Implementing Structured Condom Distribution in Puerto Rico for MSM and Trans populations
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The document outlines a structured condom distribution program in Puerto Rico aimed at men who have sex with men (MSM) and transgender individuals, addressing the high HIV prevalence in the region, where over 49,000 people are living with HIV. The program, initiated by the non-profit organization Coaí, Inc., aims to improve access to condoms and resources through community outreach, partnerships, and targeted interventions, especially after the impact of hurricanes. Key objectives include increasing availability, improving access, and enhancing the acceptability of condom use among the target population.
Implementing Structured Condom Distribution in Puerto Rico for MSM and Trans populations
- 1. Implementing Structured Condom Distribution in Puerto Rico for MSM and Trans Population César E. Concepción Peter M. Shepard José Mulinelli March 20 2019 National HIV Prevention Conference Atlanta, U.S.
- 2. Issue • Puerto Rico (PR) is ranked 10th on the list of states/territories with the highest number of reported cases of HIV with more than 49,000 people living with the HIV. It’s also within the 48 priority counties. • Political and economic transformations impact HIV preventions efforts even more, especially when taking into account that 45% of individuals live below poverty level. • As a result of homophobia, patriarchy and religious hegemony, MSM’s and Trans individuals experience high levels of stigma that translate into barriers for access to health and prevention services. • The island has also one of the most active hurricane seasons that last from June to November posing a constant threat to its infrastructure, leaving health services inoperable and population vulnerable without access to basic prevention tools such as condoms.
- 3. Who is Coaí, Inc.? •Coaí, Inc. is a non-profit organization founded in 1991 and incorporated in the Department of State of Puerto Rico on February 12, 1992. •The term "coaí" comes from the Arawak (native Indians) language and means "sown garden, joy and hope".
- 4. Mision This non-profit organization is dedicated to promoting health and preventing disease, from a social justice and human rights perspective, with emphasis on lesbian, gay, bisexual, transgender, transgender, questioning, queer and intersex people (LGBTTQQI) in Puerto Rico.
- 5. Vision To achieve in Puerto Rico the recognition of health as a human right and its guaranteed enjoyment.
- 6. Program and Eligibility Criteria Aché T.O.P. (Taking On Prevention) • Men Sex Men (MSM) and their partners • Transgender and Transexual individuals • Offices: Hato Rey (North), Juana Díaz (South), Mayagüez (West) • Ages: 30 to 59 years(North); 18 to 59 yeas(South y West) • Reach • North Office- Metropolitan Statistical Area (41 municipalities) • South Office– Ponce Heallth Region (15 municipalities) • West Office–Mayagüez and Aguadilla Health Regions (15 municipalities) Total: 71 municipalities
- 8. Services •Counseling, Testing and linkage • Traditional Counseling • Personalized Cognitive Counseling (PCC) •Testing Together •HIV Navigation Services •Linkage to medical care • ARTAS •Structured Condom Distribution
- 11. Before Technical Assistance • Before the Technical Assistance, condom distribution and safe sex kits were circulated during outreach events, in-office settings and upon participants request. Keeping track of condom distribution efforts and effectiveness was only measured through the frequency of safe sex kits distributed, monitored by inventories input and output. • Acknowledgements: Miguel Chion, MD, MPH – APLA Health (CBA Provider)
- 12. Triple A Framework: Availability, Accessibility, Acceptability • Structured time-based plan was jointly developed to respond to the challenges and barriers faced by the island. • Baseline statistical information regarding our target population was gathered through PR Department of Health reports and from an assessment developed and distributed to further understand community needs regarding condom use. • Detailed action steps and objectives were developed to inform the following interventions: in-house and community condom distribution efforts, CTR, outreach events and mail delivery. These objectives aligned with the needs of the prioritized geographic regions.
