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Ending the HIV Epidemic: Community Strategies in Disease and Health Promotion

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Ending the HIV Epidemic: Community Strategies in Disease and Health Promotion AUTHOR Petrow, Steven, Ed.; And Others TITLE Ending the HIV Epidemic: Community Strategies in Disease and Health Promotion. INSTITUTION California Univ., San Francisco. Inst. for Health Policy Studies.; San Francisco AIDS Foundation, CA. SPONS AGENCY National Inst. of Mental Health (DMS), Bethesda, Md.; Robert Wood Johnson Foundation, New Brunswick, N.J. REPORT NO ISBN-1-56071-030-6 PUB DATE 90 CONTRACT MH42459 NOTE 181p. AVAILABLE FROXNetwork Publications, 1700 Mission St., Suite 203, P.O. Box 1830, Santa Cruz, CA 95061-P30 ($24.95). PUB TYPE Books (010) -- Guides - General (050) EDRS PRICE MF01 Plus Postage. PC Not Available from EDRS. DESCRIPTORS *Acquired Immune Deficiency Syndrome; *Community Health Services; *Community Role; *Health Promotion; *Prevention; Public Health ABSTRACT This book was written to provide public health leaders, community organizers, policynakers, community-based agency directors, and health educators with the most accurate information available on developing prevention strategies to reduce the spread of human immunodeficiency virus (HIV) in communities throughout the United States. In the late 1980s the San Francisco (California) Department of Health, together with a wide range of organizations, agencies, community groups, and individuals, developed a response to the epidemic that has srved as a model both nationally and worldwide, and the lessons learned in San Francisco are presented in this book as a case study of a community in action. Part I of the book, Understanding the HIV Epidemic, provides the basic foundation for understanding the mergnc and epidemiology of the epidemic. Part II, the San Francisco Response, presents three chapters detailing different aspects of the prevention effort in San Francisco. Part III, HIV Prvention in Your Community, provides nuts and bolts expertise concerning the development, design, and implementation of prevention programs. Individual chapters include: (1) "A Modern Epidemic Emerges: History and Context" (Renate Kiefer and Stephen }Miley); (2) "Patterns of th Epidemic and Public Health IMpliCations" (Renate Kiefr, Joseph Guydish, Katherine Haynes, George Lemp and Stephen Hulley); (3) "AIDS: Putting th Models to the Test" (Margaret Chesney and Thomas Coates); (4) "A City Responds to Crisis: Creating New Approaches° (Jeffrey Amory); (5) "San Francisco's Prevention Partnership: Issues and Challenges" (Jeffrey Mary); (6) "Lessons from San Francisco: Principles of Program Design° (Ron Stall, Chuck Frutchey, Mindy Thompson Fulillove, and Pat Christen); (7) °Planning and Implementing Community Strategies" (Pat Franks, Henrik Blum, Thomas Coates, Edward Morales, and Paul Gibson); and (8) °Ending th HIV Epidemic: A Call for Community Action" (TLMOthy Wolfrtd). (NB) 17r THEru v EPIDEMIC COMMUNITY STRATEGIES IN DISEASE PREVENTION AND HEALTH PRO 611PARTMEAT Or EDWATION 144.9,MIIION9Rti E Ode* ol Educational Rasaaren and Inuounoninit MATERIAL IN MICROFICHE 011M. EDUCATIONAL RESOURCES INFORMATION HAS BEEN GRANTED BY CENTIR mac eTh,, clecumint has Mao tOteaticati IS UM/PM MIT MS OVUMOfoftlanozam)n S. 8134ell ofonsung r_s Mims Cheap, hav OW made to mom. 113t0Ouction quatOY Polls ot vow at 000m0n stated ol lila dOCu EdRed by Steven Petrow TO THE EDUCATIONAL RESOU owl Oa not oC4111Stoly ritotStit atfiCial INFORMATION CENTER (ERIC)." OEM004Ott ot Ow" IMO wnn Pat Franks and Timothy R. Wared t.D ENDING THEHIV EPIDEMIC COMMUNITY STRATEGIES IN DISEASE PREVENTION AND HEALTH PROMOTION Edited by Steven Petrow with Pat Franks and Timothy R. Woifred Son Froncisco AIDS Foundation institute for Health Policy Studies and Center forAIDSPrevention Studies University of California. San Francisco Network Publications, a division of UR Among*. Ilants Cita, California 4 0 MeTide 910 4407 do fa Sat III. Cover 8 1. it. Ending Primed 1990 Weds &damand ISSN Library 7 Network the No.No. 6in Wiwi= Sr et by thenterlbe sad 5 &California, Libety Psadootk1 PalleilCO. AIDS cm. promotion 345550 design; 4the ram of*UNIX 2,IDNLM:Wowed, FIIV 3 San S. Develwpasentof Ropcloco. 1. 