CHOWÂ’s HIV/AIDS Program in Detroit Chosen for National Expansion
Detroit-based Community Health Outreach Workers, Inc. (CHOW) is poised to expand their successful capacity building assistance (CBA) across the USA through a recent grant award from the U. S. Centers for Disease Control & Prevention (CDC). CHOW improves the overall ability of community-based organizations (CBOs) to implement strategies that facilitate access to and utilization of HIV/AIDS prevention services on the part of the African American population and important sub-population of African American men who have sex with men (AA/MSM) that the CBOs serve, by developing the quality of these services with specific attention to cultural competence, which fosters participation from the affected community and incorporates their integral input; unparalleled CBA expertise that CHOW has exemplified during the past decade of local, state and regional service.
Detroit, MI (PRWEB) May 1, 2004
There are few enough success stories (in Detroit or anywhere) when it comes to local organizations providing innovative HIV/AIDS care for the unique needs of African American populations, but Community Health Outreach Workers, Inc. (CHOW) is one such success story. Begun by a group of health and social service volunteers over 10 years ago on a shoestring budget, this local non-profit health organization is now poised to expand their unique brand of culturally competent HIV/AIDS capacity building assistance across the country. Official approval was received just days ago, as CHOW became one of the few community-based organizations in the nation to receive an award from the U. S. Centers of Disease Control & Prevention (CDC) as part of their recent grant titled “Capacity Building Assistance to Improve the Delivery and Effectiveness of Human Immunodeficiency Virus (HIV) Prevention Services for Racial / Ethnic Minority Populations” (Program Announcement 04019). There was stiff competition among the 33 total awardees chosen for funding, with just 12 awards available in the focus area that CHOW competed in, which was “Strengthening Community Access to and Utilization of HIV Prevention Services.” CHOW helps build capacity by improving the overall ability of community-based organizations (CBOs) and other community stakeholders to implement strategies that will increase access to and utilization of HIV prevention and risk-reduction and avoidance services for racial/ethnic minority individuals. To this end, CHOW has used the principles of Parity, Inclusion and Representation throughout the past decade, developing the quality of HIV/AIDS services with specific attention to cultural competence that facilitates access and utilization to better serve the African American target population and important sub-population of African American men who have sex with men (AA/MSM), in such desperate need of these health services.
The programs most associated with CHOW are the successful Midwest African American Men United Against AIDS (AAMUAA) offering unparalleled capacity building assistance across the Midwest region, the POWer Set facilitating health outreach worker training certification, and the LINKS Referral Network that established standardized referrals and a first ever Resource Guide to coordinate HIV/AIDS and other gateway services -- having served some 4,397 clients. CHOW is located in the very epicenter of HIV/AIDS in Detroit, at 2727 Second Avenue, staffed by a cadre of indigenous health professionals, headed by Executive Director, Schawne Parker, a local Detroiter. Mr. Parker has served as the Chair of the Statewide Prevention and Care Planning Council, Michigan HIV/AIDS Council (MHAC), which is the HIV/AIDS Services planning body for the State of Michigan, administered by the Michigan Department of Community Health. The staff of CHOW is integrally involved in collaboration and coordination with the Community Planning Process, working closely with local, state, and regional health agencies (IL, IN, IA, KA, MI, MN, MO, NB, ND, OH, SD, and WI). Active participation in the planning councils of these organizations serve as springboards to present new initiatives, and a vehicle for maintaining connections with the organizations that make up the continuum of HIV Prevention & Care Services, providing a vast referral network of culturally appropriate providers. CHOW staff regularly provides presentations such as the comprehensive community planning orientation process for new and existing partner providers, designed to encourage more meaningful participation by planning group members, and to feature African American leadership in an effort to mentor emerging leaders. Highlights from such presentations include:
~ The Historical Perspective of Community Planning
~ Understanding Disease Surveillance
~ Conducting Needs Analysis for “Hard-To-Reach” Populations
~ Identifying Community Assets
~ Developing Multi-Year Prevention Plans
This new grant is an important part of the CDC’s new HIV initiative, “Advancing HIV Prevention: New Strategies for a Changing Epidemic,” focusing more on people living with HIV, and helping to ensure that the Minority AIDS Initiative dollars will benefit minority communities that are disproportionately affected by the HIV/AIDS epidemic. Prevention programs may be slowing the epidemic, but more needs to be done to reduce new infections. More HIV-infected people learning their serostatus should significantly reduce new infections. Focusing more on people living with HIV is consistent with the CDC HIV Prevention Strategic Plan (Goal 1 / Objective 1) as follows:
“By 2005, decrease by at least 50 percent the number of persons in the United States at high risk for acquiring or transmitting HIV by delivering targeted, sustained and evidence-based HIV prevention interventions. Among people living with HIV, increase the proportion who consistently engage in behaviors that reduce risk for HIV transmission or acquisition”.
