Minnesota Department of Health
STD and HIV Section
HIV/AIDS Community Prevention Planning
COMMUNITY COOPERATIVE COUNCIL ON HIV/AIDS PREVENTION
Snelling Office Park
9:00 a.m. - 5:00 p.m.
Thursday, August 5, 2004
Present
TASK FORCE MEMBERS
Gerry Anderson – Community Co-chair
Kip Beardsley – MDH Co-chair
Donna Clark
JT Webster for Alissa Fountain
William Grier
Kelly Hansen - Parliamentarian
Doris Johnson
Steven Moore
Amy Moser
Clifford Noltee
Bankole Olatosi
Gary Remafedi
Rosemary Thomas – Community Co-chair
Charlie Tamble
Traci Capesius
Kevin Sitter
Absent:
Kathy Brothen (notified)
Becky Clark (notified)
Lois Crenshaw
Jerry Moss
Drew Parks (notified)
Wynfred Russell (notified)
Muhidin Warfa
COMMUNITY MEMBERS
Jared Erdmann
Eileen McCormick
MDH STAFF
Peter Carr
Kathy Chinn
Girard Griggs
Julie Hanson Pérez
Angela Kotrba
Japhet Nyakundi
Tracy Sides
INTRODUCTIONS
Introductions were made. Rosemary Thomas lit the candle. Bankole Olatosi read the goals of
community planning, Charlie Tamble read the ground rules, and Rosemary reviewed the
desired outcomes for the meeting.
BUSINESS
Approval of Minutes: Rosemary called for comments regarding the May 20th and 21st, 2004
meeting minutes. The May minutes were approved with no changes.
Review Meeting Evaluation: Rosemary briefly reviewed the feedback from the May meeting
evaluation forms. Recommendations included accommodating non-English speaking
participants and improving time management of the meetings.
Announcement List: Rosemary passed around the announcement list.
Community Cooperative Council on HIV/AIDS Prevention Minutes 08/05/04 Page 1
PROCESS & PROCEDURES REPORT
Julie Hanson Peréz reported that several revisions to the Bylaws were recommended at the July
8th meeting of the Process and Procedures Committee. The proposed revisions were included
in the CCCHAP mailing for review prior to the meeting (contact Girard Griggs at 612-676-5572
or [email protected] for a copy). The revisions were recommended in response
to questions raised at the last two CCCHAP meetings regarding the scope of influence the
CCCHAP has in its role as an advisory body to the MDH. The proposed revisions are intended
to clarify:
Specific decision-making responsibilities of the CCCHAP (prioritization of target
populations and co-factors, prioritization of unmet needs);
The role of the CCCHAP in relation to the concurrence process;
The role of the CCCHAP in relation to the development of the comprehensive HIV
prevention plan (review and provide guidance);
The role of MDH in relation to the development of the comprehensive HIV prevention
plan (write the document based on decisions made by the CCCHAP); and
The revised prioritization process, which now requires the CCCHAP to prioritize cofactors for each target population instead of identifying effective interventions.
Julie then reviewed the recommended Bylaw changes, receiving consensus on each revision as
she proceeded. There was discussion about the following proposed change to III.B.1.g. Role of
CCCHAP Members:
“Review the health department application to the CDC for federal HIV prevention funds,
including the proposed budget, and as a result of the concurrence process, review and
approve a written response that describes whether the MDH-STD & HIV application
does or does not, and to what degree, agree with the priorities set forth in the
Minnesota Comprehensive HIV Prevention Plan.”
Kevin Sitter felt it was misleading to state that the CCCHAP would review and approve the
proposed budget included in the health department application. Julie replied that the “review
and approve” referred to in the paragraph is regarding the letter of concurrence, not the
application itself. She added that the language regarding the review of the proposed budget is
included because MDH is required by CDC to share the budget with the CCCHAP.
Julie proposed deleting the phrase, “including the proposed budget” from the paragraph cited
above. Section III.E.2.h. Major Duties and Tasks of the MDH-STD & HIV refers to the
requirement to share the budget by stating that MDH shall “present the funding application and
budget to the CCCHAP with adequate time for the CCCHAP to review and issue a written
response.” CCCHAP members agreed to this change.
Julie noted that in addition to the other proposed revisions, needs assessment was removed as
a grievable process from VII. Grievance Process. She explained that, at this point, the
CCCHAP does not have a standard process in place for needs assessment. In addition, while
the CCCHAP is responsible for identifying populations for needs assessment projects, they do
not have control over whether the needs assessments actually occur. Given current funding
limitations, it will be difficult to do in-depth needs assessments in the future. Julie stated that
she did not want the CCCHAP to run the risk of having a grievance regarding something that is
out of their control.
