          9                                                  July/August 2004
Save the Date...August 12 - 15, 2004
2004 Minority Women’s Health Summit
                                                                          Objectives for the Minority Women’s Health Summit:
T   he theme for this summit, “Women of Color, Taking
    Action for a Healthier Life: Progress, Partnerships
and Possibilities” will be held August 12-15, 2004, in                        Explore current prevention strategies that work in
Washington, D.C.                                                               various communities, both urban and rural.
     The 2004 Minority Women’s Health
Summit—sponsored by the Office on Women’s                                    Promote dialogue among policy makers, service
Health—aims to build on the outcomes of                                             providers, community women, academia
the 1997 National Conference “Bridg-                                                   and other stakeholders to address current
ing the Gap: Enhancing Partnerships to                                                  health care issues for women of color.
Improve Minority Women’s Health.”
     Over 500 professionals from                                                            Recommend action-oriented strate-
diverse fields of expertise, including                                                     gies to increase positive health out-
policy makers, public health officials,                                                    comes for women of color across the
health care workers, medical institution                                                   lifespan, from rural and urban commu-
researchers, employers, faith-and commni-                                               nities.
ty-based organization advocates, allied
health professionals and more are expected to attend.                          Foster community partnerships to identify and
     The summit program will include plenary ses-                               implement best practices that target prevention,
sions focusing on national, state and community col-                            diagnosis and treatment of diseases that dispro-
laborations, along with breakout and poster sessions.                           portionately affect women of color.
     Key areas in women’s health including cardiovas-
cular disease, cancer, diabetes and HIV/AIDS will be                      Promote strategies to diversify leadership in health sci-
highlighted among different minority groups—African Ameri-                 ences, education, research and policy.
cans, American Indians and Alaska Natives, Asian Americans,
Hispanics/Latinas, Native Hawaiians and other Pacific                 Ensure health issues of women of color remain at the fore-
Islanders, Africans and Indians.                                       front of national, state and local health policy agendas.

                                 For more information on the Minority Women’s Health Summit,
                                  call 202-205-0571, or go to

Maui continued from 9

 innovative, replicable projects for largely underserved populations, including racial and ethnic minorities, women and people liv-
ing in rural areas.
     Maui AIDS was one of 11 non-profit organizations nationwide that was awarded a $1.1 million three-year SPNS grant that
year, which it administrated with help from its partners. In 2003, the grant was renewed for $1.6 million.
     “We had been using a significant amount of our Ryan White emergency financial assistance funds for emergency rental assis-
tance, and our clients were still becoming homeless or close to homeless because there was very little housing money available,”
Berliner said. “The grant has moved us up a level in the services we are able to provide to families living with HIV/AIDS.”
     These days, Berliner said that state budget cuts and decreasing private funding has once again forced them to spend much of
their time looking for additional revenue sources.
     His newest pet project, though, is to develop vocational programs that would help reintegrate people back into society who
have been living with HIV for some time. He is swapping his fundraising expertise for help in developing the programs with an
organization in San Francisco that has already had some success in bringing longtime HIV sufferers back to the workplace.
     “Even though they are a large city and we are a small community, we still have a lot to share with each other,” Berliner said.
“That’s really what it is all about; people within the health and human services sector sharing ideas and helping each other so that
we aren’t all reinventing the wheel.”
     For more information on the Maui AIDS Foundation, call 808-242-4900, or visit http://www.mauiaids.orgN

July/August 2004                                                10                                                      HIV Impact
What’s New?
The Latest from Health and Human Services

  AIDSinfo Help Line Now                                    Use of Rapid Oral HIV Test Extended
        Live Online

