Boulder County AIDS Project

Program name
HIV Prevention Last updated 4/21/2009 by Dan Hanley	details
HIV Care Services Last updated 4/21/2009 by Dan Hanley	details

HIV Prevention

HIV Prevention


BCAP’s HIV prevention programs strive to embrace safer sex and knowing one’s HIV status as a community norm.


Harm reduction, community mobilization, early disease detection and support accessing care upon a positive diagnosis provide the foundation for implementing strategic programming. Prevention programs provide the context for services such as education, public awareness campaigns, peer-to-peer discussions and HIV testing. BCAP prevention programs include:


*Atlas: Atlas is a HIV prevention program for gay and bisexual men. Atlas trains a core group to design, implement and evaluate HIV prevention initiatives for the community.

*Hispanos Para la Salud (Hispanics for Health): Salud focuses on the Latino community. Programming and HIV testing cater to population trends and needs; including incorporation of cultural influences such as gender relations and stigmatizations associated with both HIV/AIDS.

*Sexual Health AIDS Awareness Peer Education (SHAPE): SHAPE is a collaborative effort between BCAP and Women’s Health. Youth provide peer-implemented, peer-based sexual health outreach and education that simultaneously allows for development of self empowerment skills.

*Community Education: BCAP’s community education consists of HIV 101 presentations and Positive Perspective speakers. Educators diffuse information on transmission and prevention as well as personalized stories that cater to a spectrum of audiences.


Atlas

Founded in January 2007, Atlas is a leading-edge HIV prevention program for men who have sex with men (MSM). Founded by members from within the targeted MSM community, program staff and volunteers mobilize to serve the community by designing, implementing and evaluating innovative HIV prevention initiatives. These initiatives are aimed to decrease the transmission of HIV and to prevent morbidity and mortality of AIDS amongst MSM in Colorado. This program builds upon community expertise from paid staff and volunteers who facilitate community discourse about HIV and provide transformative contexts for HIV prevention.

Atlas’ social network testing, offsite HIV testing and outreach testing events reach MSM who reside in BCAP’s service area; however, Atlas serves MSM throughout Colorado. Atlas works to ensure that the HIV testing service is accessible to MSM who may not know their HIV status or sexual partners’ HIV status; be married or partnered and having sexual partners outside their primary relationship; have condomless sex with multiple sexual partners; be exposed to, treated for or living with other sexually transmitted infections; use recreational drugs; receive post-exposure prophylaxis treatment; be HIV-positive; or be in a sero-discordant relationship.


Hispanos Para la Salud

BCAP began prioritizing HIV prevention among Latino groups in Boulder County during the mid-1990s as a response to a growing disproportionate rate of HIV infections among communities of color. Culturally and linguistically appropriate programming has traditionally been used, and prevention personnel have historically operated from within the perspective of the community. Programming involves traditional HIV prevention tactics, such as education regarding risks and transmission routes, HIV testing and prevention counseling, combined with community empowerment models and relationship-building activities to increase trust and communication within the population.

BCAP added a facility in Longmont in 2007 to increase access to the Latino population; and Longmont and Lafayette residents who had difficulty traveling to our main Boulder facility. These group constitute approximately 23% of our clients.

Through culturally and linguistically appropriate program initiatives, our program Hispanos Para la Salud (Salud) addresses the “gap” between the Latino culture and the vital HIV awareness needed to decrease the risk of HIV transmission. This program prioritizes education and awareness about HIV and risk behaviors associated with transmission, using education and awareness as empowerment tools to initiate changes in social thinking and behaviors. Formation of a relationship built on trust and communication in the Latino community is the initial point-of-contact. This is followed by education and awareness surrounding HIV in the Latino community, with a self-reflective component to begin individualized prevention interventions. Education leads to HIV testing and prevention counseling, with an emphasis on the Latino cultural influences and thought processing associated with risk behaviors for HIV.

Salud strives to reach a wide array of individuals from all sectors of the Latino community, as well as their extended social networks of family, friends and personal contacts. Included are individuals accessing venues associated with high-risk behaviors, and/or impacted by health disparities as pertinent to culturally and linguistically responsive interventions and/or in need of outreach HIV testing initiatives or social influence to have an HIV test done.

One-on-one and group outreach is the core component of Salud, including outreach done at community events, youth programs, educational institutions, local fairs, and Latino-identified social venues. Moreover, given the migration of risk, Salud coordinates with Northern Colorado AIDS Project to conduct outreach into the rural areas adjacent to Longmont. In keeping with BCAP’s stated value of knowing one’s HIV status, existing testing resources will be leveraged to provide anonymous testing to members of the target population. Persons who are found to be HIV-positive will be provided with additional services to link them to medical care.



HIV Testing
BCAP currently collaborates with the Boulder County Public Health Department to offer free HIV testing at diverse outreach sites, including Salud Community Health Center (both in-house and through their mobile unit), Sister Carmen Community Center, Boulder Shelter for the Homeless, Carriage House Day Shelter, Boulder Clinic (the methadone treatment clinic), El Comité, Boulder County Jail, and Boulder Valley Women’s Health Boulder and Longmont Teen Clinics. Additionally, BCAP provides intense Internet and community outreach to men who have sex with men in order to bring them into BCAP for testing. BCAP and Boulder Public Health collaborate to provide on-going identification and development of new sites.

BCAP provides both confidential and anonymous rapid HIV antibody testing with use of the UniGold and OraQuick Advance testing kits. This has eliminated the need for return appointments, thereby increasing the rate of individuals who receive their test result. BCAP employs trained individuals, including bilingual and bicultural staff, to conduct testing. Those with positive test result are referred to Boulder Public Health for free confirmatory testing.