Consensus: The CCCHAP agreed to adopt all proposed revisions to the Bylaws, including the
additional revision made at today’s meeting to remove the wording, “including the proposed
budget” from III.B.1.g.of the Bylaws.
Community Cooperative Council on HIV/AIDS Prevention Minutes 08/05/04 Page 2
Amy Moser suggested that absent members be contacted to review the Bylaw changes so that
they are aware of the changes and understand them.
Members will receive copies of the revised Bylaws and the updated version will also be
available on the CCCHAP website.
COMMUNITY GROUPS AND FORUMS
Overview of Community Groups and Forums
Kip Beardsley stressed the importance of bringing the community planning process out to
targeted populations via community groups and forums. The planning process is, by nature,
formal, systematic, lengthy, and time consuming, and is not necessarily conducive to getting
participation and valuable input from all community groups by way of the CCCHAP’s regular
meetings.
Kip reviewed the desired outcomes of the community group discussions:
Gathering qualitative data for use in the prioritization process and for determining risk
co-factors and unmet needs;
Gathering information needed to better understand and advocate for communities other
than our own; and
A written and oral report of the findings.
Kip reviewed the populations identified this year in preparation for the 2005 prioritization
process that will be targeted for community input: HIV Positive Individuals, Men Who Have Sex
with Men (MSM) of All Races, MSM of Color, African High Risk Heterosexuals (HRH), African
American HRH, Asian/Pacific Islander HRH, Latino HRH, Native American HRH, White HRH,
Injecting Drug Users (IDU), and Youth At Risk. Note: some of the subpopulations that were
identified by the CCCHAP have been combined for the purpose of conducting the community
groups/forums. Whether or not Greater Minnesota will be included as a population for the
community groups/forums will be determined by another decision to be made later in the
meeting.
Kip proposed the formation of small teams of 3 CCCHAP members to gather input from these
populations. One person will serve as the facilitator and should be somebody who identifies with
or has significant experience with the targeted community. The other two members of the team
do not have to be from the targeted community, and will provide backup assistance to the
facilitator and take notes. MDH staff will help coordinate meeting logistics and refreshments,
and will attend if necessary to help take notes; however, the CCCHAP team will run the
meetings and facilitate the discussions. The role of the facilitator will be to determine whether
there is an existing community group meeting the team could participate in. If not, the facilitator
will pull together an ad hoc community forum, and set the location and time that works for the
community. The facilitator will be responsible for generating a brief written report as well as
providing an oral report at the upcoming prioritization meeting in March 2005. The groups can
be self-defining as necessary, adding roles and responsibilities as needed.
Kip provided an overview of the proposed questions regarding the impact of HIV in Minnesota:
1.
2.
3.
4.
How has HIV impacted your community?
What are the factors that contribute to HIV infection or transmission in your community?
What are the barriers to effective HIV prevention in your community?
What are the prevention resources in your community?
Community Cooperative Council on HIV/AIDS Prevention Minutes 08/05/04 Page 3
Kevin suggested that the fourth question be phrased in such a way as to help assess the quality
of services: What services do you engage in within your community? Which ones do you avoid
and why? How are the services effective? How are they not effective?
The timeline for the community groups/forums will be:
October 2004: Facilitator training (open to all, but focused on facilitators)
October 2004 – January 2005: Complete meetings
February 15, 2005: Written reports due to MDH
March 2005: Information used in the prioritization of populations
April 2005: Information used in the prioritization of cofactors
Kip commented that MDH would also develop a simple survey in order to collect direct feedback
from the community groups that would be unfiltered by note takers’ perceptions. He also noted
that if the CCCHAP discovers problems with the process, it can be adapted and changed for
future years.
Discussion
Steven Moore indicated his approval of this effort to go to the community and break down
barriers of communication between government and the community.
Jared Erdmann suggested reviewing information that has been gathered in the past so that the
teams could focus on groups within a targeted population that have not previously provided
input. Kip responded that the teams could look at the information in the prevention plan in order
to determine what gaps exist, and focus on collecting additional information that is needed for
the plan.
Amy Moser voiced concern about how the qualitative information would be weighed and used.
She mentioned that there was no clear guidance during the last prioritization process about how
to weigh the information gathered through community forums against the other type of data
provided. Kathy Chinn stated that it is important to cite the scope and limitations on the reports
so as to not be misleading. Julie responded that the question about how to weigh the
information has not yet been addressed, but stated that the community input will be integrated,
by target population, into the packets of information that the CCCHAP will use for the
prioritization process in March 2005. This information will also be used to prioritize co-factors in
April 2005. Kip noted that if a the CCCHAP prioritizes a certain co-factor for a target population,
it would be included in the request for proposals (RFP) and applicants would need to describe
how they will address that particular co-factor within the population.