N     eed answers to your questions
      about federally approved informa-
                                             O     n June 25, 2004, U.S. Department of Health and Human Services (HHS) Secre-
                                                   tary Tommy G. Thompson announced that HHS has extended the availability of
                                             a recently approved rapid oral HIV test from the current 38,000 laboratories permit-
tion on HIV/AIDS treatment and pre-          ted to perform the test to more than 100,000 sites, including physician offices, HIV
vention research, HIV/AIDS clinical          counseling centers and community health centers. In addition, Thompson announced
trials, and treatment and prevention         that HHS would fund a $4.8 million effort to add the rapid test to HHS-funded pro-
guidelines?                                  grams to reduce HIV/AIDS among injection drug users.
     The National Institutes of Health’s           "These actions will expand even further the availability of a simple, rapid HIV
(NIH) educational Web site, AIDSinfo,        test to communities where people are at high risk of HIV," Secretary Thompson said.
recently launched “Live Help,” an            "HIV testing has never been easier or more accessible than it is today."
online service that provides individual,           To perform the oral test, the person being tested for HIV-1/2 takes the device,
anonymous, confidential assistance to        which has an exposed absorbent pad at one end, and places the pad above the teeth
visitors experiencing difficulty navigat-    and against the outer gum. The person then gently swabs completely around the outer
ing the AIDSinfo Web site or locating        gums, both upper and lower, one time around. The device is then inserted into a vial
federally approved HIV/AIDS informa-         containing a solution. The test device will indicate with more than 99 percent accura-
tion.                                        cy if HIV-1/2 antibodies are present in the solution by displaying two reddish-purple
     The help line is available at           lines in a small window on the device. Monday through            Widespread availability of the rapid oral version of the HIV test will likely fur-
Friday, from 12:00 noon to 4:00 p.m.         ther increase overall HIV testing and decrease the number of people—an estimated
EST. Visitors can also contact Live Help     225,000 Americans—who are unaware they are infected with the HIV virus. Early
staff via e-mail at ContactUs@aidsin-        testing enables infected individuals to obtain medical care earlier in the course of their, or the AIDSinfo Telephonic       infection, potentially saving lives and limiting the spread of this deadly virus.
Information Service, available Monday              For more information on the rapid HIV test, call 888-463-6332 or go to
through Friday, from 12:00 noon to 5:00
p.m. EST, at 301-519-0459 (Internation-
al); 800-448-0440 (toll-free); or 888-          $595 Million Awarded for AIDS Care in Urban Cities
480-3739 (TTY/TDD).
     Live Help staff members are trained
health information specialists with a
detailed knowledge of many HIV/AIDS-
                                             O     n March 1, 2004, U.S. Department of Health and Human Services Secretary
                                                   Tommy G. Thompson announced the allocation of more than $595 million to the
                                             cities hit hardest by the HIV/AIDS epidemic. The 51 grants will help these cities pro-
related resources, including hotlines,       vide primary care and supportive services for low-income residents with HIV/AIDS.
publications and Web sites. They cannot,          “These grants will increase access to quality health care for those Americans liv-
however, provide medical advice. Only        ing with HIV or AIDS, especially those who need help the most, including minorities,
qualified health care providers can          the uninsured and the underinsured,” Secretary Thompson said.
answer personal medical questions.                The grants to 51 Eligible Metropolitan Areas (EMAs), which include both formu-
     The help line is sponsored by the       la and supplemental grants, are funded under Title I of the Ryan White CARE (Com-
National Institutes of Health, the Centers   prehensive AIDS Resources Emergency) Act. Formula funds are awarded based on
for Medicare and Medicaid Services, the      the estimated number of people living with AIDS in the city, and supplemental funds
Health Resources and Services Adminis-       are awarded competitively among EMAs based on demonstration of severe need and
tration and the Centers for Disease Con-     other criteria. A portion of the grant awards will fund the Minority HIV/AIDS Initia-
trol and Prevention.                         tive to bolster care and services among minority populations.
     For more information, go to                  For a complete list of cities and grant allocations, go to          

HIV Impact                                                      11                                                  July/August 2004
African Immigrants in the Spotlight
Minnesota Devises Strategies for Newest At-Risk Community
Jennifer L. Rich

