Community-based AIDS Service Organizations Research Articles

Abstract B042: Identifying effective interventions using community-based participatory practices to improve cancer-related health outcomes in a high-risk population

Abstract Persons Living with HIV/AIDS (PLWHA) have an increased life expectancy when they adhere to highly active antiretroviral treatment (HAART). At the same time, ~25% of AIDS related deaths are due to non-HIV related comorbidities including cardiovascular disease, atherosclerosis, and hypertension. In the aging PLWHA population on HAART, an increasing risk for multiple cancers is clear and the cancers are more aggressive and advanced compared with an age-matched population. In addition to the liver cancer related to Hepatitis B and C, genital cancers related to human papillomavirus (HPV), increases in non-immune cancers including lung and melanoma cancers are the leading causes of death in PLWHA. Evidence has shown that community-based participatory approaches can be used to improve health outcomes in many populations. In this study, we focus on interventions for at-risk African-American, HIV positive, Men having Sex with Men (MSM) population. Typical community-based participatory activities include cancer-related awareness, prevention, diagnosis, and treatment. We plan to utilize partnerships with community-based AIDS service organizations (ASO), community leaders, and local community state-representatives. Preliminary data shows that partnering with city-wide programming initiatives such as Black Gay Pride, Philly Pride Present and National Coming-Out Week will ensure community participation, leadership and engagement among the community. Currently, there is little research on how best to reach the Black or Hispanic PLWHA community. This project will investigate the socio-political-economic factors impacting these populations and the interventions that will increase engagement with healthcare educators and providers. Furthermore, knowledge from the PLWHA will help devise preventative approaches for reducing and addressing cancer risks. Citation Format: Tyrell T Mann-Barnes, Grace X Ma. Identifying effective interventions using community-based participatory practices to improve cancer-related health outcomes in a high-risk population [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B042.

Establishing the feasibility, acceptability and preliminary efficacy of a multi-component behavioral intervention to reduce pain and substance use and improve physical performance in older persons living with HIV

Older persons living with HIV (PLWH), often defined as age 50 years and older, are a rapidly growing population, with high rates of chronic pain, substance use, and decreased physical functioning. No interventions currently exist that address all three of these health outcomes simultaneously. An 8-week behavioral intervention combining cognitive-behavioral therapy and tai chi reinforced with text messaging (CBT/TC/TXT) was developed and pilot tested in a community-based AIDS service organization with substance using PLWH aged 50 years and older who experienced chronic pain. Fifty-five participants were enrolled in a three arm randomized controlled trial that compared the CBT/TC/TXT intervention (N = 18) to routine Support Group (SG) (N = 19) and Assessment Only (AO) (N = 18) to assess the intervention's feasibility, acceptability and preliminary efficacy to reduce pain and substance use and improve physical performance. Participants were assessed at baseline, treatment-end (week 8) and week 12. Feasibility and acceptability indicators showed moderate levels of participant enrollment (62% of those eligible), excellent 12-week assessment completion (84%) and high attendance at CBT and tai chi sessions (>60% attended at least 6 of 8 sessions). Efficacy indicators showed within-group improvements from baseline to week 12 in the CBT/TC/TXT group, including all four substance use outcomes, percent pain relief in the past 24 h, and in two physical performance measures. Observed between-group changes included greater reductions in days of heavy drinking in the past 30 days for both CBT/TC/TXT (19%) and SG (13%) compared to the AO group. Percent pain relief in the past 24 h improved in the CBT/TC/TXT group relative to SG, and the CBT/TC/TXT‘s physical performance score improved relative to both the SG and AO groups. Findings demonstrate that the CBT/TC/TXT intervention is feasible to implement, acceptable and has preliminary efficacy for reducing substance use and pain and improving physical performance among a vulnerable population of older PLWH.

Community Data Collection with Children of Mothers Living with HIV: Boundaries of the Researcher Role.

