beneath the tip of the iceberg:an intersectional approach...

Beneath the tip of the iceberg: An intersectional approach to violence prevention in minority US-MX border communities at high risk for HIV and

Substance Use DisorderVirginia Rueda, Coordinator of Services

Thenral Mangadu, MD, MPH, PhDIsaac Duran, MA

Max Orezzoli, PhDRebecca Gallegos, MPH

Center Against Sexual and Family Violence The University of Texas at El Paso

Presentation Outline

• Program and priority population contexts• Evidence Based Interventions• Assessment• Active learning discussions

Program

• Mujer Saludable, Familia Feliz

• Funding• $1,479,820.00 (09/2016) • Substance Abuse and Mental Health Services Organization (SAMHSA) from the

Department of Health and Human Services (HHS)• SAMHSA Grant: TI080065

• Focus• Targeted SUD treatment capacity expansion for HIV prevention among

minority women

Program Goals

1. Reduce HIV infection, transmission, and SUD rates 2. Address impact of violence and trauma on priority

population’s risk for substance use disorder (SUD), Human Immunodeficiency Virus (HIV) and Hepatitis C (HCV)

3. Conduct formative and summative evaluation

Our community: El Paso, TX on the US-MX Border

El Paso, TX• Population of 800,000+• 81% Hispanic• Low educational attainment• Lack of access to service• >32,000 reports related to domestic violence in 2013• 30% of the U.S.-MX border population live below the poverty level• 63 % of US-MX border counties are Health Professional Shortage Areas

(HPSAs)• Gender norms exacerbating violence risk• Immigration contexts of victim and perpetrator shaping violence risk• Intersecting local contexts shaping violence, HIV and Substance use

disorder (SUD) risk

Priority Communities in El Paso County, TexasSan Elizario, Clint, Fabens, Socorro

Clint, Texas

Clint, Texas Colonia in El Paso County, TX

http://arcg.is/1VBfAkq

Partnering Organizations

• Domestic Violence • Engaged Bystander Intervention• Sexual Assault Support Group

• Delivered− Six weeks sessions−One-hour modules −Community-based organizations and

community sites

Evidence Based Interventions for Violence Prevention

Sexual Violence

• Educational Groups

• Developing the sexual violence topics

• Description of groups

Sexual Violence

• Introduction to participants

• Types of Sexual Violence

• Gender Roles

• Labels

Sexual Violence

• Understanding Sexual Violence

• Consent

• Myths and Realities

• Statistics

Sexual Violence

• Expressing and Managing Emotions

• Activity to identify emotions

• Continuum Behavior

• Grief Cycle

Sexual Violence

• Coping Skills

• Self-Care

• Relaxing Time

Sexual Violence

• Respect • Healthy relationships/Healthy Boundaries

• Sexual intimacy

• Sexual transmitted disease and HIV

Sexual Violence

• Effective Communications

• Social Media

• Red Flags

• Survivor Rights

• Resources

Sexual Violence

• Taking the audience in consideration

• The importance of the sexual violence groups

• Challenges

Sexual Violence

• Benefits from partnering with Alivane Inc.,

• Our learning experience

Bystander EngagementCenter Against Sexual & Family Violence

• increase and use victim services by priority communities.

• assist in increasing awareness about services program clients and communities.

• increase in knowledge about sexual violence topics.

Bystander Engagement

Engaging Bystanders in Sexual Violence Prevention (CDC)The concept of bystander intervention and some factors that lead people to act; it considers who bystanders are and some circumstances that would motivate people to get involved in the prevention of sexual violence.

https://www.ncjrs.gov/App/Publications/abstract.aspx?ID=248017

Bystander Engagement

The Transtheoretical Model of change. It takes into account both social and biological factors while recognizing the process that is involved with people making changes in their behavior.