                                                                          tested or treated. Africans are often uncomfortable addressing

       everal years ago, health workers in Minnesota started to
       notice an alarming trend. After years of relative stability        any issues around HIV/AIDS, including sex.
       or decline in new HIV infections in the African American                “Cultural taboos around sex are still very much in place,”
community, the numbers started to rise again, particularly                said Lucy Slater, the planning director of the STD and HIV sec-
among women. The change was dramatic.                                     tion of the Minnesota Department of Health.
     “We had been working with the African American commu-                     “We are finding that HIV-positive individuals rarely even
nity for a long time,” said Gloria Lewis, director of the Min-            talk to their sex partners about their status or about using pro-
nesota Office of Minority and Multicultural Health. “So when              tection.”
we saw the numbers we thought, ‘oh my God, what have we                        Getting Africans to seek treatment for HIV or AIDS is also
been doing wrong’?”                                                       a challenge, since they fear leaving clues of their infection, like
     After combing through the epidemiological data, the Min-             frequent visits to the doctor or caseworker or a medicine cabi-
nesota Department of Health came to a shocking conclusion.                net full of pill bottles.
The jump could be attributed entirely to an increase in infec-                 In an attempt to address some of the issues around HIV
tions among African immigrants, who had been categorized as               disease in the African community, the Minnesota Department
African American for statistical purposes. Indeed, while the              of Health convened an HIV advisory group that represents the
African-born community in Minnesota accounted for only                    major African communities statewide. One of the first things
around one percent of the population, it represented 21 percent           the group decided, Slater said, is that they had to adopt new
of all new infections in 2002. That’s 65 of the 305 new HIV               ways of thinking about HIV interventions.
diagnoses in the state that year.                                              “There is a culture around HIV prevention here that we
     Though Minnesota is the first state in the country to break          just go in and tell it like it is,” Slater said. “But that is just not
out HIV/AIDS figures for African immigrants, states like New              an approach that is going to be effective in the African commu-
York and Washington also suspect that infection rates are high            nity.”
in their African-born communities. They point to the need for                  She said that the advisory group is considering interven-
services specifically targeted to African immigrants in the Unit-         tions that are modeled on health initiatives in Africa that aren’t
ed States.                                                                related to HIV, such as vaccination campaigns.
     Because of refugee and faith-based resettlement programs,                 “For vaccination campaigns, they send people into the
Minnesota, and particularly the Minneapolis/St. Paul area, has            community several weeks beforehand to talk to leaders and
experienced the fastest growth in its African-born population of          answer questions in the community in order to gain their con-
anywhere in the country over the last 10 years. Most of these             fidence and trust,” she said. “So, by the time the people arrive
immigrants are from the East African countries of Somalia and             with the actual vaccine, the community is prepared.”
Ethiopia, with smaller populations from Liberia, Kenya and                     Slater said that a recently successful intervention in the
Uganda.                                                                   south of the state was a telling example. In the town of Manka-
     Many of the social and cultural issues that contribute to the        to, a health worker spent an entire year working with the east
spread of HIV in Africa are also found in African communities             African community to organize walking groups and cultural
here, starting with a basic lack of knowledge about reproduc-             activities before she ever mentioned HIV. When she finally
tive health and HIV/AIDS transmission.                                    held an HIV intervention, it was well attended, but, Slater said,
     “In American communities, we know that HIV infection is              “It would never have happened if she hadn’t have spent a whole
about drug use or sex,” said Gwendolyn Velez, the executive               year there building trust.”
director of the African American AIDS Task Force. “In African                  State and local organizations have also started sending
communities, transmission is often believed to come from                  African-born outreach workers to attend local community gath-
other places, whether it is preordained from God, or other cul-           erings and work with leaders in African community agencies,
tural beliefs.”                                                           churches and mosques. Community organizers are also testing
     Lack of knowledge about the disease has created an envi-             the idea of using radio shows, plays and videos for HIV educa-
ronment of stigma and denial, according to the Minnesota                  tion purposes. In the Ethiopian Oromo community last year, a
Department of Health, which has conducted focus groups                    local organization developed a script, trained actors and deliv-
among African-born people in the state. Fear of being ostra-              ered a performance about HIV in the local language. A second
cized by family or community deters Africans from getting                 community-sponsored event included performances by a

