Ahalaya Case Management Model revitalized Cultural competency and integration key in quality services for Native PLWHA
HIV stigma and homophobia experienced within their tribal communities often pushes Native people to move to urban areas for more discrete care. However, they can still face interpersonal violence and stigma in urban NNAAPC is partnering with original Ahalaya Native communities, and can often feel their developer Gloria Bellymule Zuniga, as well as privacy will be violated if they seek out Native members of NNAAPC’s Community Advisory specific services. Ahalaya incorporates these Council. The Native American AIDS Project issues and promotes positive ways to integrate and the Native American Health Center in San cultural competency in case management. Francisco will host a training this fall for staff Another challenge is the red tape of and volunteers. Partnership Health Center in bureaucracy and maze of services. Many Missoula, Montana, will also host a training. NPLWHA lack the necessary skills to navigate Both areas have significant numbers of NPLWHA, as well as the cultural resources to the labyrinth of paperwork and regulations. round out the care approach that characterizes Many also carry deep seated mistrust of the system stemming from negative personal Ahalaya. experience and historical trauma. In these Updates in the training will include Web areas particularly, a skillful case manager can resources and new media to relate the stories make a great difference in the individual’s of NPLWHA and Ahalaya case managers ability to gain the quality health and social who were instrumental in the success of the services s/he needs. To this end, Ahalaya also project when it was implemented in the 1990s. focuses on integrating traditional healers and Building on lessons learned, the new iteration spiritual advisers in the array of care. Working of the model will also focus more strongly on with the client to organize a successful plan, cultural components. Ahalaya case managers build trust and bridges among community resources that are specific To understand the unique set of challenges to the individual’s needs and desires. NPLWHA face, health professionals need a solid background in history, culture and The results from the original Ahalaya project modern tribal governance. Misconceptions show an increase in positive attitudes in about the availability of “free” and “complete” obtaining services and quality of care. As health services in Indian Country abound, NNAAPC moves forward with the project, which are often reflected in service referrals we hope to continue that success to prevent that ignore cultural factors and the complex further transmission of HIV, increase access relationship between Native individuals and to quality care and improve the lives of federal programs. Finding stable housing, NPLWHA. for instance, can prove extremely difficult if service management does not include a background in the factors affecting NPLWHA. Twenty years ago NNAAPC and partner organizations began a process of creating a case management model that would pioneer quality health services for Native people living with HIV/AIDS (NPLWHA). Ahalaya – the Choctaw term meaning “to care deeply” – was developed as a training curriculum focusing on cultural competency and a unique clientbased holistic approach to health service integration. After years of success in the field, funding cuts left the project in limbo, but Ahalaya is now in the process of revitalization, and is set to be launched this fall.
The International Indigenous Working Group on HIV & AIDS is hosting a two day pre-conference to the International Conference on AIDS to specifically address the prevention, care, and treatment needs of indigenous peoples across the globe, working in the field and affected by the epidemic. Please plan on joining us! When: July 20-21, 2012 | Where: Washington, DC – Sheraton Four Points, 1201 K St. NW Secured Hosts & Sponsors: International Indigenous Working Group on HIV & AIDS, Indian Health Service, Office of Minority Health, National Native American AIDS Prevention Center, Canadian Aboriginal AIDS Network
NNAAPC’s Leadership Convenes NNAAPC is honored by the all-Native Board of Directors that leads our agency. Their years of service, expertise, and knowledge provide the guidance and stability to effectively lead a national organization. The Board of Directors of NNAAPC met in April in Albuquerque prior to the Circle of Harmony conference for their annual face to face meeting. The Directors took time to review the annual reports from staff about program progress, staff growth and the many successes NNAAPC encountered during the past year. The leaders revisited NNAAPC’s current strategic plan to see where improvements could be made. Decisions were made to increase outreach to tribal communities, increase collaborations with national partners, and intensify fund development efforts. The board also undertook the task of revising the by-laws of the agency, and completed them in June.
Community Advisory Council helps guide our CDC program NNAAPC is funded by the Centers for Disease Control and Prevention to provide capacity building assistance to mobilize communities through the use of social marketing efforts to all 50 states. NNAAPC has a Community Advisory Council (CAC) made up of seven dedicated HIV prevention workers, and community members to help guide this program and ensure we understand issues of HIV prevention programming and are taking into account any noted challenges.
