Minnesota Department of Health
STD and HIV Section
HIV/STD Community Prevention Planning
COMMISSIONER’S TASK FORCE ON HIV/STD PREVENTION PLANNING
Snelling Office Park
9:00 a.m. - 5:00 p.m.
Friday, April 16, 2004
Present
CCCHAP MEMBERS
Don Anderson for Gerry Anderson
Roxanne Anderson
Kip Beardsley
Kathy Brothen
Donna Clark
Kirk Fiereck
Rhys Fulenwider
Kelly Hansen - Parliamentarian
Doris Johnson
Nick Metcalf
Amy Moser
Steve Moore
Rosemary Thomas
William Grier
Drew Parks
Traci Capesius
Bankole Olatosi
Muhidin Warfa
Cliff Noltee
Wynfred Russell
Charlie Tamble
Becky Clark
Gary Remafedi
Alissa Fountain
COMMUNITY MEMBERS
Fred McCormick
Amber VanderHeyden
MDH STAFF
Ruth Dauffenbach-Kotrba
Luisa Pessoa-Brandão
Julie Hanson Pérez
Lucy Slater
Japhet Nyakundi
Absent:
Jerry Moss-notified
Phillip Brown-notified
Kevin Sitter-notified
Lois Crenshaw
INTRODUCTIONS
Attendees were welcomed back to the second day of the meeting and introductions were made.
BYLAWS DISCUSSION & APPROVAL
Julie Hanson Pérez reviewed the draft Bylaws that were distributed to members in March and
explained the changes that were made to the previous version of the document. During the
discussion, further ideas for revisions were suggested and agreed to by Task Force members:
CCCHAP Minutes 04/16/04 Page 1
Page 4: III.B.2. Major Duties and Tasks of Task Force Members
n. Identify and prioritize unmet needs. in the areas of: Emerging Populations; Target
Populations; Public Information; Counseling, Testing and Referral; Partner Counseling and
Referral Services; Capacity Building for Providers; Needs Assessment, Evaluation; and
Capacity/Infrastructure of the MDH-STD & HIV.
Deleted the reference to specific categories of unmet need in recognition of the possibility that the
process used to conduct gap analysis may evolve and change.
Page 11: IV.D. Attendance
Page 14: V.E. Committees of the Task Force members
Page 16: V.E.b. Committee Attendance Requirements
Task Force members are required to serve on at least one committee during both years of
their first two-year term. Members are only required to serve on a committee during one
year of their second or third two-year term.
In order to provide more continuity of membership on committees, members will be required to
serve on committees for both years of a first term instead of only serving on a committee for one
year as was originally proposed. During a second and third term, members will only be required to
serve on a committee during one year.
Page 12: IV.D.1. Proxy
Task Force members and the parliamentarian may not serve as a proxy.
The Task Force felt that members and the parliamentarian should not participate in a meeting as
two people (themselves and the person they would be proxying for)
A proxy is expected to attend the entire meeting, which in the case of a Task Force
meeting is defined as two full days.
The Task Force felt it is important for the proxy to be present for the entire meeting in order to be
able to fully participate in the process, which includes getting information, discussion and decision
making.
Page 17: Footnote referencing GHAT
Hennepin County Human Services Department (HSD)
Was changed from Hennepin County Community Health Department (CHD) in order to reflect the
recent reorganization that occurred within the department.
Page 19: VI.F. Conflict of Interest
A conflict of interest occurs when a member of the Task Force knowingly takes action or
makes a statement intended to influence the conduct of the Task Force in such a way as to
confer any direct financial benefit on the member……
Added the word “direct” to provide more clarity about the type of financial benefit that constitutes
a conflict of interest
Footnote: Conflict of interest language adapted from CDC’s HIV Prevention Community
Planning Guide, page 27.
Acknowledges the source of the language. The CDC language has been changed slightly so it is
noted that the language was adapted.
The Task Force is not responsible for making funding allocation decisions. The separate
community review process of proposals received in response to a Request for Proposals
(RFP) removes the conflict of interest from Task Force members during the process to
prioritize target populations. During discussions related to prioritization, and at all other
CCCHAP Minutes 04/16/04 Page 2
appropriate times, Task Force members shall verbally acknowledge any interest they
represent.
Acknowledges that Task Force members are shielded from conflict of interest as defined in the
bylaws during the prioritization process because of the separate RFP review process that results in
funding recommendations. However, it is important during prioritization discussions, and at other
appropriate times, for Task Force members to verbally identify interests that they represent so
people who are listening understand where they are coming from and what experience/expertise
they bring.