July/August 2004                                                     12                                                            HIV Impact
                                                                                                       Rates and New Cases
                                                                                              (per 100,000 persons) of HIV Infection by
                                                                                             Race/Ethnicity & Mode of Exposure* — Min-
                                                                                                            nesota, 2002
drama troupe from South Africa. Both              The Minnesota Department of
shows were popular.                          Health has also contracted the Red Cross
     In an effort to identify and test at-   to create a culturally and linguistically     Population                     Rate            Cases

                                                                                           White, non-Hispanic            3.0             129
risk Africans, the African American          appropriate train-the-trainer program to
                                                                                           Black**, African American      37.0            62
AIDS Taskforce has collaborated with         increase the community’s capacity to
the Hennepin County Medical Center,          educate itself.                               Black**, African-born          130-185***      65
one of the largest in the Minneapolis/St.         Health experts in Minnesota say          Hispanic                       21.6            31
                                                                                           American Indian                8.6             7
                                                                                           Asian/PI                       5.3             9
Paul area, to have HIV educators and         that they are fortunate to have highly
                                                                                           Unknown                        ---             2
case workers inside the emergency            educated and concerned members of the
walk-in clinic.                              African community who are willing to          Total                          6.2             305
     “Most of the African community          get involved.
uses the clinic as their primary source of        “The African leadership is really
                                                                                            * HIV infection includes all new cases of HIV infection
                                                                                            (both HIV [non-AIDS] and AIDS at first diagnosis)
healthcare, so we are able to reach them     taking the lead to devise a solution for
                                                                                            among Minnesota residents in 2002.
more effectively,” Velez said. “When         the community,” Velez said. “But we are
you are out in the community, it is like a   starting from a different place, where we      ** African-born Blacks are reported separately from
needle in a haystack.”                       still need to work on breaking the             other Blacks (born in the U.S. or elsewhere).
                                                                                            ***Accurate population estimates for Black, African-
                                                                                            born persons living in Minnesota are unavailable -
     She said that much like a hospital      silence. We have a lot of work to do.”
                                                                                            anecdotal (50,000) and 2000 U.S. Census data
would send in a nutritionist to talk to           For more information on the Min-
someone diagnosed with diabetes about        nesota Department of Health’s STD/HIV          (35,188) ) were used to create the range of rates
a healthy diet, they send in an African-     section and HIV/AIDS statistics, go to         reported for African-born persons. The population esti-
                                                                                            mate for Black, African American persons (167,784)
                                                                                            was calculated by subtracting the U.S. Census esti-
born outreach worker when patients are and click
                                                                                            mate for African-born persons (35,188) from the total
either diagnosed with an STD or appear       on Health and Statistics.N
to be at risk for HIV. Often, patients are                                                  Black population (202,972). Note that this assumes
convinced to get tested on the spot and                                                     that all African-born persons are Black (as opposed to
are immediately provided with cultural-                                                     another race).
ly sensitive case management services.
Since the program began two years ago,       Parents continued from 3
Velez said the Taskforce staff has identi-
fied 17 HIV positive people, 15 of                “Sex is a mystery to a lot of parents—to a lot of people—and there are a lot of
whom were African born.                      venues around kids and parents that are trying to unveil that mystery and a lot of
     Health workers across Minnesota         times parents are totally overwhelmed about the discussion about sex,” he said.
stress that they are just beginning to            Faced with a question about sex, Austin said, parents tend to shut down because
make inroads into the African communi-       they don’t know what to say.
ty. Needs assessments are still being             “But we are trying to convey to parents that they shouldn’t run away from that,”
done, and capacity building is a princi-     Austin said. “When a question comes up—what we call a teachable moment—par-
pal focus.                                   ents need to slow down long enough to say, ok, I can actually deal with this ques-
     Capacity building in the African        tion.”
community is one of the key priorities of         To avoid telling people what to do, facilitators try to get the parents themselves
the Minnesota Office of Minority and         to devise their own messages.
Multicultural Health, according to                “I explain to parents that this is like a board: Nike has a board. VH1 has a board.
Lewis.                                       All of those venues out there that are sharing information about sex with our children
     “We’re building these agencies          all have a group of people who sit around and craft the message,” Austin said. “And
from the bottom up, but I think that we      so the question we ask the parents is: ‘What message do you have?’”
are making strides,” she said.                    He added: “When you have eight or nine mothers sitting around with 100-plus
     One priority is to make sure that       years of parenting experience among them, there is all kinds of information that they
outreach workers and case managers           can share with each other. We tell them: ‘This is your board.’”
understand the language and culture of            The “Board” concept also serves to create lasting relationships among group
their clients. Equally important, howev-     members, many of whom are raising children by themselves.
er, is that service providers understand          Austin says that the parents love the program because it provides them with the
the intricacies of the health care and       tools to be better parents.
social service systems as well as the             Austin, who has four kids of his own, understands that feeling.
needs associated with recent immigra-             “I don’t want someone to unveil the mystery of sex for my kids,” he said. “I want
tion, such as housing, employment and        to be able to have the skills and abilities to deal with this subject on a day-to-day
legal paperwork.                             basis regardless of how busy I am or how much is going on in my life.”
                                                  For more information on the Parents Matter program, call 706-542-1806.N