The TRACK-II program is a multi-site, community-based randomized controlled trial evaluating an intervention to assist mothers living with HIV (MLH) in disclosing their HIV status to their young children. Many participants-both mothers and children-reported significant depression and/or suicidal ideation, a phenomenon that presented ethical challenges. This article focuses on participants at one site (Atlanta). Through the vignette of "Jordan," we describe ethical challenges that may arise when faced with the responsibility of maximizing participants' safety while maintaining the boundaries of the researcher role. Guided by community psychology values, our team has taken measures within our role as researchers to empower and protect children and mothers endorsing suicidal ideation. For example, we have relied on relationships with community-based organizations and AIDS service organizations to connect HIV-affected families to mental health services. Furthermore, we have expanded our system of documentation to follow-up adequately with families at risk, and we track family resources to promote a strengths-based framework. We have solicited families' feedback about their supports and needs to understand how we may best serve them by connecting them to the resources they report needing most and empowering them to care for themselves.

Testing the effectiveness of a motivational interviewing-based brief intervention for substance use as an adjunct to usual care in community-based AIDS service organizations: study protocol for a multisite randomized controlled trial

BackgroundIn 2010, the first comprehensive National HIV/AIDS Strategy for the United States was released and included three goals: (1) reducing the number of people who become infected with HIV, (2) increasing access to care and improving health outcomes for people living with HIV, and (3) reducing HIV-related health disparities and health inequities. In 2013, as part of its effort to help address the National HIV/AIDS Strategy, the National Institute on Drug Abuse (NIDA) funded a type 2 effectiveness-implementation hybrid trial titled the Substance Abuse Treatment to HIV Care (SAT2HIV) Project. Aim 1 of the SAT2HIV Project tests the effectiveness of a motivational interviewing-based brief intervention (MIBI) for substance use as an adjunct to usual care within AIDS Service Organizations (ASOs) as part of its MIBI Experiment. Aim 2 of the SAT2HIV Project tests the effectiveness of implementation and sustainment facilitation (ISF) as an adjunct to the Addiction Technology Transfer Center (ATTC) model for training staff in motivational interviewing as part of its ISF Experiment. The current paper describes the study protocol for the MIBI Experiment.MethodsAs part of a multisite randomized controlled trial, individuals with comorbid HIV/AIDS and problematic substance use are randomized to receive either the ASOs’ usual care (control condition) or usual care plus a MIBI for substance use (experimental condition) delivered by trained ASO case-management staff. Primary outcome measures are reductions in days of primary substance use, number of substance-related problems, times engaging in risky behaviors, days of non-adherence to HIV medications, and increases in substance use treatment. As part of this paper, we describe the trial protocol in accordance with the Standard Protocol Items: Recommendations for Interventional Trials guidelines.DiscussionIf successfully able to implement MIBI as an effective adjunct to usual care, the current trial may have a significant impact on increasing the capacity of ASOs to address problematic substance use among individuals living with HIV/AIDS. Reducing the prevalence of problematic substance use among individuals living with HIV/AIDS within the United States may lead to significant improvements on key performance measures (i.e., the HIV Care Continuum and the 90-90-90 target).Trial registration ClinicalTrials.gov: NCT02495402

Prevalence and predictors of food insecurity among people living with HIV affiliated with AIDS service organizations in Ontario, Canada

ABSTRACTUp to half of people living with HIV in resource-rich settings experience moderate to severe food insecurity. Food insecurity, in turn, has been linked to adverse health outcomes including poor antiretroviral adherence, poor HIV viral suppression, frailty, and mortality. We estimated the prevalence of food insecurity among 649 adults living with HIV and recruited from community-based AIDS service organizations in Ontario, Canada. Food security was assessed using the Canadian Household Food Security module. We used logistic regression modeling to identify demographic, socioeconomic, and psychosocial factors independently associated with food insecurity. Almost three-fourths of participants (70.3%) were food insecure and a third (31%) reported experiencing hunger. The prevalence of food insecurity in this sample is approximately six times higher than that of the general population. Factors independently associated with food insecurity were: having dependent children at home, residing in large urban areas, low annual household income (<$40,000), difficulty meeting housing-related expenses, cigarette smoking, harmful drug use, and depression. Broad, multisector interventions that address income, housing affordability, substance use and mental health issues are needed and could offset future public health expenditures.

