Lets get to the bottom of health inequity.

Safe Sex and Tupperware Parties

In Sounds good to me..., Things I found on August 18, 2009 at 6:49 pm
People need to be given not only reasons to alter risky habits but also the behavioral means, resources, and social supports to do so.

"People need to be given not only reasons to alter risky habits but also the behavioral means, resources, and social supports to do so."

The Pittsburgh AIDS Task Force is busy making moves.

As you’ll read (or may have read), its Girlfriends Project (GP) “targets at-risk [black] women” in the Pittsburgh metro area for HIV/AIDS awareness raising, assertiveness counseling, and domestic violence education. Between January 1 and June 15, 2009, the GP had 135 women to take advantage of free, confidential HIV testing…none of the women have tested positive.

The project’s structure and organization brings the generally uncomfortable topic of HIV/AIDS (associated in the collective consciousness with sex, death, sickness, needles, loss of ability, possible social alienation, etc) into participants’ comfort zones. Seems like a great way to reduce some of the stigma and anxiety attached to HIV testing.

What’s also interesting to me is that the program leverages social networks and social support to address black women’s health issues. 

Here’s how it works (reminds me of a Tupperware Party!):

Women, usually five to eight of them but sometimes as many as 15, get together at the home of a friend, who must be able to provide a private area in which Ms. Dukes can do the HIV/AIDS swab test one woman at a time after her talk. The task force provides refreshments and the hostess receives a $50 gift card for volunteering the use of her home. The attendees get $20 gift cards.

The party starts with some ice-breaking conversation, an HIV/AIDS quiz, raffles and giveaways of things like body lotions, and the opening of gift bags containing condoms and other safe-sex products. Then comes Ms. Dukes’ educational program, in which the women learn how to protect themselves from both HIV/AIDS and domestic violence…

After the presentation, Ms. Dukes gives another quiz on HIV/AIDS to see what the women have learned. Then, she offers the HIV/AIDS swab tests. She sends the tests on to the health department for processing. If there were a positive, the result would come back to Ms. Dukes, who would inform the woman. (Pittsburgh Post-Gazette, 2009)

So far, I guess about five women have been tested per week of the program’s life (though it’s likely the actual rate of testing will increase exponentially as women tell their friends and family about the resource). While 135 women is a tiny number in proportion to the population, it’s certainly better than zero testing, which was apparently the rate in Braddock, Clairton and Duquesne before the project got going.

Verdict on this intervention: 

Backed by reasonable evidence? Check.

Gives me that “Smell of Fresh-Baked Brownie Feeling,” which is good for marketing and other outreach? Check.

Potential for far reach and influence? Debatable.

In all fairness, the program is new and small and hungry. That said, I wonder whether growth (i.e., more money) has been linked explicitly to outcomes (will there be a program evaluation?), or whether the program is more of a symbolic tool to draw necessary attention to HIV/AIDS in Pittsburgh’s black community.

While I personally believe helping even one person justifies social action, professionally, I wonder about this program’s long-term potential to affect hard outcomes–specifically, reductions in rates of new infection in target communities.

Conclusion:

I think the force of GP’s impact will hinge on the breadth of its reach, which in turn relies on the mysterious powers of family, friendship, community, and word of mouth.

Are these enough?

Additional resources:

“Views and Experiences with HIV Testing Among American Americans in the U.S.” (Kaiser “We Don’t Mess Around” Family Foundation, June 2009).

Using data from the Kaiser Family Foundation 2009 Survey of Americans on HIV/AIDS, we find that in many ways, African Americans’ reported views and experiences reflect the disproportionate impact of the epidemic on their community.  Compared with whites and Latinos, African Americans are more likely to say AIDS is a more urgent problem for their local community now than it was a few years ago, more likely to say they know someone who is infected with HIV or has died from AIDS, and more likely to say they are personally very worried about becoming infected themselves.

“Social Cognitive Theory and Exercise of Control over HIV infection” in Preventing AIDS: Theories and Methods of Behavioral Interventions. (Albert Bandura, 1994)

To achieve self-directed change, people need to be given not only reasons to alter risky habits but also the behavioral means, resources, and social supports to do so. 

“From social integration to health: Durkheim in the new millennium.” (Berkman et. al., 2000)

First, social networks via social influence or supportive functions influence health-promoting or health-damaging behaviors such as tobacco and alcohol consumption, physical activity, dietary patterns, sexual practices, illicit drug use. Second, social networks via any number of pathways influence cognitive and emotional states such a self-esteem, social competence, self-efficacy, depression and affect. Third, networks may have direct effects on health outcomes by influencing a series of physiologic pathways largely related to stress responses.

 




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