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    DSHS HIV/STD Program

    Post Office Box 149347, MC 1873
    Austin, Texas 78714

    Phone: (512) 533-3000

    DSHS strives to respond to all email requests in a timely manner. It is important to note, however, that messages that you send to us by email may not be secure and may be intercepted by a third party. Therefore, we recommend that you do not send any confidential health information to us by email.

16th Texas HIV-STD Conference Proceedings, Monday, May 19, 2008

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Monday, May 19, 2008

Texas HIV, AIDS and STD Update

Ann S. Robbins, Ph.D.

Monday, May 19, 2008
10:15 to 10:30 am

Tools Every Prevention Educator Needs to Maintain Credibility and Motivate Behavioral Change (A1)

Stephen Fallon, Ph.D.

Monday, May 19, 2008
1:00 to 2:30 pm

Workshop Overview:

Effective HIV prevention efforts build skills and self-efficacy. However, if a client asks a specific question about HIV or STD transmission, and receives only a vague or inconclusive response, the client’s motivation to reduce risks diminishes. In other words, while knowledge alone doesn’t guarantee behavioral change, knowledge is a prerequisite to motivate any client. Some clients will even use a “gotcha” question to excuse themselves from taking your health messages seriously. This workshop compiles all of the tough questions that clients raise again and again in the field. The workshop offers tools and boilerplates for responding to clients quickly, confidently, and correctly. Participants will receive not only the answers to questions about risk rates and protective strategies, but also scientific yet accessible explanations behind each fact, each illustrated with an analogy to make it linguistically appropriate for any client. Though information about HIV transmission efficiency, biological susceptibility, and co-factors exists in numerous peer review journals, many prevention workers report that they needed an accessible yet accurate tool to empower their work in the field. The session will model the tool, and then show participants how to use it in their own settings. Whether you’re brand new in the field, or a long time worker, this workshop will give you the tools so you don’t get stumped! You’ll be better able to guide clients past general questions and on to a discussion of their personal risk reduction plans.

Habla Conmigo : Mother-Daughter Retreats for Latinas At-Risk (B1)

Yolanda Rodríguez-Escobar, L.M.S.W., Ph.D. Candidate

Monday, May 19, 2008
1:00 to 2:30 pm

Workshop Overview:

Mujeres Unidas Contra el SIDA is the only Latina-serving AIDS Services Organization in San Antonio, Texas. Its mission is to unify the Latino community by providing a safe environment for bilingual/bicultural support services and education to Latinas and their families living with or impacted by HIV/AIDS. Habla Conmigo: Mother-Daughter Retreats for Latinas is a homegrown HIV prevention program developed by Mujeres Unidas specifically designed to meet the needs of Latinas and their daughters (ages 12-15). Currently in its third year of existence, this intervention seeks to model healthy approaches for Latinas and their daughters to examine such issues as HIV, STDs, teen pregnancy, date violence, depression, body image, self-esteem, etc. in a culturally and linguistically competent manner. It is through this approach that participants can identify the cultural barriers that get in the way of maintaining open communication between mothers and daughters to ensure health and well-being. Although there is a special emphasis placed on the prevention of HIV/STDs by using pláticas with both mothers and daughters, there are other topics that are introduced that foster healthy relationships. This presentation will cover helpful tips on how to replicate a program such as Habla Conmigo.

Successful Strategies to Improve Intergenerational Sexual Health Communication among Hispanics (C1)

Sheetal Malhotra, M.B.B.S., M.S.
Patricia M. Thickstun, Ph.D.
Katherine A. Hendricks, M.D., M.P.H.&T.M.

Monday, May 19, 2008
1:00 to 2:30 pm

Workshop Overview:

El Paso County, with around 232,000 households, has 725,000 residents, 44 percent of whom are under 24 years old. Approximately 28,000 grandparents reside with grandchildren under 18; half of those provide care for their grandchildren. Seventy-six percent of El Paso residents speak Spanish at home. Seventeen percent of El Paso middle school Youth Risk Behavior Survey (YRBS) participants have had sex, 30 percent before age 12. In the city of El Paso, 66 percent of births to teen mothers are nonmarital, greater than 90 percent are to Hispanic teens, and 25 percent are repeat births. El Paso County has the highest cervical cancer rate in Texas, a state with the fifth highest rate in the US. El Paso HIV/AIDS rates are highest among 20- to 24-year-olds. A Spanish language sexual health curriculum was provided to parenting adults (grandparents and parents). Participants received eight hours of training on sexually transmitted infections (STIs), nonmarital pregnancy (NMP), contraception, effective parent-child communication and decision-making. The curriculum objectives were to increase parenting adult knowledge of STIs and NMP and improve parenting adult-child communication on sexual health issues. Ninety eight percent (101 out of 103) participants aged 26-73 years completed pre- and post-tests on sexual health knowledge, attitudes, and behaviors. Seventy three percent had at least one grandchild attending middle or high school. Post-tests revealed significant increases in knowledge of NMP, STIs, and their consequences. There were significant increases in reported comfort discussing STIs with grandchildren and frequency of communication with peers and children on sexual health issues. Parenting adults demonstrated increased knowledge of and communication on sexual health issues with peers and children.

Changing Drug Trends and Their Implications for HIV/STD in Texas (D1)

Jane C. Maxwell, Ph.D.

Monday, May 19, 2008
1:00 to 2:30 pm

Workshop Overview:

Trends in drug use are changing around the world. Cannabis is the most popular illicit substance worldwide, with methamphetamine being the second most prevalent illicit substance of abuse. Cocaine is becoming more popular in Europe and the emergence of Southwest Asian heroin will impact drug use patterns. In Texas, cocaine is the primary illicit drug for which Texans enter treatment and it is a major problem on the border with Mexico. Major indicators of cocaine use remain stable, although crack cocaine continues to move beyond African American users to White and Hispanic users. Heroin indicators are changing with increasing “snorting” of “cheese” heroin and the emergence of a population of heroin-using youths and young adults. Hydrocodone is a larger problem than oxycodone or methadone, and fentanyl indicators fluctuate from year to year. Codeine cough syrup, “Lean,” continues to be abused, and methadone pain pills are abused. Marijuana treatment admissions with criminal justice problems are less impaired than those who are referred from other sources. Methamphetamine is a growing problem across the state and smoking “Ice” is now the major route of administration for persons entering treatment. Abuse of Xanax and Soma is increasing. All indicators of Ecstasy use are increasing as the drug spreads from the club scene to “the street.” GHB and GBL remain a problem, particularly in the Dallas-Fort Worth Metroplex area. PCP indicators are high and stable, and dextromethorphan is a problem with adolescents. Inhalants remain a problem with different types of users. The proportions of HIV and AIDS cases associated with male-to-male sex are increasing and heterosexual mode of transmission now exceeds injection drug use.

Texas HIV/STD Epidemiology Update (E1)

Jennifer Chase, M.S.P.H.
Nita Ngo, M.P.H.
Elvia Ledezma, M.P.H.
Ed Weckerly, M.S.
Douglas Schuster , M.P.H.

Monday, May 19, 2008
1:00 to 2:30 pm

Workshop Overview:

The DSHS HIV/STD Epidemiology and Surveillance Branch monitors the HIV/AIDS and STD epidemics in Texas through the routine collection of HIV/AIDS and STD surveillance, enhanced perinatal, and incidence data. This presentation will provide a general overview of the epidemiology of HIV/AIDS and STDs in Texas using these data gathering systems. Topics for this presentation will include HIV/AIDS prevalence and incidence data on race, risk, gender, Texas-Mexico border cases, perinatal transmission, as well as epidemiologic data on syphilis, chlamydia, and gonorrhea.

Project SEEK: Brings Care to a Hard to Reach HIV/AIDS Population (F1)

Diana (Dee) Medina, M.A., L.P.C.
Teresa Talley, R.N.
Seferino Mireles, L.B.S.W.
Damita Dibrell

Monday, May 19, 2008
1:00 to 2:30 pm

Workshop Overview:

Project SEEK is a Substance Abuse and Mental Health Services Administration (SAMHSA) funded project targeted at serving HIV-positive people who are lost to medical care and have a diagnosis of substance abuse and/or a mental health diagnosis. The primary goal of the project is to locate these people and provide the assistance needed to return to regular medical care. In addition to being difficult to locate, this population requires intensive efforts to assist them in meeting their day-to-day needs and to remove barriers so that they are sufficiently stable to receive necessary medical care.

