1. Expanding the Reach of HRC:
Addressing the HIV Prevention
Needs of Black/African American Men
& Women
Camille A. Abrahams, MS
Harm Reduction Coalition
September 2008
CDC/ASPH Institute for HIV
Prevention Leadership 1

2. Summary of Presentation
Overview of Strategic Planning Process
• Mission, Vision and Goals
• Strategic Issue: Activities, Evaluation, Resources
Needed
Overview of Project Initiative
• Community Assessment Process
• Intervention Activities
• Evaluation Activities
Budget
2

3. Harm Reduction Coalition
Mission:
The Harm Reduction Coalition (HRC) is a national advocacy and
capacity-building organization that promotes the health and human
rights of people who use drugs and confronts the adverse effects of
drug use, by advocating for effective policy responses to drug-related
harms, by serving as an incubator for new ideas, and by promoting
best practices for the harm reduction movement.
HRC advances policies and programs that help people address the adverse
effects of drug use including overdose, HIV, hepatitis C, addiction,
and incarceration.
Vision
We recognize that the structures of social inequality impact the lives and
options of affected communities differently, and work to uphold every
individual's right to health and well-being, as well as in their
competence to protect themselves, their loved ones, and their
communities.
3

4. HRC’s National Goals
Lead national advocacy campaigns on the following
issues:
• Lifting the federal ban on syringe exchange funding,
increased
• Increase government funding for community-based
hepatitis C programs
• Developing a comprehensive plan on the federal level
to reduce overdose mortality
• Improve federal policy/prescribing guidelines to
increase access to Buprenophrine
HRC will accomplish these goals as a national capacity builder for
programs addressing the harm reduction, prevention, and treatment
needs of people who use drugs. HRC will also develop and promote
minimum standards for harm reduction service provision .
4

5. African American Capacity
Building Initiative
The African American Capacity Building Capacity Building
Initiative (AACBI) is a CDC-funded program that was
founded in 2004 to assist community based organizations
(CBOs), health departments (HDs) and other community
stakeholders serving the African American community in the
CDC’s North Region.
Goals:
• To strengthen the capacity of CBOs & HDs to develop and
implement effective HIV prevention interventions.
• To decrease the number of people at risk of acquiring or
transmitting HIV infection.
5

6. Strategic Planning Group
Harm Reduction Coalition
• Jagadisa-devasri Dacus, MSW, Senior Director of Training
& Capacity Building Programs
• Dorcey Jones, MPH, Capacity Building Assistance Specialist
Hunter College School of Social Work
• Darrell Wheeler, PhD. Associate Dean for
Research/Associate Professor and AACBI Behavioral and
Social Science Consultant
• Bernadette Hadden, PhD, Assistant Professor and AACBI
Evaluation Consultant
Brick Rebuilding
• Allen Frimpong, Founder and Program Coordinator
6

7. Strategic Issue
Stabilizing the program staff by addressing recent staff
turnover and challenges filling the positions.
Rationale for Issue:
• AACBI recently experienced a long-term period of instability
as a result of a vital program position being vacant for seven
months.
• The Program Director had to juggle both administrative and
programmatic work, which was overwhelming both personally
and professionally.
• The Program Director views that period as a lesson learned,
and wants to be prepared when staff turnover occurs.
7

8. Goal and Objectives
The goal is to develop and maintain program
sustainability for the AACBI program in the event of
staff turnover.
Objective 1
• By April 30, 2009, AACBI/HRC will expand its cadre of
trainers/technical assistance providers by recruiting, hiring
and training new consultants.
Objective 2
• By May 30, 2009, AACBI/HRC will develop a staff
recruitment and retention plan that will address, among
other things, monetary and non-monetary incentives.
8

9. Objective #1: Recruit, Hire & Train
New Consultants
OCT NOV DEC JAN FEB
1. Develop job
descriptions
2. Post job
description
3. Develop
selection criteria
4. Identify
candidates
5. Invite candidates
for interview
6. Interview
candidates
7. Observe
candidates train
9

10. Objective #1: Recruit, Hire & Train
New Consultants
NOV DEC JAN FEB MAR APR
8. Plan orientation
9. Develop
orientation
manual
10. Host consultant
orientation
11. Hire qualified
candidates
12. Train new
consultants –
HR
13. Train new
consultants –
CD
10

11. Objective #2: Develop a Staff
Recruitment and Retention Plan
OCT NOV DEC JAN
1. Determine staffing
needs
2. Evaluate cause of
staff turnover
3. Sr. Management
Mtg
4. Learn best practices
from partners
5. Link R&R plan
w/strategic plan
6. Develop R&R plan
(short/long term)
7. Develop selection
criteria
11

