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Targeted Peer Support Model Development for Caribbeans Living with HIV/AIDS Demonstration Project

About this initiative... Background Grantees Journal Articles Initiative's Website

SPNS-related publications... Listing of SPNS Products Download SPNS technical assistance publications (government- and grantee-produced) from the TARGET Center Library keyword: SPNS

Background 

It is well known that systemic barriers based on cultural beliefs and stigma prevent persons of Caribbean origin living with HIV from learning their HIV status and accessing care. This is confirmed by the social support literature which has found that the behaviors of individuals are affected by the social norms of their communities.

Interventions that address social network and community-level phenomena, have been shown to be effective in reducing HIV risk behaviors in diverse populations. These interventions have included enlisting peer counselors who are trained to communicate, encourage, and reinforce health-protective messages. A peer counseling intervention that addresses the characteristics of the targeted population and the interactions between clients and their providers offers a potential solution to retaining Caribbeans living with HIV into care and achieving their appropriate utilization of care.

This Special Projects of National Significance (SPNS) initiative is intended to strengthen and evaluate community-based peer programs that are serving people living with HIV who are underserved and of Caribbean origin. Five demonstration sites, in conjunction with SPNS and an Evaluation and Support Center, will develop, implement and evaluate peer support interventions, which are designed to enable Caribbeans living with HIV disease to understand the nature of their HIV infection and HIV treatment options, and obtain HIV medical and ancillary services. SPNS will fund this initiative during Federal fiscal years 2003 - 2006 for four years.

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Grantees 

• Brookdale Univ Hospital and Medical Ctr
• Community Healthcare Network
• Lutheran Medical Center
• University of Miami
• Montefiore Medical Center
• Academy for Educational Development

Brookdale University Hospital and Medical Center
Treatment for Life Center
1 Brookdale Plaza
Brooklyn, NY 11212-3198
Phone: 718-240-6190
Fax: 718-240-6637

Project Title: Zanmi ede Zanmi (Friends Helping Friends)

Project Period: 2003-07

Target Population: Haitians living with HIV or AIDS in East Brooklyn, NY

Description: This project will examine the development and impact of a culturally specific peer support intervention targeting Caribbeans living in the awardee's general service area. The project will identify endemic and culturally specific barriers to care, develop a cadre of peer promoters to assist persons in need of services with overcoming such barriers, implement small group and individualized health education sessions to assist clients with engaging in medical care and using support services. The awardee will conduct a process and outcome evaluation of the project, using an intervention group and a comparison group design.

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Community Healthcare Network
79 Madison Avenue
New York, NY 10016
Phone: 212-366-4500
Fax: 646-312-0481

Project Title: Caribbean Access Initiative

Project Period: 2003-07

Target Population: Jamaican and Trinidadian/Tobagonian immigrants who are HIV-infected and residing in the Bedford-Stuyvesant, Crown Heights, Flatbush and East New York communities of Brooklyn, New York

Collaborating Partners: STAR Health Center at SUNY Downstate Medical Center in Brooklyn, and the New York State Psychiatric Institute/Research Foundation for Mental Hygiene, Inc./HIV Center for Clinical and Behavioral Studies at Columbia University

Description: Caribbean immigrants are disproportionately affected by HIV/AIDS and face numerous barriers to accessing HIV/AIDS care in the U.S. The Caribbean Access Initiative is an empowerment-based, culturally consistent peer-support intervention specifically tailored to address the unique challenges faced by HIV-positive Caribbean immigrants.

This HRSA-SPNS demonstration project implemented by Community Healthcare Network, a consortium of eight community clinics in NYC, is designed to (1) increase participants' knowledge and understanding of HIV, HIV treatment options and the service delivery system; (2) reduce barriers to care through skill development; (3) identify effective strategies to increase timely and consistent use of appropriate HIV medical care and ancillary services; and (4) utilize innovative outreach methods, including snowball sampling, to engage this hard-to-reach population.

The intervention consists of six intensive group sessions and twelve individual peer-participant sessions. Group process enhances peer support by providing a supportive, non-threatening environment to experiment with new behavior and skills and to receive feedback. Strategies include culturally relevant person-centered participatory approaches, didactic role-playing and vignette analysis. Group session topics include HIV education and myth deconstruction; navigation of the health care system; nutrition and access to ancillary services; male/female condoms; coping skills; and self-efficacy. A Caribbean PLWHA advisory board and key informant interviews frame session content.

Trained peer educators facilitate outreach and intervention sessions. Peer educators are of Jamaican and Trinidadian/Tobagonian origin, are HIV-positive and reside in the same NYC communities as participants. Peers receive rigorous preparation in the areas of HIV/AIDS education, creating therapeutic environments, effective communication, crisis intervention, group process and burnout prevention.

