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Sarasota County HIV/AIDS Needs Assessment Results:
Strategy 2 – Implement New Models for Diagnosing HIV infections
Outside Medical Settings
Prepared by:
Moya L. Alfonso, MSPH
Graduate Research Associate
Florida Prevention Research Center
at the University of South Florida
College of Public Health
13201 Bruce B. Downs Blvd., MDC 56
Tampa, FL 33612
email: moalfons@mail.usf.edu
Submitted: March 8, 2006
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Table of Contents
Executive Summary .........................................................................................................................3
Overview ..........................................................................................................................................7
Guiding Research Objectives ...........................................................................................................7
Participants .......................................................................................................................................7
Methods............................................................................................................................................8
Analysis ...........................................................................................................................................8
Methodological Limitations and Strengths ......................................................................................9
Results ..............................................................................................................................................9
1. HIV in Sarasota County ............................................................................................10
2. Community Members’ Perceptions of HIV ..............................................................10
3. Knowledge of the Testing Process ............................................................................11
4. Previous HIV Testing Efforts in Nonmedical Settings .............................................12
5. Determining Priority Groups ....................................................................................13
6. Core Product Benefits (Testing in Nonmedical Settings) .........................................15
7. Price (Testing in Nonmedical Settings) ....................................................................16
8. Place (Testing in Nonmedical Settings) ....................................................................21
9. Promotion (Testing in Nonmedical Settings) ...........................................................22
10. Obtaining Test Results ..............................................................................................23
11. Needs Related to Diagnosing HIV Infections in Nonmedical Settings ....................24
12. HANS’s Role in Diagnosing HIV Infections in Nonmedical Settings .....................24
13. Establishing Linkages ...............................................................................................24
Conclusions ....................................................................................................................................25
Next Steps – Results to Action ......................................................................................................29
References ......................................................................................................................................30
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List of Tables
Table 1:
Table 2:
Table 3:
Table 4:
Table 5:
Community Focus Group Participant Characteristics: Testing in Nonmedical Settings 33
Barriers to Testing in Nonmedical Settings ....................................................................33
Where to Place Information about Testing in Nonmedical Settings...............................33
Nonmedical Testing Settings ..........................................................................................33
Testing in Nonmedical Settings Needs Summary Table ................................................33
List of Appendices
Appendix A:
Appendix B:
Appendix C:
Appendix D:
Appendix E:
Appendix F:
Appendix G:
Appendix H:
Appendix I:
Appendix J:
Appendix K:
Appendix L:
Appendix M:
System Analysis Guide .........................................................................................35
Interview Guide: Gatekeepers and Venue Representatives ...................................39
Interview Guide: Key Informants (e.g., churches, local businesses) .....................42
Focus Group Guide: Community Members Under the Age of 50 .........................43
Pre-group Questionnaire (A)..................................................................................47
Cuestionario Del Pre-grupo(A) ..............................................................................52
HANS Testing Focus Group Discussion Results...................................................55
Key Informant Interviews Summary .....................................................................60
Minutes of AA Male Focus Group (Testing), Goodwill 6/8/05 ............................60
Minutes of AA Male Focus Group (Testing), Goodwill 6/22/05 ..........................60
Minutes of AA Female Focus Group (Testing), Hippy 6/9/05 ..............................60
Minutes of AA Female Focus Group (Testing), Hippy 6/30/05 ............................60
Minutes of Spanish Female Focus Group (Testing), Community AIDS Network ...
6/22/05 ...................................................................................................................60
Appendix N: State Level Data for Determining Priority Groups ................................................60
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EXECUTIVE SUMMARY
This report describes the methods and results of a needs assessment conducted to gather strategic
information specific to Strategy 2: ‘Testing in Nonmedical Settings’. The following objectives
guided this component of the needs assessment: (1) to identify action steps that counties and
areas have taken that work; (2) to identify to whom and where to focus testing efforts; (3) to
determine how to adapt or tailor strategies proposed at the state level to meet the needs of
Sarasota County residents; (4) to identify gatekeeper information (i.e., how to access those in
most need of being tested); (5) to identify needs not currently being met – either at state level or
local level; and (6) to explore how to establish linkages (e.g., with local churches, between STD
and HIV testing at local health department, linking Hepatitis C testing and HIV testing).
In 2005, one focus group with 15 providers from north and south Sarasota County, including six
Sarasota County Health Department representatives and nine community agency representatives
(one with providers, two with PLWHA), five focus groups with African American and Hispanic
community members, and individual telephone interviews with four key informants who work
with African American and Hispanic community members in Sarasota County were conducted to
gather information specific to each guiding research objective. The study protocol including
methods and materials was approved by the University of South Florida Institutional Review
Board, Social and Behavioral Science Division.
HANS members and key informants identified action steps that have worked and those that have
not worked to diagnose HIV infections in nonmedical settings. Overall, community outreach
efforts that involve advance notice or taking advantage of scheduled events such as fair or
parties, support groups, or gay bars, offering incentives geared toward the target audience, and
working with local businesses and community-based organizations to offer testing were
considered action steps that have addressed the need to diagnose infections in nonmedical
settings. Results suggested ongoing visibility and long-term relationship building with
communities were key to diagnosing HIV infections in nonmedical settings.
Action steps that have not worked well in diagnosing HIV infections in nonmedical settings have
included testing in residential neighborhoods, especially with Hispanic participants, testing the
homeless, testing in jails, testing in areas with large populations of elderly, and approaching sex
workers on the street in front of clients or pimps.
For the purposes of this needs assessment, zip code data were analyzed to reveal areas of high
risk. Results suggested 34234 and 34236 had the highest rates of HIV infection per 100,000
population between 1998-2004. These areas in addition to south Sarasota County should be
considered in need of outreach and testing. State level trends suggested women (especially
heterosexual, African American women), white MSM, all age groups with increased outreach to
youth (13 – 24 years) and older individuals (50+), and African Americans, including injection
drug users should be considered in need of increased outreach and prevention. Comparisons
between state and local trends should be used to identify priority target audience to target with
community-based testing efforts. Once priority target groups are identified, additional
information should be used to segment these groups into meaningful subgroups if using a social
marketing approach. Information from this report could be used to develop a social marketing
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campaign to increase testing among African American males and females and Hispanic females
similar to those individuals who participated in the needs assessment focus groups (i.e.,
individuals receiving community-based services).
Strategic marketing information needed to adapt or tailor strategies for meeting the needs of
Sarasota County residents was collected, including information on the core benefits associated
with HIV testing and costs and barriers associated with being tested was gathered. This
information should be kept in mind when developing or selecting interventions designed to
facilitate testing in nonmedical settings.
The product, or the behavior being promoted, at the heart of this needs assessment was ‘testing in
nonmedical settings’. Results suggested the core benefit (i.e., what members of the target
audience receive in exchange for adopting HIV testing) to African American and Hispanic focus
group participants was “the great feeling knowing you’re negative.” The feeling of relief and
having a second chance served to motivate some participants to continue testing over time.
African American participant were particularly attracted to the idea of being offered a “second
chance” or an opportunity to “straighten” out their lives. Hispanic females did not, however,
discuss testing in terms of offering a second chance.
Although testing offers benefits to community members, results suggested they also pay a price
for being tested and face many barriers to being tested for HIV. Results suggested African
American and Hispanic community members risked embarrassment or “people knowing your
business” if they sought HIV testing at the health department or other testing sites. Participants
across male and female groups suggested “the people at the venue” are “in your business,”
“voice an opinion,” or “take too long to give results.” African American males and females
discussed the need to come back for results or extended waiting periods (e.g., two weeks) for
obtaining results as a price paid for being tested. Waiting for results was described as a “scary”
experience. African American females were particularly concerned about the potential for
receiving a positive result, suggested it would result in the lost of loss of relationships (“being
alone”) and was equivalent to receiving a “death sentence.”
HANS members, key informants, and community members discussed numerous community,
system, and individual level barriers to diagnosing HIV infections in nonmedical settings (see
Table 2 for a summary). Fear and uncertainty, compounded by having to wait for results, were
the most frequently mentioned barrier to being tested by African Americans. Sources of fear
included fear of finding out (a.k.a., “not wanting to know” or “denial”), fear of the unknown, and
fear of what others would say about them. African American males also suggested having to go
to the health department was a barrier to being tested because of the fear of being seen by other,
having to answer questions, and also from being turned away. African American females also
suggested not having the “nerve” to go because of embarrassment and anger made it difficult to
be tested. Finally, not knowing how HIV is transmitted, fear of needles, and having to deal with
people were mentioned as barriers to being tested.
One barrier to diagnosing HIV infections in Sarasota County identified by HANS was failure to
obtain testing results once tested. Community members suggested providing quick or instant
result, explaining the pros and cons of picking up results, and holding half of the offered
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incentive until results were obtained would address this barrier. Educating community members
as to what will happen if they receive a positive result may also help overcome this barrier.
Hispanic females suggested two key barriers to being tested: unawareness of or inability to
access free testing and fear of being exposed or facing personal questions (e.g., fear that someone
they know will see them, fear that parents will find out they were tested). Hispanic females also
suggested not wanting to know if they have HIV was a barrier to being tested. Finally, not being
educated about HIV and fear of needles were mentioned as barriers to being tested.
Key informants also described what made it difficult to access testing services. Two out of four
key informants suggested access was not the issue as long as organizations continue to “come
into the community with testing.” Further, key informants suggested most churches support the
CAN network and their efforts to increase testing. The key barriers to taking advantage of access
to testing, key informants suggested, were being uniformed, “walk[ing] around in denial,”
privacy concerns, and fear of being shunned.
HANS, key informant, and community member suggestions for where to place information about
testing organized into five main categories of information channels, including: “close to home,”
“community organizations/services,” “local businesses,” media,” and “social clubs” and
summarized in a table. Differences across genders and ethnicities were discussed. For example,
community members suggested HANS rely on inexpensive and local information channels for
reaching community members. Flyers and word-of-mouth were mentioned as the most effective
media for reaching community members. A variety of settings for placing information about
testing that have not been utilized in the past (e.g., check cashing stores, flea market) were
identified. In addition, numerous potential testing settings were identified and organized
according to the following categories: “close to home,” “community organizations/services,”
“local businesses,” and “social clubs.” Tables 3 and 4 should be used when placing information
in the community and planning community-based testing events. When selecting testing sites,
the need to help community members overcome barriers identified should be considered,
including stigma, privacy and confidentiality concerns, transportation, and the need for
consistency in testing locations.
Results suggested several key strategies for reaching those in most need of testing, including:
education and awareness, taking advantage of test opportunities when individuals come in for
other symptoms (e.g., itching, burning, unexplained illness), utilizing peer-to-peer education and
advocacy, building relationships with communities, increasing visibility in the community, and
utilizing spokespersons who are known and trusted (e.g., church members) to spread testing
information and emphasize the benefits of being tested.
Key informants in Newtown suggested HIV infection in their community was ‘invisible’. It is
only through the efforts of local agencies and encounters with infected family members or
friends that the prevalence of HIV in Sarasota County’s high risk areas came to light. To
increase visibility in the community, HANS will need to establish linkages with agencies that
already have a relationship with members of the community (e.g., HIPPY), work with churches,
ministers, and the Ministerial Alliance to influence the African American Church, address
HIV/AIDS within the framework of “wellness, ” hold multiple annual testing drives, make
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community announcements that offer “private, individual help,” utilize flyers and word of
mouth, and place information in identified information channels.
Lay individuals and health professionals were identified as the best spokesperson for reaching
individuals at risk for HIV infections. Overall, results from discussions with African Americans
suggested the best spokesperson might be a combination of trained ‘family members’ who had
cared for or lost someone to HIV/AIDS and a doctor who could share medical information.
Hispanic females were more trusting of health professionals, including a doctor, public health
workers, or an HIV educator. Only one suggested a person living with HIV would be a trusted
source of information.
Community-based organization (e.g., resources), system (e.g., increased collaboration), and
community member needs (e.g., fear reduction) related to diagnosing HIV infections outside of
medical settings were identified and summarized in Table 5. The extent to which each of these
identified needs has already been addressed should be determined. Unmet needs should be
considered in terms of priority and feasibility of being met by the resources available to HANS.
Finally, strategies for addressing each need identified as unmet, priority, and feasible to meet
should then be decided upon and action steps and timeline for meeting each delineated. HANS
members, key informants, and community members shared numerous ideas for meeting unmet
needs, such as making the testing process, including results distribution, quick and easy (e.g.,
adopt Rapid Testing, have multiple sites, after hours testing, consistent testing sites, offer child
care).
Possible linkages (e.g., HANS and local businesses) that may assist Sarasota County in
implementing new models for diagnosing infections outside medical settings were identified.
Emphasis was placed on determining how to link with community-based organizations since
community-based participatory approaches to reducing new HIV infections by community
empowerment, ownership and involvement has been recommended as a key strategy for
addressing HIV infection within high risk areas. Community-based participatory approaches to
diagnosing HIV infections in nonmedical settings would require linkages with community-based
organizations. Results from this needs assessment identified facilitators to linking with
community-based agencies (“partnership is in”), barriers to linking e.g., competition for
funding), benefits of offering testing in community-based settings (e.g., fulfilling organizational
mission), facilitators to incorporating testing (e.g., space that accommodates privacy), and
community-based organizations’ needs related to incorporating tested (e.g., funding, ongoing
relationships with testing agencies, information). Fortunately, key informants were unable to
identify any barriers to incorporating testing on site.
Recommendations for turning needs assessment results into concrete strategies for addressing
prevention with positives are included, such as rating identified needs as to the extent to each has
been met, priority, and feasibility (see “Prioritizing Needs Worksheet” in Alfonso, 2004) and
developing a ‘Prevention with Positives’ strategy team that will recommend strategies and
identify indicators of success.
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Sarasota County HIV/AIDS Needs Assessment Results:
Strategy 2 - Implement New Models for Diagnosing HIV infections
Outside Medical Settings
Overview
The purpose of the needs assessment described herein was to assist the HIV/AIDS Network of
Sarasota (HANS) in gathering strategic information specific to Strategy 2: Implementing new
models for diagnosing HIV infections outside of medical settings (‘Testing in Nonmedical
Settings’). In 2003, the Center for Disease Control and Prevention (CDC) along with other U.S.
Department of Health and Human Services agencies and government agencies and
nongovernment agencies launched a new initiative, Advancing HIV Prevention: New Strategies
for a Changing Epidemic. The purpose of the initiative is to provide new strategies that rely on
research-based or proven effective public health approaches to decreasing the number of new
cases of HIV (CDC, 2003a). Preventing new infections by diagnosing HIV infections outside of
medical settings is one of the four key strategies recommended.
This report details needs assessment methods, participants, and results specific to Strategy 2:
‘Testing in Nonmedical Settings’.
Guiding Research Objectives
Guiding needs assessment research objectives stemmed from interviews conducted with key
informants in Fall 2004 and were further revised by HANS Needs Assessment Small Group
members. The following objectives guided this component of the needs assessment:
 To identify action steps that counties and areas have taken that work.
 To identify to whom and where to focus testing efforts.
 To identify gatekeeper information (i.e., how to access those in most need of being
tested).
 To determine how to adapt or tailor strategies proposed at the state level to meet the
needs of Sarasota County residents.
 To identify needs not currently being met – either at state level or local level.
 To explore how to establish linkages (e.g., with local churches, between STD and HIV
testing at local health department, linking Hepatitis C testing and HIV testing).
Participants
Fifteen providers from north and south Sarasota County, including six Sarasota County Health
Department representatives and nine community agency representatives, participated in a two
hour focus group discussion.
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Five focus groups were conducted with African American (15 males, 11 females) and Hispanic
(5 females) community members in Sarasota County. Group discussions lasted approximately
60 minutes. Table 1 provides a summary of focus group participant characteristics. Overall, an
equal number of males and females participated; however, HANS was unable to organize a focus
group with Hispanic males. Most participants were between the ages of 25 and 54 years (91%),
African American (81%), heterosexual (97%), and resided in zip code 34235 (72%).
Individual telephone interviews were conducted with four key informants who work with
African American and Hispanic community members in Sarasota County. These individuals
were identified as key informants by Community AIDS Network (CAN) representatives. Key
informants are individuals who can give unique insight into a topic or population based on their
personal and professional experiences with the topic or group.
Methods
Zip codes with high rates of HIV infection per 100,000 population between 1998-2004 in
Sarasota County (i.e., 34234 and 34236) were targeted for focus group and interview recruitment
purposes.
Four interviews with key informants were conducted via telephone. Interviews were conducted
with individuals familiar with African American and Hispanic community members located in or
near these two zip codes in Sarasota County.
CAN in conjunction with Sarasota County Health Department and HANS conducted one focus
group discussion with Hispanic community members (up to age 50) residing in zip code 34236.
Due to recruitment difficulties only one group with females was conducted. Despite efforts to
recruit a mix of those who had been tested and those who had not, most participants had been
tested (94%). The evaluator provided the questions and informed consent form in English. The
evaluator provided incentives in the form of $10.00 Wal-Mart gift certificates for distribution
during the focus group. CAN provided refreshments. Sarasota County Health Department
provided CAN with audio-cassette recorders and assistance with making logistical arrangements
for the group. CAN provided the evaluator with a summary of responses (in English) for the
focus group conducted in Spanish.
Four focus groups were conducted with African American male and female community
members. Focus groups were conducted in June and July 2005. The provider focus group was
conducted at the Sarasota County Health Department. Community agencies recruited
participants from existing support groups in Sarasota County. Community members were
offered incentives for participation in the form of $10.00 Wal-Mart gift cards. Refreshments
were provided.
Focus groups were audio-recorded. In addition, the focus group facilitator and assistant took
extensive notes. Audio recordings were not transcribed; however, they were used to fill in notes
and locate illustrative quotes.
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The study protocol including methods and materials was approved by the University of South
Florida Institutional Review Board, Social and Behavioral Science Division.
Analysis
Qualitative data (i.e., focus group notes, interview notes) were entered into Microsoft Word
documents and organized according to question and sorted by group. Partial transcripts from
each focus group conversation were read and data were used to identify categories. Each partial
focus group transcript was then coded. Codes were based on the original questions, key
marketing concepts (e.g., product, price, place, promotion), and themes that arose from the data.
Patterns and themes across and within these coded categories were sought, and the range of
diversity in responses was examined. After themes and patterns were identified, summary and
interpretive statements were made and passages worthy of quotation were selected for inclusion
in the final report.
Questionnaire data were entered into a Microsoft Excel data file and frequencies were calculated
using SAS v8.0 data analysis software.
Methodological Limitations and Strengths
The following methodological limitations should be considered when reading and utilizing the
results of this needs assessment, including:
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Recruitment efforts for community focus groups did not result in the recruitment of
sufficient numbers of individuals residing in the two zip codes identified as most at-risk
for unidentified HIV infection in Sarasota County.
Hispanic males, men who have sex with men (MSM), and homeless community members
are not represented in this needs assessment report.
Despite efforts to recruit a mix of those who had been tested and those who had not, most
participants had been tested (94%). Thus, the views of individuals who had not been
tested for HIV were underrepresented, making it difficult to determine key differences
between those who had been tested (‘doers) and those who had not (‘nondoers).
The limited number of focus groups conducted with Hispanic participants suggested
theoretical saturation (i.e., no new information discussed) was not reached within this
target group.
Unfortunately, efforts to interview venue owners and individuals who worked with
Hispanic community members were met with nonresponse. Thus, community-based
efforts are limited to those working primarily within the Newtown community. Finally,
the needs of local businesses related to incorporating testing and suggestions for working
with venues are not included in this report.
The presence of a CAN employee in one group and a community group leader in the
male focus group may have influenced participation and disclosure.
The reliance on untrained focus group moderators to conduct three out of five focus
groups may have impacted the quality of the data obtained (e.g., depth of information
shared, adherence to focus group script, etc.).
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When combined, these limitations suggest if this needs assessment was conducted with other
groups of community members, new information that is not included in this report might be
discovered.
Ideally, qualitative results would be used to develop a survey, which would be administered to
members of the target audience to determine the best marketing mix to use when trying to reach
the target audience/s. However, the limited resources allocated to this needs assessment
precluded the development and administration of a survey.
Despite these limitations, this needs assessment provides a detailed description of the testing
related needs of African American males and females and Hispanic females, community-based
agencies working in high risk neighborhoods, and organizations striving to address HIV/AIDS in
Sarasota County.
The following strengths support the use of these results to guide efforts to address testing in
nonmedical settings in Sarasota County:
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The conduction of interviews with key informants prior to designing the needs
assessment increased the odds of gathering relevant and strategic information.
A focus on identifying needs specific to one key CDC-recommended strategy and
gathering preliminary market information that could be used to address these needs drove
the needs assessment process.
Sources of information were triangulated to provide a more comprehensive view of
factors and needs related to testing in nonmedical settings in Sarasota County.
A focus on system-level factors that impact testing in nonmedical settings was
incorporated in addition to individual and community level factors.
Results
Where appropriate, results of the HANS group discussion, community focus groups, and key
informant interviews are combined within subheadings to allow for comparisons. Participants
from focus groups conducted with community members are referred to as “community
members.” Copies of the focus group and interview guides and pre-group questionnaire
administered to community members are included in Appendices A-F. Summaries of each focus
group discussion and an aggregated key informant interview summary are provided in
Appendices G-M.
1. HIV in Sarasota County
Key informants from agencies who worked with African American and Hispanic community
members discussed HIV in Sarasota County. One key informant suggested HIV/AIDS was
“running rampant” in Newtown. Another emphasized the importance of local agencies in
providing community-based organizations with information on the status of HIV in the
community. Minority communities, including African American and Hispanic, one key
informant suggested, “don’t know if people have it until after they die.”
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Two key informants were asked to describe how local African American churches respond to
HIV/AIDS within their congregations. One suggested churches were supportive. However,
another explained that community members feared and shunned those with HIV until they “get a
full understanding of it.” They further explained it was important for trusted church members to
explain and discuss HIV/AIDS with elders in the church, particularly women in the 35 to 44 age
range who have influence over younger members of the church.
Key informants discussed three main needs associated with preventing and diagnosing HIV
infections in the community: more visibility in the community on an ongoing basis (e.g., flyers,
conversations, town hall meetings, churches), increased education and awareness, and more
condoms for clients.
2. Community Members’ Perceptions of HIV
Community members shared their initial reactions when they hear the word “HIV.” Analysis of
their reactions suggested the following:
 Across genders and ethnicities, HIV was associated with negative images of fear, death,
disease, and suffering.
It sends a chill down your back. I think about the last test – should I test again?
African American Male
 African American and Hispanic female focus group participants associated HIV with
several aspects of relationships – concern, anger, rejection, and loneliness. Women were
concerned with younger individuals who tend to “think it won’t happen to them.” Also,
one women expressed feelings of sympathy for children who are impacted by HIV/AID,
and another suggested women with HIV “wouldn’t want to risk having other kids.”
Further, women associated a positive diagnosis with rejection from friends, family and
the community and loneliness.
 Male participants told stories of prior risky behavior and suggested testing offered a way
of getting ‘back on track’. Only one women, seemed to agree with males, suggesting
being tested was “a second chance to get their lives together.”
It scares me too. It’s an attention getter. My last result was negative. I became very careful. It
does exist. There are people out there who have it. I’m more aware of what they are going
through. African American Male
 African American women were particularly negative toward HIV, using words such as
“stupidity,” “anger,” “nasty,” “destroys,” and “fucked up.”
They have a lot of anger depending on how they contracted it. Hate toward others. When they
tell you about it, it still adds up to death. It’s a virus, you’re really sick. It’s loneliness. People
are scared of it. No one understands. African American Female
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 Only one woman in one focus group discussed the ability to prevent HIV infection
through the use of condoms.
Interestingly, when asked who should be tested for HIV, community members across genders
and ethnicities, stated, “everybody” – except clergy. However, some participants disagreed,
suggesting only “people who have a reason should be tested,” such as those with identifiable
risks (e.g., prostitutes, those with tattoos, blood transfusions, people in a relationships with
someone who has had multiple partners). When asked to explain whey everybody should be
tested, one person stated, because “you never know where you can get it from – dentists, sharing
needles, other can give it to you.”
3. Knowledge of the Testing Process
Since most (94%) focus group participants had been tested for HIV at least once, knowledge of
the testing process was high. Most participants knew how to identify testing locations and where
to go to be tested (e.g., health department). African American males explained they found out
where to be tested through treatment centers, hotlines, television, Yellow Pages, and newspapers.
There was some confusion as to what a person had to do if they wanted to be tested. For
example, one male participant suggested someone had to have “a reason” such as illness for
being tested. One female participant suggested a person would have to find how who exposed
them to HIV before they were tested. African American males and female participants were
aware of how to obtain their results; however, Hispanic females were confused as to how to
obtain testing results. Finally, participants expressed confusion and uncertainty as to what
happens if test results are positive.
4. Previous HIV Testing Efforts in Nonmedical Settings
Organizations and agencies in Sarasota County (e.g., CAN) have begun to address the need for
diagnosing HIV infection outside medical settings. HANS members identified several efforts,
including projects such as Project Unity and the Venues Project. In addition, testing has been
conducted at crack houses, health fairs, local gay bars, areas in the Newtown Community (BP
gas station, community center, and True Vine Baptist Church), home shelters, and jails. In an
effort to reach Hispanic community members, testing was carried out in a local trailer park.
South County efforts have included testing in Northport and at local skate parks. Finally, CAN
continues to build relationships with local pastors and churches, especially those churches that
traditionally serve African American community members.
HANS members learned much from prior attempts to diagnose HIV infections in nonmedical
settings. Strategies associated with successful efforts included:
 Giving advance notice.
 Offering testing at already scheduled events such as job fairs and tattoo parties.
 Offering incentives geared toward the target audience (e.g., CDs, local business gift
certificate, Wal-Mart or Publix gift cards).
 Outreach efforts that emphasize visibility and long-term relationship building in
communities (e.g., Newtown).
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 Implementing group level intervention and education.
 Holding health fairs in the community, which serves to take away some of the stigma
associated with HIV.
 Going to local gay bars between 10 pm and 2 am.
 Working with local businesses in the community to offer testing (i.e., The Venues
Project).
HANS members also noted strategies that have not worked well, including:
 Testing in residential neighborhood (e.g., trailer park).
 Testing the homeless: the turnout is very poor (e.g. at the Resurrection House).
 Testing in the jails (i.e., “many prisoners willing to take a Syphilis test, but they refuse an
HIV test”).
 Testing in areas with large population of elderly (e.g., Northport).
 Approaching sex workers on street in front of clients or pimps.
Community coordinators and advocates who participated in key informant interviews discussed
what they were currently doing to address HIV in the groups they served. Results suggested
HANS members had established relationships with some of the key community-based
organizations in the Newtown community. Key informants discussed the importance of having
ongoing relationships with experts from the health department and local organizations focused
on HIV/AIDS in offering testing on site. Key informants had incorporating testing and HIV
education into their program planning. Efforts to address HIV included offering HIV and life
management skills, offering condoms, offering support groups, inviting outside organizations
that address HIV to present at meetings or events, and allowing testing on site.
One key informant discussed their experience advocating for HIV prevention in a Newtown
church. HIV education was presented as a part of the “wellness idea.” The key informant was a
trusted member of the church; thus, she served as a gatekeeper to the pastor and the women’s
group that could have served as a barrier to reaching other congregation embers.
5. Determining Priority Groups
Public health interventions are usually targeted to those who are most in need of services or most
‘at-risk’ for contracting a specific disease or performing a risk behavior. The Sarasota County
Health Department examined local HIV and AIDS prevalence data to determine those groups
and areas of the county (i.e., zip codes) that should be targeted with increased testing efforts
based on evidence of increase risk for infection. Zip codes with high rates of HIV infection per
100,000 population between 1998-2004 in Sarasota County included 34234 and 34236. These
areas were considered in need of attention. In addition, at least one key informant suggested
south Sarasota County was in need of attention, particularly given population growth. These
results were compared to state level data, which is summarized in Appendix N. Overall, state
level trends suggested the following groups should be considered priority groups for HIV
prevention and outreach: women (especially heterosexual, African American women), white
MSM, all age groups with increased outreach to youth (13 – 24 years) and older individuals
(50+), and African Americans, including injection drug users.
15
Comparisons between state and local trends should be used to identify priority target audience to
target with community-based testing efforts. Once priority target groups are identified (e.g.,
African American community members), additional information should be used to segment these
groups into meaningful subgroups if using a social marketing approach.
HANS members who participated in the testing focus group identified several groups they
believed should be targeted with increased testing efforts. For the most part, these groups were
defined based on the presence of particular risk behaviors associated with HIV infection. Groups
identified included:







sex workers and their clients,
wives of promiscuous husbands,
gay men with unfaithful partners,
adolescents, particularly those who participate in group sex activities,
prisoners,
the poor and underserved (e.g., Northport Ukrainian community), and
college students (i.e., University of South Florida, Manatee Community College.
6. Core Product Benefits (Testing in Nonmedical Settings)
Within the social marketing framework, the product refers to the behavior, good, service or
program being promoted (McCormack Brown, Alfonso, & Bryant, 2004). The product at the
heart of this needs assessment is ‘testing in nonmedical settings’. At the heart of the product is
the concept of benefits to the consumer (target audience) for accepting the product. In other
words, what do members of the target audience receive in exchange for adopting the product
offered?
Core Benefits
Participants across all focus groups suggested one key benefit associated with being testing for
HIV – “the great feeling knowing you’re negative.” Some were motivated to continue testing
after experiencing the feeling of relief after receiving a negative result. One participant
explained feelings of “gratitude for not having contracted HIV.”
African American participants but not Hispanic females suggested HIV testing offered a “second
chance.” Participants suggested HIV test results could “straighten you out” and would make life
“more manageable.”
A couple of participants suggested a key benefit associated with being tested for HIV was safety
– information needed to protect themselves and others.
Motivating Factors
To understand what motivated participants to be tested, community members were asked to
explain, “What makes someone go to be tested for HIV?” The following key themes emerged:
16
 African American males in one group discussed being “tired of the life” they were living
or “wanting to do something positive” as a motivating factor.
I got tired of living the life I was living. I wanted to do something positive in my life. I just
became baptized two weeks before I tested negative. Now I know if I want a relationship, now I
can ask comfortable to get tested before to have sex. If she is woman enough to get tested, that’s
all right with me. Don’t just go around killing everybody. African American Male
 Some African American males suggested they were motivated to be tested in response to
unexplained symptoms or illness or having lived a “promiscuous life.”
 Other motivators mentioned less often in groups with African American males included
access to a mobile unit, being curious, or having it affect their household. One African
American male, who suggested he had not been tested for HIV, stated he would be tested
if someone close to him became infected:
If somebody close to me would get it, I would get tested. Not until if affects your household –
awareness comes with that. African American Male
 The most frequently mentioned motivating factor mentioned by African American
females was having been exposed to a known risk, including risky sexual behavior (e.g.,
unprotected sex), drug use (e.g., sharing needles), blood transfusion, exposure to infected
bodily fluids (e.g., breast milk, spit), and hearing someone “from the past” has
HIV/AIDS.
 Some African American females suggested just “wanting to know” or routine safety
purposes motivated them to be tested.
 Some African American women suggested they were motivated to be tested when their
partner accused them of cheating or when they found out their partner had cheated.
 Other motivators mentioned included: knowing where HIV infection started, hearing
“that someone’s got it – a young person,” and in response to an unexplained illness.
 Hispanic females suggested two primary motivating factors for being tested: awareness
of where to go to be tested for HIV or having a mobile unit in “different parts of town”
and fear or doubt associated with unexplained symptoms, possible risk status (e.g., blood
transfusions, multiple partners).
Making Testing Appealing
African American males suggested the following would make testing more appealing:
 addressing barriers to testing (see Table 2) and reassuring people “there’s a chance even
if they test positive,”
 holding a contest and offering prizes for whoever brought in the most people to be tested,
 making testing fun or festive (e.g., cookout, rally, fair in the park, music),
 offering incentives such as gift cards, clean needles, and
 promoting the benefits (e.g., testing offers a “second chance”).
17
Other suggestions for making testing appealing mentioned by individual African American
males included:




having a famous person talk about HIV/AIDS,
offering 24 hour access,
“telling people it’s for you, just come and do it,” and
using music videos to educate about HIV/AIDS.
African American females in one focus group emphasized the importance of offering safety and
information on HIV/AIDS in making HIV testing appealing. Participant suggested offering
classes on HIV (i.e., “safe sex classes”), male and female condoms, flyers with medical
information about HIV/AIDS, and information on how to be safe while using drugs.
African American females in the other focus group emphasized showing the effects of HIV
infection in making testing appealing. For example, one woman suggested showing pictures of a
person who did not want to know progressing through the illness without treatment. Another
suggested showing pictures of “positive people with AIDS.” At the gist of this suggestion is the
need to explain to African American females, in particular, that “even it [they’re] positive, [they]
have a chance if [they] take medications early.”
African American females also suggested the following make testing more appealing:
 having someone supportive to go with them to be tested,
 making testing fun or festive (e.g., cookout, rally, fair in the park), and
 offering incentives, such as food baskets with lotion, door prizes, $25 gift cards to WalMart, Target, Bath and Body Works.
Hispanic females emphasized the role of offering incentives in making HIV testing appealing.
Suggested incentives included movies passes, compact discs, or Best Buy cards when testing
teens and the following incentives for adults: food vouchers or restaurant gift cards, Wal-Mart
gift cards for women, and Home Depot gift cards for men.
7. Price (Testing in Nonmedical Settings)
Price refers to the monetary and nonmonetary costs the target audience must pay to adopt the
product (McCormack Brown, Alfonso, & Bryant, 2004). The barriers the target audience will
have to overcome to adopt the product are also included in this section.
Costs of Being Tested for HIV
Results suggested African American and Hispanic community members risked embarrassment or
“people knowing your business” if they sought HIV testing at the health department or other
testing sites. Participants across male and female groups suggested “the people at the venue” are
“in your business,” “voice an opinion,” or “take too long to give results.”
18
I was lucky: I did not have to go the Health Department. It was brought to me. It is
embarrassing to go there. African American Male
Difficult? Going to the Health Department. They see you there and voice an opinion. People
would ask, “Why are you here?” African American Male
African American females suggested a positive diagnosis would result in the loss of relationships
(“being alone”).
African American males and females suggested a positive result meant there was “nothing to live
for” and was equal to receiving a “death sentence.”
African American males and females discussed the need to come back for results or extended
waiting periods (e.g., two weeks) for obtaining results as a price paid for being tested. Waiting
for results was described as a “scary” experience.
Barriers to HIV Testing
HANS members, key informants, and community members discussed numerous community,
system, and individual level barriers to diagnosing HIV infections in nonmedical settings (see
Table 2 for a summary).
HANS members suggested several characteristics of Sarasota County that serve as barriers to the
diagnosis of HIV infections in nonmedical settings. Sarasota County was described as an
affluent, conservative county. This conservatism is seen, for example, in local school policies
that resist testing and comprehensive sex education in the schools, which is supported by the
government’s focus on abstinence only approaches to education and prevention. Sarasota
County, as one HANS member explained, is a “very large territory” to cover. Transportation to
testing sites, especially in South County, is difficult for many community members, particularly
those who may rely on public transportation. Finally, the physical layout of Sarasota County and
patterns of development and settlement have contributed to a “divide” between north and south
Sarasota County, which has contributed to a unequal distribution of services and resources and a
lack of HIV/AIDS infrastructure in South County. A couple of HANS members suggested the
underdeveloped infrastructure in south county made it difficult for new employees to establish
credibility.
Results from African American male focus groups suggested fear was the most substantial
barrier to address when promoting testing in the community. African American males discussed
several sources of fear, including fear of finding out (a.k.a., “not wanting to know” or “denial”),
fear of the unknown, and fear of what others would say about them.
It’s obvious. People know about it; they just don’t want to do it [be tested].
African American Male
Fear. It would make it difficult for most. They found out if they have it, now they feel like they
have nothing to live for. It messes up your ego – the fear of what others say about you.
19
African American Male
In addition, African American males discussed waiting for results and related anxiety as a barrier
to being tested.
Expediency is important – test results in two hours. It is scary to wait. It takes too long.
African American Male
African American males also suggested having to go to the health department was a barrier to
being tested because of the fear of being seen by other, having to answer questions, and also
from being turned away.
The Health Department. Sometimes they said, “We are not taking anymore walk-ins today.
They should take everyone.” African American Male
African American males also suggested fear of needles, drug use and low self-esteem made it
difficult for some individuals to be tested for HIV.
Fear and uncertainty, compounded by having to wait for results, was the most frequently
mentioned barrier to being tested by African American females. African American females also
suggested not having the “nerve” to go because of embarrassment and anger made it difficult to
be tested. Finally, not knowing how HIV is transmitted, fear of needles, and having to deal with
people were mentioned as barriers to being tested.
Wanting to die rather than know [makes it difficult to be tested]. African American Female
Hispanic females suggested two key barriers to being tested: unawareness of or inability to
access free testing and fear of being exposed or facing personal questions (e.g., fear that someone
they know will see them, fear that parents will find out they were tested). Hispanic females also
suggested not wanting to know if they have HIV was a barrier to being tested. Finally, not being
educated about HIV and fear of needles were mentioned as barriers to being tested.
Key informants also described what made it difficult to access testing services. Two out of four
key informants suggested access was not the issue as long as organizations continue to “come
into the community with testing.” Further, key informants suggested most churches support the
CAN network and their efforts to increase testing. The key barriers to taking advantage of access
to testing, key informants suggested, were being uniformed, “walk[ing] around in denial,”
privacy concerns, and fear of being shunned.
I don’t think it’s difficult for anybody to access. Key Informant
8. Place (Testing in Nonmedical Settings)
Place refers to the locations where interventions are implemented, products are distributed, target
audience members perform the behavior being promoted, and target audience members receive
20
information about the product (McCormack Brown, Alfonso, & Bryant, 2004). In addition to
physical locations, place refers to specific times of the day, week, or year and individuals or
organizations who play a role in distributing or promoting products to the target audience.
Frame of Mind – When to Approach Community Members about Testing
The frame of mind when community members are most receptive to hearing about HIV testing
varied across ethnicities. Results suggested:
 African American males and females were in the best frame of mind to hear about testing
when they had been exposed or when it “hit home” (i.e., someone close to them had been
diagnosed with HIV).
 However, other African Americans suggested creating a festive, related setting would
make community members more open to being tested.
 African American females were more likely to suggest they would be open to hearing
about testing if their partner had been diagnosed or had been promiscuous/unfaithful.
 African American females suggested people were in the right frame of mind to hear about
HIV testing when they were ill or experiencing symptoms (e.g., open sores, cough).
 Hispanic females suggested people were in the right frame of mind to hear about HIV
testing when they were watching TV or a movie, when they received information in an
enclosed envelope (i.e., Florida Power and Light bill), when it came up in a casual
conversation, when they were eating, or when they visited their doctor.
Where to Place Information about Testing
HANS, key informant, and community member suggestions for where to place information about
testing are summarized in Table 3. Results were organized into five main categories of
information channels, including: “close to home,” “community organizations/services,” “local
businesses,” media,” and “social clubs.” Results across sources of information suggested the
following:
 Whereas a few African American females suggested flyers should be delivered door-todoor, African American males preferred information channels that were, for the most
part, outside of their homes.
 Locations to place information do not necessarily overlap with potential testing locations.
For example, although Hispanic females suggested receptiveness to receiving information
about testing in their monthly bills, they did not recommend testing in the home.
 Compared to other recommendations, few suggested placing information on media
channels, with the exception of the Tempo News. Other media channels, including
Channel 6 News, SNN, 95.7, and 98.7, were suggested in response to a focus group
moderator’s direct inquiry (as opposed to spontaneous response).
 African American males and females suggested information should be placed in churches
and community organizations/settings. However, Hispanic females did not mention these
locations as possible sources of information.
 Local grocery stores were mentioned by all groups as possible information channels.
21
Where to Offer Testing
According to CAN, rapid testing sites will include CAN, Goodwill, Senior Friendship Center,
and Joseph’s Place. HANS members, key informants, and community members suggested
numerous additional locations where testing should be made available (see Table 4). Potential
testing sites were organized using the following four categories: “close to home,” “community
organizations/services,” “local businesses,” and “social clubs.” Comparisons between sites
HANS identified versus those identified by key informants and community members suggested
the following:
 HANS is already aware of a number of possible locations for conducting testing.
 Community members were able to list a number of additional local businesses where
testing should be offered. For example, African American males mentioned check
cashing sites, while African American females suggested local pharmacies (e.g., CVS).
 The one potential testing site that was not identified by any other group than Hispanics
was “flea market.”
 Testing in the park “with music or food” was mentioned by most groups as a way to
create a relaxed environment around HIV testing.
When selecting testing sites, the need to help community members overcome barriers identified
should be considered, including stigma, privacy and confidentiality concerns, transportation, and
the need for consistency in testing locations (see Table 2).
9. Promotion (Testing in Nonmedical Settings)
Promotion refers to the combination of activities or strategies designed to achieve behavior
change among the target audience (McCormack Brown, Alfonso, & Bryant, 2004). Promotional
activities include specific messages to use to promote behavior change, spokespersons the target
audience will trust to give them information, and the specific information channels to use in
delivering the messages.
Spokespersons for Testing
Results across genders and ethnicities suggested two possible categories of spokespersons for
conveying the testing message – lay individuals and health professionals. Possible lay
spokespersons mentioned fell into two categories: individuals with HIV/AIDS or people who
were close to the target audience (e.g., pastors, teachers, friends, family, or peers). Possible
health or service provider spokespersons included doctors or nurses, paramedics, or police.
Results suggested ethnic differences in trusted sources of information about HIV testing,
including:
 Overall, results from discussions with African Americans suggested the best
spokesperson might be a combination of trained ‘family members’ who had cared for or
lost someone to HIV/AIDS and a doctor who could share medical information.
22
An older person who lived with someone who had it and saw their suffering, because a doctor
will only tell you the medical stuff - you want to know the side stuff things as well.
African American Female
 Only 20% (4/20) of African American participants suggested a pastor would be the best
spokesperson for HIV testing in the community.
 For African Americans in particular, spokesperson should be “people of their own color
and kind” and who “have a personal relationship with them.”
 Although a couple of African American focus group participants suggested a person who
had AIDS would be a trusted source of information about testing, most suggested adults
would be “scared of them.” African American females were particularly adamant about
the potential for other African Americans to fear people living with HIV/AIDS.
For kids, someone with AIDS. For adults, not someone with AIDS because adults may feel like
they don’t want to breathe the same air. African American Female
 Hispanic females were more trusting of health professionals, including a doctor, public
health workers, or an HIV educator. Only one suggested a person living with HIV would
be a trusted source of information.
Promotional Strategies
Promotional strategies include strategies for reaching members of the target audience and
strategies for encouraging members of the target audience to be tested. Key informants and
members of the community were asked to describe “the best ways to reach members of the
community who may be at risk for HIV,” “how we could get the word out,” and “how we could
encourage people to be tested for HIV.”
The following strategies for reaching community members who may be at risk for HIV were
suggested:
 Collaborate with agencies that already have a relationship with members of the
community (e.g., HIPPY).
 Work with churches, ministers, and the Ministerial Alliance to influence the African
American Church. Address HIV/AIDS within the framework of “wellness.”
 Hold two or three annual events in the community that involve churches, organizations,
preschools, head start, library; and other organizations.
 Make community announcements but offer “private, individual help.”
 Flyers and other announcements should emphasize the type of testing offered (i.e., no
blood or needles involved), the location, and the cost (free).
 Utilize flyers and word of mouth. Flyers should be posted in the locations identified in
Table 3 and sent to the Ministerial Alliance for distribution. The HIV testing message
should be spread through communities using word-of-mouth (e.g., HIV support groups,
churches, parenting groups, etc.).
 Local information channels such as flyers in neighborhood locations, word-of-mouth, and
placement of notices in local media channels such as the Tempo News should be utilized
23
in lieu of more expensive approaches such as radio and television ads that are not unique
to target communities.
Word of mouth works well in the Newtown community. Contact Ms. Lisa at Hippy.
African American Female
Flyers with the red women; tell people where free HIV tests are available.
African American Female
Pass out flyers at Wal-Mart and other stores in town. At schools. Hispanic Female
A few participants, across groups, suggested making HIV testing mandatory, perhaps through
requiring HIV testing as a part of the marriage license process, through entry into the jail system,
or requiring testing to become eligible for social services. Most participants, however, offered
strategies for encouraging voluntary testing in the community, including:
 Approach the topic indirectly. Discuss HIV/AIDS within the framework of “wellness.”
When recruiting for testing, ask community members to be a part of a discussion group,
or “have a well-known person in the community offer to speak but don’t advertise the
topic.”
 Emphasize the benefits of being tested (see Section 6 of this report) and address barriers
to testing (see Section 7 of this report).
 Identify African American, Hispanic, and youth speakers with HIV/AIDS to speak in the
community and dispel myths.
 Make HIV education and testing an ongoing, persistent, proactive, visible presence in the
community. For example, hold a CAN testing drive every two to three months. Or,
collaborate with other agencies to hold a health week that covers HIV/AIDS, physical
fitness, and other issues that disproportionately affect African Americans during Black
History Month (February).
Every two to three months, every six months, have a big CAN testing drive. Throw that at the
community. You keep on doing something over and over gain, then it lessons the stigma.
Key Informant
 Increase availability of HIV education in the community.
 Encourage “people of color” to be “up front with this” [HIV/AIDS] be cause they will be
“loved regardless.”
 Offer incentives to encourage testing, and offer food at testing events.
 Emphasize the testing process will be quick and will not involve blood or needles.
10. Obtaining Test Results
HANS members identified the failure to obtain testing results once tested as a substantial issue in
need of attention. Thus, community focus group participants were asked to suggest strategies for
encouraging individuals to pick up their results and for making the process easier, including:
24
African American Males
African American males suggested offering quick or instant results and incentives would be the
two best strategies for encouraging people to pick p their results. Other suggestions mentioned
less often included:





Provide free transportation.
“Scare them.”
Emphasize getting results is “very important.”
Show a famous person (e.g., Michael Jordan) getting results.
Distribute reminder cards.
African American Females
African American females suggested talking with individuals about the pros and cons of
obtaining their results, including what can be done if they receive a positive result, was the key
to encouraging individuals to pick up their results. Further, the benefits of knowing your status
should be explained, such as “living for your kids.”
Providing moral support (i.e., having someone to confide in) and emphasize the confidentiality
of the results (and the setting in which they’re delivered) were the second most frequently
mentioned strategies for encouraging individuals to pick up their results.
Other strategies mentioned by individual African American females included:





Have the testing staff make a follow-up phone call.
Provide a copy of the results to show potential partners.
Offer incentives ($10 gift card to test, $15 gift card to get results).
Provide transportation.
“Be in good spirits.”
Hispanic Females
Hispanic females suggested offering incentives but holding half until the results were obtained
was key to encouraging individuals to pick up their testing results. One suggested having a
drawing of a $50 gift certificate would be encouraging. Other strategies mentioned included:
having a drive through window for obtaining results, providing reminder cards, and connecting
the testing process to the marriage license process.
11. Needs Related to Diagnosing HIV Infections in Nonmedical Settings
Table 5 provides a summary of community-based organization, system, and community member
needs related to diagnosing HIV infections outside of medical settings. The extent to which
each of these identified needs has already been addressed should be determined. Unmet needs
should be considered in terms of priority and feasibility of being met by the resources available
25
to HANS. Finally, strategies for addressing each need identified as unmet, priority, and feasible
to meet should then be decided upon and action steps and timeline for meeting each delineated.
Once unmet needs are identified, strategies for meeting those that are priority and deemed
feasible to meet can be determined. HANS members, key informants, and community members
shared numerous ideas for meeting unmet needs associated with testing in nonmedical sites, and,
thus, facilitating the testing process, such as:
 Address resource deficiencies, including staffing (e.g., teams to go into dangerous
settings, counselor availability).
 Address transportation either through providing or offering within walking distance or at
planned event.
 Advertise testing as free, quick, and needle-free.
 Develop relationships with communities (e.g., targeted individuals, local venues).
 Educate community members about what will happen if they test positive. Reassure
them that treatment and support are available if they test positive.
 Encourage females to “go with a friend for support.”
 Ensure privacy and confidentiality during the testing process.
 Identify and train spokespersons who are known and trusted (e.g., church members).
 Increase education and awareness.
 Increase visibility in community and alert community members about testing
opportunities by placing information in identified channels and working with communitybased organizations.
 Make the testing process, including results distribution, quick and easy (e.g., adopt Rapid
Testing, have multiple sites, after hours testing, consistent testing sites, offer child care).
 Offer incentives geared toward each target audience.
 Offer testing in park on holidays such as Martin Luther King Day.
 Train peers and family members to share information and resources (e.g., brochures) with
others in the community.
 Use mobile testing unit.
12. HANS’s Role in Diagnosing HIV Infections in Nonmedical Settings
Although there are numerous barriers to diagnosing HIV infections in nonmedical settings,
HANS members brainstormed several innovative ideas for diagnosing HIV infections outside of
medical settings – many of which were reiterated by key informants and community members:
 Develop relationships and trust and increase community support.
 Build relationships with local businesses.
 Teach pastors to “sell” HIV testing to other pastors and elders and to go to congregations
with “compassionate awareness.”
 Conduct social marketing campaign to increase community buy-in (i.e., awareness of
HIV in Sarasota county, dispel myths/stereotypes, increase openness to testing).
 Replicate “unique partnership between True Vine Baptist Church and the Sarasota
County Health Department.
26
 Support school nurses in providing education and offering testing (see Lee County
effort).
 Work with organizations of other health concerns such as the American Cancer Society
with the goal of linking a stigmatized health concern (HIV/AIDS) with more ‘acceptable’
issue (e.g., cancer, heart health).
 Set up space or kiosk in Sarasota Square mall.
Although there are limited resources including funding, staffing, and time to taking action in the
community, HANS members suggested several actions could be taken to further progress toward
diagnosing HIV infections outside of medical settings, which would not require additional
resources:








Do “low-level pro-bono” work.
Build on strengths (e.g., commitment, desire).
Improve communication and collaboration.
Participate in community efforts to address this issue.
Encourage open dialogue.
Focus on early prevention (e.g., youth).
Focus on education and outreach with testing.
Help facilitate change (e.g., meet with other organizations, lobby for policy/legislative
change, work on collaborative grant opportunities).
 Educate those in positions of power (e.g., health care providers, pastors, business
leaders).
 Empower the community (e.g., one-on-one education so can pass on to others).
13. Establishing Linkages
One of the objectives of this needs assessment was to explore how to establish linkages that
would assist HANS in addressing the need to implement new models for diagnosing infections
outside medical settings (e.g., with local churches, between STD and HIV testing at local health
department, linking Hepatitis C testing and HIV testing). Possible linkages worthy of further
discussion identified during the HANS focus group discussion, included:








Testing with “venue development and relationship building”;
HIV and Sexually Transmitted Disease Units at the Health Department;
HANS and local businesses;
Charlotte County and [South] Sarasota County;
Manatee County and Sarasota County (e.g., Manatee County Rural Services);
HIV and less stigmatized health concerns (e.g., cancer);
Health Department and Clinics (e.g., Comprehensive Care Clinic); and
Testing and faith-based organizations (especially Northport).
Florida Department of Health (2004) data suggested increased and sustained HIV primary
prevention efforts should be targeted to African Americans with new and innovative approaches
that do not further stigmatize this group and should have prevention messages that are culturally
sensitive and developed by the community it is intended to reach. Thus, community-based
27
participatory approaches to reducing new HIV infections by community empowerment,
ownership and involvement should be utilized.
Community-based participatory approaches to diagnosing HIV infections in nonmedical settings
would require linkages with community-based organizations. As one key informant explained,
“collaboration with agencies that already have a rapport with families is key” to being able to
diagnose HIV infection outside medical settings. HANS members identified the following
community organizations that could help with testing in nonmedical settings:
 schools and alternative schools,
 faith-based organizations (e.g., churches),
 local businesses (“larger employers”) and organizations (e.g., Chamber of Commerce,
BB),
 Coastal Recovery,
 Homeless Coalition,
 Community Alliance,
 SCOSA,
 AIDS organizations with “political arms,”
 “Wellness community” organizations such as American Cancer Society,
 insurance companies, and
 Sarasota Film Festival.
Four key informants from community-based organizations described what made it easy to
network with other agencies such as those represented on HANS. One suggested networking
was made easy by the reduced costs associated with networking – “partnership is in.” Another
suggested networking was made easier when groups “remember it’s about the people” and put
aside competitiveness. Finally, one key informant explained networking with churches when the
pastor was receptive to “wellness” made it easy to network with churches.
Need more agencies to collaborate together - takes all of us working together. We are willing to
work with anybody. I don’t know why they don’t collaborate. I do know why – it’s competition
with funding. They have to remember it’s about the people. You have a lot of agencies who
come into this area and do nothing and get the funding. Key Informant
Key informants also described what made it difficult to network with other agencies. Specific to
churches, one key informant suggested some “older women” in the churches made it difficult to
network with HIV/AID agencies. Other factors that made it difficult to network included:
 recognition concerns,
 failure to keep community-based organizations informed of meetings and available
resources,
 competition for funding,
 agency representatives’ resistance (fear) to come into high risk areas, and
 “outside” agency representatives’ lack of understanding of what is going on in high risk
areas.
28
Funding so we can do outreach instead of agencies that are out like CAN that come into the
community but are not a part of the community. We’re already in the high risk area. Funding is
very important in this area. We see outreach here but we could really cut down on HIV because
we see the people all the time. Key Informant
HANS members discussed barriers to networking with businesses and churches. HANS
members suggested the focus on financial return on investment made it difficult to network with
businesses. Finally, denial of the existence of a problem with HIV and a disconnect between
pastors and the church elders’ ideas made it difficult to network with churches.
Benefits of Incorporating Testing
Needs assessment results suggested community-based agencies have much to gain from
networking with HANS members and incorporating testing into their programming, including:
(1) learning about their clients, (2) being able to report to potential funders that “we collaborate
with other agencies,” (3) being more responsive “to the people we serve,” and (4) fulfilling their
organizational mission.
It makes us more responsive to the people we serve. It’s another preventive measure. Due to
our efforts people are walking around protecting themselves. Key Informant
Facilitators to Incorporating Testing
Key informants described what would make it easy to allow HIV testing on site. Results
suggested having space at their facility that accommodated privacy was a key factor: clients need
a separate room for testing so they “feel secure talking with them and sharing ideas.” A “prior
working relationship” with CAN also made it easy to offer testing on site. Finally, being able to
offer testing in response to client-identified needs or questions raised during monthly meetings
made it easy to offer testing on site.
Barriers to Incorporating Testing
None of the key informants interviewed identified barriers to incorporating testing at their sites.
Community-based Organizations’ Needs Related to Incorporating Testing
Most key informants suggested agencies represented on HANS were “doing a good job,
especially going door-to-door in housing projects” and coming in to agencies and doing testing.
However, they were able to identify needs specific to incorporating testing on site (see Table 5).
Interestingly, one key informant suggested increased funding should be provided to agencies
already working with at-risk areas so they could increase outreach to the people they “see every
day.”
Funding so we can do outreach instead of agencies that are out like CAN that come into the
community but are not a part of community. Key Informant
29
Conclusions
This report described the methods and results of a needs assessment conducted to gather strategic
information specific to Strategy 2: ‘Testing in Nonmedical Settings’. This needs assessment
focused on gathering strategic information from HANS members, key informants from
community-based organizations, and African American and Hispanic community members that
would help HANS diagnose HIV infections in nonmedical settings in Sarasota County. More
specifically, action steps that have and have not worked, suggestions for whom and where to
focus testing efforts, information needed to adapt or tailor strategies proposed at the state level to
meet the needs of Sarasota County residents, gatekeeper information (i.e., how to access those in
most need of being tested), needs related to testing in nonmedical settings, and information
needed to establish linkages with community-based organizations were identified.
HANS members and key informants identified action steps that have worked and those that have
not worked to diagnose HIV infections in nonmedical settings. Overall, community outreach
efforts that involve advance notice or taking advantage of scheduled events such as fair or
parties, support groups, or gay bars, offering incentives geared toward the target audience, and
working with local businesses and community-based organizations to offer testing were
considered action steps that have addressed the need to diagnose infections in nonmedical
settings. Results suggested ongoing visibility and long-term relationship building with
communities were key to diagnosing HIV infections in nonmedical settings.
Action steps that have not worked well in diagnosing HIV infections in nonmedical settings have
included testing in residential neighborhoods, especially with Hispanic participants, testing the
homeless, testing in jails, testing in areas with large populations of elderly, and approaching sex
workers on the street in front of clients or pimps.
For the purposes of this needs assessment, zip code data were analyzed to reveal areas of high
risk. Results suggested 34234 and 34236 had the highest rates of HIV infection per 100,000
population between 1998-2004. These areas in addition to south Sarasota County should be
considered in need of outreach and testing. State level trends suggested women (especially
heterosexual, African American women), white MSM, all age groups with increased outreach to
youth (13 – 24 years) and older individuals (50+), and African Americans, including injection
drug users should be considered in need of increased outreach and prevention. Comparisons
between state and local trends should be used to identify priority target audience to target with
community-based testing efforts. Once priority target groups are identified, additional
information should be used to segment these groups into meaningful subgroups if using a social
marketing approach. Information from this report could be used to develop a social marketing
campaign to increase testing among African American males and females and Hispanic females
similar to those individuals who participated in the needs assessment focus groups (i.e.,
individuals receiving community-based services).
Strategic marketing information needed to adapt or tailor strategies for meeting the needs of
Sarasota County residents was collected, including information on the core benefits associated
with HIV testing and costs and barriers associated with being tested was gathered. This
30
information should be kept in mind when developing or selecting interventions designed to
facilitate testing in nonmedical settings.
The product, or the behavior being promoted, at the heart of this needs assessment was ‘testing in
nonmedical settings’. Results suggested the core benefit (i.e., what members of the target
audience receive in exchange for adopting HIV testing) to African American and Hispanic focus
group participants was “the great feeling knowing you’re negative.” The feeling of relief and
having a second chance served to motivate some participants to continue testing over time.
African American participant were particularly attracted to the idea of being offered a “second
chance” or an opportunity to “straighten” out their lives. Hispanic females did not, however,
discuss testing in terms of offering a second chance.
Although testing offers benefits to community members, results suggested they also pay a price
for being tested and face many barriers to being tested for HIV. Results suggested African
American and Hispanic community members risked embarrassment or “people knowing your
business” if they sought HIV testing at the health department or other testing sites. Participants
across male and female groups suggested “the people at the venue” are “in your business,”
“voice an opinion,” or “take too long to give results.” African American males and females
discussed the need to come back for results or extended waiting periods (e.g., two weeks) for
obtaining results as a price paid for being tested. Waiting for results was described as a “scary”
experience. African American females were particularly concerned about the potential for
receiving a positive result, suggested it would result in the lost of loss of relationships (“being
alone”) and was equivalent to receiving a “death sentence.”
HANS members, key informants, and community members discussed numerous community,
system, and individual level barriers to diagnosing HIV infections in nonmedical settings (see
Table 2 for a summary). Fear and uncertainty, compounded by having to wait for results, were
the most frequently mentioned barrier to being tested by African Americans. Sources of fear
included fear of finding out (a.k.a., “not wanting to know” or “denial”), fear of the unknown, and
fear of what others would say about them. African American males also suggested having to go
to the health department was a barrier to being tested because of the fear of being seen by other,
having to answer questions, and also from being turned away. African American females also
suggested not having the “nerve” to go because of embarrassment and anger made it difficult to
be tested. Finally, not knowing how HIV is transmitted, fear of needles, and having to deal with
people were mentioned as barriers to being tested.
One barrier to diagnosing HIV infections in Sarasota County identified by HANS was failure to
obtain testing results once tested. Community members suggested providing quick or instant
result, explaining the pros and cons of picking up results, and holding half of the offered
incentive until results were obtained would address this barrier. Educating community members
as to what will happen if they receive a positive result may also help overcome this barrier.
Hispanic females suggested two key barriers to being tested: unawareness of or inability to
access free testing and fear of being exposed or facing personal questions (e.g., fear that someone
they know will see them, fear that parents will find out they were tested). Hispanic females also
31
suggested not wanting to know if they have HIV was a barrier to being tested. Finally, not being
educated about HIV and fear of needles were mentioned as barriers to being tested.
Key informants also described what made it difficult to access testing services. Two out of four
key informants suggested access was not the issue as long as organizations continue to “come
into the community with testing.” Further, key informants suggested most churches support the
CAN network and their efforts to increase testing. The key barriers to taking advantage of access
to testing, key informants suggested, were being uniformed, “walk[ing] around in denial,”
privacy concerns, and fear of being shunned.
HANS, key informant, and community member suggestions for where to place information about
testing organized into five main categories of information channels, including: “close to home,”
“community organizations/services,” “local businesses,” media,” and “social clubs” and
summarized in a table. Differences across genders and ethnicities were discussed. For example,
community members suggested HANS rely on inexpensive and local information channels for
reaching community members. Flyers and word-of-mouth were mentioned as the most effective
media for reaching community members. A variety of settings for placing information about
testing that have not been utilized in the past (e.g., check cashing stores, flea market) were
identified. In addition, numerous potential testing settings were identified and organized
according to the following categories: “close to home,” “community organizations/services,”
“local businesses,” and “social clubs.” Tables 3 and 4 should be used when placing information
in the community and planning community-based testing events. When selecting testing sites,
the need to help community members overcome barriers identified should be considered,
including stigma, privacy and confidentiality concerns, transportation, and the need for
consistency in testing locations.
Results suggested several key strategies for reaching those in most need of testing, including:
education and awareness, taking advantage of test opportunities when individuals come in for
other symptoms (e.g., itching, burning, unexplained illness), utilizing peer-to-peer education and
advocacy, building relationships with communities, increasing visibility in the community, and
utilizing spokespersons who are known and trusted (e.g., church members) to spread testing
information and emphasize the benefits of being tested.
Key informants in Newtown suggested HIV infection in their community was ‘invisible’. It is
only through the efforts of local agencies and encounters with infected family members or
friends that the prevalence of HIV in Sarasota County’s high risk areas came to light. To
increase visibility in the community, HANS will need to establish linkages with agencies that
already have a relationship with members of the community (e.g., HIPPY), work with churches,
ministers, and the Ministerial Alliance to influence the African American Church, address
HIV/AIDS within the framework of “wellness, ” hold multiple annual testing drives, make
community announcements that offer “private, individual help,” utilize flyers and word of
mouth, and place information in identified information channels.
Lay individuals and health professionals were identified as the best spokesperson for reaching
individuals at risk for HIV infections. Overall, results from discussions with African Americans
suggested the best spokesperson might be a combination of trained ‘family members’ who had
32
cared for or lost someone to HIV/AIDS and a doctor who could share medical information.
Hispanic females were more trusting of health professionals, including a doctor, public health
workers, or an HIV educator. Only one suggested PLWHA as a trusted source of information.
Community-based organization (e.g., resources), system (e.g., increased collaboration), and
community member needs (e.g., fear reduction) related to diagnosing HIV infections outside of
medical settings were identified and summarized in Table 5. The extent to which each of these
identified needs has already been addressed should be determined. Unmet needs should be
considered in terms of priority and feasibility of being met by the resources available to HANS.
Finally, strategies for addressing each need identified as unmet, priority, and feasible to meet
should then be decided upon and action steps and timeline for meeting each delineated. HANS
members, key informants, and community members shared numerous ideas for meeting unmet
needs, such as making the testing process, including results distribution, quick and easy (e.g.,
adopt Rapid Testing, have multiple sites, after hours testing, consistent testing sites).
Possible linkages (e.g., HANS and local businesses) that may assist Sarasota County in
implementing new models for diagnosing infections outside medical settings were identified.
Emphasis was placed on determining how to link with community-based organizations since
community-based participatory approaches to reducing new HIV infections by community
empowerment, ownership and involvement has been recommended as a key strategy for
addressing HIV infection within high risk areas. Community-based participatory approaches to
diagnosing HIV infections in nonmedical settings would require linkages with community-based
organizations. Results from this needs assessment identified facilitators to linking with
community-based agencies (“partnership is in”), barriers to linking e.g., competition for
funding), benefits of offering testing in community-based settings (e.g., fulfilling organizational
mission), facilitators to incorporating testing (e.g., space that accommodates privacy), and
community-based organizations’ needs related to incorporating tested (e.g., funding, ongoing
relationships with testing agencies, information). Fortunately, key informants were unable to
identify any barriers to incorporating testing on site.
Next Steps – Results to Action
The following recommended steps can be used to turn needs assessment results into concrete
strategies for addressing ‘Testing in Nonmedical Settings’:
1. HANS members read, evaluate, and discuss the needs assessment report.
2. HANS members rate identified needs (see Table 5) as to the extent to each has been met,
priority, and feasibility (see “Prioritizing Needs Worksheet” in Alfonso, 2004).
3. HANS members develop a ‘Testing in Nonmedical Settings’ strategy team.
4. The ‘‘Testing in Nonmedical Settings’ strategy team uses the “Translating Results into
Action Worksheet” (Alfonso, 2004) to brainstorm data-based strategies for addressing
unmet needs and achieving behavior change among the target audience.
5. The strategy team presents results to the larger group and obtains feedback.
6. The strategy team finalizes strategies and identifies indicators of success.
7. The existing strategic plan is updated to include ‘Testing in Nonmedical Settings’
outcomes, strategies and indicators of success.
33
References
Alfonso, M.L. (2004). HIV/AIDS needs assessment manual: How to gather strategic
information. Sarasota, FL: HIV/AIDS Network of Sarasota, Sarasota County Health
Department.
CDC. (2003a). Advancing HIV prevention: New strategies for a changing epidemic – United
States. MMWR, 52(15), 329-332.
CDC. (2003b). Procedural guidance for selected strategies and interventions for community
based organizations funded under program announcement 04064. Atlanta, GA:
National Center for HIV, STD, and TB Prevention, Division of HIV/AIDS Prevention.
http://www.cdc.gov/HIV/partners/pa04064_cbo.htm (Accessed 10/7/04)
McCormack Brown, K., Alfonso, M.L., & Bryant, C.A. (2004). Obesity Prevention
Coordinators’ Social Marketing Guidebook. Tampa, FL: Florida Prevention Research
Center at the University of South Florida. Reprinted with permission.
Centers for Disease Control & Prevention (2002). HIV/AIDS surveillance report, 13(2), 144.
Centers for Disease Control and Prevention, National Center for HIV, STD and TB Prevention,
Division of HIV/AIDS Prevention. How can people who use injection drugs reduce their
risk for HIV infection?
Retrieved November 14, 2004, from http://www.cdc.gov/hiv/pubs/faq/faq26.htm
Centers for Disease Control and Prevention. (2003). Incorporating HIV prevention into the
medical care of persons living with HIV: Recommendations of CDC, the Health
Resources and Services Administration, the National Institutes of Health, and the HIV
Medicine Association of the Infectious Diseases Society of America. MMWR, 55(RR12),
1-24.
Florida Department of Health. (2003a). Florida HIV/AIDS data profile. Retrieved November
14 from http://www.doh.state.fl.us/disease_ctrl/aids/trends/msr/MSR0704.pdf
Florida Department of Health. (2003b). HIV/AIDS in young people Florida, 2003 Fact Sheet.
Retrieved November 14, 2004, from
http://www.doh.state.fl.us/disease_ctrl/aids/updates/facts/2003FS-YoungPeople.pdf
Florida Department of Health, (2004). State of Florida 2004-2006 HIV/AIDS prevention plan.
Retrieved November 14, 2004 from
http://www.doh.state.fl.us/disease_ctrl/aids/compln/PrevPlan-2004-08.pdf
34
Table 1
Community Focus Group Participant Characteristics: Testing in Nonmedical Settings
Gender
Male
Female
Age
13 – 19
20 – 24
25 – 34
35 – 44
45 – 54
55 or more
Hispanic
Yes
No
Race/Ethnicity
African American
Hispanic
White
Residence
Rent apartment
Live with family
Live with friends
Rehabilitation
center
Homeless
Other
Residential Zip Code
34210
34232
34234
34235
34237
34240
34243
Sexual Orientation
Heterosexual
Bisexual
Hispanic
Females
African
American
Males
(Group 1)
African
American
Males
(Group 2)
African
American
Females
(Group 1)
African
American
Females
(Group 2)
Total
0
5
7
0
9
0
0
4
0
7
16
16
0
0
2
2
0
1
0
0
1
1
5
0
0
1
3
2
3
0
0
0
4
0
0
0
0
1
4
2
0
0
0
2
14
7
8
1
5
0
0
4
0
5
1
1
0
7
6
17
0
5
0
7
0
0
8
0
1
4
0
0
7
0
0
26
5
1
4
1
0
4
1
0
3
2
0
4
0
0
7
0
0
22
3
0
0
0
0
2
0
0
5
0
0
0
0
0
0
0
0
7
0
0
0
0
1
0
3
1
0
0
0
0
6
0
0
0
0
0
0
9
0
0
0
0
0
0
4
0
0
0
1
1
0
4
0
0
1
1
1
1
23
3
1
1
5
0
7
0
8
1
4
0
7
0
31
1
35
Table 2
Barriers to HIV Testing in Nonmedical Settings
Geographic/Community
 Affluence
 Conservatism
 Dangerous situations
 Difficulty reaching high
risk or hard to reach
 Divide between north
and south county
 Lack of visibility in the
community
 Large, spread out
territory to cover
 Poor turnout
 School policies
System
 Bureaucracy around HIV
 Competing job duties
 Funding for outreach,
intervention, and advertising
 HIPPA policies
 Insufficient time and staffing
resources
 Knowing when and where to
test
 Lack of CDC funding for
presumed negatives
 Law enforcement efforts that
shut down testing sites
 Only two interventions
approved for HIV high risk
negatives
 Rapid Testing Waiver site
listing requirement
 Results distribution issues
 Underdeveloped infrastructure
in south county
Individual – Adults
Most Frequently Mentioned
Barriers Identified by Community
Members:
 Denial, not wanting to know
status
 Fear of: finding out, the
unknown, what others will say,
being exposed, facing personal
questions, being shunned,
needles
 Having to deal with people –
questions, discrimination
 Having to go the health
department
 Having to wait for results –
fear and anxiety
 Inability to access free testing
 Stigma – privacy concerns,
being shunned
 Unawareness of testing sites
Other Barriers Mentioned by
Community Members:
 Anger, embarrassment
 Drug use
 Lack of education about HIV
 Low self-esteem
Individual – Youth
Barriers Identified by
HANS members and Key
Informants:
 Fear of parents finding
out
 Feelings of
invincibility
 Lack of awareness of
right to be tested at 12
years-of-age
 Parent denial
36
Table 2
Barriers to HIV Testing in Nonmedical Settings Continued
Geographic/Community
System
Individual – Adults
Barriers Identified by HANS
members and Key Informants:
 Power and control issues
 Transportation (especially in
south county)
 Resistance to knowing status
 Not knowing where
nonmedical testing sites are
 Stereotypes or myths of whom
HIV affects (e.g., sex workers,
gays)
 Lack of awareness of
HIV/AIDS in Sarasota County
 “Lot of people try to sweep it
under the rug”
 Lack of education about
HIV/AIDS and available
testing services
 Reluctance to come to an
“open venue”
 Belief that “if I don’t know,
then I don’t have to worry
about it”
Individual – Youth
37
Table 3
Where to Place Information about Testing in Nonmedical Settings
Key Informant Suggestions
Community
organizations/services:
 support groups
 churches
 Ministerial Alliance
 preschools
 Head start
 Boys and Girls Clubs
 library
Local businesses:
 grocery stores and
corner groceries
 Humphrey’s Sundries
 Lans’ Seafood
Restaurant
African American Male
Suggestions
Close to home:
 any public place
 apartments
 bulletin boards
 in the neighborhood
 poles on US 41
 “walking billboards”
(leaders)
Community
organizations/services:
 churches
 rehabilitation centers
 shelters
 Salvation Army
 schools
Local businesses:
 “on the job”
 check cashing
 drivers license places
 grocery stores
 motels/hotels on US 41
 pawn shops
 stores
Social clubs:
 bars
One man suggested rap videos.
African American Female
Suggestions
Close to home:
 community center
 door-to-door
 inside the newspaper
 trees
Community
organizations/services:
 churches
 hospital
 Manatee Community
College
Local businesses:
 convenience stores
 daycare centers
 kids who sell papers
 grocery stores
 music recording studios
 restaurants (e.g.,
McDonalds)
 Wal-Mart
Social clubs or “hot spots”: Club
Heat, Club Envy, Bungalow,
Gilligan’s
Media: Tempo News, Channel 6
News, SNN, 95.7, 98.7
Hispanic Female
Suggestions
Close to home:
 information in
monthly bills,
coupons
Local businesses:
 local department
store
 neighborhood
stores
 restaurants
Media:
 local radio station
 television
commercial
Social clubs:
 nightclubs,
nightclub
restrooms
38
Table 4
Nonmedical Testing Settings
HANS Suggestions
Close to home:
 close but outside of
residential areas
 community centers
 crack houses
 health fairs
 skate parks
 streets in high-risk
areas (e.g., US 41
between Myrtle and
University Avenue)
Community
organizations/services:
 churches
 emergency response
sites
 Girls/Boys Clubs
 jails
 schools/alternative
schools
Local businesses:
 gas stations
 malls (including one
in Port Charlotte)
Social clubs:
 bars
Key Informant
Suggestions
Close to home:
 community
complexes
 health/community
fairs
 housing complexes
(including
“offline”
apartments)
 housing,
recreation,
community centers
 local parks
Community
organizations/services:
 Boys and Girls
Club
 health department
 libraries
 Goodwill
industrial office
 local NAACP
 MLK community
fund raising drive
 support or parent
groups
African American Male
Suggestions
Close to home:
 fairs/parks (“set
up a stand”)
 mobile units
Community
organizations/services:
 churches
 clinics
 health
department
 jails (mandatory
testing)
 Sarasota
Memorial
Hospital
 Resurrection
House
 churches
Local businesses:
 check cashing
with finger
printing
 malls (booth)
African American
Female Suggestions
Close to home:
 At home
 Community/
Activity Center
 Housing
Authority
properties
(Venice
Housing)
 mobile units
Community
organizations/services:
Churches (New Bethel)
 Emergency
Services
Agencies (e.g.,
Goodwill)
 HIPPY
 Manatee
Community
College
 nursing homes
 True Vine Clinic
Local businesses:
 Pharmacies
(CVS)
Hispanic Suggestions
Close to home:
 fairs
 mobile testing
Community
organizations/services:
 schools
Local businesses:
 flea markets
Social clubs:
 nightclubs
(bathrooms)
39
Table 5
Testing in Nonmedical Settings Needs Summary Table









Community-based
Organization Needs
Agency (HANS members)
participation in health fairs
(i.e., test during fair)
Increased initiative from
outside agencies (i.e., call
the program director and
explain what they are
going to do)
Condoms
“The right materials” for
their clients
Information
Private workshops,
education
Information on meeting
and available resources
Funding
Ongoing relationships
with testing agencies
System Needs
 Increase collaboration between Health Department and
local agencies represented on HANS
 Increase visibility
 Give credit to HANS for successful efforts
 Resources for cultivating relationships with venues,
community organizations, and communities within
Sarasota County
 Infrastructure development in South County
 Mandatory HIV/Syphilis testing at intake in jails
 Availability of Mobile Unit in Sarasota County
 Adopt Rapid Testing
 Change in site listing requirement on Rapid Testing
Waiver
 Funding for interventions with presumed negatives
 More interventions for high risk negatives
 Revise School Board Policy to include testing in
comprehensive education
 Include local businesses in HIV prevention efforts
 Increase community control over HIV prevention (e.g.,
educate community members so can “pass on”)
 Collaborative grant opportunities
Community Member Needs