Kevin commented that this is a significant task and asked what criteria and standards should be
used in determining which groups are surveyed. The following ideas were suggested by the
CCCHAP to help the teams determine how to best define and access the community
groups/forums:
Further define what “high risk” means for the population of high risk heterosexuals
Review existing survey information and focus on other groups that we know little about
Survey people that are associated with a target group (example: wives of Latino men,
African American women who have partners on the down low)
Participate in the Deaf Aware Fair
Focus on the people who are at highest risk in the targeted population
Be careful to not focus entirely on the professionals in the community
Target groups that will provide reliable information
Community Cooperative Council on HIV/AIDS Prevention Minutes 08/05/04 Page 4
Be sensitive to communities’ preferences regarding working with a CCCHAP member of
a certain gender
Where possible, focus on existing groups for efficiency (i.e., support groups)
Eileen McCormick suggested giving thought to how many focus groups should be conducted to
provide statistically significant results and quality data. The standard practice is to keep
sampling until no new information is being gathered. Kip stated that this process will be
repeated in future years, one time per year. While he supports the idea of CCCHAP teams
volunteering to meet additional groups, he cautioned members to consider the balance between
resources and time.
Charlie suggested that a subcommittee be formed to develop the questions to be used. Julie
agreed to convene a subcommittee and asked for volunteers. The CCCHAP also discussed
ideas and issues surrounding advertising resources. It was suggested that the facilitator
training include ways to effectively promote the community groups/forums.
Kip passed around a sign-up sheet and asked CCCHAP members sign up for two or three
teams. Absent members will be contacted for their commitments.
HIGH RISK POPULATION SIZE ESTIMATES
Overview of High Risk Population Size Estimates
Julie reminded the CCCHAP that at the May meeting, it was decided that incidence and
prevalence rates would be two of the factors considered during the prioritization process. The
determination of incidence and prevalence rates requires an estimate of population size. At the
last meeting, Peter Carr presented an initial proposal for how to estimate the size of each
population. The CCCHAP had asked that MDH try to refine the population estimates so that
they more accurately reflect the number of people that are truly at risk in each of the population
categories.
Peter presented the new population estimates by category and explained that every attempt
was made to be as accurate and sound as possible, and he noted the lack of behavioral data
that could validly be used to estimate the proportion of each population that is at high risk. The
new estimates do not change the previous rank order of the high risk populations.
HIV Positive Individuals: The number of living HIV/AIDS cases in 2003 were used to determine
the size of this population. Risk redistribution was used to assign cases with unspecified risk to
specified exposure categories.
MSM: The total MSM population was estimated at 2 percent of the male population aged 15 to
19, and 6 percent of the male population aged 20 to 64 within each racial/ethnic group. Census
data, adjusted to re-classify persons reporting more than one race, provided the number of
males in each sub-group. The 2 percent figure for young males is based on a 1992 study
authored by Gary Remafedi and the 6 percent figure is based on a national study by R. Sell
conducted in 1995. This population was limited to ages 15 – 64 based on STD incidence and
HIV/AIDS prevalence data.
HRH: Census data were used to estimate the size of this population, adjusted to re-classify
persons reporting more than one race. Based on the Sell study, the estimated number of men
(0.8%) and women (0.3%) who only have sex with the same gender was subtracted from the
number of men and women for each racial/ethnic group. The HRH category was limited to
persons between ages 15 and 54 based on STD incidence reports.
Community Cooperative Council on HIV/AIDS Prevention Minutes 08/05/04 Page 5
IDU: The Institute for AIDS Research estimated that the number of IDUs in the 11-county
eligible metropolitan area (EMA) is 8,081, or an estimated 0.27 percent of the EMA’s population.
This percentage was then applied to the entire population of the state, across all gender and
race/ethnicity categories to determine the size of the IDU population in the state. The 6 percent
figure was applied to the estimated number of male IDUs in order to estimate the number of
MSM/IDUs.
Greater Minnesota: The methods described for the populations above were applied to the
number of people for people living in Greater Minnesota (according to Census data) in order to
estimate the size of the Greater Minnesota subpopulations (HIV+, MSM, HRH, and IDUs). For
youth, Census data were used to identify the number of persons in Greater Minnesota aged 13
through 24.
Discussion
Amy voiced concern about the age range being capped at 54 for HRH when it is capped at 64
for MSM. Peter responded that they were trying to focus primarily on risky behavior age groups.
He explained that STD incidence reports can help guide which age groups are of significance
for the calculations of populations at risk. He highlighted that STD incidence among
heterosexuals is primarily driven by adolescents and young adults. The incidence is
significantly reduced in groups age 40 and above, and further diminishes for the age group of 50
and above. Among MSM, both STD incidence (primarily syphilis) and HIV/AIDS prevalence
data show infections among older men.
