# Community Planning for HIV/AIDS health services system transformation #### (2019) - Graham F Watts, Deidre L Kelly, C Watson **Link**:: https://www.cdc.gov/std/statistics/2022/2021-STD-Surveillance-Report-PDF_ARCHIVED-2-16-24.pdf **DOI**:: **Links**:: **Tags**:: #paper **Cite Key**:: [@Watts2019-df] ### Abstract ``` HIV is a public health concern. Duval County schools Youth Risk Behavior Surveillance data on middle and high school students for 2013 reveal high-risk sexual activity; yet, one in five received no formal instructions about HIV/AIDS. Knowing one’s HIV status is pivotal for HIV prevention and treatment. HIV positive youth who seek treatment, and achieve viral suppression have optimal health outcomes and are less infectious. Northeast Florida joins the national initiative to reduce HIV infection. The City of Jacksonville, Ryan White Part-A Program, Florida Department of Health-Duval, and local HIV/AIDS organizations convened a Youth Summit. Conversations focused on how HIV prevention and treatment may integrate for seamless access and transition of youth into services. Six openended questions guided the summit. Three eight-member, moderated focus groups explored answers to two questions during one hour. From a healthcare access barriers perspective, structural and cognitive opportunities exist for health system integration. Almost twice as many solution strategies emerged for barriers to care and prevention-and-treatment attrition factors, compared to gaps in prevention, treatment, and health education. The Youth Summit is a first step in the journey toward a seamlessly integrated youth and adult HIV prevention, treatment, and health education system. Florida Public Health Review, 2017; 14, 13-21. BACKGROUND The Jacksonville Chapter of the Florida Department of Health, Integrated HIV Prevention, and Care Plan 2017-2021 states that the health of youth and young adults is a local priority (unpublished). However, health disparities related to race, gender, sexual orientation, and age exist in the populations most impacted by the HIV epidemic in Duval County – namely, African-American men and women. The National HIV/AIDS Strategy 2020 identifies youth, ages 13 – 24 as a key population, noting the particularly high burden of HIV among young black gay and bisexual men (https://www.aids.gov/federal-resources/national-hivaids-strategy/nhas-update.pdf). The Jacksonville system of HIV prevention and care has many agencies, medical clinics, and community-based organizations in place to provide HIV prevention and care services, but few specialize in services for youth. Youth experience multiple challenges that affect their ability to access and retain in HIV prevention, support services, and medical care. The Jacksonville adult-oriented, HIV care system requires adaptations to support optimal linkage, care engagement, and retention of youth in HIV prevention and HIV Continuum of Care activities (Reisner et al., 2009) to support the health of HIV infected youth and young adults. Purpose In Florida, HIV affects a significant number of today’s youth. Data on the prevalence of HIV and AIDS among adolescents (ages 13-19) and young adults (20-24 years) tell a compelling story. According to Florida Department of Health, in 2014, persons under the age of 25 years accounted for 16% of all newly reported cases of HIV infections (http://www.floridahealth.gov/diseases-andconditions/aids/surveillance/_documents/factsheet/2014/2014-adolescents-and-young-adults-factsheet.pdf). In Florida Partnership 4, a title for Baker, Clay, Duval, Nassau, and St John’s counties, the year 2014 data showed that youth and young adults comprised 16% of the general population; 6% of all AIDS cases, but 16.5% of all HIV cases (http://www.floridahealth.gov/diseases-andconditions/aids/surveillance/epi-profiles/2014/part04-1314b.pdf). The knowledge of youth perceived invulnerability, risk-taking, peer influence, and experimentation during their developmental trajectory, makes it hard for public health and health services professionals to dismiss these prevalence 1 Watts et al.: Community Planning for HIV/AIDS Health Services System Transforma Published by UNF Digital Commons, 2017 Florida Public Health Review, 2017; 14, 13-21. Page 14 http://www.ut.edu/floridapublichealthreview/ rates as a way of life when they indicate the need for community-wide, public health action. Youth comprise an important segment of the public. Therefore, Partnership 4 health and social community leaders recognize the need to engage youth in dialog about how the system of HIV prevention and treatment should be modeled to make it inclusive of and responsive to the needs of at-risk and infected youth. Consequently, the University of Florida Center for HIV/AIDS Research, Education, and Services approached the City of Jacksonville Social Services Division, Ryan White HIV/AIDS Part A Program Manager to mobilize community partners such as Florida Department of Health in Duval County, and other community stakeholders for hosting an all-day Youth Summit. On July 19, 2016, the City of Jacksonville hosted its first communitywide Youth Summit