I. Action Planning Workshop Overview Priorities for Local AIDS Control Efforts

The Action Planning Workshop: Part of Step 5 in the PLACE Method 1 identified as area for PLACE study 2-4 Conduct PLACE assessment in 2 Identify venues where people meet new partners 3 Visit, characterize, map all venues 4 Describe the characteristics of people socializing at venues 5 Use results to improve programs

Presentation Outline ∆Purpose of action planning workshop ∆Steps to formulate action plan ∆Next steps following the workshop

Purpose of Action Planning Workshop ∆Inform community about local PLACE assessment findings ∆Improve understanding of findings through discussion with those who know community best ∆Generate renewed local interest in HIV prevention ∆Develop an action plan

Purpose: Development of Action Plan ∆Identifying activities that can be initiated at community level without additional resources ∆Identifying what activities are of the highest priority if additional funding can be obtained

Workshop Itinerary: Steps to Formulate Action Plan ∆Review PLACE method and procedures ∆Review PLACE results from ∆Discussion groups review key findings ∆Develop recommendations based on the key findings

Workshop Itinerary: Steps to Formulate Action Plan ∆Prepare a Matrix of existing programs and activities ∆Prepare action plans for filling obvious gaps ∆Agree on a timetable for activities ∆Revise the local AIDS strategic plan as needed

Next Steps ∆Update the PLACE Report based on feedback received during the workshop ∆Insert Action Plan ∆Present a revised PLACE report at a national workshop of HIV/AIDS prevention stakeholders

II. Template for Presenting Results of the PLACE Assessment

PLACE Findings in Action Planning Workshop Priorities for Local AIDS Control Efforts, Presented By, Etc.

Presentation Overview ∆ Background ∆Description of ∆Review of PLACE Method ∆Findings from PLACE Assessment in –Step 2 methods and results –Step 3 methods and results –Step 4 methods and results ∆Summary

PLACE – St. James, Jamaica A Joint Initiative of: ∆MEASURE Evaluation, Carolina Population Centre, University of North Carolina ∆Jamaican Ministry of Health – National STI/HIV/AIDS Prevention & Control Programme ∆Western Regional Health Authority ∆St. James Public Health Department

Country Background

JAMAICA ∆Island nation in Caribbean Sea ∆Population – 2.5 million ∆Divided into 14 parishes ∆Estimated 24,000 People living with HIV/AIDS ∆HIV prevalence – 1.5% of adult population ∆National cumulative AIDS case rate: 252/100,000 persons ( )

JAMAICA – AIDS Case Rates

Description of Priority Prevention Area (PPA)

∆A parish in western Jamaica ∆Population – 175,000 ∆Tourism capital of Jamaica ∆Parish capital – Montego Bay Why was PLACE conducted in ???

HIV Epidemic in ∆Highest AIDS case rate in Jamaica: 607 per 100,000 (> 2x national rate) ∆1 in 30 pregnant women are HIV infected (1.5x national rate) ∆Factors driving epidemic in St. James not fully understood ∆Need for cost-effective way of focusing HIV prevention interventions where may achieve greatest impact

Quick Review of PLACE Method

PLACE Initiative Rationale: Urgent need for tools to focus local HIV/AIDS prevention Objectives: ∆To identify WHERE to target interventions ∆To monitor interventions in target areas Strategy: ∆Identify areas likely to have high HIV incidence ∆Within these areas, focus prevention at venues where new sexual partnerships are formed

PLACE Method Overview 1 Identify areas of likely high HIV incidence 2-4 Conduct rapid assessment in each area 2 Identify venues where people meet new partners 3 Visit, characterize, map all venues 4 Confirm high partnership formation rates at venues 5 Use results to improve programs

Study Strengths ∆Rapid implementation; reasonable cost ∆Study strategy minimized reliance on self- reported behaviors through use of community informants and venue verification process ∆Study provides indicators useful for identifying priority venues for targeted intervention and for monitoring and evaluation

Study Limitations ∆Sexual behavior and condom use are difficult to measure and can be under-/over-reported ∆People younger than 18 not interviewed ∆Self-reported data biased

PLACE Findings

Step 2 Community Informant Interviews ∆Community informants are asked: Where do people meet new sexual partners? ∆Types of community informants: Taxi drivers, hairdressers, bar/restaurant employees, people on street, youth, others

Step 2 Community Informants Report Venues ∆12 interviewers reached 560 informants in 4 days ∆1,897 venue or event reports ∆419 venues and events were reported within St. James ∆Refusal rate - 17%

Step 2: Types of Community Informants

Step 3: 288 Venues Visited

Characteristics of Venues Obtained from on-site interviews: Prevention ∆Type of venue ∆Condom availability ∆Evidence of HIV/AIDS prevention ∆Busy times ∆Maximum occupancy ∆Venue stability Patrons ∆Male:Female ratio ∆Regular patrons ∆Where patrons reside ∆Whether patrons include commercial sex workers, gay, IDUs, youth, ∆Whether people meet new partners at the venue