2 Hos*robin 1114644.11251153 Julia 1 asseeinied this 1914.093--dc20 3. ciscoProvention. /edited Congress United popes& Publications, in /0142459 Tknothy 146071433-0 by with PolleyWood book 1990 Aapimd 3. epidemic (iollbotmd) Cowen Otakeenksprevention &lobed : (hardbound) States Francisco dos lksticieoo; thefromwas R. P.O. - & Chiapella of die Studies text Steven Johnson the Conenunity Health BoxAIDS Sonand we assisted (Disease)Prevention. the by Health 2. Peuow,community America 1830, developmentof ofthose National a control.San Feurehn; Immunodeficiency education. with &miceCenter the pant Santa Foundation. the the Immunodeficiency I. for bathos Patstrategies text. AIDS in Catalogiatie-Pablkatioa Cruz,All AIDS authors offrom" 5.Francisco. Petrow, Franks Data CA National andMental lie ServicesSan rights do sod disease Foundation; Robert Health Steven. or Prevention ofInstitutenot Health. II. reserved. any TheWoop Francisco. Syndromeprevention& Tunothyinvention 95061-1830, Studies,Mental 4. R. other neetessily and Johnson CIP Pranks, AIDS(Disease)CaliforniaSan Published agency Health; opinions, 90-6384 PromotionSan Disease control SyndromeepidemiologySan Pat.Fran- Wolfred. health 1-800-321-by or Universitytherepresent con- Founds- This book is dedicated to Sam B. Puckett (1937-1988). Sam was a longtime San Franciscan, a lawyer, a Southern gentleman, a curmudgeon, a community activist, a gay man and an imiovator in AIDS pieveedon. Cofounder of die STOP AIDS Project, Sam was convinced from the stwt that AIDS prevention was not really a "hest& eduesdon issue" buts local narked% mean issue centered on undemanding community norms mid values. The questionhe posed for himself mid others as we began to write this book wm, How do se create new petterns of interaction within the community that aupport new patterns of behavior and health? 6 Contents Forewordxiii Mervyn F. Silverman, MD, MPH Acknowledgmentsxvii Introducdonixx Steven Petrow Part I: Understanding the HIV Epidemic 1. A.Modern Epidemic Emerges: History and Context3 Renate G. Kieftr and Stephen B. Halley Introduction3 AIDS: A New Disorder 4 Patterns of Risk: Pintecting the Blood Supply 7 Isolating the Virus8 The HIV Epidemic in Context 9 Epidemics: A Phenomenon of the P-...4?9 Syphilis and Oonortea 11 Controlling Venereal Disease 12 HIV: The Natural History13 The Virus13 The Clinical Specuum 17 7 2. Patterns of the Epidemic and Public Health Implications20 Remus G. Kiefer, Joseph R. Guydish, Katherine C. Haynes, George F. Loy and Stephen B. Hu lley Introduction20 Distribution of AIDS 21 Distribution of HIV Infection25 Estimates Based on Studies of High-Risk Groups 25 Estimates Based on Surveys of Other Populations27 V- Prospects for the Future29 Public Health Implications30 Modes of Trmsmission30 Sexual Transmission30 Blood-Borne Transmission33 Perinatal Transmission35 How KW Is Not Transmitted35 Preventing NW Infection36 Preventing Sexual Transmission37 Preventing Transmission Through Injection Drug Use 40 Preventing Transmission Through Blood and Blood Products40 Preventing Perinatal Transmission 41 Preventing Occupational Transmission42 Social and Cultural Prevention Issues42 The Role of the Community 42 Marginalizadon and Its Effects44 Summary 46 3. AIDS: Putting the Models to the Test48 Margaret A. Chesney and Thomas J. Coates Introduction 48 The Germ 'Theory and Modem Medicine50 Behavior Replaces the Germ is Target51 Contents Chemins Behavior 11ie Five -Stages52 Stage 1: Providing Information53 Stage 2: Motivation and Perwasion 55 Perceived Vulnerability55 Costs vs. Ducats 56 Stage 3: Teaching Specific Skillg57 Stage 4: Increasing Self-Efficacy58 SW* 5: Maintaining Changed Behavior 59 Summary 61 Part II: The San Francisco Response 4. A City Responds to Crisis: Creating New Approaches 65 Jeffery W. Amory Introduction65 The Thee Elements: Audiences, Approaches and Messages67 Audiences67 Approadies69 Messages 70 Coordinating the Elements71 Identifying Appropriate Providers 73 Which Approaches? Which Messages9 75 Limiting the Prevention Agenda 77 Educating the General Public78 Summary 79 S. San Rancisco's Prevention Partnership: Isms and Challenges80 Jeety W,Amory Introduction80 The Bathhouse Controversy82 Significance of the Bathhouse Controversy84 Subsequent Devdopments85 The HIV Antibody Test85 . 9 M_ _ Cor `ests Mandatory Testing and Reporting87 Voluntary Tesdng and Counseling Programs 88 Testing Donated Blood89 Partner NotifIcadon 89 Subsequent Developments 90 Outreach to Ethnic Communities 91 Initial Response 91 Subsequent Developments93 Ltallenges to the Partnership94 The Impact of Growth 94 Censorship of Materials95 Changes in Contracting Policies96 Summary 97 6. Lessons from San Francisco: Principles of Program Design98 RonStall, Chuck Frutchey, Mindy Thompson Fullilove and Pat Christen Introduction 98 Designing Apptoaches and Messages 99 Building Relationships with Target Audiences103 Changing Public Policy 107 Research and Evaluation107 Summary110 Part III: HIV Prevention in Your Community 7. Planning and Implementing Community Strategies113 Pat Frank& HenrikL. Blum, Thomas I. Coates, Edward S. Morales and Paul M. Gibson Introduction113 Levels of Community Response114 Factors That Influence Community Response116 Stages in Community Response117 Stage I: Denial118 10 Contents Stage 2: Straggle118 Stap 3: Acceptance and Coping119 Sias) 4: Relapse120 Developing Stnteglec The Role of Planning121 Policy Planning122 Strategic Planning122 Tactical, Operational or Implementation
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