Page 21: VII. Grievance Process
The grievance will be considered and resolved by the Executive Team and the
Parliamentarian.
Because the Parliamentarian is responsible for advising co-chairs on procedures, s/he should be
involved in discussions about how to resolve grievances, which by definition may be filed when a
person feels that the Task Force did not follow an established process or bylaw.
Page 21: IX.B. Change in Bylaws
The Task Force will be notified of a recommended change in the Bylaws, as well as the
rationale for the change, through a Task Force mailing.
Ensures that Task Force members are aware of the motivation for the recommendation prior to
discussion.
Task Force members will receive an updated document at the next meeting, and there will be
an opportunity to that the ideas for revisions were accurately captured in words.
Vote: The revised Bylaws were approved by a vote of 15 in favor, 0 opposed, and 2 abstaining.
ADJUSTMENT OF MEMBERSHIP TERMS
The Task Force will now only be recruiting new members once a year, and they will be brought
on in November. In the past members have been brought on as needed, and their membership
terms end at different times. In order to avoid having current members leave throughout the
year, they are being asked to adjust their current membership terms so that they end in a
November. Members were each given a form customized to their specific membership term
and asked to choose the November that worked best for them. For example, if a membership
term is supposed to end in June 2005, that member could choose to shorten their term and
have it end in November 2004 or lengthen their term so that it would end in November 2005.
PRIORITIZATION MODELS
REVIEW OF DECISIONS FROM PREVIOUS DAY
Julie began by reviewing the discussion and decisions made related to prioritization at the April
15, 2004 meeting. Kip Beardsley noted that the process will be reviewed again by the Process
and Procedures Committee prior to actually conducting the prioritization process in 2005.
In response to the suggestions made by Task Force members the previous day regarding
information that should be taken into consideration when determining which subpopulations will
be included on the list to be prioritized, MDH staff agreed to the following process:
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The following criteria will be used to determine which subpopulations will be included on the list
to be prioritized:
Population has an average of 5 new infections annually over the last 3 years, AND
Population has at least 100 living HIV/AIDS cases
Additionally, a population will be included if it does not meet the first two criteria, but the
following criteria are met:
Population has an incidence rate that matches or is close to rates found in
subpopulations that do meet the first two criteria
Data indicate a steady increase in new infections within the population over the last 5
years.
STD infections will not be considered as a criterion for inclusion on the prioritization list, but will
be part of the information the CCCHAP reviews when doing the actual prioritization.
PRIORITIZATION MODELS
Julie presented two models for prioritizing subpopulations. Both models require Task Force
members to consider factors such as HIV incidence, prevalence and trends; population size;
impact of epidemic on a population, risk behavior; co-factors; barriers to prevention information
and services; and other resources as they are making decisions about how to prioritize.
Model #1 was developed by the Academy of Educational Development (AED) and has been
used by many states, including Minnesota in the past. The model uses rating scales and
weighting to help Task Force members consider the various factors listed above, but allows
Task Force members to consider data as well as experience and community input.
Model #2 is a forced choice model that is also being used by the Minnesota HIV Services
Planning Council (Planning Council) to prioritize services for people living with HIV/AIDS. This
model is less driven by numbers, and it also allows Task Force members to consider data as
well as experience and community input. Model #2 requires members to compare each
subpopulation to the others (two at a time) and make a determination of which population has a
greater need based on the factors mentioned above.
The Task Force broke into small groups to practice using Model #1 to prioritize subpopulations
under MSM. The small groups then practiced using prioritization Model #2.
TASK FORCE NAME CHANGE
The Task Force has decided to change its name. The group has talked about doing it for years,
but the recent restructuring has provided a particularly opportune time for moving forward with
the change. At the Celebration of Change event held in February, Task Force and community
members were asked to present names for consideration. Those present at the event voted,
which resulted in a tie between two names.
The two names being considered today are, “HIV/AIDS Prevention Planning Force” (suggested
by Gerry Anderson) and “Community Cooperative Council on HIV/AIDS Prevention” (suggested
by Rhys Fulenwider). The Task Force conducted a “dots” exercise to determine the winning
name. Community Cooperative Council on HIV/AIDS Prevention (CCCHAP) was chosen as
the new name by a vote of 12 dots to 8. Julie noted that the newly revised Bylaws will be
updated to reflect the new name.