The CAC met in Denver the first week of June for two days. During this time, they received comprehensive updates on not At each annual meeting, the Board must select new just the CDC program, but all of NNAAPC’s leadership and NNAAPC is proud to announce that Stacy programs as well. In considering the Bohlen (Sault Ste Marie Band of Chippewa) will serve as success of the CDC program, the CAC a second term as Chairperson, Gloria Bellymule Zuniga discussed ways to improve program (Southern Cheyenne) will serve as Vice-Chairperson, outreach and challenges that communities Alexander White Tailfeather (Kashaya Band of Pomo currently face when implementing or Indians) will serve as Treasurer, and Mary Helen Deer seeking to implement social marketing (Kiowa/Muskogee) will serve a second term as the campaigns. Some common themes Secretary. This Executive Committee will continue to included: lack of funding specifically lead NNAAPC and advise the management into a time of for such campaigns, lack of knowledge projected growth. of how social marketing differs from promotional activities, how to implement NNAAPC’s leadership would like to extend a heartfelt social marketing in conjunction with thank you to Lisa Tiger (Muscogee Creek/Seminole/ existing intervention-based programming. Cherokee) for her years of service on the Board of Directors. NNAAPC staff have taken this feedback Her dedication, strong voice, and temerity have brought to incorporate it into the programs and awareness of how HIV is impacting Indian Country to direction for the second year of our CDC thousands of people. We look forward to working with Lisa capacity building program. The CAC also as she flexes those famous muscles of hers and shows Indian nominated individuals to submit to the Country what health and wellness is all about. International AIDS Society in hopes they might be selected for potential inclusion on As Lisa steps off the board, NNAAPC welcomes three new planning committees, plenary addresses board members. D’Shane Barnett (Mandan/Arikara), Edgar and non-abstract solicited workshops for Villanueva (Lumbee) and Gwenda Gorman (Diné) have all the International Conference on AIDS in decided to use their time and expertise to help NNAAPC Washington, DC next summer. grow and prosper. We welcome them and would like to thank them in advance for their commitment and service. NNAAPC is honored to be able to work Please visit http://www.nnaapc.org/about/board.htm for a alongside these powerful people and tap complete list of our esteemed directors. into their expertise and insight. We would like to thank them for the work they are doing in their own communities and for NNAAPC.
The Office of HIV/AIDS Policy (OHAP) launched an innovative demonstration project to research what comprises an effective HIV prevention intervention targeting college students on the campuses of minority-serving institutions. This marks one of the first times OHAP has been able to dedicate monies to this level of prevention research and service. OHAP, working with the grant administrator Abt Associates, awarded a total of six grants to six different minority serving colleges – four Historically Black Colleges/ Universities (HBCU), one Hispanicserving institution, and two Tribal colleges – with three year awards to design and implement HIV prevention interventions on their respective campuses. NNAAPC was given the opportunity to participate in the initial consultation on the structure of this project and then was awarded a contract to work alongside the National Minority AIDS Council (NMAC) to provide technical assistance to the grantees. NNAAPC is honored to be able to provide individualized assistance to Diné College and Stone Child College as they create and put forth culturally-relevant and locally-developed HIV programs. Representatives from NNAAPC and Abt Associates visited the Diné College campuses in Shiprock, NM and Tsaile, AZ on Feb. 17 & 18, 2011 to learn about the efforts of Diné College’s HIV prevention program. Robert Foley and Hannabah Blue from NNAAPC, and Alex Orr and Liza Solomon from Abt Associates met with the Diné College HIV Prevention Program staff. They were given a tour of the two campuses and talked with several professors, faculty members and staff who are supportive of the program. NNAAPC and Abt Associates also conducted a needs assessment to inform a technical assistance plan for the program, and several additional site visits and trainings have been held since then. NNAAPC conducted a mini-staff institute with the staff of Diné College’s HIV prevention program, Darlene Hunt, Sheldon Benally and Donald Chee, on June 16 & 17. Hannabah Blue and Matt Ignacio also co-facilitated a focus group and peer educator retreat with Diné College staff at the Tsaile campus August 11-13. NNAAPC is excited to see the program grow and to offer continual support for their efforts to address HIV risk among the college students and communities.
In June, NNAAPC staffers Tony Aaron Fuller and Vicki Peterson visited Stone Child College on the Rocky Boy Indian Reservation in northern Montana. Stone Child College hosted a peer education training event that NNAAPC facilitated. As part of the campuses’ HIV project, peer educators were trained in the basics of “HIV 101” and the “ABCs of Hepatitis” as well as presentation skills and a candid cultural conversation with some Chippewa Cree elders. “Having our elders at the table when it comes to talking about HIV is crucial to our program’s success,” said Shane Sangrey, Stone Child College’s HIV Project Coordinator. “It’s important for our students to know what the elders are saying about HIV because it shapes how we do outreach in Rocky Boy.” NNAAPC is also assisting the project with a community assessment and the design of their social marketing materials. The program hopes to have a testing event this fall term as well as a provider workshop for employees at the local tribal health clinic. For NNAAPC’s Tony Aaron Fuller, it was his first time in Montana and for Vicki Peterson it was a long awaited return to her former home. “Montana is everything people say about it,” said Fuller. “It’s gorgeous and Rocky Boy reminds me so much of my home reservation, I can’t wait to go visit our friends at Stone Child in the future!”
