Description of the pilot HIV/AIDS Prevention Initiative conducted by the Afrolatin@ Project in 2008-2009, funded by the Ford Foundation.

1. CONVERSEMOS
An HIV/AIDS Prevention Model
Descriptive Summary
George Priestley, PhD
Marcia Bayne Smith, PhD
The Afro-Latino Project
Queens College – CUNY
June, 2008
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2. ABOUT CONVERSEMOS
Introduction
Introductory information on issues related to prevalence as well as regional and
population considerations are provided here as a backdrop against which the
Conversemos Model is framed. Therefore it is important to first recognize that the UN-
AIDS division has assigned a 2% HIV prevalence rate among adults 15-49 for the
circum-Caribbean region1 which is now considered to be second only to AIDS-ravaged
sub-Saharan Africa, where the prevalence of HIV among adults ages 15-49 is reported to
be 8.0%.2,3 New trends specify a shift: half of all new cases are now found in young
women 15-19. The most prevalent mode of transmission for these young women is
heterosexual sex which has implications for their children both living and yet unborn.4
The groups most affected by this new trend are Afro-descendant populations such as the
Garifuna (living primarily in Honduras, Guatemala and Belize) who have some of the
highest HIV/AIDS (8% to 14% in Honduras) rates in Latin America.5
Regional and Population Considerations
The circum-Caribbean region includes all of the island states and nations within
and surrounding the Caribbean Sea. Initial Conversemos pilot work will be done in:
Honduras, Panama and the Dominican Republic and will focus on Afro-descendant
populations. A major challenge is the absence of consensus about socio-political identity.
Race for example is a politically charged issue in some countries contributing to a dearth
of data disaggregated by race. Also, regional poverty presents economic stressors while
rampant HIV/AIDS related stigma, forces some people to forego seeking treatment
and/or related services. The more powerful challenges will come from socially
prescribed gender roles, one of which is the economically driven, historical practice of
relationships between very young girls and much older men.
Afro-Latin@ populations and Trans-nationalism (circum-Caribbean ~ United
States). A unique characteristic of the HIV/AIDS epidemic among Afro-Latin@
population has to do with the practice of circular migration and living on two home
fronts: the country of origin and the U.S. Contributing factors to this trans-national
phenomena include:
• geographic proximity and facility of air travel between the two regions,
• constant bi-directional flow of people, goods, services, etc., to and from the
circum-Caribbean region as a vacation destination hotspot,
• the need for migrant farm workers and domestic workers in the U.S.
• access to dual citizenship policies shared between the U.S. and many nations of
the circum-Caribbean region,
• dual social networks in both regions which assures migrants of support systems
on both home fronts.
• U.S. policy regarding deportation of ex-prisoners. 6
2

3. The Conversemos Intervention
The Conversemos Intervention, is an interdisciplinary community wide approach to
reduce prevalence of HIV/AIDS through prevention and treatment services in accord
with the United Nations goal of Universal Access by 2010. Conversemos aims to
integrate multiple components of health and prevention services into existing public
health and social services systems in 7selected countries of origin as well as in the U.S. in
an effort to expand appropriate and timely access to these systems for Afro-Latin@
transnational communities. Key leaders from Afro-Latin@ communities both in
countries of origin and in the U.S. will be trained8,9. to work locally with:
1. public health departments to scale up targeted voluntary counseling and testing
programs, and encourage compliance with HIV/AIDS medical treatment
2. social service agencies both public and private to expand HIV prevention and
social support services around economic, and socio-political issues such as: self
esteem, housing, job protection, empowerment, disclosure, confidentiality, etc.
3. media outlets (print, radio/TV, electronic) and cultural entities (dance groups,
vocal and instrumental artists) to produce and disseminate (through broad/deep
community penetration); culturally and linguistically appropriate, relevant
HIV/AIDS prevention messages/images/symbols that encourage protection,
prevention as well as compliance with medical care and medication regimen for
those already infected.
4. regional and international funding sources to collect and analyze individual and
cross-site data that provides evidence of the effectiveness of the Conversemos
Initiative.
Conversemos goals are to:
♦ Increase and sustain effective communication about HIV prevention
♦ Reduce stigma
♦ Increase (develop) ongoing universal access for residents of targeted communities to
high-quality HIV Services such as prevention, medical treatment and social supports
Description of the Conversemos Components
Conversemos activities are divided into three major program components: Community
Mapping, Promotoras and Celebrando Salud. As described below, Community Mapping
happens in Phase One, while Promotoras and Celebrando Salud are essential to Phase
Two of Conversemos implementation. In Phase three the ongoing work of Phases I and
II are integrated into the service delivery systems of the major public agencies (health and
social service departments) serving the targeted communities and those efforts are
supported by local private entities. All three components operate under an overlay of
formative and outcomes evaluation activities designed to measure the performance of
each component and to ultimately determine the nature and extent of any changes
resulting from the use of the model.
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4. Phase One: Resident Recruitment and Information Gathering
I. Community Mapping
Community Mapping is composed of a clear-cut set of activities that collect data about
the community at large. Community Mapping is used to determine which neighborhoods
would be best for the program, and which agencies would be best suited to implement it
successfully. The Community Mapping process then collects information on the
community’s attitudes, knowledge, beliefs and behaviors, regarding HIV/AIDS, and it
uses this information to recruit and involve residents in formulating locally developed
solutions. To accomplish these objectives, Community Mapping is divided into the
following six activities:
1. Choosing an Implementing Agency
2. Choosing the Target Area/Community
3. Recruiting Community Members/Residents
4. Physical Mapping of the Target Area
5. Survey Mapping of the Target Area
6. Survey Analysis and Results Preparation
7. Developing Conversemos messages
Phase Two: Community Outreach and Mobilization -
Promotoras
Promotoras, the term used here are also known as community health workers,
capacitadoras, neighborhood health messengers and a variety of other terms. Essentially
they are community residents who undergo training to go into their community to
initially do mapping, then to recruit fellow residents to participate in the Conversemos
Initiative while simultaneously and continuously spreading and saturating their
community with Conversemos messages and helping residents to access needed services.