12. Objective #2: Develop a Staff
Recruitment and Retention Plan
DEC JAN FEB MAR APR MAY
8. Train/coach
managers -
perf/change
mgmt
9. Draft R&R
manual
10. Seek feedback
11. Finalize R&R
manual
12. Develop QA
plan
13. Plan to review
R&R plan
annually
12

13. Evaluation
Goal How Will You Measure Achievement?
To develop and maintain program Tracking and examining:
sustainability for the AACBI program in • the staff’s length of tenure
the event of staff turnover • job satisfaction
• the quality of staff job performance
This data will be collected through:
• Observation
• Staff supervision
• Program evaluation (i.e. training
evaluation)
This data will be reviewed every trimester.
13

14. Evaluation
Objectives How Will Your Measure Achievement?
1. By April 30, 2009, AACBI/HRC will After each recruitment cycle, monitor and
expand its cadre of trainers/technical analyze the number of trainers/TA
assistance providers by recruiting, providers:
hiring and training new consultants. • Recruited
• Added to the consultant pool and
compare to the baseline number (pre-
recruitment)
• Completed trainings
2. By May 30, 2009, AACBI/HRC will Monitoring and analyzing the following:
develop a staff recruitment and • Length of time it takes to recruit new staff
retention plan that will address, among • Length of staff tenure
other things, monetary and non-
• Staff job satisfaction
monetary incentives.
• Staff job performance14

15. Safety Counts
A Behavioral HIV Intervention For
Black Men Who Use Drugs and
Have Sex With Women
15

16. Priority Population
Black/African American adult women (ages 20-49) of
unknown or HIV-negative status, engaged in heterosexual
contact with men who use drugs and live in New York City.
Why this population?
• In NYS, over 42% of African Americans don’t
know how they were infected.
• In NYC, 54% of black women acquired HIV from
heterosexual contact. Another 27% do not know
how they were exposed to HIV.
Therefore, the focus of our prevention efforts needs to be
on the sexual partners of these women.
16

17. HRC’s Capacity To Work With
Priority Population
Harm Reduction Coalition is not a direct service agency.
Therefore, our capacity to work with this priority
population is limited.
However, the Board of Directors is open to supporting a
program for black women who are partners of drug users
(our target population).
HRC is a culturally competent organization with experience
working with the African American community.
Furthermore, HRC has extensive knowledge about drug
use and the adverse effects of drug use (e.g. overdose,
viral hepatitis, HIV/AIDS, etc.)
17

18. Assessment & The Theory
Behind It
Individual Assessment: Web-based Survey questionnaire
• Target pop - Black/African American women (ages 20-49) of unknown
or HIV negative status, engaged in heterosexual contact with men who
use drugs
Community Assessment: Focus Groups
• Target Pop - Key Informants and Community Leaders – individuals who
understand the influence and connection between poverty, incarceration
and sexual networks within Black/African American communities that
lead to HIV infection among heterosexual women
Behavioral Theory :The Theory of Gender and Power
• The theory argues that self-protection by women is often swayed by
economic factors, abusive partnerships, and the socialization of women
to be sexually passive or ignorant.
• The theory incorporates the structure of gender relations, societal
definitions of masculinity and femininity, and economic power.
18

19. Key Findings From Individual
Assessment
The top two reasons why women did not use condoms all the
time with their drug using main partners were:
• Their partner doesn’t like to use condoms
• They are in a monogamous relationship
The main reason why women did not use condoms all the time
with their drug using casual partners was a history or
potential for partner violence.
Although the majority of women surveyed think they are at
risk for HIV, that does not always lead to using a condom
each and every time with their partner.
19

20. Key Findings From Community
Assessment
HIV prevention education does not effectively incorporated drug education,
especially understanding how a partner’s use of drugs can place them at
risk for HIV
Black/African American women need to find their voice in the fight against
HIV.
• Lack of self- empowerment to protect and defend their needs with
their sexual partners
Relationship dynamics between men and women need to be functional,
balanced and healthy.
• Economic disparities, unemployment/underemployment for either
partner, especially the man, can cause distress in the relationship
leading to high-risk behaviors
There are stigmas that are specific to the black community (e.g. faith-based
homophobia).
20