Consensus: The CCCHAP agreed to apply the age range of 15 – 54 for the HRH population
size estimates.
Tracy Sides commented that there is a need to develop better population size estimates and
shared that MDH plans to establish an ad hoc community group to try and come up with a
consensus on how to best estimate these population sizes. Although this will not be
accomplished in time for the 2005 prioritization process, it will be information that can be used in
the following prioritization process (2008).
There was discussion about whether the category of High Risk Heterosexuals should be
changed to Heterosexuals since the population size estimate doesn’t necessarily reflect the
number of heterosexuals who are at high risk. Kevin stated his opposition to moving away from
the “high risk” terminology. He commented that we are doing better job at capturing population
denominators, but felt that the numerators need to be distinguished and appreciated. He felt
that using generalized terminology poses the risk of everyone claiming a stake in the available
public prevention dollars, which could negatively impact prevention work being done in the state
to specifically target high risk populations. Kevin suggested looking at other co-factors or
indicators to better define categories of high risk.
Consensus: The CCCHAP agreed to continue using the terminology “high risk heterosexuals.”
There was discussion regarding how to improve the calculation of population sizes. It was
stated that a behavioral surveillance study would have to be conducted to determine how
various indicators translate into high risk. Learning more about indicators such as health
services admissions, rates of incarceration, poverty, prostitution, etc, would help. In addition,
bringing in members of high risk communities would benefit the study.
Community Cooperative Council on HIV/AIDS Prevention Minutes 08/05/04 Page 6
Consensus: The CCCHAP approved the methods described above for calculating population
size estimates. Footnotes will be added to explain how high risk is being defined.
Peter stated that new behavioral surveillance information is available from the Twin Cities Men’s
Health Survey through which approximately 400 interviews were conducted at the Twin Cities
Pride festival in June. The preliminary results are now posted on the MDH website under
STD/HIV Statistics. The CCCHAP will receive a presentation on the findings at the September
meeting. There was discussion regarding the limitations of the survey and how it might be
beneficial to accommodate deaf and non-English speaking individuals in future surveys.
Members suggested conducting additional surveys at other festivals such as Black Pride, Cinco
de Mayo, and Pride festivals in Greater Minnesota.
RATING SCALES FOR PRIORITIZATION
Review of Factors for Prioritization
At the May meeting, the CCCHAP identified which factors, or pieces of information, will be
considered during the upcoming prioritization process in 2005. Because the CCCHAP had not
yet seen the final results of that discussion, Julie reviewed the factors that were identified at the
previous meeting:
Proportion of new HIV cases
- This subpopulation accounts for X% of all new HIV infections diagnosed in the past 3
years
Incidence rate
- New HIV cases per 100,000 within this subpopulation
Trends
- Whether new infections among this subpopulation have increased, decreased or
remained stable over the last 5 years
- Any other concerning trends noted within the subpopulation, such as the proportion of
new cases that were AIDS at first diagnosis over the last 3 years
Proportion of living HIV/AIDS cases
- This population accounts for X% of all living HIV/AIDS cases in the previous year
Prevalence rate
- Living HIV/AIDS cases per 100,000 among this subpopulation
Size of population
- The size of the population at high risk for HIV infection, based on population size
estimates previously discussed
Community impact
- Years of potential life lost (YPLL)
- Medical expenses associated with not preventing infection
- Socioeconomic cost of not preventing infection
- Relative risk (ratio of incidence rates)
Co-morbidities
- Other diseases that indicate risky behavior or inhibit the ability to maintain safe
behavior (STDs, unintended pregnancies, hepatitis B and C, substance use, mental
health)
Co-factors
- Contributors to HIV infection or transmission, including things such as sexual
networks, socioeconomic status, stigma, education, immigration status, population
mobility, and perceived risk
Community Cooperative Council on HIV/AIDS Prevention Minutes 08/05/04 Page 7
Barriers
- Barriers to HIV prevention information and/or services (limited or no access to health
care, language, transportation, affordable health care)
Resources
- Resources and/or capacity available in the community for HIV prevention (look at
historical availability as well)
- Utilization and accessibility of prevention services
- Amount of information available about effective interventions for this subpopulation
Discussion
Julie noted that Tracy Sides and Nicoline Collins, epidemiologists at MDH, reviewed the factors
and voiced concern that it may not be possible to find data related to co-morbidities for all
subpopulations, and the data that are available may be similar across populations. Gary
Remafedi suggested that the co-morbidity data should be applied as available since none of this
information is perfect. Amy agreed that she would rather have the information on co-morbidities
than lose it. Kip thought that having the co-morbidity information would be useful in identifying
future research and can be used for focus group topics.
Consensus: The CCCHAP approved the definitions of the factors as presented above. The
CCCHAP also agreed to use data related to co-morbidities as they are available.
