CDC NPIN In the Know: Gaming & Mobile for Public Health Webcast Presentation
A Community Assessment Tool to Measure Syringe Access Readiness
1. A Community Assessment Tool to
Measure Syringe Access Readiness
H a r m R e d u c t i on Co a l i t i o n ( H R C)
N a r e l l e E l l e n d on, R N
1 Katie Burk, MPH
2. Overview of the Harm Reduction
Coalition and CBA for SAS
Mobilization team
Reviewing Syringe Access Services
(SAS) in the US
Defining the A PLACE model
Applying the A PLACE model to
community assessment work
2
3. Harm Reduction Coalition
Founded in 1994 to work with individuals and
communities at risk for HIV infection due to drug
use and high-risk sexual behaviors.
The Harm Reduction Coalition is a national
advocacy and capacity-building organization that
promotes the health and dignity of individuals and
communities impacted by drug use.
3
4. The Institute @HRC
◦ Capacity Building for Syringe Access Services Mobilization
◦ HIV Prevention Capacity Building Initiative for CBOs
◦ Harm Reduction Training Institute
◦ Overdose Prevention Programs (SKOOP/DOPE)
◦ LGBT Project
Policy Advocacy
National and Regional Conferences
◦ Next National Conference: Portland, Oregon in Nov. 2012
◦ Harm Reduction in The South; NC Sept 2011
4
5. Provide technical assistance to Community
Based Organizations, Health Departments and
Communities to address IDU (Injecting Drug
Users) Health Needs, including HIV
Prevention.
Provide expertise to:
Establish, Expand & Improve
Effectiveness of Syringe Access
Services (SAS)
5
6. Syringe access programs are the most
effective, evidence-based HIV prevention
tool for people who use drugs.
Seven federally funded research studies
found that syringe exchange programs
are a valuable resource.
Incities across the nation, people who
inject drugs have reversed the course of
the AIDS epidemic by using sterile
syringes and harm reduction practices.
6
7. Every year 32,000 people get
infected with HIV/AIDS and
Hepatitis C in the US by sharing
contaminated syringes(1).
Nationally, injection drug users
represent 12 % of annual HIV
infections and 19 % of people
living with HIV/AIDS.
1) Drug Policy Alliance, http://www.drugpolicy.org/facts/drug-war-numbers
7
9. Significant shifts toward support of syringe access
programs on a federal level:
Lift of the federal ban in 2009
◦ Federal funds can now be used to directly support
syringe access programs
National HIV/AIDS Strategy (NHAS) 2010
◦ Calls for minimizing HIV infection among IDUs
◦ Specifically sites syringe exchange as an intervention
that will reduce the HIV infection rate among IDUs
National Hepatitis plan 2011
◦ Call to enhance IDU access to sterile syringes
Sources: http://www.whitehouse.gov/sites/default/files/uploads/NHAS.pdf,
http://www.hhs.gov/ash/initiatives/hepatitis/actionplan_viralhepatitis2011.pdf
9
10. • Mobilize community • Mobilize communities
• Intensify prevention
National HIV/AIDS Strategy
CBA for SAS Mobilization
HHS hepatitis action plan
resources to prevent to provide effective
efforts in communities
viral hepatitis caused SAS (an evidence-
where HIV is most
by IDU based intervention)
heavily concentrated
• Ensure that IDUs have
• Expand efforts to • Establish/Expand SAPs
access to hepatitis
prevent HIV using to provide HIV testing,
prevention services
evidence based linkages to SA tx,
approaches hepatitis education
• Provide IDUs with
and screening,
access with access to
medical care
• Promote a holistic care and SA treatment
approach to health to prevent
that addresses transmission and • Build leadership,
comorbidities with disease progression alliances, community
STDs and hepatitis C awareness
10
11. Reducing new infections
◦ Main focus of CBA for SAS Mobilization
Access to care and improving health outcomes
◦ Support people living with HIV with co-occurring health
conditions and those who have challenges meeting their
basic needs, such as housing.
Reducing HIV disparities and health inequities
◦ Adopt community level approaches to reduce HIV
infection in high-risk communities
More coordinated national response to the HIV
epidemic
◦ Increase the coordination of HIV programs across
federal, state, and local governments
11
12. Develop Community Mobilization Model
(A PLACE)
Identify services to provide, recipients of
services, process, and outcomes
Provide trainings and TA to targeted
communities
Increased utilization of SAS should
emphasize other services related to
prevention
12
14. A •AWARENESS
P •POLICY
L •LEADERSHIP
A •ALLIANCES
C •CULTURE
E •ESTABLISH/EXPAND
14
15. Build and/or Expand :
Community AWARENESS of the need for SAS
Understanding around POLICY issues that impact SAS
LEADERSHIP to champion SAS
ALLIANCES that support and aid the establishment &
expansion of SAS
IDU CULTURAL competency of SAS
Capacity to ESTABLISH SAS
SAS capacity to EXPAND to meet IDU health needs
15
16. A • AWARENESS
What is the existing level of
community awareness around HIV &
HCV transmission among IDUs?