Factors associated with sex work involvement among transgender women in Jamaica: a cross-sectional study.

Introduction: Transgender women are disproportionately impacted by HIV. Transgender women involved in sex work may experience exacerbated violence, social exclusion, and HIV vulnerabilities, in comparison with non-sex work-involved transgender women. Scant research has investigated sex work among transgender women in the Caribbean, including Jamaica, where transgender women report pervasive violence. The study objective was to examine factors associated with sex work involvement among transgender women in Jamaica.Methods: In 2015, we implemented a cross-sectional survey using modified peer-driven recruitment with transgender women in Kingston and Ocho Rios, Jamaica, in collaboration with a local community-based AIDS service organization. We conducted multivariable logistic regression analyses to identify factors associated with paid sex and transactional sex. Exchanging oral, anal or vaginal sex for money only was categorized as paid sex. Exchanging sex for survival needs (food, accommodation, transportation), drugs or alcohol, or for money along with survival needs and/or drugs/alcohol, was categorized as transactional sex.Results: Among 137 transgender women (mean age: 24.0 [SD: 4.5]), two-thirds reported living in the Kingston area. Overall, 25.2% reported being HIV-positive. Approximately half (n = 71; 51.82%) reported any sex work involvement, this included sex in exchange for: money (n = 64; 47.06%); survival needs (n = 27; 19.85%); and drugs/alcohol (n = 6; 4.41%). In multivariable analyses, paid sex and transactional sex were both associated with: intrapersonal (depression), interpersonal (lower social support, forced sex, childhood sexual abuse, intimate partner violence, multiple partners/polyamory), and structural (transgender stigma, unemployment) factors. Participants reporting transactional sex also reported increased odds of incarceration perceived to be due to transgender identity, forced sex, homelessness, and lower resilience, in comparison with participants reporting no sex work involvement.Conclusions: Findings reveal high HIV infection rates among transgender women in Jamaica. Sex work-involved participants experience social and structural drivers of HIV, including violence, stigma, and unemployment. Transgender women involved in transactional sex also experience high rates of incarceration, forced sex and homelessness in comparison with non-sex workers. Taken together, these findings suggest that social ecological factors elevate HIV exposure among sex work-involved transgender women in Jamaica. Findings can inform interventions to advance human rights and HIV prevention and care cascades with transgender women in Jamaica.

Fostering supportive environments: A case study of public pedagogy in a community-based AIDS service organization

Fostering supportive environments: A case study of public pedagogy in a community-based AIDS service organization

Patient-provider communication with HIV-positive women about abnormal Pap test results

ABSTRACTIn this article, the authors examine communication between women living with human immunodeficiency virus (WLH) and health care providers (HCPs) regarding abnormal Pap tests. During the period of March 2011 through April 2012, 145 WLH were recruited from Ryan White funded clinics and community-based AIDS service organizations located in the southeastern United States. WLH who had an abnormal Pap test (69%, n = 100/145) were asked if their HCP shared and explained information about abnormal Pap tests. The authors performed chi-square tests and multivariable logistic regression analyses using Stata I/C 13. HCPs shared information about abnormal Pap tests with 60% of participants, and explained the information they shared to 78% of those. Health literate participants were more than three times as likely to have read the information received about abnormal Pap tests (adjusted odds ratio [aOR] = 3.49, 95% confidence interval [CI] 1.19–10.23), and almost five times as likely to have understood the cancer information they read (aOR = 4.70, 95% CI 1.55–14.24). Knowing other women who had had an abnormal Pap test was not significantly associated with cancer information seeking or processing after controlling for confounding factors. The present findings underscore the need to increase WLH’s health literacy as an intermediate step to improving patient–provider communication among WLH. Lay sources of cancer information for WLH warrant further study.

