Minnesota Department of Health
STD and HIV Section
HIV/AIDS Community Prevention Planning
COMMUNITY COOPERATIVE COUNCIL ON HIV/AIDS PREVENTION
Minneapolis Urban League
9:00 a.m. - 5:00 p.m.
Friday, May 21, 2004
Present
TASK FORCE MEMBERS
COMMUNITY MEMBERS
MDH STAFF
Gerry Anderson
Lois Crenshaw
Lucy Slater for Kip Beardsley
Kathy Brothen
Donna Clark
Kirk Fiereck
Rhys Fulenwider
Kelly Hansen - Parliamentarian
Doris Johnson
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
Jerry Moss
Fred McCormick
Adam Wennersten
Jorge Rivera
Jared Erdmann
Lolita Davis Carter
Erick McCoy
Ruth Dauffenbach-Kotrba
Peter Carr
Julie Hanson Pérez
Japhet Nyakundi
Absent:
Kevin Sitter-notified
INTRODUCTIONS
Cliff Noltee lit the candle. Introductions were done. Gary Remafedi read the ground rules. The
announcement sheet was passed around. Through the generosity of Amy Moser, bagels were
provided for the group.
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CONSENSUS ON PRIORITIZATION FACTORS
To begin the meeting, Lucy Slater reviewed the results of Thursday’s small group discussion
about adding and deleting factors to be considered during the prioritization process:
Suggestions for factors to be added:
1. Incidence Rate
2. Prevalence Rate
3. Change “Impact” to a “Disparity,” which would be described as a ratio
4. Add each of the Core Risk Behaviors (CRB) identified at the April meeting as an
individual factor. Add one additional CRB: HIV negative person having unprotected sex
with a known HIV positive person.
5. Marginalized populations
6. Co-morbidities (STDs, unintended pregnancy, IDU/chemical dependency, mental health)
7. Change “Impact” to “Community Impact”
a. YPLL (years of potential life lost)
b. Medical expenses associated with not preventing HIV infection
c. Socioeconomic costs associated with not preventing HIV infection
8. Community readiness, or the extent a community is ready to use prevention services
9. Historical weight (history of marginalization, what has been done within this community
in the past)
10. Current resources by population (equity in terms of FTEs available to serve population)
11. How much published information available for each population
12. Accessibility of services and accessibility of population (how easy it is to reach a
population)
13. Change “Other Resources” to “Other Resources Available”
Suggestions for factors to be removed:
1. Risk behaviors – every population engages in risk behaviors
2. Other Resources – availability of services does not equal utilization
3. Prevalence
4. Impact - the information contained here is misleading
Lucy then led the group through an exercise to come to consensus about what to do with each of
the suggestions. She reminded the group that they had already arrived at consensus on the
previous day to add incidence rate and prevalence rate as factors.
Consensus: The group agreed to change “Impact” to “Community Impact,” which will include
information regarding YPLL, medical expenses associated with not preventing infection, and
socioeconomic costs of not preventing infection. This category will also include information
about disparity ratios, or relative risk.
There was discussion about whether to include each of the Core Risk Behaviors (CRB) identified
by the CCCHAP in April as a factor. Rhys asked how it would be possible to rate CRBs in order
to determine if a behavior is unusually risky, risky, slightly risky; or not risky at all. Two
options were offered, either to completely remove CRBs as factors, or to redefine how CRBs are
being defined and measured. The argument in favor of not including CRBs as factors was that
risk behavior is a constant across every population; they each have at least one risk behavior.
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Under the new prioritization model, every prevention program will be required to address the
CRBs identified by the CCCHAP last month. (Julie noted here that it would not be necessary to
add the suggested CRB defined as an “HIV negative person having unprotected sex with a
known HIV positive person” to the list of CRBs. This is already covered under the CRB of
“unprotected sex with a person of a different or unknown serostatus.”)
Consensus: The CCCHAP agreed to remove “Core Risk Behaviors” from the list of factors to be
considered during prioritization.
Consensus: The CCCHAP agreed to include information about marginalized populations under
the “Barriers to Prevention Information and Services” factor instead of adding a new factor.