21. Safety Counts
• Safety Counts is an HIV prevention intervention for out-of-treatment active
injection and non-injection drug users aimed at reducing both high-risk drug
use and sexual behaviors. It is a behaviorally focused, seven-session
intervention, which includes both structured and unstructured psycho-
educational activities in group and individual settings.
• The goal of the intervention is to reduce the HIV acquisition and/or
transmission incidence for adult men who use drugs and have sex with
African American women.
• Harm Reduction Coalition is in the pre-implementation stage with Safety
Counts. In partnership with a direct service provider, Safety Counts can be
implemented with fidelity, because two HRC staff members are Safety
Counts master trainers and have extensive knowledge of the intervention.
21

22. Adaptation of Intervention
• Safety Counts would have to be adapted to serve African
American male clients who use drugs and their primary goal
behavior is to use a condom.
• Since the ultimate goal is to effect the risk of African American
women who are having sex with men who use drugs, it is
important and necessary to link Safety Counts to another
intervention for women, SISTA, for their female partners.
• Both sexual partners will be receiving the same risk reduction
messages simultaneously.
• Safety Counts social events will be open to female sex partner
who are also SISTA participants. In addition, another group
session will be added to Safety Counts to include information on
healthy relationships between black men and black women.
22

23. Intervention Implementation
Stakeholders
Stakeholder Name Resources and/or Rationale for Inclusion
Adam Viera Serves as program staff, therefore he would be
CBA Specialist implementing the intervention.
Harm Reduction Coalition
Dorcey Jones Serves as program staff, therefore she would be
CBA Specialist implementing the intervention.
Harm Reduction Coalition
Darrell Wheeler, PhD Supports the program with expertise around
Behavioral & Social Science Consultant behavioral theory, interventions and the target
Hunter College School of Social Work population
Bernadette Hadden, PhD Expertise in formative, program and outcome
Evaluation Consultant evaluation
Hunter College School of Social Work
23

24. Process Outcome or Behavioral or Goal
Objectives Immediate Intermediate Statement
Objectives Objective
Process Monitoring Outcome Monitoring and Impact
and Evaluation Evaluation Evaluation
24

25. Behavioral or Intermediate
Outcome Objective
By the completion of the intervention
(4 months), each client will have the knowledge
and skill to reduce the transmission risks
associated with unprotected vaginal and/or
anal sexual intercourse.
25

26. Evaluation of
Behavioral Objective
Objective Indicator Source of Evidence
By the completion of Increase in awareness # of participants that
the intervention, 100% of the link between increased their
of participants will internalized awareness of the link
increase their homophobia and HIV between internalized
awareness of the link risk behavior among homophobia and HIV
between internalized participants who risk behavior
homophobia and HIV completed the
risk behavior leading intervention
to rising HIV rates
among African
American women.
26

27. Outcome or Immediate
Outcome Objectives
• By the completion of the intervention, 75% participants will bring
their AA female sex partners to at least one social event, where
they will discuss the risk of HIV infection due to drug/alcohol
use.
• By the completion of the intervention, 75% of the Safety Counts
participants will receive at least one referral to a job training
program .
• By the completion of the intervention, 100% of participants will
increase their awareness of the link between internalized
homophobia and HIV.
• By the completion of the intervention, 75% of Safety Counts
participants will state an intention to use condoms with their
female sex partners. 27

28. Evaluation of Outcome Objectives
BY THE
COMPLETION OF INDICATORS SOURCE(S) OF
THE EVIDENCE
INTERVENTION: Number of A/A
Bring AA female sex
partners attending Sign-in sheet
female sex Head count at
partners to at social event
Social Event
least one social Program
event Number of Social
Events Monitoring Form
Receive at least Number of job
one referral to a training programs in
job training List of referrals,
referral network
program MOAs with job
Number of training programs
participants referred in referral network
to job training , Client Records
28
programs

29. Evaluation of Outcome Objectives
BY THE
COMPLETION OF INDICATORS SOURCE(S) OF
THE EVIDENCE
Increase in awareness of
INTERVENTION:
the link between
awareness of the link internalized
between internalized homophobia & HIV Pre and Post
homophobia and HIV risk behavior Risk Reduction
among participants Interview
who completed the
intervention
state an intention # of participants who Program Monitoring
to use condoms completed the intervention Form
with their female Client Record
sex partners # of participants who Risk Reduction
completed the intervention Interview
who stated an intention to
use condoms with female 29
sex partners

30. Process Objectives
1. By November 2008, a formal collaborative agreement -- for the
purposes of running Safety Counts in conjunction with their SISTA
program, recruiting clients, utilizing office space and sharing staff --
with Diaspora Community Services, a direct service provider, will be
established via a Memorandum of Agreement (MOA).
2. By January 2009, the Safety Counts staff at HRC and Diaspora (also
referred to as “The Safety Counts Team”) will be hired.
3. By February 2009, a client recruitment and retention plan will be
developed by the Safety Counts Team.
4. By February 2009, all Safety Count Team members will have
completed a CDC-sanctioned Safety Counts training.
30