Findings: Sex Partners Meet at Venues

Findings: Prevalence of Other Activities at Venues

Findings: HIV/STI Prevention at Venues

Step 4: Interview Persons Socializing at Venues ∆Opinion: Do people come here to meet new partners? ∆ Behavior: Ever met a new partner at venue? Use condoms? Traded sex for money? ∆Sociodemographic and behavioral characteristics ∆Number of new and total partners in the past four weeks and past year ∆Exposure to HIV/STI prevention intervention

Representative sample of all venues verified: ∆Selected randomly ∆ Special sample of most popular venues: ∆All venues named by or more community informants ∆ Sampling Methodology for Step 4

Average age: Men 32, women 31 Unemployed: men 12%, women 33% Average years of education: 13 Refusal rate: 13% Patrons Interviewed in Step 4

Patron Venue Visiting Behavior in Step 4

Sexual Partners at Venues

Patron Sexual Behavior: Exchanging Sex for Money and Sex with Non-Residents

Patron Condom Use

Patron Exposure to HIV/AIDS Prevention, Past 3 Months

On-site Patron Exposure to HIV/AIDS Prevention in Past 3 months

In Summary…. Main Questions to Answer: Answers:

Gaps between Condom Availability, Programs, and New Partnerships at Venues

What can be done about this unmet need?

Good News!! Venues Are Willing to Have HIV Prevention Programs According to venue representatives: ∆81% of venues are willing to have HIV/AIDS/STI prevention programs ∆49% of venues are willing to sell condoms

Way Forward – PLACE in ….. ∆Results shared with HIV/AIDS control program staff island-wide ∆Since then PLACE methodology has been implemented in 3 other parishes ∆St. James: venue-based vs. community-based targeted HIV prevention intervention – moving toward a more structured approach

1.Review PLACE process and procedures 2.Review PLACE findings in 3.Develop recommendations based on the key findings 4.Prepare a matrix of existing programs and activities 5.Prepare action plan for filling obvious gaps 6.Agree on a timetable for activities 7.Revise the local AIDS strategic plan as needed Next Steps in Action Planning Workshop:

Acknowledgements Ministry of Health – Jamaica ∆Dr. Peter Figueroa – Chief, Epidemiology & AIDS Western Regional Health Authority ∆Dr. Janice Alexander, Regional Epidemiologist ∆Dr. Tamu Davidson-Sadler, Regional STI/HIV/AIDS Programme Coordinator ∆Mrs. Jennifer Stuart-Dixon, Regional BCC Coordinator St. James Health Department ∆HIV/STI Programme Team University of North Carolina ∆Dr. Sharon Weir ∆Mrs. Sarah Bassett-Hileman ∆Ms. Carrie Brewer Residents of & Visitors to St. James

III. Action Planning Workshop: Developing the Action Plan Priorities for Local AIDS Control Efforts

The Action Planning Workshop: Part of Step 5 in the PLACE Method 1 identified as area for PLACE study 2-4 Conduct PLACE assessment in 2 Identify venues where people meet new partners 3 Visit, characterize, map all venues 4 Describe the characteristics of people socializing at venues 5 Use results to improve programs

1.Review PLACE process and procedures 2.Review PLACE findings in 3.Develop recommendations based on the key findings 4.Prepare a Matrix of existing programs and activities 5.Prepare Action Plans for filling obvious gaps 6.Agree on a timetable for activities 7.Revise the local AIDS Strategic Plan as needed Action Planning Workshop Agenda:

Prepare a Matrix of Existing Programs and Activities for Each Program Area

Matrix of Existing Programs and Activities : Condom Use Program/ Activity Type Area and Site Covered Target Population Program/ Activity Name Organization Name/Contact Information Free Condom Distribution Northern Clinic Attendees Clinic Condoms Ministry of Health Dr. Francis Free Condom Distribution Coliseum Sporting Event Attendees PlaySafe Youth AID Marion Alexander Condom Billboard Main Street, Red Light District PassersbyPlaySafe Youth AID Marion Alexander

Questions to Consider: 1.Who is covering this program area? 2.Is the whole district covered? 3.Are all the target populations covered? 4.Are all the priority venues covered? 5.Are there gaps in coverage? 6.Who will fill the gaps?

What Gaps Exist in Program Coverage?

Prepare Action Plans for Filling Gaps

Action Plans to Fill Gaps in Program Coverage Immediate (local resources) Future (outside resources)

Agree on a Timetable for Activities

Action Plan Timetable

Revise the Local AIDS Strategic Plan as Needed

Next Steps ∆Update the preliminary PLACE report based on feedback received during the workshop ∆Present the revised PLACE report at a national workshop of HIV/AIDS prevention stakeholders