How does the community regard SAS
as an intervention for their jurisdiction?
How does the community obtain
information about IDU health issues?
16
17. P • POLICY
What are the current policies that
impact SAS?
Are any advocates or groups working
on SAS-related policy?
How does the community perceive &
implement these policies?
17
18. L • LEADERSHIP
Who are the leaders who work to
address IDU health issues?
What are the capacity needs of
leadership to address the needs of
new or existing SAS?
18
19. A • ALLIANCES
What alliances address HIV or HCV
prevention, IDU issues, and/or SAS?
Who are the constituents of the
alliances?
What are the capacity needs of alliances
to address and/or champion SAS?
19
20. C • CULTURAL COMPETENCY
How do agencies or programs meet IDU
health needs?
In what ways do new or existing SAPs and
other programs promote consumer
involvement?
What data/research/evaluation is available
to assess IDU needs and effectiveness of
services?
20
21. E • ESTABLISH/EXPAND
What are the capacity needs to
establish SAS?
In what ways do can existing SAS be
improved to better meet the needs of
IDUs?
21
22. Leveraging the
strengths of…
Communities
Leaders
Advocates
Programs
Alliances
in order to address
barriers to SAS.
22
23. State of SAP Obstacles
Aw P Aw.
. P
L
GOAL
GOAL
Al. L
Al.
C
E
E C
23
24. Key informant
interviews
Surveys
Strategic planning
processes
Expansion of existing
needs assessment
processes
Support for community
coalitions
Focus groups
24
25. Applying the needs assessment model to the
jurisdictions in the CBA for SAS Mobilization
team’s work plan
25
26. 5 new pilot SAPs in the state
Leadership in 5 programs to form an
alliance, become HR experts in NJ
CBA for SAS facilitating planning
process for Harm Reduction
Partnership of NJ (HRPNJ)
26
27. Key informant interviews with 6 leaders
of the 5 NJ-based SAPs
Interviews transcribed
Qualitative analysis of data by CBA for
SAS Mobilization team
SWOT analysis employed with results of
qualitative data
Report drafted on interviews and SWOT
analysis, disseminated to HRPNJ
27
28. Guiding HRPNJ’s strategic planning process:
Solidify and expand alliance (HRPNJ)
Increase awareness of law enforcement
Improve IDU cultural competency of programs
◦ Create more avenues of consumer involvement at SAPs
◦ SAPs as leader/model of IDU cultural competency for
other local programs
Expand reach of existing programs
◦ Expand hours, other program models
◦ Providing OD Prevention, hepatitis education, food
28
29. Improving drug user cultural competency—
CBA activities
◦ Drug User Stigma training
◦ Syringe Access and Law Enforcement training
◦ Focus groups at 2 sites
Strengthening alliances—Creation of policy
and procedures, bylaws for HRNJP
Focusing on awareness of program and its
usefulness (working with law enforcement)
29
30. Boulder has 3rd oldest program in US,
had been operating under the radar
before legislation passed
Recent SAS legislation passed statewide,
called for local buy-in
Restrictive city ordinance in Denver
posing barriers to establishment of SAP
30
31. Syringe access affinity session during APHA
conference in Denver, Nov 2010
Key informant interviews with 6 key
informants who are involved with IDU-
related serviced in CO
Interviews transcribed
Qualitative analysis of data by CBA for SAS
Mobilization team
31
32. Political and legislative barriers
Limited cross-jurisdictional support among
programs working with IDUs
Strong leadership in harm reduction field
and IDU health
Impressive IDU cultural competency of
programs
32
33. City ordinance in Denver amended, RFP
released
Building capacity of leaders
Boulder to advocate for Narcan availability
Strong cross-jurisdictional alliance between
Boulder, Denver, Fort Collins
Trainings on Drug User Stigma, Building
Alliances between SAPs and Law Enforcement,
Improving Health with Drug Users
33
34. Interest in initiating SAS
among county health
department staff in Washoe
County
NV-based needs assessment
processes pointing to need for
SAS
No legal or underground SAPs,
no enabling legislation
CBA for SAS working to
support IDU CC, community
awareness, leadership
34
35. Syringe access
legislation did not pass
in 2011
Before next political
process an
establishment of the
program, need to build
up…
◦ SAS leadership
◦ Alliances
◦ IDU cultural competency
◦ Awareness of the
effectiveness of SAS
35
36. Limited SAS, high rates of HIV incidence and
prevalence
Legislation restricting SAS in many states
Lack of awareness, IDU cultural competency,
alliances & leadership on drug user health
issues
Pockets of effective harm reduction advocates
and providers in different parts of the region.
36
37. Focus on building awareness, alliances, and
IDU cultural competency:
◦ Southern Network google group
◦ Southern HR Conference Sept 2011
◦ Collaborating with agencies also doing work in the
South (LCOA, ACRIA)
◦ Supporting & showcasing working models of SAS in
the South (NCHRC, AHRC)
◦ Building our understanding of Southern drug user
community issues to provide specific SAS CBA
jurisdiction work
37