Behaviors that place the disproportionately affected African American population at high risk for HIV infection or for transmitting the virus are: unprotected oral, anal, and vaginal sex with men and women; inconsistent condom use; multiple sex partners; poor communication between sex partners; poor adherence to risk reduction activities for HIV+ persons; use of intravenous drugs accompanied by needle sharing; and bartering sex for drugs.
There are a variety of reasons for the discrepancies in infection rates among the target population of African Americans and the sub-population of AA/MSM that can only be touched upon here, but include: cultural norms, homophobia, racism, intra-ethnic discrimination, structural barriers and lack of access/utilization of appropriate medical care. The medical establishment is often perceived as catering to white populations, or which focus on a mainly white MSM client base, where HIV/AIDS is concerned. These perceptions and realities affect health-seeking behavior, which is often reinforced by negative experiences with public health systems and/or institutions devoid of a nurturing, respectful, culturally congruent and judgment-free environment, engendering goodwill and trust. Add to that the findings of the 2000 Census, which showed the entire Detroit Metropolitan area to be the most segregated in the country. Such segregation, historically, has had negative ramifications on health.
Comparing numerous other socioeconomic indicators between the City of Detroit and the neighboring communities in the state of Michigan reveals disproportionate levels of poverty, lower levels of education and high unemployment. Also prevalent in the City of Detroit, as in many major urban centers, are crime, teen pregnancy/early parenthood, domestic and firearm violence, incarceration and drug use. When considering the health of the whole person, as well as the community, all of the above become risk factors for HIV/AIDS and other preventable diseases. Based on this formative research, it is clear that there is a severe need for capacity building assistance and a linked network of services among provider organizations that will serve the whole client. The gaps in services which CHOW has addressed are not so much about the number of providers, but more about their ability to provide culturally competent and holistic services.
The numbers hit home, as we see the disproportionate impact of the disease among MichiganÂ’s African American population. As of 1 July 2003, there were 10,860 reported persons living with HIV or AIDS (PLWHA) in the State of Michigan, which is about 0.10% of the population. However, African Americans comprise 14% of the stateÂ’s population, and an alarming 56% of the stateÂ’s HIV/AIDS cases, at 5,626 total AA/PLWHA. By comparison, whites comprise 79% of the stateÂ’s population and are 39% of the stateÂ’s HIV/AIDS cases, at 3,847 total white/PLWHA. Among the total PLWHA, the rate of HIV/AIDS cases for African Americans is a shocking 401 per 100,000 persons. By comparison, whites have a rate of just 49 HIV/AIDS cases per 100,000 persons. (Quarterly HIV/AIDS Analysis, pages 10 and 12, HIV/AIDS Surveillance Section, Communicable Disease and Immunization Division, Bureau of Epidemiology, State of Michigan, 3 July 2003).
In all risk categories (except health care worker and receipt of blood products), African American MSM had a larger proportion of persons with risks than white MSM. The rates for sexual contact of African American MSM as compared with their white counterparts
Are as follows:
~ 59% of AA/MSM also had sex with a female, versus 37% of white MSM.
~ 16% of AA/MSM had male-to-male anal sex with IDU, versus 11% of white MSM.