HIV Impact                                                      13                                                         July/August 2004
                                                                                        CDC Releases Asian-Language
Resources                                                                                 HIV/AIDS, STD Materials
Center for AIDS Prevention Studies          National Minority AIDS Council
at the AIDS Research Institute              1931 13th Street, N.W.                     “HIV and AIDS: Are You at Risk?”
University of California, San Francisco     Washington, DC 20009                       Explains HIV transmission and pre-
74 New Montgomery, Suite 600                202-483-6622                               vention methods; dispels myths; dis-
San Francisco, CA 94105                                   cusses testing and lists resources.
415-597-9100                                                                           Available in: Tagalog (SKU: E064),                    National Women’s Health Information        Khmer (SKU: E065), Vietnamese
                                            Center                                     (SKU: E066), Korean (SKU: E067)
Centers for Disease Control                 8550 Arlington Blvd., Suite 300
and Prevention                              Fairfax, VA 22031                          “HIV and Pregnancy: Ten Things You
National Prevention Information Network     800-994-WOMAN                              Should Know: For You and Your
P. O. Box 6003                                          Baby”
Rockville, MD 20849-6003                                                               Explains risk behaviors associated
800-458-5231                                New York Academy of Medicine               with HIV transmission including ways                      1216 Fifth Avenue                          to lower the risk of perinatal and
                                            New York, NY 10029                         neonatal transmission of HIV to
Maui AIDS Foundation                        212-822-7200                               infants. Available in: Chinese (SKU:
1935 Main Street, Suite 101                               E084), Vietnamese (SKU: E085),
P. O. Box 858
Wailuku, Maui HI 96793                      National Institutes of Health              “Learn About HIV Testing”                     Office of AIDS Research                    Describes HIV testing and who needs
                                            Building 2, Room 4E08                      to be tested; HIV testing is structured
Minnesota Department of Health              Bethesda, MD 20892                         and what one should do if one tests
Infectious Disease Epidemiology,            301-496-0357                               positive. Available in: Khmer (SKU:
Prevention and Control Division      E097), Vietnamese (SKU: E098),
717 Delaware Street Southeast               /microbicides/oarmicro.htm                 Korean (SKU: E100), Tagalog (SKU:
P. O. Box 9441                                                                         E101)
Minneapolis, MN 55440-9441
612-676-5414                                                                           “Living with HIV/AIDS”                                              Provides an overview of the virus, as
stdhivsection.html                                                                     well as information on how to stay
                                                                                       alive and healthy. Available in: Taga-
                                                                                       log (SKU: E060), Khmer (SKU:
                 National Minority AIDS Council (NMAC)                                 E061), Vietnamese (SKU: E062),
            Organizational Effectiveness Series Now On CD-ROM                          Korean (SKU: E063)