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Lutheran Medical Center
Caribbean-American Family Health Center
150 55th St
Brooklyn, NY 11220
Phone: 718-431-2610
Fax: 718-436-7810

Project Title: Targeted Intervention of Peer Support (TIPS)

Project Period: 2003-07

Target Population: HIV-infected Trinidadians in the Flatbush, Crown Heights, and Bedford-Styvesant neighborhoods of Brooklyn, NY, with a particular focus on women

Collaborating Organizations: Caribbean Women's Health Association, the Special Care Immunology Services program at Lutheran Medical Center

Description: The TIPS project will use peer educators to conduct a culturally-specific individual and community level intervention to communicate HIV related information and influence community norms and values regarding use of HIV related services. Specific goals are to increase knowledge of HIV infection among the target population, increase understanding of HIV treatment options and the service delivery system, and increase entry into appropriate HIV medical care. Recipients of peer services will be compared to a similar group not receiving services. Evaluation strategies that will be pursued are:

• Process evaluation during the project;
• Outcomes measurement of the intervention at the time of its conclusion;
• Descriptive evaluation of intervention and comparison groups;
• Measurement of duration and intensity (dose) of the intervention;
• Measurement of effects on client and community characteristics.

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University of Miami
School of Medicine, Departments of Medicine (Division of Infectious Disease) and Epidemiology and Public Health
1500 NW 12th Avenue, 8th Floor West
Miami, FL 33136
Phone: 305-243-3011
Fax: 305-243-3005

Project Title: Enabling Haitians Access to Needed Care (ENHANCE)

Project Period: 2003-07

Target Population: Haitians living with HIV or AIDS in the Miami-Dade County area

Collaborating Organizations: Jackson Memorial Hospital in Miami, FL

Description: The project will develop, implement, and evaluate a theory-guided peer intervention that seeks to enhance use of HIV-oriented primary medical care and ancillary services by the target population. Specific focus will be on persons enrolled in care who have not seen a primary care provider for at least six months. Follow-up assessments will be conducted at six month intervals to assess the proportion of persons who increase use of medical care and ancillary services. The intent is to improve the transition of Haitians from hospital care at Jackson Memorial Hospital to outpatient care.

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Montefiore Medical Center
Department of Family Medicine and Community Health
111 East 210th Street
Bronx, NY 10467
Phone: 718-920-2918
Fax: 718-515-5416

Project Title: Targeted Peer Support and Model Development

Project Period: 2003-07

Target Population: Jamaicans living with HIV or AIDS

Description: This project will develop a culturally-specific peer outreach and small group intervention among HIV-infected Jamaicans living in the North Bronx. The project's goals are to increase use of HIV-oriented primary medical care, mental health care, and case management. Peer outreach workers will provide current information on HIV and treatment options, address cultural practices and meanings related to sexuality and HIV, and assist patients with support services such as nutrition education, transportation, and child care. Civic leaders, clergy, and medical providers from the local Jamaican community will be enlisted to support the project. The project's evaluation will compare baseline data at the project's founding with measurements taken at six-month intervals. The evaluation's focus will be on use of medical and social services by clients, and the impact of training and intervention activities related to peer outreach workers.

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Academy for Educational Development (Evaluation Center)
1825 Connecticut Ave NW
Washington, DC 20009
Phone: 202-884-8796
Fax: 202-884-8879

Project Title: Evaluation and Support Center for Caribbean Peer Support Initiative

Project Period: 2003-07

Target Population: Participating Demonstration Project Sites in the Caribbean Peer Support Initiative

Description: The Evaluation and Support Center will assist the SPNS program staff with three tasks:

1. assisting demonstration project sites with implementing and evaluating theoretically-sound, evidence-based, and culturally specific peer support interventions;
2. conducting a cross-site evaluation to determine models that are effective for specific groups of Caribbeans living in the US; and
3.  identifying, compiling, and disseminating best practices, lessons learned, and other relevant findings to HIV service providers, policy makers, funders, and patients.

The Evaluation and Support Center will conduct an initial needs assessment, design a structured technical assistance system, provide ongoing technical assistance, and develop and deliver training for peer workers and data collection. Key features of the cross-site evaluation will include a cross-site logic model, common data collection instruments and protocols, and a common analysis plan. The approach to dissemination activities will be demand-based and feature early engagement of multiple external audiences. Preliminary results will be shared and dissemination products will be tailored to audience needs.

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Journal Articles 

Thomas L, Clarke T, & Kroliczak A. (2008) Implementation of Peer Support Demonstration Project for HIV+ Caribbean Immigrants: A Descriptive Paper. Journal of Immigrant & Refugee Studies, 6 (4): 526 – 544.

Rodriguez AE, Metsch LR, Saint-Jean G, Molina EG, & Kolber MA (2007) Differences in HIV-Related Hospitalization Trends Between Haitian-Born Blacks and US-Born Blacks. Journal of Acquired Immune Deficiency Syndromes, 45 (5): 529–534.

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