Project SEEK is a community partnership that engages substance abuse, medical, and mental health providers, community based organizations, and academic educators and evaluators. The collaboration uses the unique skills of each member organization to maximize services and resources needed by this population. Working together, the partnership provides outreach to locate and enroll participants, case management for health and human services, mental health and substance abuse counseling services, HIV education, medical and psychiatric care, project evaluation, and project management. Now in the final year of the project, results show that the strategy of intensive outreach, case management, and treatment is successful in reducing risk taking behaviors and keeping participants in medical care for the one year enrollment period.

This presentation will provide information on the key components implemented in serving this population, describe the impact services have made on the community, and identify evaluation data which supports Project SEEK’s model.

Once-Daily Protease Inhibitor-Based HAART: Considerations in the Selection of a Regimen in Patients with HIV (G1)

W. David Hardy, M.D.

Monday, May 19, 2008
1:00 to 2:30 pm

Workshop Overview:

HIV/AIDS continues to be a significant health problem in the United States and worldwide. More than one million people in the United States are living with HIV/AIDS, and each year 40,000 new cases of HIV are diagnosed. Patients are now living longer because of treatment advances; however, treatment is lifelong. Combination therapy is likely to remain the gold standard for the treatment of HIV and AIDS. Combination therapy with nucleoside reverse transcriptase inhibitors plus protease inhibitors (PIs) significantly improves the prognosis in patients with HIV. To help increase adherence in these patients, potent well tolerated highly active antiretroviral (HAART) regimens have been developed, including once-daily PI-based regimens that have minimal impact on quality of life. Extensive data are available on antiretroviral drug regimens, including once-daily PIs, yet treatment issues are complex. Therefore, physicians and healthcare providers need to be educated about the benefits and limitations of once-daily PI-based HAART, the pharmacokinetics of once-daily dosing, and all factors critical in selecting a once-daily PI-based HAART regimen.

Tobacco Cessation as Key to HIV + Wellness: Strategies and Resources for Client Quitting (H1)

Zandt Bryan
Mary Banski VanWisse, Ph.D.

Monday, May 19, 2008
1:00 to 2:30 pm

Workshop Overview:

This presentation overviews nicotine addiction and the relationship to the HIV-positive person’s health and well being. Quitting tobacco is beneficial to HIV-positive persons and will help decrease co-infections, for example those related to oral health and side effects like dry mouth as well as reduction of cancer risk, already higher in people with impaired immune systems. Smoking is related to an increased risk for heart disease and stroke for the person with HIV as well. Oral thrush and Pneumocystis Pneumonia (PCP) are more common in smokers. A rationale for including tobacco in a substance abuse treatment model is discussed. There is a higher than average prevalence of tobacco use in the Lesbian/Gay/Bisexual/Transgender (LGBT) community and the marketing of tobacco at LGBT targeted events. The ramifications of this marketing are discussed. The presentation will cover resources for helping clients to quit as well as giving tips for the dos and don’ts of helping someone quit.

How to be an Organized First Line Supervisor/Operations Manager (I1)

Scott Salo

Monday, May 19, 2008
1:00 to 2:30 pm

Workshop Overview:

One of the greatest challenges faced by First-Line Supervisors (FLS) and Operations Managers (OM) is getting and staying organized. They function in a highly fluid, turbulent environment that presents new daily challenges. This session is designed to provide insights, strategies and tactics that will allow FLS and OM to be more successful in achieving their programmatic and individual goals.

Universal HIV Testing (J1-A)

Jenny McFarlane

Monday, May 19, 2008
1:00 to 1:45 pm

Workshop Overview:

This presentation will provide an overview of the U.S. Centers for Disease Control and Prevention Revised Recommendations for HIV Testing of Adults, Adolescents and Pregnant Women in Health-Care Settings.

Universalizing HIV Testing: Easier Said Than Done (J1-B)

Henry Pacheco. M.D.
Laura Armas-Kolostroubis, M.D.
Tracy Tessmann, M.A.

