Destigmatizing HIV and Syphilis Testing through an Integrated Testing Outreach Strategy
Reinventing Delivery Options for HIV/AIDS Health Education
Involving Youth in Outreach: Partnering with a Local High School
Community-Level HIV Prevention
Screening Tool Identifies High Risk Behaviors
Increasing Male Farmworkers’ Interest in Seeking Health Services
Destigmatizing HIV and Syphilis Testing through an Integrated Testing Outreach Strategy
2007, Tri-County Community Health Center, Dunn, North Carolina
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To encourage more farmworkers to take advantage of Tri-County Community Health Center’s (TCCHC) community-based syphilis and HIV screening events, staff now combine these two screenings with other health screenings that are less stigmatized: cholesterol, glucose, and blood pressure.
With the support of a CDC grant, TCCHC runs a Non-Traditional Testing Program that allows staff to perform rapid HIV tests and syphilis tests for interested farmworkers directly in the communities where they live and work. Even though the testing services are community-based, TCCHC staff initially had a difficult time finding farmworkers willing to approach the TCCHC tent advertising free HIV and syphilis testing. Because of the stigma attached to these illnesses, TCCHC staff had to devise a way to make their testing efforts more attractive and acceptable. By combining cholesterol, glucose, and blood pressure screenings with the HIV and syphilis tests, TCCHC staff have been able to entice farmworkers with the option to have five free screenings at once without focusing specifically on HIV or syphilis.
The change in attitude among farmworkers to being screened and tested was observed almost immediately once the HIV and syphilis tests were no longer advertised and offered on their own. Since including the other three screenings, TCCHC has seen a 60% increase in the number of farmworkers willing to be tested for these two illnesses.
In addition to getting more farmworkers into care for HIV and syphilis, the integrated screening and testing program has also allowed TCCHC to identify farmworkers who were not aware that they were at risk for high cholesterol, hypertension and diabetes. Farmworkers, who had never been routinely screened for these conditions in the past, are now referred back to TCCHC’s chronic disease clinic if they have significant results warranting follow-up care. TCCHC staff organize the follow-up appointments and provide transportation if necessary. The Medical Director for Chronic Care at TCCHC is so pleased with this new program that he covers the cost of the expendable materials necessary to administer the three tests in conjunction with the HIV and syphilis tests.
Reinventing Delivery Options for HIV/AIDS Health Education
2006, Bluegrass Farmworker Health Center
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Bluegrass Farmworker Health Center began a pilot program based on the concept of “Tupperware Parties” as part of an effort to improve the effectiveness of HIV/AIDS prevention education. An Outreach Specialist makes arrangements with someone from the community to invite 6-10 friends to their home for a “party.” At the gathering, the Outreach Specialist begins by providing a general information session to the entire group. Following this session, the Outreach Specialist sets up office in a separate private room where each attendee can come and speak about personal concerns. If they so desire, they may also receive an HIV test.
The “Tupperware Party” model is effective because it engages people in a community setting with people that they know and trust while still respecting their need for privacy regarding a sensitive issue. These home-based health education sessions have been well received by members of the population who have tended to shy away from other types of HIV/AIDS education events that BFHC has offered in the past. The sessions are intimate and relaxed because of the small numbers of attendees who generally already know each other. Also, by offering one-on-one consultations, confidentiality is still maintained.
Involving Youth in Outreach: Partnering with a Local High School
2006, Quincy Community Health Center, Moses Lake Community Health Center
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Quincy Community Health Center collaborates closely with a project-based high school in the area, High Tech High, doing prevention education, holding community meetings and celebrations, conducting community needs assessments and spreading the word about a variety of topics. The majority of the students at the school are Latino and come from farmworker families. As one result of this partnership, a local senior developed an HIV/AIDS awareness art project that was accepted as a poster presentation at the most recent Western Migrant Stream Forum. The art project will be on display at the clinic to encourage youth research on the topic of HIV/AIDS, especially prevention.
This project uses the educational system, an existing system trusted by the farmworker community to stretch limited resources. The collaboration with a local high school, whose students are children of local farmworkers, crew chiefs and growers, has given students an opportunity to get involved with local, national and bi-national health issues and participate in projects that will impact local and state health outreach models. By tapping into the leadership of farmworkers and their children, QCHC hopes to make lasting and generational changes in regards to health issues.
Community-Level HIV Prevention
2006, Farmworker Justice Fund, Inc.
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Farmworker Justice Fund has implemented the
Young Latinos Promotores (YLP) project which is a community-level HIV prevention project targeting 18-30 year old migrant men who have sex with men with HIV risk-reduction messages based on the Popular Opinion Leader model. At the suggestion and input of the YLPs, bilingual English/Spanish educational cards about STIs were developed. All YLPs were trained on how to use the education cards and rated them as their most useful health education tool. Participants who received the health education training shared that their lifestyles were never discussed in their communities or with their families, which was a cause for great stress, leading some of them to engage in high risk behaviors.