The group discussed whether to add “Co-morbidities” as a factor. When asked what the
difference between co-morbidity and co-factor, Lucy replied that co-morbidity is related to
disease, and co-factors are related to the person. Co-factors are activities or environmental
things that promote the transmission of HIV.
Consensus: The CCCHAP agreed to add “Co-morbidities” as a factor. Information about STDs,
Hepatitis B and C, unintended pregnancies, substance use, and mental health will be included.
Consensus: The CCCHAP agreed to include information about community readiness under the
“Barriers to Prevention Information and Services” factor instead of adding a new factor.
Consensus: The CCCHAP agreed to include information about historical weight under the
“Barriers to Prevention Information and Services” factor instead of adding a new factor. The
group agreed that information related to historical weight would also be considered during the
gap analysis process.
Consensus: The CCCHAP agreed to change the name of the factor from “Other Resources” to
“Resources.” Information included under this factor will include: list of all resources, including
those funded by MDH; information about FTEs funded to serve the various populations; data
about utilization of prevention services; and how much published research is available.
Consensus: Information regarding the accessibility of services and the accessibility of the
population will be included under “Barriers to Prevention Information and Services” factor
instead of adding a new factor.
The discussion then turned to the suggestions for factors to be removed. All but one had been
addressed during the previous discussion, so the CCCHAP focused on whether to remove
prevalence as a factor. Gary stated that incidence measures new cases and prevalence is the
number of overall living cases. Incidence is a direct estimate of the probability or risk of
developing the disease during a specific period of time. This contrasts with the prevalence,
which measures the number of living cases that are present at or during a specific period of time.
He stated that prevalence is something that the Planning Council would use if they want to know
how many people need medical care and felt that incidence is what the CCCHAP would want to
use to measures risk of getting the disease.
Peter Carr responded that incidence is largely driven by prevalence. The higher the prevalence,
the more likely one is to encounter someone with the disease, which directly relates to the risk of
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becoming infected. He also said that risk of acquiring a disease is directly related to the
prevalence.
Bankole Olatosi spoke in favor of maintaining prevalence as a factor because in order for new
cases to develop, there must be a pool of people who are already infected. Prevalence tells us
how many people make up that pool. Kirk agreed with Gary that prevalence is not as important
in helping us determine how to be responsive to the current epidemic, and suggested assigning a
lower weight to the factor. Lucy responded that the weighting of factors will be a separate
conversation.
Consensus: The CCCHAP agreed, with Gary Remafedi stepping aside, to maintain
“Prevalence” as a factor.
Julie announced that MDH staff will review the remaining comments from the small group
discussions about information to be included under each of the factors. MDH will consider
whether or not it is feasible to collect the suggested information. The information that is not
feasible to collect will be the type of information that can be gathered when CCCHAP members
speak to existing community groups or conduct community forums.
GAP ANALYSIS
Overview of Gap Analysis
Julie presented an overview of gap analysis. Gap analysis is a process used after the major
prioritization process has been finished in order to determine what the met and unmet prevention
needs are. There are nine categories of unmet need that the CCCHAP considers as part of gap
analysis:
Emerging Populations
Priority Target Populations
Needs Assessment
Public Information
Counseling, Testing and Referral (CTR)
Partner Counseling and Referral Services (PCRS)
Evaluation
Provider Capacity
MDH Capacity/Infrastructure
The CCCHAP is primarily responsible for identifying needs within the first three categories.
The three-year planning cycle will be divided up as follows. Prioritization occurs in Year A, and
an RFP is released based on the prioritization decisions. As a result of the RFP, new community
based prevention contracts start at the beginning of Year B. In Year B, gap analysis will be
conducted in relation to prevention programs/activities that are directly administered by MDH
(Public Information; Counseling, Testing and Referral (CTR); Partner Counseling and Referral
Services (PCRS); Evaluation; Provider Capacity; and MDH Capacity/Infrastructure). Unmet
needs among Emerging Populations will also be identified. In Year C, after the newly funded
prevention programs targeting specific populations have been in place for a year, the CCCHAP
will identify unmet needs among Priority Target Populations. They will look at unmet needs
among Emerging Populations and Needs Assessment, as well.