Monday, May 19, 2008
1:45 to 2:30 pm

Workshop Overview:

In Texas there were 3,529 new HIV cases in 2005 and nationally an estimated 40,000 new infections occur per year. Furthermore, of the one million people estimated to be living with HIV in the US, as many as one third are unaware of their infection and 25% of those unaware of being HIV-positive are responsible for over half of the new infections yearly. Those that are unaware they are infected are also not benefiting from current HIV therapies. The CDC’s September 2006 Recommendations for HIV Testing in Health-Care Setting seeks to change our current paradigm from that of “risk-based” HIV testing to encouraging HIV testing in all health care settings. The Texas/Oklahoma AIDS Education and Training Center (AETC) HIV Testing Training and Education Initiative is designed to advance the CDC’s recommendations by collaboratively developing training curricula, providing educational services, technical assistance, referrals, and consultations to targeted health care providers in public hospitals, emergency departments, labor and delivery, STD clinics and community health centers. Our Initiative will promote the adoption of the CDC recommendations for routine HIV testing by increasing the knowledge and skills of health care administrators and practitioners and the capacity of centers in locations of high HIV/AIDS prevalence in Texas. In practice, this has not proven to be easy. Our Texas-based project, as well as many other similar AETC projects, has experienced a series of barriers. These include poor information about Texas laws regarding HIV testing, systemic barriers in larger health settings, economic and other obstacles, to the actual adoption of clinicians and centers of these CDC Recommendations. Although the argument for the implementation of the CDC recommendations is based on solid public health principles, much progress is still needed in creating momentum, acceptance and adoption of the CDC recommendations, at least in the health care setting where the greatest gains can be made.

Problem Solving Strategies for Protocol-Based Counseling in HIV Prevention (A2)

Jeffrey R. Wagers, B.A.
Amanda Reese, B.S.

Monday, May 19, 2008
3:30 to 5:00 pm

Workshop Overview:

Protocol-based counseling (PBC) became the state standard in Texas for HIV counseling and testing in 2006. The paradigm shift in providing HIV risk reduction has caused some risk reduction specialists to struggle. This interactive workshop will address the most common challenges and misconceptions about PBC. DSHS staff will share observations and lessons learned from technical assistance visits. Solutions to these challenges will be discussed.

Surveillance Do's And Don'ts: False Positive HIV Western Blots in Pregnant Women (B2)

Shirley Chan
Biru Yang
Naqi Mohammad
Jeffrey Meyer, M.D., M.P.H.
Marcia Wolverton

Monday, May 19, 2008
3:30 to 5:00 pm

Workshop Overview:

Guidelines from the CDC recommend that all pregnant women be offered voluntary HIV counseling, testing and referral. As a result, more pregnant women are being screened for the presence of antibodies to HIV. Many states have passed a law to permit the opt-out approach to prenatal HIV testing. However, there are over 60 factors documented that may affect the accuracy of an HIV antibody test, one of which is pregnancy. False positive and indeterminate test results present a challenge to the HIV/AIDS surveillance personnel who must confirm that a pregnant woman whose first positive HIV test result occurs during pregnancy is truly infected. In this presentation, we will first present the phenomenon of false positive HIV test results in pregnant women through case studies, and then describe the additional guidelines that the Houston Department of Health and Human Services has implemented to further investigate and verify the reportability of these individuals. The guidelines are: Contact the provider to confirm HIV infection, ascertain prenatal HIV tests and other HIV tests, e.g. viral load, qualitative viral tests, CD4; and elicit risk behavior and associated clinical manifestations; Contact testing laboratory to ascertain Western Blot (WB) band pattern. Two to three bands constitute a minimal WB positive and should be interpreted with caution; and Alert Disease Intervention Specialists (DIS) of a possible false positive WB result to encourage retesting and avoid wrongly informing patient of HIV infection. To avoid misinforming patients about their HIV status, providers need to be aware of the possibility of false positive tests and know how to verify an indeterminate test. To avoid over reporting the incidence of HIV infection in pregnant women who may not be truly positive, the HIV surveillance programs must implement safeguards to thoroughly investigate and verify HIV diagnosis. Until more sensitive HIV testing algorithm is developed, the health care providers and surveillance units should consider adopting the additional guidelines to safely identify the true HIV positive status of the pregnant women.