- 13. Availability • Objective: Increase condom availability in priority population • Intervention • Community Level • Identify population in geographical area • Estimate quantity and condom preference • Establish Objective • Individual Level • Increase the spaces, instances and options for individual condom acquisition • Install Condom Dispensers • Send Condom through mail • Distribute in office and during events
- 14. Goals to achieve Availability • Obtain Epi data for priority population • Build and distribute questionnaire to identify preferences, barriers and myths regarding condom use • Have condoms available in every Coaí Program that serve priority population
- 15. Epi. Profile Priority Municipalities • San Juan • San Juan, Bayamón, Río Piedras y Carolina • Aguadilla • Aguadilla, San Sebastian, Aguada, Isabela • Mayagüez • Mayagüez, Cabo Rojo, Añasco, San Germán Region of San Juan • 55%- Number of MSM living with HIV to be reached in prioritized municipalities • 249- Estimated number of MSM who don’t know their status in the prioritized municipalities municipalities • 65.7% – Cases of MSM diagnosed with HIV are between the ages of 25-44 -Data reported on May 2017 by PRDH
- 17. Community Input
- 18. Community Input
- 19. Community Input
- 20. Community Input
- 21. Access • Objective: Reduce access barriers to our target population • Increase distribution in traffic areas • Distribute condom to other programs and collaborators • Increase access in commercial premises where the target population is • Goals to achieve access • Install condom dispensers and develop agreements with commercial stores • Distribute condoms by mail each month to High Risk Negatives and People Living with HIV. • Distribute condom kits at outreach events
- 22. Gorritos por Correo • achepr.org/condones • Evaluation
- 26. Gorritos por Correo- Evaluation
- 27. Gorritos por Correo- Evaluation
- 28. Gorritos por Correo- Evaluation
- 29. Gorritos por Correo- Evaluation
- 30. Aceptability • Objective: Increase acceptance of condom use by impacting the environment and perceptions in our target population • Create a culturally competent and relevant social marketing campaign • Design attractive preventive materials to our target population • Present them in places where our target population frequents • Strategies • Video Campaign • Prevention tools • Address perceptions around the use of condoms • Goals • Create social marketing campaign • Make condoms and condom packages more attractive
- 34. Juracán Project- Hurricanes Irma and María (Sept 6 & 20) • Median age of participants (n=49) was 35 years old. • Most (76.6%) identified as trans women • Over half (59.2%) of the population identified lived in San Juan Metropolitan Area. • 95.5% reported having little or no access to food. • 86.7% didn’t have access to water • 50% didn’t feel safe in their homes.
- 35. Condoms Distributed 15475; 46% 12286; 36% 400; 1% 2400; 7% 3220; 10% Dispenser OPE-TAC Correo Paradas Prueba Total:33,781
- 36. Lessons Learned • Evaluate resources needed to carry out social marketing campaigns • A component of graphic design is vital • It is necessary to negotiate with the shops the installation of dispensers • Remember the benefits • They do not always call to fill • Search more aesthetically pleasing models and offer options (fishbowl or direct delivery of kits for events) • Estimating to plan is vital • You can monitor trends and foresee needs or changes • Condoms by mail depends -of course- on the mail (María / Irma) • Don’t be surprised if they brake or disappear!
- 37. Lessons Learned • Through the implementation of 3As, Coaí has increased the efficiency of condom distribution and reduced barriers to access condoms for the community members. This was especially vital after the hurricanes Irma and Maria. • Partnering with different institutions (i.e. health department, CBOs, businesses, etc.) is key in addressing access. • Mailing orders have increased access to condoms and is cost-effective for the program. • Increasing acceptability of condoms can be done through more cost- effective measures such as providing trainings to HIV testing providers to offer condoms, conducting outreach campaigns to normalize and increase the visibility of condoms.
- 39. Implementing Structured Condom Distribution in Puerto Rico for MSM and Trans Population César E. Concepción Peter M. Shepard José Mulinelli ¿Preguntas? Visit our websites: coaipr.org achepr.org