Special Report on Prevention Initiatives

Harlem center focuses on prevention for positives 

Risk-reduction strategies are main focus

The Harlem United Community AIDS Center in New York City recognizes that HIV-positive people who engage in high-risk activities are not going to change their behaviors overnight, so the center focuses on reducing their risk behaviors one step at a time.

The prevention-for-positives program, which is funded through the Centers for Disease Control and Prevention (CDC), begins with counselors meeting with HIV-positive clients, says Tata Traore, program director.

"In other programs, we usually have case managers who take care of clients’ needs, the millions of needs like entitlements, housing, Medicare, etc.," she says. "With this program, the counselors are solely counselors."

Evaluating readiness for participation

Counselors meet with clients to evaluate their readiness for the program. If they determine other needs have not been met, clients are referred to the various services they need, Traore says.

Once clients are enrolled in the prevention program, the counselor spends one hour, twice a month with them, focusing solely on prevention, she says.

"They also participate in monthly groups where we hope they are influenced by other participants in the group, and for those who are not ready to change, this is peer-level counseling," Traore explains.

Identifying risk behaviors

Counseling sessions include asking clients to identify risk behaviors they have that they would like to work on. Then clients decide which steps they’ll take, and these steps are what they will take over a six-month period while they are meeting with the counselor, she says.

"Instead of trying to eliminate every risk factor, we want people to understand it’s their responsibility to not infect the community," Traore says.

"We target their own choices and decisions, and we focus on behavior change depending on what a person identifies as an issue."

For example, while most clients may decide to focus on their sexual behavior or substance use, occasionally someone’s goal may be to develop healthy relationships or learn who their sexual partners are, she says.

"Sometimes, we have people who have multiple partners because for multiple reasons that’s what works for them at that moment," Traore says.

"And sometimes, a person’s goal can be to achieve partner notification, and they need assistance with that."

A single session’s goal might be to reduce the number of sexual partners from 10 to five, she adds.

At additional sessions, the counselor will help the client figure out why he or she has engaged in this risky behavior and then help the client brush up on the objectives that were set in previous sessions, Traore says.

Counselors assess whether clients are engaging in risky behaviors, other than what the client has chosen to focus on, and when the client needs additional help with issues like adherence to medications, the counselor will make referrals, Traore notes.

"It’s client-centered — most of the information comes from them," she says.

Clients and counselors will discuss behavior change plans, and if a strategy doesn’t look feasible, then the counselor will suggest they try something else, Traore adds.