PRIORITY POPULATION You may be more familiar with the 4 P’s, but we have added a fifth, or rather put another P in front of the other four to emphasize the importance of segmenting your priority population. For example, we might want to target “women,” as our population, but which women? Are we trying to reach young women, older women? Or maybe we want to reach women who inject drugs or are engaged in commercial sex work. The more you segment your priority population, the more likely your social marketing campaign will show results.
PROMOTION This P is responsible for creating the message. What do we want our Priority Populationto know (think); what do we want them to believe (feel); what do we want them to do? What are the benefits of adopting a particular behavior change? An effective message will be attention getting, and connect with something that is important to the priority population. What media will you use? Posters? Videos?
PRODUCT The product is designed to facilitate behavior change. It should support a single, doable behavior, and be explained in simple terms. The Product is not the “message,” it is the behavior change goal. Your behavior change goal may be to increase the number of young, heterosexual women between the ages of 14 and 24 who voluntarily come to your agency for an HIV test.
Social networking sites?
PRICE This is not about the monetary cost to the individual, but the societal, emotional or psychological cost of the behavior change. This P will address the barriers that could prevent adoption of a new behavior and will consider issues like transportation, child care, embarrassment, stigma and social norms.
PLACE Think about where and when your Priority Population will best access your message. Your message may be accessed in bar bathrooms, clinic waiting rooms or more publicly on billboards or through public service messages. Where and when you disseminate your message will also depend on what media you have selected. Your research will have already indicated where your Priority Population can be found. Use this research to inform the placement of your message. Remember, social marketing is the application of marketing techniques and tools to achieve specific behavioral goals for a social good. This might include reducing stigma around HIV testing, encouraging the increased use of condoms or supporting clean syringe access for injection drug users. As community members are exposed to specifically targeted messages, their attitudes and perceptions of HIV and HIV risk begin to change.
For the third year in a row, NNAAPC is providing funds based on a competitive application process to three locations to host a training on one of the following topics: • HIV Prevention and Social Marketing • HIV and Social Media • Listening to the Community Speak: The Art of Community Assessment These topics were selected to coincide with the NNAAPC Social Marketing and Community Mobilization Capacity Building Program, designed to increase access to and utilization of HIV prevention services in Native communities through the use of innovative and locallytailored social marketing efforts. This year’s successful applicants are: Albuquerque Area Indian Health Board (New Mexico) will host an HIV and Prevention Social Marketing training October 25 and 26, 2011. The Confederated Tribes of Warm Springs (Oregon) will host an HIV and Social Media training on October 18 and 19, 2011. The Cherokee Nation Behavioral Health Prevention Service will host an Art of Community Assessment training on December 13 and 14, 2011. To further discuss the Regional Training Program, other capacity building assistance services and to begin the process of creating a formal request for assistance, please contact Vicki Peterson, vpeterson@nnaapc.org, Tony Aaron Fuller, tfuller@nnaapc.org or call NNAAPC at (720) 382-2244. Feel free to visit NNAAPC’s website, www.nnaapc.org for a comprehensive view of NNAAPC services, and be sure to “Like” our Facebook page to stay current with all NNAAPC events and projects.
NNAAPC’s Role in the 5th Annual National Native HIV/AIDS Awareness Day (NNHAAD) March 20, 2011, the first day of spring marked the fifth annual National Native American HIV/AIDS Awareness Day (NNHAAD). This national mobilization effort is designed to encourage Native people from across the nation to get educated, tested, and involved in prevention practices. Because NNHAAD is a nationwide effort, the Asian & Pacific Islander Wellness Center, National Native American AIDS Prevention Center [NNAAPC], Center for Applied Studies in American Ethnicity [CAE7AE], Great Plains Tribal Chairman’s Health Board, and Inter Tribal Council of Arizona [ITCA]) made a “Call to Action” for Native people and Native-serving agencies to organize and plan pivotal events such as HIV testing, talking circles, powwows, and film festivals to raise awareness of the growing HIV/ AIDS epidemic within Native communities. The CBA Network provided technical assistance to communities across Indian Country to support them in their Awareness Day event planning.
