1 Promotoras, Peer Participant Providers and Community Outreach as Preconception in the Continuum of Perinatal HIV Transmission Armida Ayala, M.H.A., Ph.D. Arthur Durazo Office of AIDS Programs and Policy Kimberly West, M.D. Maternal and Child Adolescent Health Los Angeles County, Department of Health Services CityMatch Annual Urban Maternal and Child Health Leadership Conference Expedition 2004: Exploring the Boundaries of Urban MCH September , 2004 Hilton Portland Portland, OR

2 “I have the right to know what is written about me. You have the duty to plan responsibly with me. Then, we can all act on behalf of our health and the future of our little girls”. - Lisa, Promotora.

3 ISSUE Perinatal transmission prevention is most effective in the presence of appropriate access to health education, prenatal care, HIV counseling & testing and linkages to treatment. Who & how is examined in the following…

4 Rates of HIV-Newborns: Los Angeles County by Service Planning Area (SPA), ( Total Tested: 79,242 Total Positive: 65)

5 OBJECTIVES  To recruit members and consumers of the target populations as providers and agents of health education  To implement strategies and services designed to increase test acceptance rates among women without prenatal care and/or a history of injection drug use

6 OBJECTIVES (Cont’d)  To recruit and train peer service providers to make perinatal HIV prevention services more accessible to pregnant women  The increase proportion of pregnant women who accept an HIV test  The increase proportion of pregnant women who are offered HIV counseling and testing

7 EXPECTED RESULTS  Effective co-participation of Promotoras through peer model design  A collaboration of government and community partners to reach pregnant women in Los Angeles County  A multi-level intervention that will provide accessible prenatal care and perinatal HIV transmission prevention services to low- income pregnant women

8 METHODS  System Integration  Community Partnerships  Participatory Action Research  Focus Groups/Interviews  Lay Health Promoter Approach (Promotora Peer Model)  Multi-Level Intervention  Social Marketing Campaign  Provider Training  Outreach

9 KEY PARTNERS  Department of Health Services  Los Angeles County Office of AIDS Programs and Policy  Educational Services  Prevention Services  Public Affairs  Planning & Research  Maternal and Child Adolescent Health  Pediatric Surveillance of HIV Disease

10 KEY PARTNERS (Cont’d)  Los Angeles County Sheriff’s Department  Community Partners  Los Angeles Family AIDS Network  Harbor Community Health Center  East Los Angeles Women’s Center  Promotoras  Consumers  Target Population members

11 ROLE OF THE DEPARTMENT OF HEALTH SERVICES  To create systemic changes in collaboration with departmental, interdepartmental and community partners  Provide research-based knowledge to facilitate the development of effective prevention strategies  To implement and evaluate key activities of a multi-level intervention

12 COST AND RESOURCES  Multi-level intervention  $120,000  Federal/State funds  Integration of existing resources

13 RESULTS  Community partnerships facilitated the implementation and dissemination of the “Loving Responsibly” HIV prevention campaign  Participatory training increased the acceptance of Promotoras to become active in the intervention  Participant action research and peer reinforcement resulted in African-American women adopting the Promotoras model  Outreach in targeted areas increased opportunities for leadership and communication about perinatal issues in a supportive relationship

14 BARRIERS  System  Inadequate health insurance  Fragmentation of services for hardest to reach and low-income  Limited community participation  Insufficient focus on prenatal and HIV prevention services  Inadequate delivery of services

15 BARRIERS  System  Low offer rates and minimal HIV counseling and testing  Cultural distance between providers and patients  Limited access to HIV counseling and testing  Lack of outreach to youth, substance users and foreign-born.  Minimal opportunities for women to address perinatal issues in a supportive relationship

16 BARRIERS  Individual  Fragmented knowledge of services available  State of fear, isolation  Distrust of institutional entities  Stressed social networks and resources  Domestic and environmental violence  Incarceration and drug abuse  Limited language skills  Divergent future perspectives  Minimal self-management of health education

17 BARRIER BUSTERS  Integrate interdepartmental HIV prevention resources and programs  Establish partnerships  HIV service providers  Non-HIV service providers  Community Leaders  Consumers  Co-participation of target group members  To advise  To reach hardest to reach women  To provide services as Promotoras

18 BARRIER BUSTERS (Cont’d)  Focus outreach in areas of highest estimated need  Target young women, substance users and foreign-born women in social marketing campaign, outreach and provider training  Involve agencies who have earned the trust of respective women

19 LESSONS LEARNED  System Integration is Key  Ensures collaboration  Enables coordination of services  Acceptance Rates of HIV Tests Increase with  Accessible HIV prevention information  Peer-based counseling  Familiar and trustworthy settings  Culturally and Linguistically Relevant Social Marketing Campaigns  Promote self-management of health education  Facilitate the adoption of health promotion practices  Increase participatory action

20 LESSONS LEARNED  Collaboration Works Best when  Power, decision making and knowledge are shared among key partners in government, universities, and community stake holders  Is guided by an advisory group with consumer membership  Promotes fair social structures  Effective Multi-level Interventions  Evidence based  Actively involve key partners in all aspects of the research, intervention and dissemination process  Include values central to the research process: co- participation, supportive relationships, social justice and ongoing learning

21 Promotoras Training

22 Promotoras Training

23 Media Campaign Bus Cards

24 Media Campaign Bus Cards

25 Media Campaign Refrigerator Magnets

26 Media Campaign Refrigerator Magnets

27 Responses Los Angeles Social Marketing Campaign

28 Responses Los Angeles Social Marketing Campaign

29 Responses Los Angeles Social Marketing Campaign