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The CCCHAP will be asked to prioritize unmet needs identified within each gap analysis
category, as well as to prioritize the categories. This information will be included each year in
the unmet needs portion of the grant application. The information is also used to determine how
to utilize unspent or supplemental funds when, or if, they become available.
Review of Gap Analysis Plan
Julie reviewed a draft of the gap analysis plan, which describes the steps to be taken in order to
identify unmet needs within each of the nine categories (for a copy of the gap analysis plan, contact Ruth
at 612-676-5590). She asked for feedback and recommendations from the group.
Emerging Populations
Amy suggested contacting prevention and care providers to see if there are populations in which
they are seeing newly emerging needs. Julie asked for suggestions of organizations that should
be contacted outside of prevention and care-funded agencies. Amy also suggested asking the
Planning Council about any emerging trends they have seen.
Priority Target Populations
No comments
Needs Assessment
No comments
Partner Counseling and Referral Services (PCRS)
No comments
Counseling, Testing and Referral (CTR)
Amy asked if there was any way to take into account non-MDH funded testing sites since there
are no MDH funded testing sites in Greater Minnesota. Julie responded that she had been
thinking about assessing the goals of the CTR program, which place priority on CTR being
provided as part of a comprehensive prevention counseling program. The CTR program is also
supposed to target the most at risk populations, which, in general, does not include Greater
Minnesota. Assessing the goals would allow us to identify gaps in the overall CTR program,
such as the lack of CTR programs in Greater Minnesota. Kirk asked whether the lack of testing
available to specific high risk groups in Greater Minnesota, such as MSM, would be a gap. Lucy
said it is not really a gap because the goal of the program, after risk reduction counseling, is to
target resources to areas where there is high risk, which doesn’t eliminate Greater Minnesota.
Lucy said that MDH’s implementation of CTR has lagged behind the development of the new
goals, but there will be a new funding process for CTR around the same time MDH releases the
Health Education Risk Reduction (HERR) RFP in 2005.
Lucy suggested adding something related to gaps in terms cultural competency of the testing
programs. Charlie asked if new testing methods were being incorporated into the data sets in
terms of measuring the positivity rate. For example, the Red Door Clinic is doing rapid testing.
They only submit serum tests to the MDH lab for people who have tested positive with the rapid
test, resulting in a high positivity rate on the serum tests, which could skew the data. Peter stated
that this is helpful to know as MDH analyzes the data. Charlie stated that the Red Door does
report all of the rapid tests that are done to MDH.
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Public Information
It was suggested that the cultural competency of public information efforts also be assessed for
gaps.
Provider Capacity
No comments
Evaluation
Amy asked if the outcomes data from the grantee programs would be seen by the CCCHAP.
Julie responded MDH stopped collecting data on the scannable forms as of June 30, 2004
because CDC hasn’t finished developing all of the variables that will be required for their new
data collection system. Once MDH is clear about what CDC will be requiring, they will move
forward with data collection. Hopefully by the time CCCHAP conducts gap analysis related to
the community based prevention programs in 2007, that data collection system will be in place
and the CCCHAP will be able to use some of the data.
MDH Capacity/Infrastructure
Charlie said that it would be helpful to gain feedback from agencies that are currently funded by
MDH as part of the assessment of gaps in MDH’s capacity. Julie suggested that the CCCHAP
could provide feedback on MDH’s capacity related to supporting community planning.
Amy asked if there will always be a delay in when the target population portion of gap analysis
can be done. Julie responded that prioritization will always occur in Year A of the planning
cycle, meaning that new contracts will not get implemented until the beginning of the second
year (Year B). It would not be fair to assess the gaps in programs reaching target populations
until they have been up and running for a while. After the CCCHAP conducts gap analysis for
the priority target populations at the beginning of Year C, we will have the rest of that year and
all of Year A to address the gaps, before new contracts are again put in place at the beginning of
Year B.
