Jennifer Marshall Memphis Center for Reproductive Health Memphis, TN

1. Lessons from the Field: Integrating HIV Prevention and Testing Services into a Reproductive Health Care Setting Jennifer Marshall Memphis Center for Reproductive Health Memphis, TN Suzanne Kinsky National AIDS Fund Washington, D.C.

2. Why Integration Makes Sense • Common Purpose • Overlapping Populations • Shared Opportunities • HIV+ Person’s Needs for Sexual and Reproductive Healthcare Engender Health. (2004). Preventing HIV/AIDS Through Family Planning.

3. Why Integration Made Sense in Memphis, TN • Fastest growing rate of infection in TN • Women ages 15-19 • Leading cause of death among African American women ages 25-34 • Half of all new infections occur in youth ages 13-24

4. MCRH’s Patient Population • 2105 women served in 2006 • 976 youth served in 2006 (17 and under) • 60% African American • 30% Caucasian • 9.5% Latina • 96% - unprotected sex during the 3 months prior to their clinical visit

5. MCRH’s HIV Programs • Rapid HIV testing • Group level prevention intervention

6. Rapid HIV Testing • CDC Revised Recommendations for HIV Testing of Adults, Adolescents and Pregnant Women in Healthcare Settings • Released in 2006

7. Rapid HIV Testing • Successes • Agency Collaborations • Patient Satisfaction • Visibility to Other Populations • Challenges • Clinic Flow • Staff Training

8. The Need for Innovation • Evidence-based interventions in use • Strengths • Weaknesses • Reality of the HIV epidemic among US women

9. National AIDS Fund • History and background • Community partnership model • Special initiatives

10. March 2007 July 2007 July 2008 June 2009 Formative Phase Year One Year Two Implementation Phase • Focus groups, interviews • Curriculum development • Creation of materials, tools, measures, etc. • Pilot testing • Documentation • Initial recruitment • Ongoing recruitment • Implementation of intervention • Process & outcome data collection & data review • Ongoing curriculum refinement • Ongoing modification of implementation process • Synthesis of lessons learned • Sustainability Women’s InitiativeProgram Model

11. Grantee Memphis Center for Reproductive Health TA Support Health Equity Initiatives - San Francisco State Evaluation Support Jakatae Jessup

12. MCRH Prevention Intervention • Funded by National AIDS Fund Women’s Initiative Grant • Intensive Organizational Support • Formative Phase – Adaptation • Implementation Phase • Evidence-based Evaluation • Technical Assistance Team

13. MCRH Prevention Intervention • Modeled after Safe in the City and VOICES/VOCES • Focus: Condom Negotiation Skills • Completely integrated into flow of clinical services at AB follow-up • Fills gaps in patient education and counseling • Collaboration with other community agencies

14. MCRH Prevention Intervention • 145 clinic participants • 40% follow-up rate • 55 outreach participants • 80% follow-up rate

15. Preliminary Findings • Increased knowledge about correct condom use • Increased steps towards behavior change • 73% talked to their main male partner about condom use • 76% used a condom the last time they had sex

16. Preliminary Findings • Patient Response at Follow-Up • 100% enjoyed participating in group • 83% would like more programs available

17. Why Integration Isn’t Hard • We’re already doing the work • Established infrastructure • Shared values and beliefs • Shared skill sets

18. Resources • www.mcrh-tn.com • www.aidsfund.org • www.engenderhealth.org • www.plannedparenthood.org/nyc • www.hivandsrh.org/ • www.aidsalliance.org/

19. Special Thanks to • National AIDS Fund • Friends For Life • Community HIV Network • Dr. Cynthia Gomez

20. Jennifer Marshall Memphis Center for Reproductive Health 1462 Poplar Avenue Memphis, TN 38104 (901) 274-3550 outreach@mcrh-tn.com Suzanne Kinsky National AIDS Fund 729 15th Street NW, 9th FloorWashington, DC 20005 (202) 408-4848 x245 skinsky@aidsfund.org Questions or comments?