31. Process Objectives
5. By February 2009, all Safety Count Team members will have
received an Overview of SISTA by a CDC-funded CBA provider.
6. By March 2009, the Safety Counts Team will pilot-test a new
curriculum for a third group session to address the issue of healthy
relationships between black men and black women
7. By March 2009, the first cycle of Safety Counts for African
American/Black male drug users whose primary goal is to use
condoms with their African American female sex partners will
begin
8. By April 2009, at least one Social Event will be open to SISTA
participants who are receiving the same risk reduction messages
simultaneously
9. By September 2009, the Safety Counts Team will evaluate the first
completed cycle of the intervention. 31

32. Evaluation of Process Objectives
PROCESS
OBJECTIVES INDICATORS SOURCE(S) OF
EVIDENCE
(due date) # of roles and responsibilities
for the implementation of the
Formal intervention detailed in the
Agreement MOA MOA
through MOA
# of signatures from Executive
(by Nov. 08)
Directors of partner
organizations
Number of Proposed Grant Proposal
Hire Safety Staff
Hiring Letter,
Counts Team Employee Records
(by Jan. 09) Number of Staff
Actually Hired
32

33. Evaluation of Process Objectives
PROCESS
OBJECTIVES INDICATORS SOURCE(S) OF
EVIDENCE
Number of clients
identified to be
Recruitment recruited and Grant
& Retention retained Application
Plan (by Feb Client
09) Records
SC Team # of people completing
completes the Safety Counts training Certificates of
CDC SC completion
Increase in knowledge of
Training (by Sign-in sheets
Safety Counts
Feb 09)
intervention procedures
and policies
33

34. Evaluation of Process Objectives
PROCESS
OBJECTIVES INDICATORS SOURCE(S) OF
EVIDENCE
Number of people
completing the SISTA
SC Team Overview training Certificates of
completes attendance
Increase in knowledge
CDC SISTA Sign-in sheets
of SISTA intervention
Training (by
procedures and
Feb 09)
policies
#of priority population
Pilot 3rd
participating in pilot test Sign-in sheet
Group Session
re: healthy Increase in participant’s Pre-Post Test
black knowledge about healthy One-on-one
relationships relationships interviews with
(by Mar 09) participants
34

35. Evaluation of Process Objectives
PROCESS
OBJECTIVES INDICATORS SOURCE(S) OF
EVIDENCE
Number of
participants who
Begin the 1st attended Group Sign-in sheets
cycle of Session 1 Client
Safety Counts Records
Number of Group Program
(by Mar 09)
Sessions that occur Monitoring
Form
Number of SISTA
At least one SC
participants invited to List of invited
Social Event
the Social Events guests
open to SISTA
participants (by Number of Social Invitations
Apr 09) Events Program
Monitoring Form
35

36. Evaluation of Process Objectives
PROCESS
OBJECTIVES INDICATORS SOURCE(S) OF
EVIDENCE
Evaluate the Number of core Program
first elements implemented Monitoring Form
completed Pre and post Risk
Increase in knowledge
cycle of SC Reduction Interview
and skills of the
(by Sep 09) Client Participation
participants
Record
36

37. Resources Needed
Personnel Other Direct Costs
• Program Manager • Travel
• Counselor/Facilitator I • Consultants
• Outreach • Office Supplies
Worker/Facilitator II • Educational Materials
• Program Assistant • Stipends
• Printing
• Telephone/Internet
• Postage/Delivery
• Equipment
• Furniture
37

38. Year 1 Budget
Strategic Plan Intervention Plan Total
Personnel $52,800 $96,600 $149,400
Consultants $5,000 $10,000 $15,000
Stipends $2,000 $7,000 $9,000
Equipment $0 $12,000 $12,000
Travel $0 $5,000 $5,000
Supplies $1,000 $5,000 $6,000
Other Direct Costs $7,500 $17,500 $25,000
Indirect Costs 10,245 $22,965 $33,210
Total $78,545 $176,065 38 $254,610

39. Closing Remarks
Safety Counts, in partnership with SISTA, is an effective intervention that
will reduce the transmission of HIV among Black/African American
adult men who use drugs and have unprotected sex with Black/African
American women.
This unique partnership between two behavioral interventions will be
cost-effective while meeting its goal to increase the knowledge and skills
of clients and their partners.
AACBI/HRC is a culturally competent program that has an excellent
performance record as well as strong relationships in the community to
make this initiative a success!
39