In 2010, the United States for the first time put forward a National HIV and AIDS Strategy (NHAS) to address the impact of HIV and AIDS in the country. With three specific goals: reducing HIV incidence, increasing access to care and optimizing health outcomes, and reducing HIV-related health disparities; the strategy’s desired impact is to reach a time in which transmission is rare, and if to occur, medical care is of high quality. Medical care, on the other hand, will be greatly influenced by the Affordable Care Act (ACA), a law intended to ensure that everybody in the United States has access to affordable health insurance (passed in 2010, uphold by Supreme Court in 2012). These past few years have indeed been a period of CHANGE.
Naturally, the HIV and AIDS service provision is experiencing this change. Some AIDS Service Organizations and Community Based Organizations are going through a transformation to ensure that programs and services are aligning with the National HIV/AIDS Strategy, also taking into consideration the expected implementation of the Affordable Care Act. This is one way that organizations are sustainable. However, while agencies are adapting to the changing landscape, it is important not to neglect the community; their needs and participation in the process. It may not be the intent, but it is sometimes the result of having to adapt in an effective yet hurried way.
The changing landscape of the HIV/AIDS prevention field has renewed the hopes of many communities around the world as significant milestones and advances have been made in recent years. An example worth noting is the 2012 Food and Drug Administration (FDA) approval of Truvada, for pre-exposure prophylaxis (PrEP), a tool for reducing the risk of sexually acquired HIV infection in HIV negative men and women. This approval reassured the global health community that we are moving in the right direction. In addition, a clinical trial to determine the effectiveness of two treatment strategies in preventing the sexual transmission of the virus in HIV-serodiscordant couples, known as HPTN 052, found HIV treatment to be effective in reducing HIV transmission by 96%. Although, PrEP is the first of its kind in the area of prevention with those at high risk, there are currently additional clinical trials being conducted in search of additional preventive methods such as vaccines and microbicides (visit www.hptn.org and www.hvtn.org). This is what is called Biomedical HIV Prevention Research.
Since the approval of Truvada as a PrEP strategy and the implementation guidelines set forth by the Centers for Disease Control and Prevention (CDC), it seems that there are more questions than answers on behalf of both the service provision workforce as well as the community at large. Having questions is indeed crucial; they lead to rich discussions where we gain knowledge and understanding. Town Halls provide an ideal platform to engage both audiences – providers and community – in this kind of discussions. This is one of the goals of the Be The Generation Bridge (BTGB) and many of its national and local partners throughout the US that work collaboratively to foster awareness of and support for HIV prevention research. The Latino Commission on AIDS and its network Juntos Construyendo are one of the partners.
With the project, Juntos Consturyendo (Building Together) an AIDS-free Generation, the Juntos Construyendo Network and the Capacity Building Assistance Division set out to conduct Town Halls in 6 different cities: San Juan,PR, New York City, Philadelphia, Chapel Hill, NC, Dallas, and Ft. Lauderdale, FL. Although Town Halls seem to be a straight forward concept; location, audience, medium and technology suggested the need to innovate, adapt, and tailor each Town Hall to effectively reach the local audience.
As of May, four town halls have been implemented, and all have had a different format; some even included the use of multimedia and social media, while others were less technological and more conversational and workshop-oriented. Feedback and immediate outcomes from the community were varied: from getting HIV tested on site (ideal when addressing myths and facts about HIV with an elder Latino population); to discussing messages for the heterosexual community who is also at risk (prevention messages are too “gay focused” community members said); and to understanding how to craft your “Know PrEP” messages using social marketing through social media ¡en Español!
The CHANGE Model (Vega, 2010) served as framework principles to the implementation of these town halls. Below are some suggestions to consider if thinking about implementing one in your community:
- Have a concrete goal and purpose for the Town Hall.
- Know who your audience is – Customize: The term “Community members” can be segmented into many sub-groups and through that segmentation you can assess best approaches to presenting the idea, issues, topic, etc. to your constituency. It may be that you end up implementing a twitter Town Hall.
- Have a good moderator: Expert moderators would be able to use time effectively, are able to engage the audience, and facilitate a conversation between panelist and audience.
- Get support from experts on the subject you are presenting. Depending on the purpose of Town Hall, sometimes having presenters with different perspective on the subject could be beneficial. Different perspective does not mean opposing or contradictory ones – it’s not a debate. An example in the case of HIV Biomedical Prevention Research was to have a combination of panelists that included service providers, community members, and researchers.
- Create partnerships (Networking): The changing landscape in the HIV field emphasizes collaborations. Agencies can work together in bringing information to the communities they serve. As we move into the ACA-world, an up-and-coming need will be informing the community about “shopping” for their own insurance which may involve partnering with another agency.
- Lastly, process evaluation can be used to assess weather you reach the desired amount of people, type of people, topics covered, etc.
Town Halls have been and continue to be an effective way to engage the community with the work we currently do or plan to do. These gatherings serve as a time to meet and network, gather feedback, increase knowledge and awareness, and possibly have an impact on beliefs and attitudes our constituency has on a particular topic. It is a platform of communication that allows us to listen to the community’s concerns, as well as ideas that can benefit the work we do.
Written by: Bolivar X. Nieto
 Cohen MS, McCauley M, Gamble TR. HIV treatment as prevention and HPTN 052. Curr Opin HIV AIDS. 2012, 7: 99-105 PMCID: 3486734.