Unmet Health Service Needs of Newly Diagnosed HIV-Positive Men Who have Sex with Men in China: Results from An Ethnography

We examined health services needs from the perspective of Newly diagnosed HIV-positive MSM (NHIVMSM) in Southern China. Forty one NHIVMSM took part in in-depth interviews. In addition, 20 health care providers and 16 volunteers were also interviewed in focus groups or individual face-to-face interviews. Participant observations in local healthcare settings, MSM venues and NGO offices were also conducted. Six thematic groupings of unmet health and social service needs were identified, such as information and guidance, improvement in quality of services, quality of and access to medication, enhancement of social support, social welfare and psychological and mental health. Implications for professional training in counseling, flexible free ART distribution, closer cooperation between formal and informal health care services, and establishment of community-based AIDS service organizations are discussed.

HIV/AIDS Histories: Community Service Organizations and the Direct-Action AIDS Movement in Documentary Film

HIV/AIDS Histories: Community Service Organizations and the Direct-Action AIDS Movement in Documentary Film Richard A. McKay We Were Here( Peccadillo Pictures, 2011). Directed and produced by David Weissman. 89 minutes. United in Anger: A History of ACT UP( United in Anger, Inc., 2012). Directed by Jim Hubbard. Produced by Sarah Schulman. 93 minutes. How to Survive a Plague( Network Releasing, 2012). Directed by David France. Produced by Howard Gertler and David France. 105 minutes. With releases timed to accompany the thirtieth anniversary of the recognition in 1981 of a syndrome that would become known as AIDS, and the twenty-fifth anniversary of the formation of the AIDS Coalition to Unleash Power (ACT UP)—the best-known direct-action AIDS protest group—three new documentary films offer compelling and contrasting accounts of the worst years of the American HIV/ AIDS epidemic. Covering the fifteen-year period before the development of effective combination antiretroviral therapy in 1996, the films chart the initiatives that emerged from the nation’s lesbian and gay communities in response to the deaths of tens of thousands amidst widespread social apathy and governmental neglect. We Were Herefocuses on the changes wrought by the arrival of HIV in San Francisco, in particular the creation of a remarkably successful and diverse patchwork of community-based AIDS service organizations in the 1980s. By contrast, United in Angerand How to Survive a Plaguefocus predominantly on New York, and on the political activism, media savvy, and emotional dynamics of ACT UP from 1987 onward as this group fought for more effective and more widely available HIV treatment, prevention, and support for people living with AIDS. David Weissman’s We Were Herefeatures five San Francisco residents—Paul, a political activist and community organizer; Guy, a flower seller on Castro Street; Eileen, a nurse with a background in the women’s movement; Ed, an educator and caregiver; and Daniel, an artist and entrepreneur. It follows them from their arrival in the Bay Area during the 1970s and through their life-changing encounters with the disease that silently established itself in the city at about the same time. With their on-camera testimonies providing a narrative frame for a rich montage of archival photographs, documents, and film footage, the documentary unfolds more or less chronologically. It explores the community’s gradual realization of the scale of the medical disaster, the support and rejection of patients by family and friends, the constant obituaries in local newspapers, hospital treatment and experimental drug trials, and the network of volunteer organizations that sprang up to care for those who were sick and dying. Weissman and his editor and co-director, Bill Weber, set up a slow, elegiac pace for the film, regularly fading to black and employing skilful dissolves to forge powerful associations between still images, a technique that is most evident when depicting the ravages of HIV and [End Page 734]its opportunistic infections on young gay men. While such visual representations of the syndrome were at one time strongly protested by AIDS activists, it struck me that—in an era when late-stage HIV disease is much less visible in North America—a visual reminder of the infection’s devastating power might be timely for a new generation of viewers. The film’s narrators are engaging, with two moments in particular resonating with my own experience of interviewing survivors of the epidemic. One was the heart-wrenching immediacy and raw emotions captured when Daniel recalls the “avalanche” of deaths he endured in rapid succession; in addition to many friends dying, the epidemic claimed the lives of two successive lovers while he was struggling with his own HIV infection. Another striking moment was Ed’s powerful description of how the epidemic created openings in the gay community for caregiving to come to the fore. These changes allowed people like him to find and carve out places for themselves that had hitherto not been possible; thus, opportunities may be present in even the bleakest of moments. While the film’s coverage includes candlelight marches, the rise of a more confrontational AIDS activism, and the eventual development of effective antiretroviral therapy, the film’s main...