~ 11% of AA/MSM had heterosexual sex with IDU, versus 6% of white MSM.
~ 25% of AA/MSM had heterosexual sex with someone who was HIV positive but whose risk for infection was unknown, versus 14% of white MSM.
A study done in 1999 by the State of Michigan indicated that 39% of AA/MSM in Southeast Michigan also had sex with women (Using Behavioral Data to Target Prevention Activities in the Black Community, 1999, Michigan Department of Community Health, Pratt et al). When one compares that to the more recent figure of 59% (State of Michigan, 2003), the data would suggest a dramatic rise in the number of AA/MSM having sex with women in Southeast Michigan. The 1999 study pointed out that sexual partners tend to be of the same race, stating “consequently, black women are at an increased risk for HIV infection through heterosexual transmission,” based on a study population of 1,777 HIV infected persons, of whom 74% were African American and mostly male, and of that number, 67% were AA/MSM. Most bi-sexual African American men have more than one male and female sex partner, the study stated, which puts their partners at higher risk for HIV infection. Additionally, use of injectable drugs by some African American men further increases risk of transmission. Because many of these men are not current injectors, they may not be considered intravenous drug users (IDU's) by their sex partners.
Prevention activities in the African American community should be designed to address the most likely modes of transmission, the study concluded. For African American men, this includes MSM behavior. For African American women, this includes heterosexual contact not only with IDU's, as is commonly perceived, but with bisexually active men as well. Often these AA/MSM, some of whom self-identify as heterosexual, do not disclose information about their sexual encounters with men to their female partners. African American women now make up the fastest growing group of newly-infected individuals (CDC, MMWR 2003), contracting the disease mainly through their heterosexual contact with AA/MSM.
Interventions that draw from a framework of community organizing, peer influence and personal empowerment have demonstrated efficacy in engaging AA/MSM and partners, especially with regard to HIV Prevention (HIV and Young African American Men Who Have Sex With Men: A Narrative Overview of Southeast Michigan, 2002, Anderson). Further, many AA/MSM share concerns regarding their place within the larger African American society, often affecting their health-seeking behavior. Successful interaction with AA/MSM on the part of community-based organizations is vital to stemming the tide of the epidemic.
To be successful, according to the CDC, HIV prevention must address the diverse communities affected by the HIV epidemic, where prevention efforts must focus on groups at greatest risk, and programs must be relevant to the lives of the target population -- appropriate to age, culture, community standards, and language, designed with input from the affected community and delivered by organizations and people with credibility in that community. The CDC recognizes CHOW for their highly successful efforts to this end, developed over a decade of service in the City of Detroit and the Midwest region, and the more importantly, the potential for applying these activities on an expanded national scale, to significantly improve access, quality, and utilization issues regarding HIV/AIDS services for a wider audience of African Americans across the USA.
While this award comes at a critical time, federal funds alone cannot tackle this disease that has taken such a foothold in the African American community. Future success depends not only upon the continued diligence of CHOWÂ’s committed staff, but also in large part upon the private financial support from the greater community it serves. It is hoped that through this honor from the CDC, there will come a greater awareness of CHOWÂ’s many accomplishments during the past decade, and the important work they are about to embark upon, which it is hoped will result in an increase of private donations, the very lifeblood of this worthy community-based organization, having a 501(c)3 non-profit status. Such community support has funded CHOWÂ’s advocacy, health training certification and specially tailored capacity building assistance throughout the many challenges of the past decade, whose exemplary work has now brought CHOW to national attention as a true Detroit success story.
For more information, and for those interested in making a financial contribution, please contact Mr. Schawne Parker, Executive Director of Community Health Outreach Workers, Inc. (CHOW), at tel.#: (313) 963-3352, fax#: (313) 963-4579, e-mail: chow@chowlinks. org
Contact:
Mr. Schawne Parker
Executive Director
Community Health Outreach Workers, Inc. (CHOW)
Phone: 313/963-3352
FAX: 313/963-4579
E-Mail: chow@chowlinks. org
Website: www. chowlinks. org/ (http://www. chowlinks. org/)