Meet The New State of Texas HIV/STD Prevention Community Planning Group (C2)

Jamie Schield, M.P.H.A.
Tony Schmitt
Brenda Howell

Monday, May 19, 2008
3:30 to 5:00 pm

Workshop Overview:

The community voice in determining the populations most at risk for HIV and STD infection and the most effective interventions and strategies to prevent HIV/STD infection has always been determined at the local level through the creation of “Regional Action Plans”. Funding sources (including DSHS) have used the Regional Action Plans to contract prevention efforts. In 2006, a strategic, community-process determined that having six regional HIV/STD Prevention Planning Groups was not as effective as it once had been. In 2007 a 40-member State of Texas HIV/STD Prevention Community Planning Group (TxCPG) was formed. This group retained the representation of the vast diversity that is Texas, but also added roles for a broader array of populations and experience needed to have a voice in HIV/STD prevention planning. Along with the new make-up of the TxCPG, new goals and responsibilities became part of our vision. A panel of representatives will present and discuss these goals and the role of the TxCPG. This session is recommended for persons involved with conducting and managing HIV and STD prevention programs; those interested in the link between prevention and care; and, for agency planners.

Understanding Health Disparities in the African American and Latino Communities (D2)

Jesus Marquez, B.S., C.H.E.S.

Monday, May 19, 2008
3:30 to 5:00 pm

Workshop Overview:

Health disparities refer to gaps in the quality of health and health care across racial, ethnic, and socioeconomic groups. Health disparities have been well documented in minority populations such as in African Americans and Latinos in the United Sates. The purpose of this presentation is to explore major health risks and issues in both African American and Latino populations as well as health care access and use. The presentation will explore theories of racial and ethnic differences in health and address those disparities in health and health care related to HIV/STDs.

The Epidemiology Profile of HIV/AIDS in Texas for 2006 (E2)

Ann Robbins, Ph.D.
Katharine Carvelli, M.P.H.
Jeff Hitt, M.Ed.
Barry Mitchell, M.P.H.

Monday, May 19, 2008
3:30 to 5:00 pm

Workshop Overview:

This presentation will review the epidemiologic profile of HIV/AIDS in Texas. The epidemiologic profile is prepared by Texas Department of State Health Services staff under guidelines provided by the Centers for Disease Control and Prevention. The profile contains comprehensive information on HIV and AIDS in Texas. Noteworthy issues include the continued rise in prevalence, stable new diagnoses, the disproportionate impact on African Americans, a high proportion of concurrent HIV and AIDS diagnoses, differing geographic impact, and the high level of infection among certain subpopulations. This presentation will also review the development of the profile, including the source of the data and adjustments that improve our understanding of the data. The epidemiologic profile functions as a basis to guide planning and action for prevention services. A comprehensive understanding of disease impacts and trends is essential to adequately plan and provide these services. Audience members can expect a presentation and discussion of HIV/AIDS in Texas that goes beyond a surface familiarity with the scope of the epidemic.

Impact of Social Network Characteristics on High-Risk Sexual Behaviors: A Gender-Based Analysis from Dallas (F2)

Miner P. "Trey" Marchbanks III, Ph.D.
Alicia Novoa, M.P.H.

Monday, May 19, 2008
3:30 to 5:00 pm

Workshop Overview:

This presentation will explore the relationship between social network characteristics and high-risk behaviors among the male and female participants in the National Health Behavioral Surveillance Survey conducted in Dallas from June to October 2007. Focusing on a specific set of questions from the CDC-created behavioral surveillance survey instrument that assesses risk-centered social networks, social support frameworks, influences and motivators on sexual behaviors, demographics, several dimensions of sexually high-risk practices, safe sex behavioral attitudes and the perceptions of risk-reduction in the participants, the findings will reveal any possible distinct differences in the impact of social networks on high-risk sexual behaviors among the male and female heterosexual participants from the survey. A partial aim of this analysis is to flesh out the potential utility of targeted social network interventions that could be designed to enhance women’s perceived ability to negotiate safer sex with their male sexual partners. In the context of the general finding from the Dallas survey on heterosexual males recruiting sexual partners for the study at a much less rate than the women and the women’s general difficulty of negotiating safer sex with their male partners, the summary findings from this paper will be highly relevant for significant public health planning of gender-based HIV prevention interventions in the high-risk areas of Texas.

Texas HIV Medication Program Update (SPAP & ADAP) (G2)

Katherine Wells, M.P.H.
Becky Ruiz, B.S.W.
Tara Geotas, M.P.H.
John Allen

Monday, May 19, 2008
3:30 to 5:00 pm

Workshop Overview:

Over the last year there have been many changes to the Texas HIV Medication Program (THMP), including the introduction of a new State Pharmacy Assistance Program (SPAP) for people with Medicare. This presentation will introduce service providers and clients to the Texas HIV Medication Program, covering eligibility, medication order processing and recertification. Program staff will discuss what constitutes a complete application and provide tips on common errors in submitting an application. The second half of the presentation will focus on the SPAP and will discuss how the new program works, the benefits of the program and the eligibility process. Personnel who assist individuals in applying for the THMP are encouraged to attend.