Fear reduction
Support
Quick results
Ongoing exposure to
HIV/AIDS information and
testing
Education and increased
awareness
Information on safe sex and
drug use
Condoms
Clean needles
Food
Easy access (i.e., more testing
facilities in the community,
mobile testing)
More testing sites
Transportation
Area conducive to privacy
and confidentiality
Child care
24 hour access
40
Appendix A
System Analysis Guide
Strategy 2: HIV Testing Outside of Medical Settings
Tool: System Analysis Guide
Use the following questions to guide a brainstorming session with representatives already
involved in implementing this strategy and other key stakeholders (e.g., planning group
members). Be sure to assign a note taker and a facilitator.
1. What has been done to implement new models for diagnosing HIV infections outside of
medical settings?
a. What worked? What didn’t work?
b. What plans are there for addressing this issue?
c. What formal mechanisms are in place?
d. Are there any needs from the state that are not being met?
2. Do characteristics of our county (e.g., rural) affect implementing new models for
diagnosing HIV infections outside of medical settings? If so, how?
3. What aspects of the system need to change to allow for the development and
implementation of new models for diagnosing infections outside of medical settings?
4. How can we best change the system to support this strategy?
5. How we can develop new models? How we can do things differently in innovate ways?
6. Where do we need which types of services?
7. Who are the populations at risk and who are hard to reach? What ideas do you have for
reaching them?
8. What community organizations (e.g., churches) could help us address this strategy?
role can they play?
What
9. What barriers (e.g., staffing, funding, emphasis on anonymity) block progress toward this
strategy?
10. How can you or your agency help to implement new models for diagnosing HIV
infections outside medical settings? What resources do you need to incorporate this
strategy into your work?
11. What linkages could be made that would help us implement this strategy?
41
Appendix B
Interview Guide – Gatekeepers & Venue Representatives
Strategy 2: HIV Testing Outside of Medical Settings
Tool: Interview Guide – Gatekeepers & Venue Representatives
Person Interviewed: ________________________ Date: ____________________
Length of Interview: _______ Zip Code/Target Group: ______________________
Introduction
My name is [name]. I’m helping to conduct a needs assessment for [name of county]. I want to
first thank you for taking the time to talk to me today. The purpose of today’s conversation will
be to discuss implementing new models for diagnosing HIV infections outside of medical
settings. You’ve been invited to participate because of your contacts with individuals we’re
trying to reach. We’re interested in learning more about individuals who tend to be hard to reach
when it comes to HIV testing. Your participation is voluntary, so if there’s a question that you
don’t feel comfortable answering or if you’d rather not participate just let me know. Your
comments will be kept confidential. Your name will not be included in any report. If you don’t
have any questions, let’s get started.
Accessing Hard to Reach
How long have you worked in this community?
What are the most important things we should know about this community?
What is the best way to reach members of this community who may be at risk for HIV?
PROBE: When? Where? How?
PROBE: How can we gain access? Who should we talk to?
Access to Testing and Services
What makes it difficult for community members to access services like HIV testing?
What would make it easier to access HIV testing services?
PROBE: Where could we offer rapid HIV testing in the community?
What could we do to encourage testing?
Wrap Up
That was my last question. Would you like to add anything else?
Thank you very much for your participation today.
42
Appendix C
Interview Guide – Key Informants (e.g., churches, local businesses)
Strategy 2: HIV Testing Outside of Medical Settings
Tool: Interview Guide – Key Informants (e.g., churches, local businesses)
Person Interviewed: _____________________ Site: _____________ Date:________
Length of Interview: _______ Zip Code/Target Group: ______________________
Introduction
My name is [name]. I’m helping to conduct a needs assessment for [name of county]. I want to
first thank you for taking the time to talk to me today. The purpose of today’s conversation will
be to discuss implementing new models for diagnosing HIV infections outside of medical
settings. You’ve been invited to participate because of your contacts with individuals we’re
trying to reach. Your participation is voluntary, so if there’s a question that you don’t feel
comfortable answering or if you’d rather not participate just let me know. Your comments will
be kept confidential. Your name will not be included in any report. If you don’t have any
questions, let’s get started.
Background [optional for business/store owners]
Tell me about HIV in your community.
Community Response [may not be relevant for business/store owners]
What are you already doing to address HIV in the groups you serve?
PROBE: What makes it easy? What makes it difficult?
What type of support does your [church, shelter, store, school, etc.] need to address HIV?
PROBE: How can we help you?
Incorporating Testing
How can HIV testing be incorporated into your work?
PROBE: What would make it easy to allow HIV testing on site?
What would make it difficult to allow HIV testing on site?
What resources do you need to make that happen?
What would your [church, shelter, store, school, etc.] gain from allowing HIV testing on site?
What types of incentives could we offer to encourage people to be tested?
Wrap Up
That was my last question. Would you like to add anything else?
Thank you very much for your participation today.
43
Appendix D
Focus Group Guide (Community Members under the age of 50)
Strategy 2: New Models for Diagnosing HIV Infections Outside of Medical Settings
Tool: Focus Group Guide (Community Members under the age of 50)
Date: ______________
Location: ______________
Facilitator: ______________
Duration: _______________
Introduction (10 minutes for entire section)
 Thanks for coming.
 My name is __________
 I’ve been asked to talk with you about HIV testing in Sarasota County. Your assistance
is important.
 You were invited to participate because you are a member of this community or live in
this neighborhood.
 Your participation is voluntary. Feel free to not answer a question if you feel
uncomfortable. You have the right to stop participating at any time.
 Focus group is like a conversation but focuses on a few specific topics.
Purpose of Project
 We’re talking with people living with HIV about their experiences with HIV-related
services and attitudes toward prevention.
 We are interested in all your ideas, comments, and suggestions.
 No right or wrong answers: want both positive and negative comments
 Please feel free to disagree with each other, respectfully of course, and ask the group
questions.
Procedures





Should last about an 90 minutes
Group discussion, so don't wait to be called on
Please speak one at a time so I can get your opinions on the tape.
We are recording so we don’t leave out anything you have to say.
Confidential –we will not use your name, address, or any other identifying information in
reports or other materials related to this study.
 We are going by first names only.
 We have a lot to cover so I might change the subject or move ahead, but let me know if
you want to add something. Don't let me cut you off.
 The bathrooms are ____. Feel free to get up at any time during our discussion.
Consent forms and participant questionnaire
44
Before we begin the discussion, I would like to read the consent form given to you when you
came in. [Read the consent form out loud.] Please sign a copy of the consent form indicating
your agreement to participate in the study. We’ve provided you with a copy for your records.
We would also like to collect the questionnaires we asked you to complete when you arrived. As
we explained before, the questionnaire will give us some information about your background.
We will use this information for descriptive purposes only. In other words, we will never use any
identifying information such as your name or the name of the agency where you get your
services in any of our reports.
Please pass the completed questionnaire to ____________________.
Warm Up (3 minutes)
Let’s get started. I’d like to first go around the table and get to know each of you a little better.
Please tell us your first name and what you like the most about Sarasota.
Opening Question (5 minutes)
When I say “HIV” what’s the first thing that comes to mind?
Key Question (25 to 30 minutes)
Who should be tested for HIV?
What makes someone go to be tested for HIV?
PROBE: What makes it easy to be tested for HIV?
What makes it difficult to be tested for HIV?
What would they have to do if they want to be tested?
PROBE: Where would they go to be tested for HIV?
Once someone has been tested, what do they have to do to get their results?
45
Key Question (25 to 30 minutes)
For the next several minutes, I would like for you to imagine you’re a task force that has been
asked to come up with ways to encourage people in the community to be tested for HIV.
Besides the health department, where would you offer testing in the community?
How would you get the word out about HIV testing at these sites?
Probe: When are people in the right frame of mind to hear about HIV testing?
Probe: Where would you put information about testing in the community?
Who would they trust the most to give them information about HIV testing?
What would you do to make being tested appealing?
Probe: What benefits would you offer?
What would you do to encourage people to pick up their results?
Probe: How would you make it easy?
Summary & Wrap Up (5 minutes)
Do you have any other comments to add?
Thank you very much for participating in this focus group. The information you have provided
has been very helpful. This information will be used to help the HIV/AIDS Network of Sarasota
County make informed decisions about service priorities and use of resources.
Don’t forget to pick up your reimbursement before you leave. Thank you again for your help.
46
Appendix E
Pre-group Questionnaire (A)
Note: All the information collected here will be kept strictly confidential. If you feel uncomfortable answering
any question, you can leave it blank.
1. Gender
6. What is your sexual orientation?
□
□
□
Female
Male
Transgender
□
□
□
□
□
□
13 to 19 years
20 to 24 years
25 to 34 years
35 to 44 years
45 to 54 years
55 years or older
2. Age
3. Answer both parts of this question.
Ethnicity:
□
□
Hispanic or Latino
Not Hispanic or Latino
Race: (You may choose more than one.)
□
□
□
□
□
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific
Islander
White
4. Where are you living now?
□
□
□
□
□
□
□
Rent/own house/apartment
Live with family
Staying with friends
Halfway house or drug treatment
program
Shelter
On the street - no home
Other (specify)
________________________________
5. What is the zip code where you live?
_____________________________
□
□
□
□
Heterosexual/straight
Gay/Lesbian
Bisexual
Unsure/questioning
________________________________
7. Highest level of education completed
□
□
□
□
□
□
□
8th grade or less
Some high school but didn’t graduate
High school graduate or GED
Vocational certification
Associate degree
Some college
Graduated College
8. Current employment status
□
□
□
□
□
Employed full-time
Employed part-time
Unemployed
Volunteer work
Other
____________________________
9. Have you ever been tested for HIV?
□
□
□
Yes
No
Unsure
10. When was the last time you were
tested for HIV?
□
□
□
□
□
Never
Less than 12 months ago
1 to 4 years ago
5 to 9 years ago
10 years or more
47
Appendix F
Cuestionario Del Pre-grupo (A)
Nota: Toda la información recogida aquí será guardada terminantemente confidencial. Si usted se siente
incómodo contestando a cualquier pregunta, usted puede irse él en blanco.
1. Género
□
□
□
6. ¿Cuál es su orientación sexual?
Femenino
Masculino
Transgender
□
□
□
□
Heterosexual
Homosexual/Lesbiana
Bisexual
No seguro
2. Edad
________________________________
□
□
□
□
□
□
13 a 19 años
20 a 24 años
25 a 34 años
35 a 44 años
45 a 54 años
55 años o más
7. El nivel de la educación más alto terminado
□
□
□
3. Conteste a ambas partes de esta pregunta.
Pertenencia étnica:
□
□
Hispano o Latino
No hispano o Latino
Raza: (usted puede elegir más de uno.)
□
□
□
□
□
Indio americano o Nativo de Alaska
Asiático
Moreno
Nativo de las islas en la pacífica
Blanco
□
□
□
□
8vo grado o menos
Alguna Escuela secundaria pero no
graduó
Escuela secundaria graduado o
equivalente
Vocacional certificación
Grado de asociado
Alguna colegio
Graduada de Universidad
8. Estado de empleo actual
□
□
□
□
□
Empleado tiempo completo
Medio tiempo
Desempleado
Voluntario
Otro
____________________________
4. ¿Dónde usted ahora está viviendo?
□ Renta/poseer casa/apartamento
□ Viva con su familia
□ Esta con amigos
□ Instituto de rehabilitación
□ Refugio
□ En la calle - no casa
□ Otro (especifique)
________________________________
5. ¿Cuál es su código postal de donde usted
vive?
_____________________________
9. ¿Le han hecho la prueba del VIH alguna
vez?
□
□
□
Sí
No
No seguro
10. ¿Cuándo fue la última vez que le hiciera
la prueba del VIH?
□
□
□
□
□
Nunca
Menos de 12 meses
1 a 4 años
5 a 9 años
10 años o más
48
Appendix G
HANS Testing Focus Group Discussion Results
Strategy 2: Implement New Models for Diagnosing HIV Infections Outside of Medical Settings
Participants: 15 representatives from health department (6) and local agencies (9) addressing
HIV/AIDS
Duration: approximately 90 minutes
Moderator: Moya Alfonso Co-Moderator: Judit Illyes
Preliminary Results: HANS Testing Discussion
Previous Efforts to Diagnose HIV Infections Outside of Medical Settings:











Project Unity
Crack houses
Health Fairs
Local gay bars
Venues Project
Newtown Community (BP gas station, Newtown Community Center, True Vine Baptist
Church)
CAN efforts to work with faith-based communities (e.g., Pastor Summit, focus groups)
Jails
Homeless Shelters
Latino Venues Trailer Park site
South County efforts (e.g., testing in Northport, skate parks)
Factors Associated with Successful Efforts:
 Advance notice
 Incentives (e.g., CDs geared toward target audience, concert tickets, local business gift
certificate, Wal-Mart or Publix gift cards)
 Outreach
 Group level intervention and education
 Health Fairs (“take away some of the stigma”)
 Going to local gay bars between 10 pm and 2 am
 The Venues Project
 Visibility and long-term relationship building in communities (e.g., Newtown)
 Scheduled events at job fairs and parties (e.g., tattoo party)
Factors Associated with ‘Unsuccessful Efforts’:
 Testing in residential neighborhood (e.g., trailer park)
 Testing the homeless, the turnout is very poor (e.g. at the Resurrection House)
 Testing in the jails (i.e., “many prisoners willing to take a Syphilis test, but they refuse an
HIV test”).
49
 Testing in areas with large population of elderly (e.g., Northport)
 Approaching sex workers on street in front of clients/pimps
Barriers to Testing in Non-medical Settings
Individual







Stigma (e.g., people in neighborhood seeing someone being tested)
Power and control issues (e.g., prostitutes/men)
Transportation to testing sites (especially in South County)
Individual resistance to knowing status
Individuals not knowing where non-medical testing sites are
Stereotypes/Myths of whom HIV affects (e.g., sex workers, gays)
Lack of awareness of HIV/AIDS in Sarasota County
General

















Poor turnout
Not reaching high risk or hard to reach
Dangerous situations (e.g., testing in crack houses)
Results distribution issues
“Very large territory” to cover
Insufficient resources (time, funding, staffing)
Divide between North and South Sarasota County
Knowing when and where to test
Lack of infrastructure in South County (e.g., new employees have more difficult time
establishing credibility than those in North)
Rapid Testing – have to have sites listed on waiver
Lack of CDC funding for presumed negatives and only two interventions approved for
HIV high risk negatives
Participation in HANS represents only small part of job for most HANS members
Bureaucracy around HIV
Lack of visibility in the community
Expense in advertising testing opportunities
Law enforcement (e.g., shut down crack house)
HIPPA
Specific to Testing Adolescents:






Fear of parents finding out
School board policies and resistance to testing and comprehensive sex education
Lack of awareness of right to be tested at 12 years of age
Parent denial
Conservatism in Sarasota County
Government focus on abstinence only (schools, faith-based programs)
50
Barriers to Working with Businesses
 Focus on financial return on investment
Barriers to Working with Faith-based Organizations
 “Our congregation does not have a problem with HIV”
 Disconnect between pastors’ and the church elders’ ideas
Characteristics of Sarasota County that Affect Diagnosing HIV Infections Outside of
Medical Settings





Conservatism
Policies (schools) and resistance to testing and comprehensive sex education
Divide between North and South Sarasota County
“Very large territory” to cover
Transportation to testing sites (especially in South County)
Facilitators to Testing in Non-medical Settings