Definition of short-term success

Numbers of people being tested and practicing safer sex increase.

Definition of long-term success

The transmission of HIV is rare.

Program success monitored by

We monitor state and county statistics and keep track of how many people we have tested.

Examples or evidence of program success

More people being tested and wanting to be tested and transmission rates decreasing.

Photos

HIV Care Services

HIV Care Services

BCAP strives to provide a continuum of care that allows for easy integration from the initial HIV-positive diagnosis into on-going specialized primary care and case management. Under the direction of the Director of Care Services, four case managers- two of who are bilingual and one housing-specific case manger- work with a case load of over 200 HIV-positive clients in our Boulder and Longmont offices.


Care Service’s primary goal is that HIV-positive individuals seeking resources will not be denied proper care or access to treatment due to inability to pay. Patients who delay seeking treatment enter the health care sector in a compromised position, increasing the strain on community resources and health care budgets. BCAP provides comprehensive case management and direct services to both minimize barriers and lessen dependency on the social service delivery system. BCAP works collaboratively with Boulder’s infectious disease clinic, Beacon Clinic, to create a continuum of care that links case manager, patient and primary care provider with a myriad of resources and communication outlets. Clients work with case managers to develop individualized plans that allow for maximum service continuity. Included in this continuity is the integration of care providers, self-empowerment and self-sufficiency education, and a re-evaluation process that monitors the effectiveness and success of each plan.


Direct services include emergency financial assistance, housing assistance and supplemental provisions from an in-house food bank. Additionally, through the BCAP/Beacon Clinic collaborative, individuals are provided referrals and/or access to: mental health services; oral health services; substance abuse programs; palliative and end of life care; advocacy; on-call and long-term buddies; prevention and treatment adherence education; and reduced-fee or pro-bono professional services from attorneys, therapists, health care practitioners and various other health advocates as applicable.


Early intervention and Highly Active Antiretroviral Therapy remain the key factors in preventing progression of HIV. Access to specialized care and treatment are the primary objectives of BCAP case management, with no client being denied access to medical care or medications due to discrimination or inability to pay. While HIV care and treatment are no longer crisis-motivated they remain a “life line” that, upon depletion, results in death.


Findings of the National Antiretroviral Treatment Access Study, funded by the CDC, have shown that HIV-positive individuals are more likely to seek medical care if followed by a case manager. Results of this study indicated the substantial influence of the case manager’s presence on the patient’s integration into treatment. Eighty-percent of those receiving case management visited a primary care physician within the first 12 months. Only 60% of those receiving a “passive referral” accessed care.


Much of BCAP’s work in providing services for individuals impacted by HIV/AIDS involves addressing gaps in services, including creating fluidity between receiving a HIV-positive diagnosis and entering into primary medical care. Approximately nine years ago BCAP asked Boulder Community Hospital to convene a task force that would study the impact of Boulder’s only infectious disease doctor closing his business. The result of this initiative was the hospital’s agreement to underwrite indigent AIDS specialty care, and from this the Beacon Clinic was born. In close partnership with BCAP’s case management team, Beacon Clinic provides medical care for HIV/AIDS patients in the community.


In addition to the medical care supplied at the Beacon Clinic and support provided by the case managers, the BCAP provides the following services to address problems and issues faced by an individual living with HIV/AIDS:


*Adherence Education. BCAP case managers are integral parts of the adherence support team and clients may also be assigned peers or volunteers to be their “medication buddies”. Adherence tools that may be used include phone calls, beepers, pill boxes, key chains, watches, journals/logs, written instructions, calendars, etc.


*Outpatient Mental Health. Out-patient services are provided via community mental health centers and a network of pro bono psychotherapists coordinated by BCAP. Clients also utilize Access Counseling, Inc. who provides BCAP clients with reduced-fee services.


*Substance Abuse Services. Case managers assess substance abuse needs and produce appropriate referrals. Current available resources include: Boulder County Public Health’s Behavioral Health Division, Boulder Clinic (an outpatient methadone clinic), Circle Program and Arapahoe House.


*Legal Services. BCAP provides more than 50 pro bono attorneys in the community who volunteer their legal expertise for BCAP clients. Legal issues most often include discrimination, access to entitlement programs (Medicaid appeals, for instance), and preparation of living wills, powers of attorney and other end-of-life needs.


*Oral Health. Clients are assessed by a physician for oral health problems and referred to Dental Aid, a community dental clinic that has a history of serving people with HIV/AIDS. BCAP case managers help to ensure that referrals have been made, payment sources identified, and clients have received care.


*Nutritional Services. An initial nutritional assessment of clients provides important baseline information on nutritional status. The Physician’s Assistant, supported by BCAP case managers, subsequently provides nutrition education and counseling. Nutritional supplements are available and accessed through case managers and/or the BCAP food bank.


*Palliative and End-of-Life Care. Beacon clinicians are trained to provide appropriate palliative care with the integration of Hospice as applicable.


*Prevention with Positives. Beacon clinicians and BCAP case managers work to screen clients for behavioral risks, offer behavioral interventions and provide partner counseling and referral services.


BCAP also offers a food bank to all clients. Clients may shop twice monthly and may choose from a great selections of meats, fresh vegetables, canned goods and vegetarian options. BCAP also can offer dog and cat food to all clients through a relationship with a local animal group.

Definition of short-term success

The capacity to continue to accept new clients.

Definition of long-term success

Continued care for people affected by or infected with HIV/AIDS.

Program success monitored by

Client intake.

Examples or evidence of program success

The continuation of adding new clients to our client base.