Rating Scales for Prioritization Factors
The CCCHAP then turned its focus to reviewing, refining and approving rating scales for each of
the prioritization factors. Proposed scales were developed by MDH as a starting point for
discussion. Many of the scales were based on examples from the Academy for Educational
Development (AED), the organization that developed the prioritization model the CCCHAP is
using. As recommended by the CCCHAP, MDH sought feedback on the scales from a
nationally known statistician, but did not receive a reply. Two epidemiologists at MDH reviewed
the scales and provided feedback. The final step in relation to developing the prioritization
factors will be for the CCCHAP to assign a weight to each factor that will indicate the relative
importance of the factors. This will be done at the March 2005 meeting.
Kip stated that the process is intended to be flexible to allow for changes and improvements
along the way. MDH is awaiting feedback from other jurisdictions that are currently using this
tool. Any changes would be brought back to the CCCHAP for approval.
Julie then presented proposed scales for each of the factors and asked for comments,
questions, and consensus. The number/percentage ranges used in the scales were based on
the ranges found in current data. They will be updated if needed for prioritization in 2005.
Proportion of New HIV Cases
This population accounted for what percentage of all new infections in 2002 – 2004?
Proposed rating scale:
1
2
3
4
5
0 – 9%
10 – 19%
20 – 29%
30 – 39%
≥ 40%
Consensus: The CCCHAP approved the proposed rating scale for Proportion Of New HIV
Cases.
Community Cooperative Council on HIV/AIDS Prevention Minutes 08/05/04 Page 8
Incidence Rate
What was the incidence rate among this population in 2004?
Proposed rating scale:
1
2
3
4
5
≤ 4.9
5.0 – 14.9
15.0 – 29.9
30.0 – 44.9
≥ 45.0
There was discussion about the difficulty in creating a scale that would accurately reflect the
range of incidence rates among populations (i.e., from 1.05 among White heterosexuals to
451.7 among African heterosexuals), without losing the information for other populations that fall
in between.
Consensus: The CCCHAP approved the proposed rating scale for Incidence Rate.
Trends
Has the number of new infections among this population decreased, increased or remained
steady over the past 5 years?
Proposed rating scale:
1
3
5
Decrease
Steady
Increase
Gary cautioned MDH to watch out for linear versus non-linear trends. It was suggested that the
meaning of steady would need to be defined. Gary suggested changing the scale to a 1-to-5
scale with the following descriptions:
1
2
3
4
5
Decrease
Moderate decrease
Steady
Moderate increase
Increase
Consensus: The CCCHAP approved the 1-to-5 rating scale for Trends with the understanding
that MDH will determine how to define a steady number of new HIV infections.
Proportion of Living HIV/AIDS Cases
This population accounted for what percentage of all living HIV/AIDS cases in 2004?
Proposed rating scale:
1
2
3
4
5
0 – 9%
10 – 19%
20 – 29%
30 – 39%
≥ 40%
Gary commented that he didn’t think this was a good factor to use. He stated that whether or not
a person is alive and living with HIV/AIDS is determined by a lot of factors including access to
treatment. Whenever there are inequities in treatment, it influences who stays alive.
Populations that are hardest hit may not have the best access to treatment and are
disadvantaged by this factor. Secondly, when considering the attempt during prioritization to
compare the proportion of living cases among adolescent populations to those among adult
populations, this factor no longer makes sense in relationship to people who were diagnosed as
teens, but are now adults. A third issue is that this duplicates to some extent what is already
covered under proportion of new HIV cases and incidence rate.
Community Cooperative Council on HIV/AIDS Prevention Minutes 08/05/04 Page 9
Julie noted that the CCCHAP arrived at consensus at the previous meeting to include this factor
in the prioritization process. She stated that unless other people also had concerns about using
this factor, the focus of today’s discussion is on the rating scale. There were no other concerns
voiced.
Consensus: The CCCHAP approved the proposed rating scale for Proportion Of Living
HIV/AIDS Cases.
Prevalence Rate
What was the prevalence rate among this population in 2004?
Proposed rating scale:
1
2
3
4
5
≤ 4.9
5.0 – 14.9
15.0 – 29.9
30.0 – 44.9
≥ 45.0
Consensus: The CCCHAP approved the proposed rating scale for Prevalence Rate.
Size of Population
Estimated size of this high risk population
Proposed rating scale:
1
2
3
4
5
0 – 9,999
10,000 – 24,999
25,000 – 39,999
40,000 – 64,999
≥ 65,000
There were additional questions and discussion regarding the use of the term “high risk” to
describe populations. Kevin suggested that when a topic continues to resurface, it is important
to gain consensus to revisit it. As previously discussed, MDH was not able to gather good
behavioral data to help determine the size of high risk populations. Julie clarified that the age
ranges of people who experience STD infections are being used to help define high risk within
the MSM and HRH populations. An explanation of how MDH and the CCCHAP have chosen to
define high risk and how the population sizes are determined will be included.
