The collaboration process in HIV prevention and evaluation in an urban American Indian clinic for women

Within the Hidden Epidemic: Sexually Transmitted Diseases and HIV/AIDS Among American Indians and Alaska Natives

OBJECTIVES

To review the epidemiology, research, and prevention programs for sexually transmitted diseases in American Indians and Alaska Natives (AI/ANs).

STUDY DESIGN

We reviewed the current national and regional trends in sexually transmitted diseases (STDs) for AI/ANs from 1998-2004, peer-reviewed studies from January 1996, through May 2006, and reports, unpublished documents, and electronic resources addressing AI/AN STD prevention and control.

RESULTS

STD prevalence among AI/ANs remains high. For example, the case rate of C. trachomatis in the North Central Plains AI/AN populations is 6 times the overall US rate. Trends for C. trachomatis also show sustained increases. Little research exists on STDs for this population, and most is focused on HIV/AIDS. Fear of compromised confidentiality, cultural taboos, and complex financial and service relationships inhibit effective surveillance, prevention, and management.

CONCLUSIONS

Recommendations for STD control in this population include improved local surveillance and incorporation of existing frameworks of health and healing into prevention and intervention efforts. Research defining the parameters of cultural context and social epidemiology of STDs is necessary.

Collaborative research partnerships with disadvantaged communities: challenges and potential solutions

Community/campus research collaborations face multiple challenges. An understanding of the community's background, history, habits and traditions, values and mode of operations is required. This article narrates a 3-year experience of undertaking collaborative public health research with five disadvantaged communities in various provinces of South Africa. Based on the experience, five main challenges exist: the value systems of those collaborating in the research; the stakeholders' costs and benefits of being involved; issues of empowerment and capacity transfer; the need for multidisciplinary research approaches; and the prerequisite of the clarity of relationships and roles between researcher and community. Categorized under the five main challenges are examples of 19 interlacing 'concepts' that detailed the South African research partnership from the perspective of the processes, dealings and daily difficulties. Examples of the challenges and concepts are highlighted from the author's research experiences with disadvantaged communities. These challenges increase exponentially with the inclusion of more research sites, more stakeholders or when undertaking cluster research. Possible preventative measures or solutions to the problems are suggested. Both the 'town' and 'gown' partners are required to attend to a multitude of factors when embarking on collaborative community-based research.

Developing an effective intervention for IDU women: a harm reduction approach to collaboration

Harm reduction is fundamentally a movement intended to empower the patient and consumer of health services. This project applied harm reduction theory as a strategy to empower collaborating community partners and researchers to overcome their preconceptions about each other in order to create a successful HIV prevention intervention and evaluation study for injection drug using women. The Women's Options for Risk Reduction through Knowledge of Self (WORKS) intervention program offered a series of four HIV prevention workshops, in conjunction with sexually transmitted infection (STI) and HIV counseling and testing to female injection drug users (IDUs) or the partners of IDUs. This community collaboration was to integrate the strengths of researchers and service providers in a comprehensive approach to prevention evaluation. In this collaborative research context, capacity building meant developing the long-term goal, explicit commitment to and integration of evaluation into the overall operation of a HIV prevention service delivery organization. The WORKS Intervention collaboration's aim was to improve the capacity of community-based organizations (CBOs) to use research-based data on HIV risk taking behavior and prevention strategies to provide effective interventions and services and effectively evaluate their efforts. Barriers to successful planning, implementation, and evaluation are presented with the strategies used to overcome them. Intervention effectiveness results from the process evaluation are presented in the context of prevention and research capacity development in CBOs.

HIV/AIDS prevention in "Indian country": current practice, indigenist etiology models, and postcolonial approaches to change

Many tribal and urban American Indians and Alaska Native communities have initiated HIV/AIDS prevention and treatment services. The richness, depth, and scope of these efforts, however, are not well known and have not been sufficiently documented in the academic literature. In this article we assess the strengths and weakness of the published literature using the constructs of the socioecological framework. We discuss the need to apply an "indigenist" etiology paradigm to HIV/AIDS risk and protection. Finally, we define and discuss the varied postcolonial approaches to HIV/AIDS prevention, treatment, and healing.

Educational partnerships for public health: do stakeholders perceive similar outcomes?

Based on a study of five W.K. Kellogg Foundation-funded educational partnerships, this article reports the stakeholders' views on five sets of anticipated outcomes: health professions education impact, curricula and services, students, community and policy, and sustainability and structural change outcomes. The participants had a reasonable degree of certainty that their partnerships would achieve the intended outcomes. Using tightly defined "specific" stakeholder groups for the analyses reflected a more precise picture than employing "generic" groups. Partner groups that perceived greater certainty about the outcomes had higher scores on other related partnership parameters. For partnership working, the article proposes an orbital hypothesis of stakeholders' perceptions for further investigation.