Planning to Succeed: A Case Study of the Implementation of the Strategic Prevention Framework

This study is an evaluation of the use of the Strategic Prevention Framework (SPF) by a community-based AIDS service organization in Dallas, Texas. The program is sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA). The study examined how well the SPF was used by the program in its first year. The evaluation was conducted through a qualitative method of use of program documents, guided conversations with staff members, and the use of an open-ended survey. Findings show that the program has achieved notable milestones in the process of undertaking a comprehensive needs assessment, developing a strategic plan, and preparing for implementing evidence-based programs aimed at 3 groups that are in need of enhanced services: veterans, college-aged youths, and the reentry population. Lessons learned are described in this article.

Effects of an evidence service on community-based AIDS service organizations' use of research evidence: a protocol for a randomized controlled trial.

BackgroundTo support the use of research evidence by community-based organizations (CBOs) we have developed 'Synthesized HIV/AIDS Research Evidence' (SHARE), which is an evidence service for those working in the HIV sector. SHARE consists of several components: an online searchable database of HIV-relevant systematic reviews (retrievable based on a taxonomy of topics related to HIV/AIDS and open text search); periodic email updates; access to user-friendly summaries; and peer relevance assessments. Our objective is to evaluate whether this 'full serve' evidence service increases the use of research evidence by CBOs as compared to a 'self-serve' evidence service.Methods/designWe will conduct a two-arm randomized controlled trial (RCT), along with a follow-up qualitative process study to explore the findings in greater depth. All CBOs affiliated with Canadian AIDS Society (n = 120) will be invited to participate and will be randomized to receive either the 'full-serve' version of SHARE or the 'self-serve' version (a listing of relevant systematic reviews with links to records on PubMed and worksheets that help CBOs find and use research evidence) using a simple randomized design. All management and staff from each organization will be provided access to the version of SHARE that their organization is allocated to. The trial duration will be 10 months (two-month baseline period, six-month intervention period, and two month crossover period), the primary outcome measure will be the mean number of logins/month/organization (averaged across the number of users from each organization) between baseline and the end of the intervention period. The secondary outcome will be intention to use research evidence as measured by a survey administered to one key decision maker from each organization. For the qualitative study, one key organizational decision maker from 15 organizations in each trial arm (n = 30) will be purposively sampled. One-on-one semi-structured interviews will be conducted by telephone on their views about and their experiences with the evidence service they received, how helpful it was in their work, why it was helpful (or not helpful), what aspects were most and least helpful and why, and recommendations for next steps.DiscussionTo our knowledge, this will be the first RCT to evaluate the effects of an evidence service specifically designed to support CBOs in finding and using research evidence.Trial registrationClinicalTrials.gov: NCT01257724

Anal use of the female condom: does uncertainty justify provider inaction?