The YLP project, an adaptation of an intervention originally designed for homosexual white men in bar settings, addresses the health education needs of a marginalized subset of the farmworker population: migrant young men who have sex with men. The approach was innovative because the peer health education tools were developed with direct farmworker input. The interactions with this population generated a lot of useful information about their behaviors and the challenges they face. In addition, the project ensured that all participants had the option to be tested for HIV and other STIs. Those that were infected were immediately referred for treatment at the collaborating clinic, Vista Community Clinic in Vista, California.
Screening Tool Identifies High Risk Behaviors
2005, Tri-County Community Health Center
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Tri-county Community Health Center’s Community Services Department includes a mental health, substance abuse, and HIV/AIDS/STI screening tool as part of their outreach general health assessment. All outreach staff and accompanying medical students or personnel are trained in using the screening tool and familiar with the prevention model used at Tri-County. The tool allows outreach staff and medical students who partner with them to identify farmworkers engaging in high-risk behaviors for HIV/AIDS/STIs, farmworkers with mental health needs, and farmworkers substance abuse issues. Staff may then refer to an inpatient/outpatient bi-lingual substance abuse treatment center for males on-site at Tri-County Community Health Center, to Tri-County Community Health Center behavioral health or psychiatric services, or to additional services outside the health center. Staff may also refer a farmworker for HIV/AIDS/STI testing at the center, or choose to set up on-site mobile HIV/AIDS testing in high-risk camps or areas.
To provide comprehensive health services to farmworkers in their area, Tri-County uses collaborative ties with other departments within the organization, as well as with state and local organizations. Tri-County has the ability to refer farmworkers on-site at the health center to inpatient and outpatient substance abuse treatment, and to behavioral health services and psychiatric care. Tri-County provides free HIV/AIDS testing on-site in the community and farmworker camps by establishing a mobile testing unit on location for a full day, and returning on an established date to provide test results.
Routine screening for mental health needs, substance abuse, and risk behaviors associated with HIV/AIDS/STIs provides comprehensive care to farmworkers in Tri-County’s service area and meets a previously largely unmet need in the farmworker population. Tri-County’s ability to treat farmworker patients on-site at the health center for substance abuse in a bi-lingual and culturally appropriate facility greatly increases farmworker access to substance abuse services. Similarly, the ability to refer farmworkers in need of mental health services to both behavioral health and psychiatric services at the health center minimizes the need for farmworkers to travel to multiple providers to receive treatment and medications, as well as provides continuity of care and culturally and linguistically appropriate services.
Finally, by providing HIV/AIDS testing on-site in the community, Tri-County makes confidential testing much more accessible for farmworkers in the area, while also providing culturally and linguistically appropriate care. By coming to the camps and encouraging everyone to be tested, Tri-County staff members are able to target high-risk areas, work to de-stigmatize testing, and reach more farmworkers with testing services.
Increasing Male Farmworkers’ Interest in Seeking Health Services
2008, Vista Community Clinic
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The goal of Vista Community Clinic’s (VCC) Male Health Services Project is to increase access to reproductive health education and clinical services for male migrant farmworkers, ages 25 and older in north San Diego County. The bicultural and bilingual project staff provides age-appropriate, culturally and linguistically competent reproductive health education to male farmworkers in a variety of locations including farmworker residences and work sites. Another component is the male reproductive health exam, which includes vital sign screenings, screenings for testicular and prostate cancer, instruction on self-screening for testicular cancer, diagnosis and treatment of sexually transmitted infections (STIs), and information and referrals for fertility services.
Based on feedback from a needs assessment and asset mapping project carried out in collaboration with an advisory committee made up of members of the target population, VCC implemented a multi-faceted community awareness campaign to provide culturally and linguistically appropriate health education and referrals for male exams in a variety of settings. VCC also developed a clinic-based male health services enhancement plan that included provider training on recognizing and responding to male reproductive health and psychological needs, and recognizing and responding to cultural and social barriers that influence or impede patient-provider communication.
This project has enabled VCC to create a male-friendly service delivery environment. Male-oriented reading materials have been placed in the waiting rooms, and appointments are scheduled at the main clinic site away from where women and children are routinely seen. Male exams are scheduled primarily during VCC’s evening and weekend service hours to accommodate work schedules. Furthermore, project staff guide clients through the male exam process, helping them to fill out forms and providing interpretation services as needed. Men who receive the male reproductive health exam are encouraged to also access additional comprehensive health screenings, such as adult immunizations, TB testing, and diabetes and hypertension screening. Since implementing this program, the number of male farmworkers accessing health exams each month has more than doubled.