Consensus: The CCCHAP arrived at consensus on the gap analysis plan with the inclusion of
the suggestions made.
CHECK-IN ON BYLAWS
Julie reviewed all of the changes to the Bylaws that had been suggested at the April meeting.
The purpose was to ensure that the written document accurately reflected the changes that had
been discussed.
There was one additional change forwarded for approval. At the April meeting, it was suggested
that in addition to the Executive Team, the Parliamentarian should be involved in reviewing and
resolving any grievances that are filed in relation to CCCHAP processes. As Julie was revising
the Bylaws, it made sense to her to instead make the Parliamentarian a member of the Executive
Team, since the team is responsible for strategizing the overall planning process. It seemed to
her to fall within the purview of the Parliamentarian since s/he is responsible for advising the cochairs on CCCHAP procedures and decision making processes. She discussed this with the
Executive Team, and they agreed with the suggestion.
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Gary asked what type of grievances could be filed. He didn’t think it would be appropriate to
file a grievance against the CCCHAP since it is only an advisory body. Julie responded that a
grievance may be filed if someone feels that the CCCHAP did not follow its own processes.
This could be in relation to membership recruitment and nominations, attendance, prioritization,
decision making. There was another short discussion similar to the one that occurred on the
previous day regarding the role of the CCCHAP and the degree to which it had the power to
make decisions. Rosemary Thomas reminded the group that they had approved the Bylaws at
the April meeting, and that the purpose of the discussion today was to approve the written
version of the changes they verbally discussed last month. It as agreed that the discussion about
the role of the CCCHAP and whether it is accurately reflected in the Bylaws would be continued
at the Process and Procedure Committee.
Consensus: The CCCHAP approved the written version of the suggested changes to the Bylaws.
The CCCHAP also approved the additional change to make the Parliamentarian part of the
Executive Team.
FORMAT OF THE HIV PREVENTION PLAN
Julie reported that CDC had changed its requirements regarding what needs to be included in the
prevention plan. Some of the areas that have been included in the past are no longer required,
and Julie wanted to get feedback from the CCCHAP about which pieces they felt were important
to maintain and which ones could be deleted. She noted that the prevention plan is supposed to
be used to inform anyone in the state who is interested in implementing an HIV prevention
program. However, in reality, the plan is not widely used beyond the CCCHAP and MDHfunded providers.
The parts of the plan that are no longer required are the chapters related to collaboration and
coordination, capacity building and technical assistance, surveillance, and evaluation. She noted
that all of those areas except for surveillance are covered in the grant application. She added that
the grant application is not distributed as widely as the prevention plan, so not as many people
have access to the information.
Consensus: The CCCHAP agreed to the following regarding the prevention plan:
The chapter on collaboration and coordination will be maintained. The most important
pieces are the descriptions of collaborations within the HIV system, and the chart that
summarizes the various collaborative efforts.
Current capacity building and technical assistance efforts will be included in the
resource inventory chapter.
The information previously contained in the chapter on surveillance will be incorporated
into the epi profile.
The information previously contained in the evaluation chapter will be incorporated into
the introduction.
MEMBERSHIP & TRAINING COMMITTEE REPORT
Attendance Policy
Kathy reviewed the new attendance policy. Members are required to attend 75% of scheduled
meetings in a calendar year, or 3 out of 4 scheduled two-day meetings. Members may also use a
proxy to attend in their place for one meeting each year. Due to the decision making structure of
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each meeting, members are expected to attend the whole two-day meeting or not attend at all.
Proxies are also expected to attend the whole meeting. Members will be allowed a 30 minute
grace period at the beginning and end of the meeting to allow for unforeseen circumstances.
CCCHAP members are also required to serve on at least one committee for both years of their
first two-year membership term, and for one year of their second and third terms. Members will
be required to attend 75% of committee meetings scheduled during the years they are serving on
a committee. Members who do not meet the membership requirements will be automatically
removed. This removal may be appealed by a letter to the co-chairs within 30 days of being
advised of removal. The appeal will be considered by the Executive Team.