     Not able to travel to technical assistance trainings? Now you don’t have to.      “Teens and HIV and Other STDs:
                                                                                       At Risk? Get Tested!”
      To build the capacity of HIV prevention and care programs aimed at communi-      Discusses testing for STDs and HIV;
 ties of color, the National Minority AIDS Council (NMAC) has released its entire      high risk behaviors; and other issues.
 Organizational Effectiveness series of 15 technical assistance manuals and CD-        Available in: Khmer (SKU: E087),
 ROMs. Use them as do-it-yourself guides or in conjunction with NMAC recommen-         Korean (SKU: E089), Tagalog (SKU:
 dations and programs.                                                                 E090), Vietnamese (SKU: E091)
      Funded by the Centers for Disease Control and Prevention (CDC) and the Health
 Resources and Services Administration (HRSA), the series covers Board Develop-            Publications may be found by
 ment, Faith-based Leadership Development, Fiscal Management, Grant Writing, HIV       searching by their title, or by the SKU
 Prevention Community Planning, Human Resources, Leadership Development, Needs         numbers provided.
 Assessment, Program Development, Program Evaluation, Starting a Nonprofit, Strate-        Publications are also available in
 gic Planning, Surviving an Audit, Technology Development and Volunteer Manage-        English and Spanish.
 ment.                                                                                     To order these and other HIV pre-
      To order a copy of the series, call NMAC at 202-234-5120 or e-mail               vention materials, call 800-458-5231 The series can also be downloaded from the NMAC Web site at         or go to http://www.cdcnpin.orgN Click “publications,” then “TA publications.” The manuals
 and CD-ROMS will be available in Spanish later in 2004.N

July/August 2004                                               14                                                 HIV Impact
                                                                                  Mother continued from 4

Madre continued from 5                                                            to keep our traditions, but are we going to keep
                                                                                  the tradition that says that we can’t talk about sex
                                                                                  and sexual health? Do we really want to keep
“Ella decía que su mamá estaba siempre trabajando, siempre ocupada”.              passing these values on to our daughters?”
     Para paliar la situación, un segmento del curriculum les pide a las                In the third session, women came in for a pri-
madres que definan metas para crear tiempo para hablar a solas con sus            vate talk about their own challenges and risk fac-
hijas.                                                                            tors, where they were presented with specific data
     El curriculum también incluye una sección sobre promover conver-             on the increase in HIV infections among Latinas.
sación. En lugar de elementos que imposibilitan la comunicación, como “Tú               “A lot of the women are worried about infi-
no puedes tener novio hasta los 21”, se instruyó a las madres para que            delity, but they don’t use protection,” Martinez
suavizaran el lenguaje: “Aunque yo preferiría que tú esperaras, si tú decides     said.
tener un novio, yo prefiero saberlo”,                                                   To address their concerns, the team dedicat-
     Como parte de un ejercicio sobre relaciones intergeneracionales, se les      ed a segment to proper condom use.
pidió a las mujeres que explorasen los sen-timientos de sus familias con                In the end, the curriculum was universally
respecto a asuntos sexuales.                                                      praised by the participants in a post-study survey,
     Según Martínez, el mensaje fue: “Nosotros definitivamente queremos           according to Martinez. The survey also showed
conservar nuestras tradiciones, pero ¿vamos a conservar la tradición que          that the initiative significantly increased their
dice que no podemos hablar de sexual y salud sexual? ¿Realmente queremos          level of knowledge and improved their communi-
pasar estos valores a nuestras hijas?”                                            cation skills with their daughters. The women
     En la tercera sesión, las mujeres tuvieron una sesión de conversación        also began to initiate conversations with their
privada sobre sus retos y factores de riesgo particulares, en las cuales se les   daughters that they wouldn’t have had before the
presentó información específica sobre el aumento de las infecciones de VIH        program.
entre latinas.                                                                          And most importantly, Gómez said, the
     “Muchas mujeres están preocupadas sobre la infidelidad, pero no usan         women had an increase in their own perceived
protección”, dijo Martínez.                                                       risk.
     Para abordar sus preocupaciones, el equipo dedicó un segmento al uso               “We keep making the assumption that the
correcto del preservativo o condón.                                               information is already out there,” Gómez said.
     Al final, el curriculum del seminario fue elogiado por todas las partici-    “As we start to see increases in new cases of HIV
pantes en una encuesta posterior al estudio, según Martínez. La encuesta          and the rampant epidemics of STDs, particularly
también mostraba incrementó significativamente su nivel de conocimiento y         among the minority populations, we can’t forget
mejoró sus habilidades de comunicación con sus hijas. Las mujeres también         that there are some basic knowledge and literacy
comenzaron a provocar conversaciones con sus hijas que no habrían ocurri-         issues here.”
do antes del programa.                                                                  Gómez and her team are writing up their
     Y, lo más importante, Gómez dijo, las mujeres incrementaron la percep-       findings for publication and are searching for
ción de su propio riesgo.                                                         funding to do a full clinical trial that may some-
     “Seguimos asumiendo que la información ya está disponible”, dijo             day include mother-to-son communication.
Gómez. “Mientras seguimos viendo incrementos en nuevos casos de VIH y                   In the meantime, they have been presenting
la rampante epidemia de ETS, particularmente entre las minorías, no               the program to audiences around the country, to
podemos olvidar que hay algunos problemas básicos de conocimiento y               heartening results.
alfabetización en eso”.                                                                 “What is remarkable is the number of com-
     Gómez y su equipo están escribiendo sus descubrimientos para publi-          munities all over the country—rural, urban, in the
cación y están buscando financiamiento para realizar un estudio clínico           middle, on the coast—where folks were really
completo que podría incluir algún día comunicación madre a hijo.                  excited about it,” Gómez said. “They thought it
     Por el momento, ellos han estado presentando el programa a diferentes        could really be implemented in their communi-
públicos en el país, con alentadores resultados.                                  ties. They said that it goes across ethnic bound-
     “Lo destacable es el número de comunidades en todo el país—rurales,          aries.”
urbanas, en la región central, en la costa—donde las personas estaban real-             The most interesting idea, she said, was from
mente entusiasmada con esto”, dijo Gómez. “Ellos pensaban que realmente           a group in Memphis who thought that the pro-
podría ser puesto en práctica en sus comunidades. Dijeron que traspasa fron-      gram would be great for African American grand-
teras étnicas”.                                                                   mothers who are raising their adolescent
     La idea más interesante, dijo ella, fue de un grupo en Memphis que pen-      grandchildren.
saron que el programa sería excelente para las abuelas afroamericanas                   For more information on the From Mother to
quienes están criando a sus nietos adolescentes.                                  Daughter curriculum, call the Center for AIDS
     Para más información sobre el curriculum De madre a hija (From               Prevention Studies at 415-597-9230, or go to
Mother to Daughter), llame al CAPS al 415-597-9230.N                              http://www.ucsf.caps.eduN