Despite limited safety data and the absence of efficacy data, several studies have reported that the female condom is being used for anal sex by men who have sex with men. We describe providers’ awareness of female condom use during anal sex among their clients and their experiences in counseling clients. We conducted semi-structured interviews with 78 health-care providers recruited from various health-care delivery systems in New York City: a family planning agency, a sexually transmitted infection agency, a hospital-based obstetrics and gynecology clinic, and two community-based AIDS service organizations. While two-thirds of providers reported that they were uncertain as to whether the female condom could or should be used for anal intercourse, nearly one-third believed that anything is better than nothing to prevent HIV/sexually transmitted infections during anal sex. Few providers had actually talked with clients about anal use of the female condom, and clients themselves had seldom mentioned nor asked for information about such use. Our findings highlight providers’ uncertainty about anal use of the female condom. Lacking guidelines regarding the safety and efficacy of female condom use during anal sex, health-care providers are left to make their own well-intentioned recommendations (or not) to potential users. The dearth of information on female condom use during anal sex could encourage individuals to use the female condom for anal sex, which may increase HIV transmission risk or represent a missed opportunity for protecting non-condom users. There is a need for a series of harm-reduction, acceptability, and efficacy studies and, in the interim, for the development of a carefully qualified safety set of guidelines regarding anal use of the female condom for health-care providers.

Gender Differences in the Risk of HIV Infection among Persons Reporting Abstinence, Monogamy, and Multiple Sexual Partners in Northern Tanzania

BackgroundMonogamy, together with abstinence, partner reduction, and condom use, is widely advocated as a key behavioral strategy to prevent HIV infection in sub-Saharan Africa. We examined the association between the number of sexual partners and the risk of HIV seropositivity among men and women presenting for HIV voluntary counseling and testing (VCT) in northern Tanzania.Methodology/ Principal FindingsClients presenting for HIV VCT at a community-based AIDS service organization in Moshi, Tanzania were surveyed between November 2003 and December 2007. Data on sociodemographic characteristics, reasons for testing, sexual behaviors, and symptoms were collected. Men and women were categorized by number of lifetime sexual partners, and rates of seropositivity were reported by category. Factors associated with HIV seropositivity among monogamous males and females were identified by a multivariate logistic regression model. Of 6,549 clients, 3,607 (55%) were female, and the median age was 30 years (IQR 24–40). 939 (25%) females and 293 (10%) males (p<0.0001) were HIV seropositive. Among 1,244 (34%) monogamous females and 423 (14%) monogamous males, the risk of HIV infection was 19% and 4%, respectively (p<0.0001). The risk increased monotonically with additional partners up to 45% (p<0.001) and 15% (p<0.001) for women and men, respectively with 5 or more partners. In multivariate analysis, HIV seropositivity among monogamous women was most strongly associated with age (p<0.0001), lower education (p<0.004), and reporting a partner with other partners (p = 0.015). Only age was a significant risk factor for monogamous men (p = 0.0004).InterpretationAmong women presenting for VCT, the number of partners is strongly associated with rates of seropositivity; however, even women reporting lifetime monogamy have a high risk for HIV infection. Partner reduction should be coupled with efforts to place tools in the hands of sexually active women to reduce their risk of contracting HIV.

Cost-Effectiveness of Free HIV Voluntary Counseling and Testing Through a Community-Based AIDS Service Organization in Northern Tanzania

We evaluated the cost-effectiveness of fee-based and free testing strategies at an HIV voluntary counseling and testing (VCT) program integrated into a community-based AIDS service organization in Moshi, Tanzania. We waived the usual fee schedule during a 2-week free, advertised VCT campaign; analyzed the number of clients testing per day during prefree, free, and postfree testing periods; and estimated the cost-effectiveness of limited and sustained free testing strategies. The number of clients testing per day increased from 4.1 during the prefree testing interval to 15.0 during the free testing campaign (P<.0001) and remained significantly increased at 7.1 (P<.0001) after resumption of the standard fees. HIV seroprevalence (16.7%) and risk behaviors were unchanged over these intervals. Modeled over 1 year, the costs per infection averted with the standard fee schedule, with a 2-week free VCT campaign, and with sustained free VCT year-round were $170, $105, and $92, respectively, and the costs per disability-adjusted life year gained were $8.72, $5.40, and $4.72, respectively. The provision of free VCT enhances both the number of clients testing per day and its cost-effectiveness in resource-limited settings.