Kathy reported that due to the newness of the process, and the relatively short notice before the
first restructured meetings were scheduled, the attendance policy would not be enforced for
people who had to miss part of the meetings in April and May. It will be enforced for people who
missed complete meetings. The committee will be gathering feedback from people who were
not able to attend or missed part of those meetings in order to have a better understanding of
issues affecting attendance. Starting in August, the policy will be in force since people will have
had enough notice of meeting dates to clear their schedule. Julie added that this policy is not
meant to be punitive. It is in place because the work that the CCCHAP does is so important to
the community, and it will not be accomplished if members are not fully engaged in the process.
Questions
Charlie stated that at yesterday’s meeting, the agenda was passed out for both days. At that time,
the agenda for today said the meeting would end at 3:30 p.m. When they arrived this morning,
the agenda had been revised and the meeting is now scheduled to go until 4:45 p.m. He asked
how people are supposed to plan for day care, etc. Kathy suggested that everyone always block
out the 9:00 a.m. to 5:00 p.m. time slot for these meetings. Charlie asked that a message to plan
to attend from 9:00 a.m. to 5:00 p.m. be incorporated into the agenda.
Jerry asked whether he would be removed if he has already missed one meeting this year and a
proxy who is scheduled to attend another meeting does not come. Julie replied that he would
receive a removal letter, but would have the opportunity to appeal. Cliff Noltee asked what
would happen if his ride didn’t show up and he was not able to attend. Julie responded that he
would also receive a letter of removal, which he could then appeal. Steve Moore asked if a
current co-chair could proxy for a member. The Bylaws state that a member cannot proxy for
another member.
Consensus: The CCCHAP approved the attendance policy.
Membership Recruitment Plan
We will be able to bring on 8 to 10 new members in November in order to reach the maximum of
35 members. The committee reviewed a grid comparing epidemiological (epi) data and the
demographics of CCCHAP members in order to identify the following gaps in membership:
Eleven county metro area (outside of Minneapolis/St. Paul)
Greater Minnesota
Latino (preferably men)
Asian Pacific Islanders (preferably men)
MSM
HIV positive persons
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Wynfred suggested that African women are also a gap. After reviewing the grid, Julie agreed
and added them to the list.
The committee also identified the following possible mechanisms for getting the word out
regarding recruitment efforts:
Greater Minnesota – Rural AIDS Action Network, Rosemary Thomas
MSM – Lavender, GLBT Press
Asian Pacific Islanders – Asian Media Access
HIV + Persons – Camp Benedict, Aliveness Project newsletter, flyers to agencies serving
HIV+ persons
Students – word of mouth, list serve through the U of M School of Public Health
There had been no suggestions for how to recruit Latino men, and Kelly said that UMOS, Inc.
could help with recruitment efforts. Wynfred suggested adding places of worship as places to
recruit for members.
Recruitment will happen in July and August, applications will be due in September, and
interviews will happen in October. At their October meeting, the Membership & Training
Committee will make recommendations regarding nominees. The names will be forwarded for
election at the joint meeting between the Membership & Training and Process & Procedures
Committees in November. Julie noted that all CCCHAP members will be expected to assist with
promoting recruitment efforts, providing information about the CCCHAP and its work, and
distributing application forms.
Jerry presented the All That and A Bag of Chips awards.
ANNOUNCEMENTS
Amy announced that there are changes in the drug and insurance programs at DHS that will be
effective July 1, 2004. Information is available on the back table and she will be glad to answer
questions.
Lolita Davis Carter announced that the Minneapolis Urban League is looking for mentors for
African American males who will be there for the men when needed.
Kirk thanked the CCCHAP for all their contributions and said he will miss everyone.
Wynfred brings greetings from the Care System Assessment Demonstration (CSAD) Project
through the Hennepin County Human Services Department. The CSAD Project is trying to find
HIV positive African individuals who have dropped out of care in order to learn more about
why. He asked for assistance in finding HIV positive Africans, and would like to be in touch
with providers.
Becky Clark announced that she will turn 21 on Monday, May 24th.
ADJOURNMENT
The meeting was adjourned at 2:30 p.m.
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