Knowing when and where to reach “pockets” of at-risk
Relationships with communities (e.g., targeted individuals, local venues)
Education and awareness
Visibility in community
Adequate resources, including staffing (e.g., teams to go into dangerous settings,
counselor availability)
Existing agencies in North County give credibility
“Effort, savvy, and money”
Individuals come in for other needs (e.g., “itching, burning”)
Individuals share information and resources (e.g., brochures) with others, especially
youth sharing information with parents
Using spokespersons who are known and trusted (e.g., church members)
Recommended System Changes
 Increase collaboration between Health Department and local agencies represented on
HANS
 Increase visibility
 Give credit to HANS for successful efforts
 Resources for cultivating relationships (e.g., venues, community organizations,
communities within Sarasota County)
 Infrastructure development in South County
 Mandatory HIV/Syphilis testing at intake in jails
 Availability of Mobile Unit in Sarasota County
 Adopt Rapid Testing
 Revise School Board Policy to include testing in comprehensive education
51
 Include local businesses in HIV prevention efforts
 Increase community control over HIV prevention (e.g., educate community members so
can “pass on”)
 Collaborative grant opportunities
Innovative Ideas for Diagnosing HIV infections Outside of Medical Settings
 Develop relationships and trust and increase community support
 Build relationships with local businesses
 Teach pastors to “sell” HIV testing to other pastors and elders and to go to congregations
with “compassionate awareness”
 Social marketing campaign to increase community buy-in (i.e., awareness of HIV in
Sarasota county, dispel myths/stereotypes, increase openness to testing)
 Replicate “unique partnership between True Vine Baptist Church and the Sarasota
County Health Department
 Schools nurses could provide education and offer testing (e.g., Lee County effort)
 Work with organizations of other health concerns such as ACS – link stigmatized health
concern (HIV/AIDS) with more ‘acceptable’ issue (e.g., cancer, heart health)
 Set up space or kiosk in Sarasota Square mall
 HANS members do “low-level pro-bono” work
 Brainstorming of feasible approaches
Possible Non-medical Testing Settings
 Streets in high-risk areas (e.g., US 41
between Myrtle and University
Avenue)
 Community centers
 Gas stations
 Locations close to but outside of
residential areas
 Health Fairs
 Jails
 Bars
 Crack houses
 Malls
 Emergency Response Sites in the
community
 Skate parks
 Schools & Alternative Schools
 Girls/Boys Clubs
 Churches
 Other neighboring counties (e.g.,
malls in Port Charlotte)
Populations at Risk







Sex workers and their clients
Wives of promiscuous husbands
Gay men with unfaithful partners
Adolescents, particularly those who participate in group sex activities
Prisoners
Poor/underserved (Northport Ukrainian community)
College students (USF, MCC)
52
Community Organizations that Could Help with Testing in Non-medical Settings
 Schools & Alternative Schools
 Faith-based organizations (e.g., churches)
 Local businesses (“larger employers”) and organizations (e.g., Chamber of Commerce,
BB)
 Coastal Recovery
 Homeless Coalition
 Community Alliance
 SCOSA
 AIDS organizations with “political arms”
 “Wellness community” organizations such as ACS
 Insurance companies
 Sarasota Film Festival
How HANS Members Can Help Implement New Models for Diagnosing HIV infections
Outside of Medical Settings







Build on strengths (e.g., commitment, desire)
Improve communication and collaboration
Participate in community efforts to address this issue
Encourage open dialogue
Focus on early prevention (e.g., youth)
Focus on education and outreach with testing
Help facilitate change (e.g., meet with other organizations, lobby for policy/legislative
change, work on collaborative grant opportunities)
 Educate those in positions of power (e.g., health care providers, business leaders)
 Empower community (e.g., one-on-one education so can pass on to others)
New Linkages to Help Address Testing in Non-medical Settings