The Women's Circle comes full circle

Women have been the backbone of service provision for health and healing in the Native American community in the San Francisco Bay Area. The contributions of Native women are exemplified in the Women's Circle of the Native American Health Centers in San Francisco and Oakland. Women receive a broad range of services through the Women's Circle--in a coed residential substance abuse treatment facility (Friendship House), in groups, in one-on-one counseling, and at the Friendship House American Indian Lodge, a residential women and children's facility in Oakland. This article will look at lessons learned, using both quantitative outcome measures and ethnographic means to examine the impact of the Women's Circle and how the circle was completed. Program staff were interviewed to gain insight into how the program impacted female clients. The article juxtaposes the program elements clients identified as important to their healing and staff's perceptions about the growth of the program. Distinct women's health issues--physical, emotional, mental and spiritual-sculpted program development. Significant findings and lifestyle changes that occurred around involvement in the Women's Circle are examined.

Narrowing the gap between academic professional wisdom and community lay knowledge: perceptions from partnerships

Community involvement in health through community partnerships (CPs) has been widely advocated. Putting CPs into practice is complex and represents a challenge for all the stakeholders involved in the change process. Employing data from five CPs aiming to bring together communities, academics and health service providers in South Africa, this paper aims to examine and compare the views of the health care professionals with those of the community members with respect to each other's skills and abilities. Five domains of expertise in partnership working are examined: educational competencies; partnership fostering skills; community involvement expertise; change agents proficiencies; and strategic and management capacities. The findings suggest that the community recognizes the expertise and abilities brought by the professional staff to the CPs. Community members have a positive view of the capabilities of the professionals, in particular their abilities as resource persons in the areas of budget management, policy formulation and the introduction and management of change. The professionals, on the other hand, are cautious regarding the level of skill and capability in communities. The limited appreciation of community skills by the professionals covered all the five domains of expertise examined. The findings suggest that if joint working is to survive, the professionals will need to increase their valuation of the indigenous proficiencies inherent in their community partners. We conclude that programme models need to consciously incorporate in their design and implementation, capacity building, skills transfer and empowerment strategies.

The role of community consultants in designing an HIV prevention intervention

This article describes the significant role of community members during the intervention development phase of a randomized clinical trial of an HIV prevention intervention for African American and Latina women and their main sexual partners. Sixteen women and 13 male partners were engaged as "consultants" in a series of focus group discussions aimed at exploring their reactions and ideas about potential topics and approaches for the intervention. Each individual participated in three focus groups-two single-sex groups and a third that brought women and their male partners together. Focus group data extended our knowledge about the impact of relationship dynamics on safer sex negotiation and allowed us to design an intervention that is contextually specific and pragmatic. Target community members can provide critical input during the intervention development process and should be recognized as viable and meaningful collaborators in all phases of intervention research.

Collaboration and partnerships: developing the evidence base

Despite the growing literature that collaboration is a 'good' thing, there are calls emphasising the need for evidence of its effectiveness. However, the nature of the evidence to assess effectiveness is less clear. This paper examines the components that contribute to the challenges that confront evidence on collaboration. It considers the differing interpretations that have been placed on evaluation and explores how ways of determining the outcomes of collaboration and the levels of outcome measurement to assess collaborative effectiveness are influenced by the multifactorial nature of the concept. Evidence on the impact of collaboration is influenced by the diversity of perspectives and conceptual facets, and difficulty in measurement of the notions involved. Other factors discussed are the choice of macro or micro evaluation, of proximal or distal indicators, of short and long-term effects, or of individual-level or collective community-level outcomes. The suitability of randomised controlled trials for the measurement of collaborative outcomes as well as the requirement of mixed methods evaluations are highlighted. An evaluation of five community partnerships in South Africa is employed as an example to link the evaluation concepts that are discussed to a real enquiry. If collaboration is to be successful in making a difference in the lives of people, then increasing the precision and context of appraising its effectiveness will reduce the nature of inconclusive evidence and is likely to improve the practice of partnerships, coalitions and joint working in health and social care.

Organizing community research partnerships in the struggle against AIDS

Despite pharmaceutical advances, AIDS remains a health problem difficult to treat, leaving preventive interventions as the primary means of promoting risk avoidance. Increasing the capacity of university-based researchers to develop culturally, developmentally, and contextually appropriate AIDS prevention strategies requires the collaboration of community service and advocacy partners. To date, neither university researchers nor community providers have a great deal of partnership experience. Thus, a common language and set of experiences are yet to be developed. This article reviews the history of university-community and researcher-community collaboration for AIDS research and intervention, placing the innovative work of the University of California, San Francisco (UCSF) Center for AIDS Prevention Studies and its community and foundation partnerships among those efforts at the forefront of the community-university dialogue. It concludes with suggestions derived from the collaborative work of UCSF researchers and community service partners to strengthen efforts to develop theory, research methods, and results that are immediately useful and productive of long-term prevention research efforts.

Collaborative community research consortium: a model for HIV prevention

In 1991, the Center for AIDS Prevention Studies (CAPS) at the University of California, San Francisco, set out to develop a model of community collaborative research that would bring the skills of science to the service of HIV prevention and the knowledge of service providers into the domain of research. Essential elements of the model were training for community-based organizations (CBOs) in research protocol writing, partnership between CBOs and CAPS researchers, program research funding, support to implement studies and analyze results, and a program manager to oversee the effort and foster the relationships between CBOs and researchers. In this article, the authors describe the CAPS model of consortium-based community collaborative research. They also introduce a set of papers, written by researchers and service providers, that describes collaborative research projects conducted by research institutions and CBOs and illustrates how collaboration can change both HIV prevention research and service.