• Primary Prevention Programing

The information regarding the Transtheoretical Model was taken from Pro Change Behavior Systems, Inc. webpage (http://www.prochange.com/transtheoretical-model-of-behavior-change)

Bystander Engagement

• Planned activities and programming related to engaging minority women and family/network members for sexual violence prevention.

One hour sessions: These are done in order to assess the status and reinforce the progress made from preliminary ones. As such, there is progress in the change of behavior being targeted. Venues include community centers, housing authority facilities, residential SUD treatment facilities, etc.

Bystander Engagement Sessions• Recognizing "Red Dots“ “Red Flags” “Warning Signs”• Identifying stalking behaviors, dating violence, domestic violence and

sexual assault.• Understanding the role of a bystander and obstacles to action.• Implement the concept of proactive and reactive bystander.• Identifying sexual violence perpetration norms in community.• Increase the awareness and bystander intervention skills.

Bystander Engagement

As a partnering agency, CASFV assists with enhancing program objectives related to addressing community contexts of violence affecting minority women.

• To Increase• Communication between clients, community members and community

service agencies. • Awareness among community networks about responding to observed sexual

violence.• Knowledge and skills of community members in relation to making their

communities safe.

Assessment

• Mixed methods• Regionally and culturally relevant• Data collection methods

• Screening tool• Government Performance and Results Act (GPRA) tool• RHHT form fro HIV and HCV testing• Focus groups• Pre-post training surveys

Government Performance and Results Act (GPRA) participant demographics

Table 1: GPRA DEMOGRAPHICS (N=128)Demographic characteristics Frequency (n) Percent (%)

Age (Years)

18-24 38 29.725-34 58 45.335-44 24 18.845+ 8 6.2

Gender Female 128 100Origin Hispanic/Latino 112 87.5

Ethnicity Mexican 108 84.4

Highest level of education.12th grade/ high

school51 40

Current employment Unemployed 41 32Having children. Yes 116 91

Number of children.

1 34 26.62 30 23.43 26 20.3

4+ 12 9.4Currently awaiting charges, trial, sentencing. Yes 31 24.2

Currently on parole or probation. Yes 33 25.8Having experience of violence or trauma in any setting? Yes 91 71.1

GPRA

Table 4. GPRA Violence /Trauma Indicator (N=128)

Indicator Responses Frequency(n)

Percent(%)

Have you ever experienced violence or trauma in any setting?(including community or school violence; domestic violence; physical, psychological, or sexual maltreatment/assault within or outside of the family; natural disaster; terrorism or neglect)

Yes 91 71.1

Tried hard not to think about it or went out of your way to avoid situations that remind you of it?

Yes 69 54

Felt numb and detached from others, activities, or your surroundings? Yes 56 43.8

Focus group themes (n=21)

• Sexual, emotional or physical violence experience as teens/adolescents

• Coping with trauma/sexual violence by using drugs and engaging in risky sexual behavior

• Sharing drugs with partners• Network members engaging in unprotected sex while under in

influence of drugs• Not seeking timely prenatal care• Inability to negotiate safer sex/reduce HIV risk

Best practices in implementation & assessment• Pragmatic and holistic approach• Screening and referral protocols to ensure service delivery is not

fragmented• Engaging community members and networks in recruitment and data

collection• Recruitment and outreach at traditional and non-traditional venues• Engaging local promotoras in outreach for all program components

Active learning discussion 1

• What are the contexts we need to address for implementing violence prevention in minority populations at risk for SUD and HIV? (Please consider contexts in your priority communities)

• Discussion : 10 minutes• Reporting : 5 minutes

Active learning discussion 2

• Identify 3 allies/partners you will approach first in your communities to implement violence prevention in relation to HIV and SUD. What is the rationale behind choosing these allies?

• Discussion : 10 minutes• Reporting : 5 minutes

Thank youQuestions? Comments?

Virginia Rueda: vrueda@casfv.orgThenral Mangadu: tdmangadu@utep.edu

Isaac Duran: iduran@casfv.org