State works with colleges on testing and prevention
State officials say more funding is needed
North Carolina’s recent discovery of an HIV outbreak among college students across a wide network of universities has made the public health challenge clear: Either make effective prevention, testing, and counseling services available to at-risk youths, or expect in a few years to add more young people to the state’s waiting list for HIV medications.
Operating on a shoestring budget, the state has implemented a Project Commit to Prevent program. It includes collaboration from 12 minority colleges to provide HIV and STD prevention and risk-reduction education programs on campus, enhance the capacity of health services on campus, and strengthen links between institutions and other HIV/STD service providers, says Phyllis Gray, MPH, project manager in the North Carolina Division of Public Health in Raleigh. Gray is in charge of the new Project Commit to Prevent, which is being implemented at the 12 colleges.
The state has agreed to provide $111,000 in funding for HIV prevention at the institutions where state officials recently identified students who have been newly infected with HIV, she says. The public health branch has provided additional funding for testing and counseling training and peer educator training, but the money that’s available remains insufficient to expand the program to include services such as rapid testing, Gray adds.
To public health officials, the dichotomy between what they could do to stem the recent HIV outbreak and what they can do, given funding limitations, is frustrating.
"We have the ability to detect new outbreaks like this one, but we don’t have the resources to deal with it," says Evelyn Foust, MPH, branch head of the HIV/STD Prevention and Care, North Carolina Department of Health and Human Services in Raleigh.
As any state official such as Foust who works with the AIDS Drug Assistance Program (ADAP) can assert, it’s considerably cheaper to prevent new infections than to handle the cases once infection has taken place. However, even that funding, whether from the federal government or state, is hard to find. "I’m confused about how many bodies with new HIV infection we have to keep counting before the South gets attention," she says. "I don’t feel hopeless about it, but I feel angry and frustrated; we have an incredible amount of work to do."
Nonetheless, the project has been well received at the targeted campuses, and it is beginning to succeed with some of its HIV prevention goals. Here’s how the program works:
• State health officials seek partnerships with colleges.
"We made contact with each campus using an invitation to a partner approach, and we invited representatives from their student health services, both from the nursing department and the health education department," Gray says. Invitations also were sent to college chancellors and presidents’ offices. "We had an exploratory meeting in February 2003, to lay out the nature and scope of the problem as we saw it and to listen to them say what they thought would be an appropriate role for each campus," she explains.
State health officials asked the college representatives what sort of resources were needed for them to provide better HIV and STD prevention work. Although all of the colleges have STD testing available, some of them have to charge students for the service; so it’s questionable how much students seek STD services on campus, she says. Several colleges already were doing innovative peer education work that could be adapted to fit an HIV model, Gray says.
Through the meetings, state officials learned none of the colleges offered HIV testing and counseling services on their menu of student health services but would rely on the local health departments to come on campus to provide the service, she notes. "They spoke about a hesitancy among students to be seen at the student health services on a particular day of the month when HIV testing might be offered. Sometimes students were referred off-campus for testing and counseling."
However, the drawback to referring students off-campus is that they may delay being tested because the site requires finding time and transportation that are not always easy for college students, she points out.
• The program emphasizes student participation.
At the first partnership meeting, college representatives said the project needed to involve students and empower them to help make decisions about the best way to launch the program on campuses, Gray says. As a result, each campus has an advisory committee, and students are represented on each of the planning groups.
Also, there is a peer educator training program, and each campus sends four representatives to the training. The representatives are lead recruiters who return to the schools to talk about peer education on their campuses and to organize the program, she adds.
"Eleven campuses already had peer educators, so many of the schools were going to add HIV and STD education as a component of what they were doing," Gray explains. "Some of the schools had date rape education and substance abuse as part of their peer outreach."
One of the schools decided to focus peer education solely on HIV and STD issues, and another school decided to expand its HIV/STD efforts
The school that had an HIV/STD peer education program in place prior to the Project Commit to Prevent serves as a consultant to other peer educators, she says.
Peer educators provide dorm outreach and organize safe sex messages to be presented at various campus activities. "Part of the program is to get other student leaders on campus to take [HIV education] on as part of some of their school activities, such as having sororities and fraternities do this as community service work," Gray says.
Early next year, the state will sponsor a project leadership forum for all 12 schools, she states.
"We’ll pull together not only the peer educators, who will be doing the hard, grassroots work, but other peer leaders on campus to come to a student forum with the goal of looking at how you can make this a lasting initiative on your campus and how you can make a difference in your community," Gray says.
• Testing and counseling services are designed for colleges.
Project Commit to Prevent has designed counseling and testing training specifically to be used on college campuses. Training was provided to college representatives July 2003, she says.
The training was similar to what has been provided to local health departments and nontraditional testing and counseling sites, Gray explains. "They were trained for pre- and post-counseling."
Also, state health officials conducted an inventory of all the campuses to see whether they had the capacity to do the HIV testing, and all of them do, she adds.
"The state is going to pick up the cost of their having the blood work analyzed, so they’ll send samples to the state lab," Gray says.
Once the college staff completed the training, they were given a lab ID number and were told to call the program for assistance once they were ready to begin offering HIV counseling and testing services to students.
The calls have been coming in slowly as some of the colleges still had a bureaucratic process to complete before the testing services could be implemented, Gray points out. "Last week, the director of one of the student health services said that she’ll inform any student who comes into the clinic that the HIV test is available, and that if the student has done any of these risk behaviors, the student may want to be tested," she says.
The colleges will vary in how aggressively they will market their HIV services, Gray notes.
• Students are surveyed about HIV knowledge and risk behaviors.
One of the institutions developed a student knowledge and behavior assessment that was distributed to the coordinators who head the project on each campus, she says.
"The coordinators received a copy of the assessment, and we jointly looked at it and made modifications," Gray says. "Every school is going to use the assessment as part of their baseline data."
Questions on the assessment include:
— How much do you know about HIV?
— Where do you now get your information?
— Have you ever been tested for HIV before?
— Do you think you’re at risk for HIV?
— Have you been sexually active?
— Did you use protection?
"Our goal is to get as many surveys done as possible," she continues. "Everyone is aiming for 300 to 400 surveys per campus, and each campus will receive their own information."
The state will receive a composite of all of responses, which will give state health officials a good idea about what the students know and how the state should best design intervention programs targeting those most at risk, Gray adds.
North Carolinas recent discovery of an HIV outbreak among college students across a wide network of universities has made the public health challenge clear: Either make effective prevention, testing, and counseling services available to at-risk youths, or expect in a few years to add more young people to the states waiting list for HIV medications.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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