CCCHAP Minutes 04/16/04 Page 4
ADOPTION OF A PRIORITIZATION MODEL
Julie asked the CCCHAP to describe the pros and cons of the two prioritization models.
Model 1 - Pros
Uses a rate that could be described and weighting
Ability to look at epi data as well as really getting serious with risk factors and having a
discussion about the co-factors
Ranking a particular group of people on an individual basis
A number of other factors that could be taken into consideration besides incidence or
prevalence including trends, etc.
More objective
Allows consideration of a population without external competitiveness and ability to use the
weights rightly.
Structure is cleaner. Prioritization is complicated so having a clean process is good.
Felt more comfortable – very cut and dry
Any error that occurs will be due to random error
The weights are clearly given
Allows for a lot of the conversation that would occur in Model #2 to happen during the
creation of the rating scales and weights
Model 1 - Cons
The weight and rate system can cause problems that result in scores not being the score
that you expected. When multiplying the rate by the weight, the increase is exponential
instead of an additional increase.
It is not scientific and not objective. If scores are analyzed, there are probably few
statistically significant differences, most differences are due to chance alone.
Was used time before last with disastrous consequences
The weights would be determined by the CCCHAP for each of the variables, but the factors
may deserve different weights in different communities. This model doesn’t allow for that.
Prefer the statistics. The process allows for opportunity to have discussion about the nonepi factors. Has some of the style of model 2 in it.
This is an economic model and to bring it into socio-medical model is not good. Can’t
quantify culture, etc.
Model 2 – Pros
Allows people to take what they believe is most important in each community and assign
personal weights.
Is a lot harder, but it also gives you a lot more freedom to really explore all the issues of a
population in your mind.
More thoughtful process.
The CCCHAP’s job is to bring your thoughts, biases, advocacies, which will be done with
either of these models. Model #2 makes you be more thoughtful about balancing that with
the data.
Good model for experienced individuals who have been involved in this field.
Like the discussion and the ability to be able to argue a little bit.
Model 2 - Cons
More subjective.
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Didn’t like the direct comparison between groups. There was much more of a competitive
nature between groups that he didn’t feel was appropriate - pitting groups against each
other.
Didn’t want the responsibility of having to decide one population is more important than
another.
Subject to manipulation because community members can weigh higher than another since
we are pitting one community against the other.
It appears that there are no weights, but there are.
Felt someone would be left out.
Felt like they were advocating harder for a particular group and pitting groups against each
other.
Concern that people will let things that they think are true come into play instead of really
looking at the data.
Too much personal opinion.
It is a model without a model for discussion.
Discussion
There was a long discussion about the two models. Kip reminded the CCCHAP that regardless
of which model is chosen, the prioritization results will be calculated and the CCCHAP will step
back and consider whether the results make sense. He also noted that minor adjustments
could be made to the model that is chosen as we move forward.
It was suggested that a combination of the two models be used to allow for both an objective
and subjective process. MDH staff asked for a decision and offered four options:
Model #1
Model #2
Model #3 - hybrid using the Model #1 worksheet with all CCCHAP members using the
same rating scale, but each CCCHAP member determining the weight to be given to
each of the factors
Final decision will be made by the Process and Procedures Committee
Amy Moser stated that she was not comfortable with the last option since one of the major goals
of restructuring was to have decisions made by the full CCCHAP on a timeline and not have
them deferred to committees. The CCCHAP agreed, and the fourth option was removed from
the table.
Consensus Process
A preliminary show of hands was taken. Model #1 received 6 votes, Model #2 received 1 vote,
and Model #3 received 8 votes.
The discussion then focused on Models #1 and #3. Some people liked the idea of allowing
each CCCHAP member to determine what weight (or level of importance) to assign to each of
the factors being considered. Others felt that the weights should be set by the full CCCHAP to
provide greater consistency in the process.
Gary Remafedi suggested that the CCCHAP delay making a decision today, and have a
biostatistician work with the group to develop the formulas for rating and weighting. A show of
hands was taken about whether to make the decision today. 15 members wanted to decide
today and 5 wanted to make the decision at next month’s meeting.