Consensus: The CCCHAP approved the proposed rating scale for Size Of Population.
Amy asked whether the rating could be completed by MDH prior to prioritization for those
factors that have only one correct answer based on quantitative data (i.e., incidence rate).
Other members agreed that this made sense.
Consensus: The CCCHAP agreed that MDH will complete the rating based on quantitative
data for the following factors in advance of prioritization: Proportion of New HIV Cases;
Incidence Rate; Proportion of Living HIV/AIDS Cases; Prevalence Rate; and Size of Population.
Co-morbidities
Are there significant co-morbidities that indicate risky behavior among this population?
Proposed rating scale:
1
3
5
Few co-morbidities
Some co-morbidities
Many co-morbidities
Julie stated that co-morbidities may represent a combination of quantitative and qualitative
information and the scale is an attempt to assign significance to the impact of co-morbidities on
Community Cooperative Council on HIV/AIDS Prevention Minutes 08/05/04 Page 10
a population. She explained that the list of co-morbidities (refer to page 7 of the minutes) was
not necessarily a complete list, and that it was generated by members at the May meeting.
Gary suggested the following 1-to-5 scale:
1
2
3
4
5
None
Few
Some
Many
All
This would mean that CCCHAP members would be asked to consider how many of the listed
co-morbidities are experienced by each population. Eileen added that moving from a 1-to-3
scale to a 1-to-5 scale could improve accuracy and offered to work with Julie to develop final
terminology.
Bankole suggested that intended pregnancy should be considered as a co-morbidity, in addition
to unintended pregnancy. Kip clarified that pregnancy in populations with high rates of HIV may
indicate an exposure risk whether the pregnancy is intended or not. For this reason, it may be
more relevant to include pregnancy as a co-morbidity in the African born population, but not as
relevant for other Minnesota populations.
The group discussed how cultural factors influence the powerlessness of women in making
decisions about sexual activity. Gary asked whether this would be any different for Mexican or
Hmong women. Kevin responded that while Mexican and Hmong women may also be
disempowered, the outcome of this powerlessness is different in terms of HIV when compared
to African women. The outcome of disempowerment among African women is more likely to be
HIV infection because the HIV prevalence rate is much higher in the African community. Julie
added that the primary mode of exposure in the African community is also heterosexual, which
is not true in other communities.
Julie asked for consensus regarding the addition of pregnancy for a co-morbidity for African
HRH. Steve inquired whether it should also be included for Caribbean and African American
women. Kip stated that MDH can provide data on pregnancy rates for each population, but
asked that the CCCHAP weigh that data according to the HIV prevalence rate for each
population.
Kevin suggested adding rates of hepatitis A and B vaccinations as it is a reflection of
communities engaged in wellness behavior. Charlie suggested looking at data about accessing
pregnancy tests, since this would more accurately indicate risky behavior regardless of whether
there was an actual pregnancy. Rosemary stated that it would be difficult to gather data related
to these suggestions. Kip noted that adding more to the list of co-morbidities lessens the impact
that each has. He suggested focusing on the major ones already listed with the addition of
pregnancy.
Consensus: The CCCHAP agreed to add pregnancy as a co-morbidity. The CCCHAP also
agreed to use a 1-to-5 scale for Co-morbidities, and that Eileen and Julie would develop the
descriptive language to correspond with the scale.
Co-factors
Are there significant co-factors that contribute to risky behavior among this population?
Proposed rating scale:
1
3
5
Few co-factors
Some co-factors
Many co-factors
Community Cooperative Council on HIV/AIDS Prevention Minutes 08/05/04 Page 11
Julie began by stating that the scale would be changed to a 1-to-5 scale. Gary suggested that
the scale correspond to the “none/few/some/most/all” terminology suggested for co-morbidities.
The group responded favorably to the suggestion.
Amy suggested adding domestic violence as a co-factor. There was a long discussion about
whether to develop a comprehensive list of co-factors that would be considered across
populations instead of having a unique list for each population. The CCCHAP would then be
asked to consider how many of the co-factors on the comprehensive list apply to each
population. Kathy Chinn asked how the CCCHAP would account for and weight a highly
significant single co-factor for a particular population if a comprehensive list is used. Kip was
concerned that establishing a universal list for all populations may limit the process and create a
barrier to collecting the qualitative information we are seeking from the communities. New cofactors could be identified through the community forums.