to convene program and services providers to focus on the health and wellness of youth as it relates to HIV and STIs including education, prevention, early intervention, and treatment services. The Summit focused on three important areas: (1) the needs of HIV positive youth; (2) youth at-risk of HIV infection; and (3) limitations of the current, adult-oriented HIV system of care. Participants reviewed year 2014 Area 4 HIV Epidemiology of Youth and year 2015 Youth Risk Behavior Survey Data, followed by a presentation of best practices currently in place in the area for reaching and providing culturally responsive, youthcentric HIV prevention, linkage and integrated services. Summit participants heard perspectives on the impact of HIV from a panel of four youth, and then were asked to address six, formative questions. Each question had a stem that read – as it relates to HIV and STIs, including education, prevention, early intervention, and treatment services for youth: • What are the barriers that keep youth from accessing prevention and treatment services? • What can we do to eliminate or reduce barriers, if they exist? • What causes youth to fall out of prevention and treatment services? • What can we do to keep youth in care, after enrollment? • What are the gaps in education, prevention, and treatment services? • What can we do to close gaps, if they exist? The questions guiding the Youth Summit owe their existence to the “...people centered, Ground/Bottom Up model. This model is about solving problems in communities by focusing on where the basic needs of the people are paramount. It... directly consults with the people in the communities” (http://groundbottomupmodeltt.com/index.html). However, unlike the natural sciences, where a logical positivist approach seeks causal explanations, the aim here is comprehension of phenomena. Local experience and programmatic data suggest that the questions posed are relevant for improving the system of HIV/AIDS care in Partnership 4. To illustrate the hypothesized value of the summit’s questions, Figure 1 provides a framework that links the summit’s formative questions to two salient, health care phenomena: dropping out of care and poor linkage to prevention and treatment services. Figure 1 has two antecedent conditions: barriers to youth engagement in HIV prevention and treatment services, and existing gaps in Partnership 4 HIV prevention and treatment services. Local prevention and treatment network professionals assume that together, the antecedent conditions contribute to prevention and treatment avoidance and attrition factors. When this triadic state exists, there are missed opportunities for HIV testing, poor linkages to education, prevention, and treatment services, and attrition of clients formerly linked to HIV care. Hence, the local community wants to understand the issues as the first step toward system change. METHODS Community representatives met and planned the Partnership 4 Youth Summit. Participants included City of Jacksonville Social Services Division, University of Florida Center for HIV/AIDS Research, Education, and Services (UF CARES), Florida Department of Health (FDOH) in Duval County, Northeast Florida AIDS Network (NFAN), and Jacksonville Area Sexual Minority Youth Network (JASMYN). In a series of seven meetings, participants reviewed pertinent sections of the National HIV/AIDS Strategy Goals, the area’s emerging Integrated HIV Prevention and Care Plan— 2017-2021, City of Jacksonville Early Identification of Individuals with HIV/AIDS (EIIHA) goals and objectives, and a review of the literature on youthfocused HIV-care. These inputs set the stage for agenda development, which sequenced content and time limits so that the progression of events might set the stage for focus group discussions. There were seven assigned tasks. Core assignments included: (1) identification of individuals to be invited, with a focus on identifying youth services providers who provide HIV/STD or pregnancy prevention programs or testing / clinic services; (2) contacting and confirming guest speakers; (3) setting the agenda; (4) selecting questions to be asked in the breakout sessions; and (5) reserving a venue. Auxiliary assignments included: (1) inviting and confirming stakeholders; (2) arranging for meals, parking, and event security; (3) collating the power point presentations into one seamless presentation; (4) duplicating copies of event materials; and (5) 2 Florida Public Health Review, Vol. 14 [2017], Art. 2 https://digitalcommons.unf.edu/fphr/vol14/iss1/2 Florida Public Health Review, 2017; 14, 13-21. Page 15 http://www.ut.edu/floridapublichealthreview/ Barriers to Youth Engagement in Prevention & Treatment Services Existing Gaps in Jacksonville, FL HIV Prevention & Treatment Services Lost-to-Care (Dropping Out of Care) Poor Linkage to Prevention & Treatment Figure 1: Two Healthcare Systems Phenomena Prevention & Treatment Avoidance & Attrition Factors Programmatic Emphasis on Self-Respect Positive Self-Valuation Healthy Engagement in HIV Prevention & Treatment Cyclical & Interactive Process Figure 2: Frieda ``` ### Notes