Nick Metcalf asked each individual that wanted to wait until next month’s meeting what it would
take for them to be able to reach consensus today. Don Anderson wanted more information
CCCHAP Minutes 04/16/04 Page 6
about why Model #1 didn’t work the previous time it was used. Lucy stated that model did work
last time in as far as populations were prioritized. Some in the community didn’t feel it worked
because they didn’t like the outcome. She noted that CCCHAP members didn’t have all of the
information they needed to make the decisions, but that the process this time is being set up to
address that concern. Doris Johnson just wanted to see Model #1 chosen. Kelly Hansen
agreed to step aside because she knows that she will be able to use whichever model is
chosen. Kirk Fiereck felt that CCCHAP wasn’t sure how it wanted to vote at first, but now feels
that they do. Gary Remafedi would like an expert to review the statistics.
Nick called for the group to reach consensus today about which prioritization model they want to
use. He took another show of hands: Model #1 received 7 votes; Model #2 received 2; and
Model #3 received 8.
Nick then asked the two persons that voted for Model #2 what it would take for them to choose
Model #1 or #3, or step aside. Rosemary Thomas said she likes Model #2 because it really
counts on people to make an informed, intelligent decision and to make the decisions well. She
is terribly concerned that just using numbers in Model #1 will result in populations falling off.
She said she would step aside. Drew Parks agreed with Rosemary and will step aside to allow
the process to keep going. Gary will step aside, as well.
Nick called for another show of hands: Model #1 received 6 votes; Model #3 received 8; and 6
persons stepped aside. Lucy Slater noted that there would be another opportunity to tweak the
model in the Process and Procedures Committee. Charlie felt that Model #3 would slow things
down more than using Model #1 and tweaking it. Julie felt that that if tweaking occurs it would
most likely be related to the factors and how they are rated. This would be the same whether
the group used Model #1 or #3. The only difference between the two models is that in #1 the
full CCCHAP agrees on the weighting, and in #3, each member individually decides. Kelly and
Doris agreed to step aside. Steve Moore switched his vote from Model #3 to Model #1.
Nick asked who couldn’t live with Model #1. Kirk was the only person who indicated he couldn’t
live with it, and he was willing to step aside.
Consensus: The CCCHAP agreed to use Model #1 to prioritize populations.
After the break, Kip and Nick recognized that the CCCHAP is doing amazing work. Kip noted
that there should be no doubt in anyone’s mind that the CCCHAP had a full agenda and they
made decisions during these two days. It was clearly heard that there was not 100 percent
comfort level with Model #1. It is MDH’s and the CCCHAP’s responsibility to go back and do
some more work on it. He invited Gary to recommend a biostatistician to work with MDH to
present rating, weighting and scoring to the CCCHAP in a way that everyone can understand.
IDENTIFICATION OF INTERVENTIONS
INTERVENTION PROCESS
Julie presented a proposal for the process to identify interventions, which is quite different from
how the CCCHAP has done it in the past. Under this proposed process, the CCCHAP would
develop a list of core risk factors that all prevention programs would be expected to address.
After the target populations have been prioritized, the CCCHAP would identify a set of cofactors beyond the core risk factors that put each subpopulation at risk for HIV infection or
transmission. The CCCHAP would then do a “dots” exercise to identify up to three priority cofactors for each sub-population.
CCCHAP Minutes 04/16/04 Page 7
The Request for Proposals (RFP) would describe the priority co-factors for each target
population. Applicants would be asked to:
Describe the population(s) they propose to reach
Describe how they propose to address the core risk factors
Describe how they propose to address one or more of the priority co-factors
Present supporting evidence for the efficacy of the proposed intervention(s) in
preventing new infections and the appropriateness for the target population.
The supporting evidence can range from interventions that have been formally evaluated in the
same setting and with the same population, to an explanation of how the intervention was
developed through the application of behavioral/social science or a logic model.
The RFP Review Committee would responsible for reviewing funding proposals and making
recommendations to MDH. MDH would make final funding decisions to ensure that a
comprehensive set of interventions is implemented.
This model lessens the work load of both the CCCHAP and MDH staff by shifting the
responsibility of identifying interventions and supporting evidence from the CCCHAP to the RFP
applicants.
Discussion
A brief discussion followed. Amy suggested providing some kind of guidance to help community
organizations identify sources of research on interventions. Steve liked this model because he
felt it leaves more room for agencies to be creative.
Consensus: The CCCHAP agreed to adopt this model for the identification of
interventions.