Gary suggested changing the descriptions of the cofactors so that they are clear and can apply
to the various populations. For example: sexual victimization instead of domestic violence, and
immigration from high prevalence areas of the world instead of immigration status. Amy
suggested that the CCCHAP avoid defining co-factors that it cannot assess.
Several other options were suggested for rating scales. Eileen proposed a 1-to-5 scale, with 5
signifying “ten or more co-factors.” This would accommodate additional co-factors that may be
identified in the upcoming community forums. Kip offered an alternative scale that would help
define co-factor significance and gravity, “not significant/some significance/very significant”.
Jared commented that he saw value in knowing which, and how many, co-factors apply to each
population as well as the magnitude of importance.
Kevin questioned whether the co-factor ratings would yield a meaningful, comparative and
relative measure when recognizing that there are distinctly different co-factors that apply to
different populations. Kevin suggested that the CCCHAP might consider removing co-factors
from the population prioritization process and placing it in a different part of the process such as
gap analysis or needs assessment. Doris Johnson questioned the practicality of applying a
comprehensive list of co-factors to all populations and suggested that the co-factors be either
selectively applied or removed completely.
Gary recommended that the CCCHAP establish a comprehensive list of co-factors, which can
evolve based on community forum input; rephrase the factors so that they relate to the various
populations; and establish the following rating scale:
1
2
3
4
5
No co-factors
Few co-factors
Some co-factors
Most co-factors
All co-factors
Consensus: The CCCHAP approved the 1-to-5 rating scale for Co-factors recommended by
Gary. The CCCHAP also approved the development of a comprehensive list of co-factors for all
populations that will be added to with information from the community forums. The CCCHAP
also agreed that the co-factors will be described in a manner that can be applied across all
populations.
Amy also suggested that a description of the co-factors be incorporated in future RFPs. Many
members agreed with Amy’s comment.
Consensus: The CCCHAP revisited the discussion about Co-morbidities and agreed that the
same type of rating scale being used for Co-factors will also be applied to Co-morbidities.
Community Cooperative Council on HIV/AIDS Prevention Minutes 08/05/04 Page 12
Barriers
Are there significant barriers to reaching the target population with HIV prevention information
and/or interventions?
Consensus: The CCCHAP agreed that the same type of rating scale being used for Co-factors
will also be applied to Barriers.
Resources
Are there resources and/or capacity in the community for HIV prevention-related services for
this population?
Proposed rating scale:
1
3
5
Many resources
Some resources
No resources
Gary suggested applying the five public health attributes of good service (the five A’s). He didn’t
remember them all, but said that they refer to things such as accessible, available, affordable,
etc.
Capacity is being defined as having infrastructure in place to provide HIV prevention services.
Amy requested that the question be reworded so that there are not two issued covered with only
one answer.
Consensus: The CCCHAP agreed to the question being reworded as, “To what extent are
there resources available in this community that are…(list the 5 A’s)?”
After discussion of several possible scales, Amy proposed the following revised rating scale:
1
2
3
4
5
Community resources have all of the 5 A’s
Community resources have 4 of the 5 A’s
Community resources have 3 of the 5 A’s
Community resources have 2 of the 5 A’s
Community resources have 1 or none of the 5 A’s
Steven pointed out that there are built-in barriers to accessibility within some facilities; for
example, having the capacity to provide rapid HIV tests vs. blood tests. Eileen noted that
availability is relative to the population. Gary stated that the questions and scale don’t easily
reflect resource accessibility.
Consensus: The CCCHAP approved the 1-to-5 rating scale proposed by Amy for Resources.
Consensus was achieved without a full understanding of the definition of the 5 A’s.
[Note: At the August 6th meeting, the “A’s” were clarified as being a series of SIX elements of
effective policy development and program design: Availability, Accessibility, Acceptability,
Accountability, Affordability, and Advocacy. CCCHAP did not discuss how they would fit the six
“A’s” into the Resources rating scale.]
Community Impact
No proposed rating scale had been developed for this factor, and Julie asked for
recommendations from the CCCHAP.
Gary pointed out that the impact would be different for different populations. He compared the
scenario of a person becoming infected as an adolescent to that of a person becoming infected
as an adult, and pointed out the difference in the number of years of lost economic productivity
between the two age populations. Kevin suggested that CDC literature could be used to
determine the medical and socioeconomic costs of not preventing infection. Gary commented
that the cost of treating AIDS is much higher than the cost of treating HIV and would be a
Community Cooperative Council on HIV/AIDS Prevention Minutes 08/05/04 Page 13
consideration in determining community impact scenarios. Gary also asked for consideration of
the community impact of an entire generation wiped out by AIDS.
Kevin suggested that this factor be more qualitative than quantitative, noting that some
communities lack awareness of the impact of HIV because it is overshadowed by other personal
and community issues.