HIV Perinatal Transmission Prevention Projects in Texas (H2-A)

Jenny McFarlane

Monday, May 19, 2008
3:30 to 4:15 pm

Workshop Overview:

This presentation will provide an overview of HIV perinatal transmission prevention projects in Texas for the last five years, including the specialized case management programs in East Texas and the Rapid Testing in Labor and Delivery program in Houston.

The Medical Monitoring Project: From Science to Service (H2-B)

Sabeena Chintapalli, M.P.H.
Laura Armas-Kolostroubis, M.D.
Judith Dillard
David Huse

Monday, May 19, 2008
4:15 to 5:00 pm

Workshop Overview:

The Texas Medical Monitoring Project (MMP) is an initiative sponsored by local, state, and national agencies. The MMP is vital to the future of HIV care, treatment, prevention, and support services throughout Texas. The data collected in the MMP patient interview and chart abstraction will provide information on the use of HIV-related medical services, current levels of behaviors that may facilitate HIV transmission, adherence to drug regimens, and clinical conditions as a result of the disease or the medications. The data will also provide information about HIV care and support services received by patients and the quality of these services. In addition to the standard interview, a short set of local questions are administered. These questions were developed to specifically benefit programs at the state level. The data collected from the local questionnaire includes information on border issues and prenatal care. Twenty-six city/state sites were chosen using a three-stage cluster sampling method from which HIV healthcare providers in Texas were identified. From those facilities, a random sample of participants was selected. Results from the MMP will have implications for policy decisions, resource allocation, the quality of health care provided, and identify potential gaps in prevention and treatment. MMP provider, participant and community representatives will share personal experiences, expectations and perspectives regarding the utility of the project. Key variables of interest from MMP data will be presented by each of these representatives. A panel discussion of lessons learned and best practices to recruit and retain participants and facilities will conclude the session.

Interpreting Reactive Syphilis Tests and Congenital Syphilis Overview (I2)

John A. Mayfield, B.S.
Marisa E. Gonzales, B.S.

Monday, May 19, 2008
3:30 to 5:00 pm

Workshop Overview:

This workshop will cover testing methodologies, staging syphilis, interpreting titers, congenital syphilis overview, and case studies. A variety of interactive case scenarios and case studies will be presented designed to ascertain the participant’s knowledge of syphilis testing and congenital syphilis. This workshop will provide participants with useful information that can be used on a daily basis. The ability to correctly interpret reactive syphilis tests and understand congenital syphilis is an integral part of an STD program. Disease intervention specialists (DIS), first line supervisors, and STD clinic nursing staff will all benefit from this workshop as they are likely to routinely use this information in the performance of their daily disease intervention and clinical duties. Participants will be able to list two non-treponemal and two treponemal syphilis tests, define congenital syphilis, define serofast, define latent syphilis, and name a diagnostic test for congenital syphilis. Participants will leave with increased ability to conduct appropriate and timely syphilis case investigations including congenital syphilis and to assist the medical staff in providing optimum STD care.

Red Light, Green Light, GO: The Road to Public Health Investigations (J2)

Sydney Minnerly
Sherry Lyles, L.S.W.
Nekeyla Oliver
Bettye Martin
Ruben Herrera

Monday, May 19, 2008
3:30 to 5:00 pm

Workshop Overview:

This workshop will explore the purpose and process of public health investigation in order to promote greater cooperation and understanding of public health follow up. Our goal is to promote the importance and value of public health investigations by promoting “buy in” from community members. We intend to address concerns that providers, and the community overall, has with disease intervention specialist’s (DIS) investigations. We want to provide a safe and open forum in which we can honestly discuss barriers, hesitations, and obstacles from HIV/STD community partners in supporting public health follow up and investigations. Ultimately, we hope that communities will have greater ownership of their role in the public health response to HIV/AIDS which will hopefully result in a decrease in the spread of HIV and STDs.


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Last updated May 22, 2013