Training is provided through the eight session Conversemos Curriculum that is designed
to address:
1. HIV (101): Increase factual knowledge, dispel myth, treatment options
2. Explore attitudes, Unpack stigma
3. Improve stigma-free communication skills
4. Development of Positive HIV/AIDS Prevention Messages
5. Celebrando Salud - Dissemination plan for spreading HIV/AIDS Prevention
Messages
6. Adopting Personal risk reduction behaviors, modeling, getting tested
7. Building – strengthening family/community/social network bonds, to provide
stigma-free social and emotional supports
8. Partnering with local public and private health and social support agencies to
increase access to and use of HIV/AIDS prevention and treatment services
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5. The Promotoras de Salud go door-to-door, into homes, schools, community centers,
businesses, and just about anywhere they could find an audience to listen. Their primary
function is to inform and engage community residents, recruit hosts for Celebrando Salud
home health parties and to facilitate the Celebrando Salud parties sessions throughout the
community.
Celebrando Salud
The purpose of a home health party is to educate adults and parents on sexual issues and
to teach them the importance of communicating this knowledge to their children and
other adolescents in the community. The goal of the Celebrando Salud Home Parties is to
help recruit more residents, adults and youth, in the community, which in turn will
increase the accuracy and frequency of community wide communication about risk
taking and HIV/AIDS prevention issues.
Celebrando Salud home party events give adults and youth correct information on the
contraction and prevention of STDs and HIV/AIDS, reproductive health issues,
pregnancy, pregnancy prevention, and transmission of HIV from mother to child. These
events also give parents, community adults and young people the communication skills, a
new language if you will that is needed to become educated, and to forego stigma
attitudes and behaviors in order to protect adults and young people in their community,
from HIV/AIDS disease.
Phase Three: Community – Services Integration
Developing Partnerships with local health and social service agencies
Development of effective partnership relationships between community resident groups,
community agencies, private physicians, public service agencies and other health care
providers are vitally significant to the Conversemos model for the following reasons:
1. Outreach and community mobilization activities of the Conversemos intervention
must be coordinated with the goals/objectives of public service (health, social
services) agencies
2. Promotoras de salud must be trained regarding the local systems, policies and
services available in order to properly refer residents and otherwise collaborate
with local public systems.
3. Evaluation is integral to the Conversemos Model and the ongoing input and
assistance from all providers, public and private is critical.
4. Private physicians as well as Public agencies have to be integrated into the
outreach and mobilization efforts in two concrete ways: these health care
providers must become part of the larger social network of the community and
they must also provide an anchor and location of operation of the ongoing
Conversemos Intervention by utilizing the Conversemos curriculum and holding
Celebrando Salud sessions.
5. Public agencies must also serve as a resource for the comprehensive evaluation of
the ongoing Conversemos work and a link to internal and external support
systems: ie. attract additional funding, create policy change, etc.
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6. Expected Benefits of the Conversemos Model
A. Community wide benefit
1. Empowered and mobilized communities prepared to protect themselves
from HIV/AIDS disease
2. Social / emotional support available through community wide social
networks and resources
3. Enhancement of local evaluation capabilities and efforts
B. Benefits for Promotoras
1. Development of local leadership skills
2. Agents of change: Transcending myth and stigma barriers to HIV/AIDS
prevention
3. Obtain training and education that can be exchanged elsewhere in the
market place
C. All stakeholders (professional providers and residents)
1. Development of strong partnership relationships between community
residents, providers and public health and social service agencies.
2. Connection of adults, youth, families to HIV/AIDS prevention and
treatment services
3. Improved community health status
4. Long term sustainability of HIV/AIDS prevention strategies
5. Policy change???? Is that a stretch???
1
Leu-Bent, ibid.
2
Human Development Sector Management Unit, Latin America and the Caribbean Region, The World
Bank. Report No. 20491-LAC, June 2000
3
UNAIDS/WHO, 2005
4
UNAIDS/WHO, 2005
5
Leu-Bent, M. Preliminary Assessment of the Impact of HIV/AIDS on Afro-descendant populations of he
Americas, Submitted to Dr. Jacob Gayle, Ford Foundation.
6
New York State Correctional Systems Report 2006 Data on repatriation of prisoners from New York
State indicates that 11.3%of the 62,732 (99% males) prisoners in the state are foreign born of which
65.5% are from the circum-Caribbean region including 9.1% from Central America. Upon their
release either to their local U.S. communities or deported back to their country of origin, the majority
of these men will resume their former heterosexual lifestyle without alerting their partners of any
violence or other incidents that occurred while incarcerated.
7. Bayne-Smith, Marcia “Daughters of the Diaspora” An Intergenerational Model for HIV/AIDS
Prevention. A Curriculum and Intervention Program Proposal funded by The Office of Women’s Health
(OWH) in the Department of Health and Human Services (DHHS), Sept. 2006.
8.
Bayne-Smith, Marcia, HIV/AIDS Prevention program based on modifications to CDC’s DEBI – Sista
program, implemented by the Caribbean Women’s Health Association, Inc. and funded by New York City
Department of Health/Mental Health, March 2006
6