Consensus: The CCCHAP agreed that, for the purposes of planning efforts, Community Impact
will be considered a qualitative measure.
There were several suggestions for the question to be asked and the corresponding rating
scale. The first proposal was to ask, “What is the impact of HIV on this community?” and the
suggestion was made to expand it to say, “What is the impact of HIV on the families, cultures,
generations and history of this community?”
Suggestions for rating scales were variations on descriptors of the level of severity: not
significant to critical, very weak to very strong, minimal to crisis. A suggestion was also made to
determine the rating scales based on feedback from the community forums.
Gary recommended starting with quantitative data about community impact and using it to
support a qualitative summary of information gathered through community forums.
Consensus: The CCCHAP agreed to gather quantitative data related to Community Impact, as
well as qualitative data from the upcoming community forums. The information will be
presented at the March 2005 meeting, at which time the CCCHAP will review the information
and work together to rate community impact. The CCCHAP approved the following rating scale
for Community Impact:
1 Minimal
2 Moderate
3 Significant
4 Critical
5 Crisis
MDH REPORT
Infected Healthcare Workers Program: Kip announced that the Infected Healthcare Workers
Program has been moved from another section at MDH to the STD and HIV Section. The
program responds to the state statute that requires licensed healthcare workers who are
infected with HIV and/or Hepatitis to self-report. The program includes a medical practice
assessment and offers help to healthcare workers to conduct their services safely. The intent is
to make this program beneficial to the workers and community and use it as a mechanism to
work with providers to better understand infection control practices in general.
New Hires: Several new people have been hired in the STD and HIV Section. Girard Griggs is
the new staff person to the CCCHAP. Jonathan Hayes works with the Infected Healthcare
Workers Program. Cheri Reyes is the new Hepatitis C coordinator. Rob Yaeger is a new
contract manager who is also responsible for capacity building.
Funds Allocated for the Latino and African Communities: Jessie Saavedra moved into a oneyear position starting in June. The focus of his work is to build capacity in the Latino community
to provide HIV testing and/or referrals to culturally appropriate services, to raise HIV/AIDS
awareness, and to promote HIV testing by working with agencies and through media and health
fairs. At a recent health fair, Jessie tested 40 Latinos, mostly men. MDH has also funded 15
agencies in the African community to implement short-term community awareness activities.
These programs began July 1st and are one-year programs.
Community Cooperative Council on HIV/AIDS Prevention Minutes 08/05/04 Page 14
Syphilis Update: Kip reported that that reported syphilis cases are down about 50 percent as
compared to 6 months ago and that this information is consistent with national trends.
Guidelines for the Review of HIV Materials: The CDC has published on the federal register an
opportunity to comment on the review panel guidelines for HIV materials. Kip highlighted a
major change in the guideline that affects directly funded CBOs. The new guidelines would
require directly funded CBOs to use the health department’s materials review panel to submit
materials. MDH has concerns about this change and is providing feedback to the CDC. MDH
believes that this would place MDH in a monitoring role where MDH does not have jurisdiction.
CDC is also requiring information regarding the effectiveness of condoms be printed on all
materials. Kip invited organizations to read through the guidelines and provide feedback. The
deadline for feedback is August 16th. Kip stated he would be available to answer questions on
how MDH is interpreting the guidelines.
Application to CDC: The CDC had not provided updated guidance regarding the health
department’s application to CDC for prevention funding by the date expected, so MDH
proceeded to write the application based on last year’s guidance. However, on August 4th, MDH
finally received the new guidance, which had completely changed. Because of the lateness in
receiving the revised guidance, and because MDH wants to provide an opportunity for the
CCCHAP to review the application, provide feedback, and receive a revised version of the
application prior to concurrence, the meeting schedule will need to be changed. A meeting will
be held on September 9th from 2:00 – 4:00 p.m. for people who are interested in providing
feedback on the application. This will not be a required meeting for CCCHAP members. The
concurrence meeting will be on September 23rd. The application is due to CDC on October 4th.
Announcements
Gerry Anderson announced that WUWA has started a women’s support group and passed a
flyer around.
Kevin Sitter announced Project Positive and Positively Alive’s event for heterosexuals dealing
with HIV and AIDS.
Steven Moore announced that the African American AIDS Men’s Group has been formed.
Bankoli Olatosi announced an upcoming CARE Services Assessment Demonstration (CSAD)
meeting at MAP in August to inform the community about its progress and gather feedback.
Amy Moser announced an upcoming meeting to review ADAP program changes that were
recently implemented at DHS.
Cliff Noltee announced that MNRAD is having its 5th annual picnic in August.
Julie announced that the recruitment effort for new CCCHAP members is starting and asked
everyone to help recruit interested applicants.
ADJOURNMENT
The meeting was adjourned at 4:40 PM.
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