HIV Impact                                                        15                                               July/August 2004
Office of Public Health and Science                                                                                   PRSRT STD
Office of Minority Health Resource Center                                                                         U.S. POSTAGE PAID
P.O. Box 37337                                                                                                   CAPITOL HEIGHTS, MD
Washington, DC 20013-7337                                                                                          PERMIT NO. 0099

Official Business
Penalty for Private Use $300

Conferences                                                                                Consider the Benefits
September 21, 2004                                                                            to Your CBO...
Join us in encouraging those most in need of health care to visit
a doctor during the third annual Take A Loved One to the Doc-
                                                                         The Resource Persons Network !
                                                                              Professional volunteers N Minority health experts
                                                                                  Program development N Grant reviewers
tor Day. Regular health screenings are a critical step to a
                                                                                  Capacity building N Technical assistance
healthier U.S.
To learn how you can help make this year’s Take A Loved One
to the Doctor Day the most successful yet, visit our Web site at
http://www/ or give us a call at
                                                                                           Resource Persons Network
                                                                                          Connecting with Communities
October 21-24, 2004                                                                   To learn more about this free service,
                                                                         please visit the Office of Minority Health Resource Center at
                                                                    or call 800-444-6472 ext. 277.
United States Conference on AIDS
                                                                            The Office of Minority Health Resource Center is a nationwide service of the
Philadelphia Marriott Hotel, Philadelphia, PA                                             U.S. Department of Health and Human Services.
Contact: National Minority AIDS Council

July/August 2004                                                    16                                                                        HIV Impact

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