Characteristics of People Living With HIV Who Use Community-Based Services in Ontario, Canada: Implications for Service Providers

Community-based AIDS service organizations (CBAOs) direct services to multiple-needs people living with HIV/AIDS who are less likely to use mainstream health promotion services. As people live longer with HIV, the potential to enhance quality of life increases, yet little is known about who uses CBAOs or how this use affects other health and social services. This study of people living with AIDS in Ontario, Canada (n = 297) examined the demographic and health-related characteristics of people with AIDS who do and do not use CBAOs and their patterns of mainstream service utilization. It found that users of CBAOs were significantly less healthy, less able to sustain normal activities, and more often depressed. They reported physical disabilities significantly more often. Their quality of life was also lower along certain dimensions. They were significantly poorer and more reliant on government income supports. They consumed significantly more nonhospital health and social services and had significantly higher out-of-pocket costs. These results suggest CBAOs are being accessed appropriately by those most vulnerable. In an effort to strengthen CBAO capacity to recognize and address depression and physical health problems prevalent among their clients, links to other mainstream health promotion and social services is recommended.

Impact of Support Services Provided by a Community-Based AIDS Service Organization on Persons Living With HIV/AIDS

This study examined demographic, health-related, social support, and service utilization characteristics of clients with high and low use of a community-based AIDS service organization in Canada. The study confirmed that the organizations' services were reaching the most vulnerable persons living with HIV/AIDS. It found that a significantly greater number of high users compared with low users were single, lived alone, and reported poorer health. The similarity in functional health status and depression between user groups, despite high users' poorer health and greater social vulnerability, supports client reports that services have reduced client isolation and improved health-related quality of life. Finally, high users had lower expenditures for government-provided health and social services overall, particularly HIV specialists and AIDS medication, but significantly more expenditures for emergency room services and complementary therapies. The results suggest community-based services can enhance health-related quality of life for persons living with HIV/AIDS by increasing providers' capacity to identify and address client depression and its consequences.

HIV/AIDS Reference Questions in an AIDS Service Organization Special Library

ABSTRACT Librarians in many venues may anticipate a wide range of reference questions related to HIV and AIDS. Information on HIV/ AIDS is now available in medical, academic, and public libraries and on the Internet, and ranges from the most complex science to the most private disclosures about personal behavior. In this article, the 913 reference questions asked between May 2002 and August 2004 in a special library in a mid-western community-based AIDS service organization are described and analyzed.

Community-based HIV education and prevention workers respond to a changing environment

The purpose of this study was to understand the culture, values, skills and activities of staff involved in education and prevention activities in community-based AIDS Service Organizations (ASOs) in Ontario, Canada, and to understand the role of evaluation research in their prevention programming. In this qualitative study, 33 staff members from 11 ASOs participated in semi-structured interviews that were analyzed using the grounded theory approach. ASO staff experience tension between a historical grassroots organizational culture characterized by responsiveness and relevance and a more recent culture of professionalization. Target populations have changed from being primarily gay men to an almost unlimited variety of communities. Program emphasis has shifted from education and knowledge dissemination to a broadly based mandate of health promotion, community development, and harm reduction. Integration of evidence of effectiveness, social-behavioral theory, or systematic evaluation is uncommon. Understanding these points of tension is important for the nursing profession when it is engaged with ASOs in programming or evaluation research.

Current HIV prevention activities for women and gay men among 77 ASOs.

Community-based AIDS service organizations (ASOs) are important providers of HIV prevention services in cities throughout the United States. This study examined the types of HIV prevention programs that are being undertaken by ASOs and assessed the kinds of new programs that ASOs feel are needed as the HIV epidemic continues to evolve. Factors that will need attention as new HIV prevention programs are developed by ASOs include high turnover of personnel in the organizations, capacity building that will be needed for ASOs to offer more intensive or specialized programs, and strategies to provide technical assistance as ASOs develop new types of programs.