Testing with “venue development and relationship building”
HIV and STD at the Health Department
HANS and local businesses
Charlotte County and [South] Sarasota County
Manatee County and Sarasota County (e.g., Manatee County Rural Services)
HIV and less stigmatized health concerns (e.g., cancer)
Health Department and Clinics (e.g., Comprehensive Care Clinic)
Testing and faith-based organizations (especially Northport)
53
Appendix H
Key Informant Interviews Summary
Strategy 2: HIV Testing Outside of Medical Settings
Tool: Interview Guide – Gatekeepers & Venue Representatives
4 Key Informant Interview Conducted in December 2005 and January 2006 (program
coordinators, family advocates)
How long have you worked in this community?
Responses: 10 years, 11 years, 20 years, 27 years
What are the most important things we should know about this community?
Responses: people have to trust outsiders before they let them into their lives and share
confidential information with them; local media sources such as community paper, Sarasota
Herald, flyers and brochure and local businesses are best information channels; people are
willing to participate if things are explained to them – if just “drop” things on them, “will not get
a response – “it’s the presentation”; established agencies/advocates in the neighborhoods may be
concerned about grant competitiveness from outside agencies wanting to come in; must “get to
know the people”
Tell me about HIV in your community.
Responses: “don’t know if people have it until after they die”: information from agencies is key
to knowing status; community members fear/shun those with HIV until they “get a full
understanding of it”; important for trusted church members to explain and discuss HIV/AIDS
with elders in the church, particularly women in the 35 to 44 age range; “running rampant” in
Newtown – “we could do more” (e.g., workshops, AIDS awareness); HIV/AIDS needs more
visibility (e.g., flyers, conversations, town hall meetings, churches); local agencies “do a lot of
services for HIV but don’t get condoms”
What is the best way to reach members of this community who may be at risk for HIV?
Responses: Collaborate with agencies that already have a relationship with them; approach
churches with the idea of “wellness”; hold 2 or 3 annual events in the community that involve
churches, organizations, preschools, head start, library; make community announcements but
offer “private, individual help”; put flyers up in churches, grocery stores (e.g., Humphrey’s
Sundries at Osprey and MLK, corner groceries, Lan’s Seafood Restaurant on MLK, Boys and
Girls clubs, send to Ministerial Alliance for them to distribute; have minister support testing;
word of mouth (through HIV support groups, churches, etc.)
What are you already doing to address HIV in the groups you serve?
54
Responses: offer HIV and life management skills; network with cross section of “experts” from
the health department; “run it past” pastor at church – to present the “wellness idea”; give
condoms, offer support groups, testing; invite organizations that address HIV to “come to any
special meetings or events we have”; have representatives from HIV organizations come to
parent meetings; allow testing onsite; incorporate testing into “our planning”; had someone come
in and talk to a group of youth in educational class
What makes it easy to network?
Responses: All society is looking at costs – that’s where it counts – cuts costs – partnerships is
in, volunteers; “have to remember it’s about the people”; every church is different but if pastor is
receptive to wellness makes it easier
What makes it difficult to network?
Responses: some older women in the churches; You always have, everybody wants to know
whose name is going to be first, recognition concerns; outside agencies don’t keep those working
in the community aware of “what’s available, the meetings”; agencies in Newtown “don’t get
what they get outside”; people from the outside “don’t have a clue about what’s going on but
people want to do stuff with them (i.e., projects)”; need more collaboration but competition for
funding; businesses may be “scared to come down or it’s so high risk they don’t want to try”
What makes it easy to be tested?
Responses: community members “hear about it every day”
What makes it difficult to be tested?
Responses: “lot of people try to sweep it under the rug”; young people don’t think it can happen
to them age wise, lack of education about HIV/AIDS and testing services available, reluctance to
come to an “open venue”; belief that “if I don’t know, then I don’t have to worry about it”;
expectation that diagnosis will “change the way they live”
What type of support does your [church, shelter, store, school, etc.] need to address HIV?
How can HIV testing be incorporated into your work?
Responses: agencies are doing a good job, especially going door-to-door in housing projects;
collaboration with agencies that already have a rapport with families is key; have nurses come
once a month and do testing/comeback with results – could hold health fairs while do testing;
“outside agencies [need] to come in and say that’s what we’re going to do” (i.e., come in and do
screenings) – “give the program director a call”; need condoms; need funding “so we can do
outreach instead of agencies that are out like CAN that come into the community but are not a
part of community” – “we see people all the time”; condoms, “the right material,” and funding;
information, private workshops, education
What would make it easy to allow HIV testing on site?
55
Responses: Space and the privacy, to have a facility that will accommodate private area – feel
secure talking with them and sharing ideas and have a separate room for testing; offer in
response to identified needs or questions raised in monthly parent meetings; prior working
relationship with CAN
What would make it difficult to allow HIV testing on site?
Responses: not difficult for us
What would your [church, shelter, store, school, etc.] gain from allowing HIV testing on
site?
Responses: information from the clients; “when looking for funding, we can say that we
collaborate with other agencies”; make condoms available – meet community members’
needs/provide service for the community; consistent with mission – want to “keep them up and
running”; makes us more responsive to the people we serve” (“another preventive measure”),
due to our efforts “people are walking around protecting themselves”; meets the needs of new
parents/clients coming into service
What types of incentives could we offer to encourage people to be tested?
Responses: food, gift cards (Wal-Mart), door prizes (e.g., bath stuff for women, something for
the men – even if it’s just a large bucket with paper products – bleach, dish detergent, toilet
paper), a night off from cooking a meal for the family; free gifts, a drawing – opportunity to win
something; door prizes; child care; offer a well known speaker; food baskets; personal hygiene
items; one person raised a concern that Wal-Mart gift cards could be used for alcohol.
What makes it difficult for community members to access services like HIV testing?
Responses: “I don’t think it’s difficult for anybody to access” – even transportation may not be
an issue when organizations come into community with testing (2 expressed not difficult as long
as services are available); community members are uniformed or “walk around in denial”;
privacy concerns and fear of being shunned; “most churches support the CAN network
What would make it easier to access HIV testing services?
Responses: offering testing in park on holidays such as Martin Luther King Day; make testing
more accessible and post signs; make process quick and easing; offer child care; address
transportation either through providing or offering within walking distance or at planned event;
being informed of the times; depends on the individual
Where could we offer rapid HIV testing in the community?
Responses:
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housing complexes (including apartment offline that they let people use)
housing recreation buildings
local parks
health or other community fairs
planned support or parenting groups
Boys and Girls club
Libraries
Sites in the community
Health department
Goodwill industrial – office area
Community Centers
Workshops – community complexes – need to be used for people to come in for general
testing
 Local NAACP
 MLK community – fund raising drive – how many people
What could we do to encourage testing?
Responses: offer incentives, approach the topic indirectly – ask them to be a part of a focus
group or have a well known person in the community offer to speak but don’t advertise the topic;
identify African American, Hispanic, and youth speakers with HIV/AIDS to speak in the
community and dispel myths; make HIV education and testing an ongoing, persistent, proactive,
visible presence in the community; increase availability of HIV education in the community;
encourage “people of color” to be “up front with this” be cause they will be “loved regardless”;
hold a CAN testing drive every two to three months; collaborate with other agencies to hold a
health week that covers HIV/AIDS, physical fitness, and other issues that disproportionately
affect African Americans during Black History Month (February)
57
Appendix I
Minutes of AA Male Focus group (Testing),
Goodwill 6/8/05
Facilitator: Bill Carter
Note taker: Judit Illyes, SCHD
Participants: 9 African American males
When I say “HIV” what’s the first thing that comes to mind?
Responses: AIDS, feeling scare, “nothing gets your attention like HIV/AIDS”, serious,
scary, gratitude for not having contracted HIV, prior risky lifestyles, the feeling of relief
after a negative result
Who should be tested for HIV?
Responses: everybody, people who have a reason should be tested – not everybody,
all sexually active people, people with tattoos, even children and newborns should be
tested, people in high risk category (e.g., prostitutes, tattoos, blood transfusion, people in
a relationships with someone who has had multiple partners)
What makes someone go to be tested for HIV?
Responses: getting “tired of living the life I was living” or wanting to do something
positive with their life, response to symptoms/illness, having a “promiscuous life,” having
a mobile unit, having it affect household, if curious
What makes it easy to be tested for HIV?
Responses: gift certificates, new testing with quick response (swab), feeling good when
negative result comes back, awareness, mobile unit, food give always, having that first
negative result, connect testing with getting drivers license, if a cure was available
What makes it difficult to be tested for HIV?
Responses: embarrassment of going to health department (“they voice an opinion”),
fear of finding out, fear of what others say about you, if positive – feeling like nothing to
live for, drug use, low self-esteem
Where would they go to be tested for HIV?
Responses: Health Department
Once someone has been tested, what do they have to do to get results?
58
This question was omitted by Facilitator
Besides the Health Department, where would you offer testing in the community?
Responses: mandatory testing If going to jail, consistent spot, parks, fairs, churches,
just set up a stand, have HIV testing as a pre-requisite, public parks, at check cashing
with finger printing
What else? Where would you put information about testing in the community?
Responses: “walking billboards” (leaders), in the neighborhood, schools, drivers license
places, check cashing, motels, grocery stores, apartments, bulletin boards, churches,
rap videos
Who would they trust the most to give them information about HIV testing?
Responses: someone who really knows about the disease, some older folks have it,
pass out flyers, role models, persons with AIDS, reverends, pastors, educate peers (take
message to family and peers)
What would you do to make being tested appealing?
Responses: give them T-shirts, “life would be more manageable,” music videos, famous
person talking about AIDS, make it festive
What would you do to encourage people to pick up their results? How would you make it
easier?
Responses: instant results, incentives ($5, free car wash), quick response, seeing famous person
get “AIDS test on TV in an AIDS mobile” (Michael Jordan)
59
Appendix J
AA MALE HIV Testing Focus Group (Testing), Goodwill
6/22/05
Facilitator: William Carter
Co-Facilitator: Judit Illyes
Participants: 7 African American males (1 repeat from first focus group)
_____________________________________________________________
When I say HIV what’s the first thing that comes to mind?
Responses: AIDS, suffering, sickness, disease.
Who should be tested for HIV?
Responses: everybody; not everybody (e.g., not clergymen) but people who have sex with more
than one person; multiple partners especially if not using protection.
What makes someone go to be tested for HIV?
Responses: risky sexual behavior (e.g, having sex with HIV+ person), addicts, wanting
to be sure, in response to unexplained illness, having had a blood transfusion
What makes it easy to be tested for HIV?
Responses: going to the health dept., free testing, anonymous testing, easy access to
facility
Would more people test if there would be more locations?
Response: yes
What would be some places for testing?
Responses: high schools, clubs, on the job, shelters, the Salvation Army
What makes it difficult to be tested for HIV?
Responses: fear, denial, not wanting to know, fear of the unknown, it is scary to wait for
results - it takes too long.
What would they have to do if they want to be tested?
Responses: ask for a test at the Health Department, go to clinic, have to have a reason
60
(e.g., illness), call 911 to get information on where to get tested.
Where would they go to get tested?
Responses: Health Department, clinics, Sarasota Memorial Hospital, Resurrection
House, booths, malls
How do people find out where to go?
Responses: they call you at home to come in, get tested, treatment centers, hotlines,
television, Yellow Pages, newspapers.
Once someone has been tested, what do they have to do to get their results?
Responses: go back to the place where they got tested, mail, phone call, follow back on
How long would they have to wait for the results?
Responses: 2 days, 2 weeks
Where else can they get tested?
Responses: mobile units, need more testing facilities.
When are people in the right frame of mind to hear about HIV testing?
Responses: when they have been exposed…risky sex behavior, if they share needles,
when it hits home (i.e., when someone in family has it), when you’re sober, when clear
minded
Where would you put information about HIV testing in the community?
Responses: stores, pawn shops, streets, public places, churches, grocery stores, rehab
centers, bars, any public place, “it’s obvious, people know about it; they just don’t want
to do it”
Where else? What about places where people have a lot of at-risk behaviors, like on
US 41?
Responses: poles, hotels (e.g., hotel rooms, hotel guys), flyers
Who would they trust the most to give them information about HIV testing?
Responses: someone who has the disease, a pastor, a teacher, a friend, family members,
doctors, nurses, paramedics, the police,
61
What would you do to make being tested appealing?
Responses: tell people; it’s for you, just come and do it, market it as a “nice event with
food and music,” have 24 hour access, provide test results in 2 hours
What benefits would you offer?
Responses: a gift card, free meal, incentives (e.g., t-shirts)
What other benefits would you offer?
Responses: free health insurance, medicines, free, clean needles, contest/prizes for
whoever brings in most people, incentives
What would you do to encourage people to pick up their results?
Responses: emphasize that it is very important, provide free transportation, free lunch or
gift card, scare them, provide homeless with meal, cigarettes
How would you make it easier?
Responses: have facilities close by, testing within walking distance, testing in park with
music and food, have result ready in two hours, distribute reminder cards, call or come to
the house to test (private testing)
Other comments?
Responses: give them beer as an incentive; no, beer would put them in wrong frame of
mind; beer would make them “promiscuous”
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Appendix K
Minutes for AA Female Focus Group (Testing), HIPPY 6/9/05
Facilitator: Seraphine Pitt Barnes
Note Taker: Judit Illyes
Participants: 4 AA females
When I say “HIV” what’s the first thing that comes to mind?
Responses: death, suffering, 2nd chance to get lives together, “stupidity” (e.g., not having safe
sex), “destroyed life,” anger/hate/loneliness/death, rejected and hurt, not having more children
Who should be tested for HIV?
Responses: everybody, heterosexual, gay, your sex partner
What makes someone go to be tested for HIV?
Responses: having unprotected sex, share needles, drugs, breast milk- if someone else is
breastfeeding your child, if someone who had it “spit in your food and drink,” blood
transfusion
What makes it easy to be tested for HIV?
Responses: having support/someone to go with, confidentiality, nothing (because of
discrimination)
What makes it difficult to be tested for HIV?
Responses: people knowing “your business,” the needle, being alone if diagnosed positive, not
knowing what the results will be, wanting to die rather than know
What would you have to do if you want to be tested?
Responses: find out where you got it from
Where would you go to be tested for HIV?
Responses: CAN (Community AIDS NETWORK), the Health Department, doctors, or AAA,
pregnancy Center, blood donation, pregnancy, at every appointment
Once someone has been tested, what do they have to do to get their results?
Responses: receive a card – make an appointment, come back in two weeks, “have to be face to
face – they won’t give you the results over the phone”
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Besides the Health Department, where would you offer testing in the community?
Responses: churches, properties of the Housing Authority, CVS Drug stores or Eckerd’s
(“anywhere where there is a pharmacy”), Blood Mobile, Activity Center
What times would be convenient to get tested?
Responses: Two shifts; lunch to 6:30 PM, 9:00am to 12:00pm.
How would you get the word out about HIV testing at these sites?
Responses: Fliers – post them or deliver them door to door
Where would you put flyers?
Responses: convenience stores, on the door, trees, businesses…newspapers, the Tempo News,
Channel 6 News, SNN, have kids who sell papers hand out the flyers or put inside the paper
What radio stations would people listen to?
Responses: 95.7, 98.7
When are people in the right frame of mind to hear about HIV testing?
Responses: scared, paranoid, if husband/boyfriend/partner is diagnosed, if partner has been
“promiscuous,” if ill (e.g., open sores, cough), if friend had it, if care about health, if spouse was
unfaithful
Where else would you put information about HIV testing?
Responses: churches, music recording studios, clubs (in the bathrooms).
Who would people trust the most to give them information about HIV testing?
Responses: a doctor (to “explain the medical stuff”), a trained family member, “not someone
with AIDS; people are scared,” “for kids someone with AIDS…for adults, not someone with
AIDS because adults may feel like they don’t want to breathe the same air,” trust God/churches,
health counselors, “an older person who lived with someone who had it and saw their suffering,”
best friend, someone that has AIDS (disagreement over this)
Who else would people trust the most to give them information about HIV testing?
Responses: doctors
What would you do to make being tested appealing?
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Responses: show pictures of a person who did not want to know progressing through the illness,
pictures of positive people with AIDS, have peers ask others to go with them, incentives (e.g.,
food, basket with lotion, door prizes), emphasize that even if positive have a chance if take
medications early
What benefits would you offer?
Responses: safe sex classes, safety, condoms (male and female), flyers with medical information
about HIV/AIDS, information on how to be safe while using drugs, “results will straighten you
out”
What would you do to encourage people to pick up their results?
Responses: have a friend go with, be in good spirits, live for your kids, talk to them, emphasize
confidentiality “out of respect”
How would you make it easy?
Responses: provide transportation, go with them (friend), take to the house (confidential),
provide moral support (someone to confide in)
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Appendix L
Minutes of AA Female Focus Group (Testing), HIPPY 6/30/05
Facilitator:
Seraphine Pitt Barnes
Co-facilitator: Judit Illyes
Participants: 7 AA females
When I say “HIV” what’s the first thing that comes to mind?
Responses: death, “Damn, that’s fucked up,” sorry for the kids, “Who’d they get it from, a
man?” “nasty,” “Lord, not me!,” prevention (“How to stop from getting it from that person.”,
condoms
Who should be tested for HIV?
Results: Everybody – those that are sexually active and not sexually active, elderly, food service
workers, children
Why everybody?
Results: you never know where you can get it from – dentists, sharing needles, others can give it
to you
What makes someone go to be tested for HIV?
Results: a cheating partner, when “don’t know where it started,” “when you hear that someone’s
got it…a young person,” when accused of cheating, routine, for safety, when hear someone from
past has it, just want to know
What makes it easy to be tested for HIV?
Results: privacy, confidentiality
What makes it difficult to be tested for HIV?
Results: coming back for the results, the waiting period – the two weeks, “the people at the
venue” (i.e., they “are in your business” or they take too long to give results), it is a death
sentence/no cure, not having the “nerve” to go because of embarrassment or anger, scary to wait,
“not knowing how to get it”
What else makes it difficult?
Results: People.
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What would they have to do if they want to be tested?
Results: Go to the clinic: 2nd Chance, Last Opportunity, CAN, HIPPY, or the Health
Department, go to primary doctor, at group meetings, not at hospitals.
Once someone has been tested, what do they have to do to get their results?
Results: have ID number and paper; come back in two weeks to go over results individually
Besides the health department, where would you offer testing in the community?
Results: at the community center, Venice Housing, True Vine Clinic, New Bethel, at their home,
Emergency Services Agencies – Goodwill, nursing homes, Manatee Community College,
HIPPY
How would you get the word out about HIV testing at these sites?
Results: Put up signs, flyers with the red women, place flyers at social clubs, MCC, restaurants,
tell people where free HIV tests are available
How about the radio or TV?
Results: word of mouth works well in the Newtown community, contact Ms. Lisa at Hippy,
SNN – a local station, Local paper: Tempo News, door-to-door with flyers
When are people in the right frame of mind to hear about HIV testing?
Results: any time, when they are worried
Where else can you put flyers?
Results: at the hospital, McDonalds, Wal-Mart, daycares, grocery stores, at the community
center, local clubs, hot spots - Club Heat, Club Envy, Bungalow, Gilligan’s
Who would they trust most to give them information about HIV testing?
Results: “people of their own color and kind,” someone who doesn’t have it (because if they
have it who are they to tell me what to do to not catch it), pastors, parent teachers, home visitors,
people who have a personal relationship with them, parents
What would you do to make being tested more appealing? What benefits would you offer?
Results: provide a class on HIV, incentives ($25 gift cards to Wal-Mart, Target, Bath and Body
Works), make it fun (cookout, rally)
What would you do to encourage people to pick up their results?
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Results: a follow-up phone call from the health department or doctor’s office, provide a copy of
the results to show potential partners, incentives ($10 gift card to test, $15 gift card to get results)
How would you make it easier?
Results: Explain the pros and cons of picking up your results, explain the benefits of testing
positive (i.e., you can still have a life with medication), tell them “if they got it, they could share
it with you”
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Appendix M
Minutes of Spanish Focus group (Testing),
Community AIDS Network 6/22/05
Facilitator: John Acevedo
Note taker: Cruz Hernandez
Participants: 5 Hispanic females
When I say “HIV” what’s the first thing that comes to mind?
Responses: fear, disease, death, Magic Johnson, concern for teens, for singles, for young people
watching movies about sex, young people think it won’t happen to them get infection, sad,
depressed
Who should be tested for HIV?
Responses: everybody, teenagers, adults people in clubs, kids 12 and over, everybody who wants
to be tested. One of the participants asked a question she wanted to know, “What is the process
that is followed if someone tested positive.” Facilitator provided the answer to that question.
What makes someone go to be tested for HIV?
Responses: knowing where to go and get tested, being aware that there is a clinic that specializes
in testing, having testing mobile in different parts of town, seeing advertised testing areas and
procedure, unexplained symptoms, blood transfusions, fear, doubts, partners.
What makes it easy to be tested for HIV?
Responses: testing is free, knowing that there is no blood drawing involved, knowing where to
go, needing to have after hours testing available, a need of more sites available, having mobile
testing done in our neighborhoods, going with a friend for support
What makes it difficult to be tested for HIV?
Responses: not being educated about HIV, not wanting to know if they have HIV, not knowing
there is free testing, transportation, fear that someone they know will see them at the clinic, for
young teens fear their parents will find they got tested, fear of needles, fear of too many
questions (i.e., personal questions), no testing sites close to them
Where would they go to be tested for HIV?
Responses: doctor’s private office, health department, any clinic, health fairs, a mobile unit
Once someone has been tested, what do they have to do to get their results?
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Responses: participants were not sure, call and find out what the results were, go back to where
they got tested and ask if results were available
Besides the health department, where would you offer testing in the community?
Responses: schools, fairs, nightclubs, mobile testing sites, flea markets, and nightclub bathrooms
How would you get the word out about HIV testing at these sites?
Responses: advertise by specifying what kind of testing is being done, mentioning that there is
no blood or needles involved, pass out flyer at Wal-Mart and other stores in town, schools, offer
incentives, offer food (i.e., feed them)
When are people in the right frame of mind to hear about HIV testing?
Responses: when watching a movie, commercial, on TV, when they receive information about
HIV in an enclosed envelope (i.e., FPL bill), when it comes out in a conversation causally,
hearing it from a doctor, when people are eating
Where would you put information about testing in the community?
Responses: advertisement on the local radio station, commercial on the TV, pass out flyers at a
local department store, restaurants, nightclubs, nightclub restrooms, and local neighborhood
stores and information in their monthly bills, coupons
Who would you trust the most to give them information about HIV testing?
Responses: doctor, a public health worker, an HIV educator, and or a person living with HIV
What would you do to make testing appealing?
Responses: give out movie passes or Best Buy gift cards if you are testing young teens, give out
food vouchers for adults, and Wal-Mart gift cards to women, Home Depot gift cards for men,
restaurant gift cards, offer food and they will come, movies passes, CDs
What benefits would you offer?
Responses: great feeling knowing you’re negative, better informed about the virus and how to
protect yourself and others, peace of mind
What would you do to encourage people to pick up their results?
Responses: would be wise to hold the incentives until the clients return for the results
How would you make picking up results easy?
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Responses: have a drawing of a $50 gift certificate, drive through window, reminder cards, holds
half o f the incentive until they return for their results
Other comments included: Participants suggested that HIV testing should be mandated when
getting birth control methods and for couple wanting to get married.
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Appendix N
State Level Data for Determining Priority Groups
The following sections summarize state level trends used to prioritize populations to target for
HIV prevention and outreach:
Sex
In Florida, the proportion of males to females for recently diagnosed adult AIDS cases was 2.5:1
and the proportion of males to females for recently diagnosed adult HIV cases was 1.8:1,
between 2000-2002. This suggests that there is an increasing trend in HIV infection among
females (Florida Department of Health, 2004).
Therefore, there should be increased attention to programming primary HIV prevention
targeted and tailored to speak and relate to women.
Age
In Florida, between 2000-2002, 38% of the adult AIDS cases were among persons 30-39 years of
age at the time of diagnosis, compared with 37% of the adult HIV cases in this age group.
Whereas 17% of the AIDS and 13% of the HIV cases were reported among persons 50+ years
old at the time of diagnosis (Florida Department of Health, 2004). Moreover, the median time
period between infection with HIV and onset of clinically apparent disease is approximately 10
years (Pantaleo, Graziosi, & Fauci, 1993), therefore the estimated age at which HIV transmission
and sero-conversion occurred for those in the 30-39 years age group would be somewhere
around 20-29 years of age. Furthermore, in 2003, 13% of new HIV cases occurred in people
between the ages of 13-24 years; while 63% of 12th graders reported having had engaged in
sexual intercourse 1/3 reported that they did not use a male latex condom (Florida Department of
Health, 2003b).
Thus, a pragmatic and justifiable approach to decreasing new HIV infections would be to
target primary prevention efforts across the board to all age groups, with increased
outreach efforts tailored to speak to youth (13-24 years) and also sensitive to older
individuals (50+ years) due to both of these groups’ marginality in terms of the taboo of
addressing the sexual and behavioral nature of the risk factors that place them at increased risk
for acquiring and spreading HIV.
Race/Ethnicity
In Florida, the ‘racial’ breakdown for both AIDS and HIV, respectively, was 29% and 27% for
Whites, 55% and 56% for Blacks, and 15% and 16% for Hispanics (Florida Department of
Health, 2004). The rate of AIDS cases reported per 100,000 for the year 2000 for both men and
women were highest among Blacks, followed by non-Hispanic Whites (Florida Department of
Health, 2004).
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Therefore, increased and sustained HIV primary prevention efforts should be targeted to
Blacks with new and innovative approaches that do not further stigmatize this group and
should have prevention messages that are culturally sensitive and developed by the community it
is intended to reach. Thus, community-based participatory approaches to reducing new
HIV infections by community empowerment, ownership and involvement should be
utilized.
Mode of Exposure
In Florida, the breakdown for both recently reported adult AIDS and HIV cases in 2002,
respectively, was 31% and 30% for MSM (Men who have with Men), 11% and 8% for IDU
(Intravenous Drug Users), 26% and 28% for heterosexual contact, and 29% and 32% for cases
with no identified risk (NIR). Among the reported MSM cases, 54% of the AIDS cases and 51%
of the HIV cases were white; whereas 27% of the AIDS cases and 26% of the HIV cases were
black. Among the reported IDU cases, 53% of the AIDS cases and 50% of the HIV cases were
black. Among cases reported with heterosexual contact, 77% of both AIDS cases and HIV cases
were black. The percent of AIDS and HIV cases among adult women, reported with AIDS or
HIV between 2000-2002, reported heterosexual contact 53% and 52% respectively. However,
the percent of AIDS and HIV cases among adult women between 2000-2002 that reported
injection drug use was 13% and 10%, respectively. The percent of AIDS and HIV cases reported
with no identified risk, among adult women between 2000-2002 was 33% and 38%, respectively.
Of cases originally reported as NIR and later reclassified, historical data suggests that 25% will
reclassify to MSM, 14% to IDU and 58% to heterosexual risk. For those NIR that remain NIR,
there is no reason to suspect that HIV is being transmitted in some unusual way but rather that
there are insufficient staff resources to devote to the reclassification process. [All information in
paragraph abstracted from Florida Department of Health, 2004.]
Therefore, particular attention should be addressed to the needs of heterosexual black
women due to the rapidly increasing rate of new HIV and AIDS case diagnoses among this
population. Furthermore, increased and sustained primary prevention efforts should be
focused on white MSM because there is a growing threat being fulfilled with the re-emergence
increased new HIV infection in this population. Also, holistic prevention approaches should
be applied to address the needs of black injection drug users, perhaps by incorporating the
harm reduction philosophy and some form of needle exchange programs that have proven to
reduce HIV risk (Centers for Disease Control and Prevention).