CORE RISK FACTORS
Julie then asked the group to come to consensus on the core risk factors that every prevention
program will be required to address. MDH suggested three risk factors as a starting point for
the discussion:
1) Unprotected sex with a person of unknown or different serostatus
2) Unprotected sex with multiple partners
3) Sharing of injection drug equipment
She asked for additions, deletions, or changes. The following additional ideas were suggested:
4)
5)
6)
7)
8)
Unprotected sex with a known HIV positive person
Unprotected sex under the influence of drugs and alcohol
Sharing of injection drug equipment with a known HIV positive person
Breast milk
Sharing of other skin piercing equipment
Discussion
Kip felt that unprotected sex with an HIV positive person was covered under the first core risk
factor. The group discussed whether sex between two individuals who are HIV positive is a risk
factor. Kip argued against it being a risk behavior because there isn’t documented evidence of
numerous cases of reinfection. For the purposes of the CCCHAP’s work, prevention of new
infection of a previously uninfected person should have priority over the reinfection of an HIV
positive person. Kip thought that talking to people about the risk of reinfection and other STDs
CCCHAP Minutes 04/16/04 Page 8
when they are having unprotected sex with another positive person is critical for specific
populations, but it is not overarching core risk factor. The CCCHAP agreed.
The group agreed to maintain the risk factor of unprotected sex with multiple partners and
unprotected sex under the influence of drugs and alcohol. It was recommended that all
references to unprotected sex be qualified in parentheses as vaginal and anal sex. It was then
suggested that oral sex also be included. Kip stated that studies show that oral sex is a very
low risk activity, and did not feel that prevention efforts should focus on preventing unprotected
oral sex. MDH is in the process of reviewing studies to determine which behaviors have the
highest risk. They will share that information with the CCCHAP in one of the upcoming
meetings. Until that time, it was agreed to leave references to unprotected sex without
qualifying what type of sexual activity is involved.
The group agreed that the sharing of injection drug equipment with an HIV positive person was
covered under sharing of injection drug equipment. The group decided to add “and other
instruments that puncture the skin” to sharing of injection drug equipment, in order to address
issues related to tattoo needles, razors, etc.
Kip reminded everyone that all providers will be expected to address the core risk factors. If
breast milk is included as a core risk factor, an MSM provider would need to address that core
risk factor although it doesn’t affect the MSM population. He felt that breast milk would be more
appropriate as a possible co-factor for HRH. The group agreed.
Consensus: In summary, the CCCHAP agreed on the following core risk factors:
Unprotected sex with a person of unknown or different serostatus
Unprotected sex with multiple partners
Sharing of injection drug equipment and other instruments that puncture the skin
Unprotected sex under the influence of drugs and alcohol
ALL THAT AND A BAG OF CHIPS
Don handed out the “All That and a Bag of Chips” awards and chips.
EVALUATIONS AND ANNOUNCEMENTS
CCCHAP members were asked to fill out the evaluation forms. The forms have been revised.
Some of the questions included will help us evaluate the new planning process.
Cliff – MN Rainbow Alliance for the Deaf is having a party on April 17th from 6:00 – 9:00 p.m.
at the Metro Center for Independent Living on Snelling Avenue. He has another grandchild
coming in December and it will be his eleventh. He is getting married May 15th in Duluth.
Amy – Doing the AIDS Walk and would love folks here to sponsor her.
Kevin - Save the date on June 10th for a sexual health community forum targeting gay and bi
men. All MSM prevention programs are invited to participate and public is encouraged to
attend.
Kirk – New telephone number for RAAN is 651-641-6167 and 1-800-966-9735.
Don – WUWA is giving a Healthy Choice Gospel Show on Saturday, April 24, 2004, from
11:00 a.m. – 3:00 p.m. at WUWA located in the First Church of God, 3149 - 35th Avenue
South and it’s free. Topics will be HIV and AIDS, Hepatitis C, Diabetes, Depression,
Medical Adherence. Refreshments will be served and they would welcome folks that do free
testing.
CCCHAP Minutes 04/16/04 Page 9
Japhet – “African Nite 2004” at the U of M on Saturday, April 17th from 5:30 p.m. to 10:00
p.m. Cultural dances, fashion show, play and singing, and African food and drinks at the
St. Paul Student Center in the Northstar Ballroom.
Bankole – The Care System Assessment Demonstration Project (CSAD) is assessing why
HIV positive Africans are not getting into care, as well as why those who are in care are
accessing care.
Wynfred – Monday, April 19, 2004 from 10:00 a.m. – 11:00 a.m. the President of Rwanda,
Paul Kagame, will be speaking about the genocide in Rwanda at Williams Arena on the U of
M campus.
ADJOURN AND PICK-UP
The meeting was adjourned at 4:00 p.m.
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