The Power of Facebook NNAAPC is reaching more and more Natives throughout Indian Country and even globally. A resurgence of NNAAPC’s Facebook page has garnered hundreds of new fans and “likes” since our last Seasons newsletter. Frequent posts and updates keep you in tune with what’s going on at NNAAPC and what other agencies are doing around the world. If you haven’t already become a fan, search “National Native American AIDS Prevention Center” on Facebook. You can also keep tabs on staff as they travel throughout Indian Country. You’ll also be able to network with others who work in the field. It’s another great resource and a fun way to engage with others across the country. When you become a fan of our page you’ll get all the updated information, articles, presentations and discussion that address HIV/AIDS in Indian Country, the Islands, and Alaska. We also like to post information from other agencies that have events or resources for HIV/AIDS services specific to American Indians, Alaska Natives, and Native Hawaiians.
It Gets Better...For Native LGBTQTS A recent project by the NNAAPC social media team was completed to honor and support Native LGBTQTS youth. The “It Gets Better” Project . It Gets Better is an Internet-based project founded by Dan Savage and his husband Terry Miller on September 21, 2010. They began the project in response to the suicide of Billy Lucas and a number of other teenagers who were bullied because they were gay - Raymond Chase, Tyler Clementi, Ryan Halligan, Asher Brown, and Seth Walsh. Its goal is to prevent suicide among LGBTQTS youth by having gay adults convey the message that these teens’ lives will improve. The project has grown rapidly: over 200 videos were uploaded in the first week, and the project’s YouTube channel reached the 650 video limit in the next week. It now has its own website, the It Gets Better Project, with more than 22,000 entries from people of all sexual orientations, including many celebrities. However, NNAAPC staff noticed there wasn’t a video that featured Native LGBTQTS, that could send a positive message to Native Youth who might be struggling with sexual identity issues. So an effort was made by Tony Aaron Fuller and Mat Barkhausen to film members of the NNAAPC Community Advisory Council and staff who shared their stories of survival, struggle and triumph. Their stories were collected and edited in to a short video that can be found on the NNAAPC YouTube Channel at http://www.youtube.com/user/ NNAAIDSPC?feature=mhee . Particants include staffers Tony Aaron Fuller, Hannabah Blue and Robert Foley, Community Advisory Council members Ashliana Hewalu, Elton Naswood, Isadore Boni and Don Little. Ale’ Castro from the Denver Two Spirit Society is also featured. This video was only up for week before it already had 400 hits! We only hope it is of service to the Native community and is reaching every corner of Indian Country to offer support to our LGBTQTS Native youth. Please access the video and share with your circles. Send the “moccasin telegram” out so our youth know they have our support!
Gender Responsiveness and HIV Prevention Strategies Gender, norms, social determinants and HIV risk. These concepts and how they are related are featured in an ongoing project from the Office on Women’s Health with the help of NNAAPC and project partner JSI Research and Training. The goal of Project HOPE (Helping Organizations Provide Effective HIV/ AIDS Prevention for Women and Girls), is to increase gender issue awareness and responsiveness for programs across the country that focus on women’s HIV risk and overall health. Gender is the way we as a community define the biological sexes - male and female. Many Native communities also have multiple gender terms, such as the Navajo “naadleeh” and “diilbaa’.” Gender norms are what we expect of behavior, characteristics and roles of individuals in a community. These norms are passed on through generations, differ by cultural and social context, and may be both strengths and vulnerabilities. They are often enforced and continued by negative stereotyping, social pressures and even violence. People can choose to buy in to the norms or not, however, there are health risks for both those who buy in and those who challenge these norms. In HIV prevention programming that addresses those health risks, gender norms are a social determinant that especially impacts women’s lives. Gender norms also affect selfimage, decision making, risk perception, power balances in relationships, and consequently, they affect HIV risk. They also impact how we approach HIV program design, implementation and evaluation. Through the HOPE Project, NNAAPC and JSI provide capacity building and technical assistance to OWH grantees to improve the effectiveness of their gender-based programs to become more effective by:
NNAAPC GENDER RESOURCES For more information please visit our gender resources page: www.nnaapc.org/resources/gender_resources.htm
• Addressing women’s role in society and realities of women’s lives in a prevention approach • Going beyond specific risk behavior by considering the context of that behavior • Creating more equitable gender relationships • Seeking change by challenging gender norms
As NNAAPC begins its second year as part of HOPE, we will continue to reach out to policy makers and stakeholders on the national level. We will also integrate more gender responsive approaches into our own programming. Ultimately, we believe that the result of this work will be higher quality and more effective HIV programs for women in the U.S. and throughout Tribal communities.