Youth

The final high-risk HIV/AIDS group in Philadelphia is potentially the most problematic: youth. A study done by Cudore Snell revealed that “African American youths were reluctant to admit they need help,” and “sixty-five percent of the youth reported one could not get AIDS from a healthy-looking person.”[i] This study indicates that inner-city youths are not receiving proper HIV/AIDS education or simply do not care about the risks they take. This ambivalence may have dramatic implications later in life. Belenko et al. studied prison inmates and indicated that “despite exposure to HIV education services, important gaps remain in African American offenders’ knowledge about HIV transmission.”[ii] Yet, there is difficulty in accessing this unconcerned demographic. One CDC AIDS research group found that “community-level interventions have had some success in prevention of HIV.”[iii] This group sough three levels of prevention: “mobilization of community members…creation of small-media materials…and increased availability of condoms and bleach kits.”[iv] The group showed that a more focused approach to HIV prevention was superior to more general risk-reduction methods. For example, “small” media, like pamphlets, were more effective than “large” media, like television commercials, because the small media methods were able to capture community-specific problems. Therefore, the message sent to the youth of a community was more personal and more realistic.[v]

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       Yet, how is it possible to activate a community against the spread of AIDS? A study by Baptiste et al. established a program called the Chicago HIV Prevention and Adolescent Mental Health Program (CHAMP) to address this very issue. Their solution was three-fold. First, information would be gathered by surveys and personal interviews in or around problem communities.[vi] Next, a sub-committee would be established, compromised of university staff and community leaders.[vii] Finally, members of the community and experts from the university would combine to make a prevention intervention program specific for their community.[viii] The target age group for this study was pre-adolescent, and the program occurred in a community center or school. This program was extremely successful because it provided an intensive 12 session intervention in which the inner-city youth were being taught by community members they know and respect. Another advantage of this program is the overall education of the community. Not only are youth benefiting from this intervention, but so too are community leaders and parents. A similar concept was at work in a study done by Dancy et al. They established a program that targeted female inner-city adolescents and trained the mothers of these teens to teach their daughters about HIV prevention.[ix] Therefore, the youths were not only receiving the community and relationship based attention they need, but the impoverished mothers were learning about risk-reduction as well. The results were successful in reducing the daughters’ risk behavior, yet in this model Dancy et al. employed a curriculum that “primarily focuses on sexual abstinence.”[x] Although abstinence education is one method of HIV prevention, Jemmott et al. found that focusing on safer-sex may yield better results. Especially among those that have already had sex, “the safer-sex intervention caused less self-reported sexual intercourse then did the control or abstinence group.”[xi] Another concern of the program is how to convey an HIV preventive message. Jemmott et al. conducted a study that measured the effectiveness of information- and behavioral-based interventions in adolescent females. They found that the information-based intervention group had a better knowledge of HIV, but that “at the 12-month follow-up, adolescents who received the skill-based intervention were significantly less likely to have an STD.”[xii] Therefore, a program like CHAMP should incorporate both information-based interventions, such as educational “small media” and lectures, and skill-based interventions, such as demonstrations of condom use and role-playing to learn social skills needed to remove oneself from a risky situation.

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            Undoubtedly, this program would be expensive. Yet, it is essential that a comprehensive program like CHAMP is established in Philadelphia to address  a new generation at risk for HIV infections, who are increasingly more indifferent towards a growing problem. A similar program was conducted for an MSM high risk community in Mississippi. In this study, Pinkerton et al. conducted a three phased community intervention program. In the first phase, the researchers recruited bartenders from gay bars; in the second phase they conducted 4 sessions of instructional interviews with the bartenders; in the final phase, they had the bartenders conduct field research on gay patrons.[xiii] This program has a similar design as CHAMP, and therefore the cost estimates for this program can correlate to rough estimates for establishing a program like CHAMP in Philadelphia. For a two month program at two locations, Pinkerson et al. found that the cost was $17,150. $6,700 paid for the staff and $5,300 was distributed as an incentive among the 22 participating bartenders, meaning each bartender received roughly $241 for participating. Additionally, Pinkerton estimated $4,100 for materials and transportation.[xiv] If a CHAMP model was installed in Philadelphia, perhaps called YoPAA (Youth of Philadelphia Against AIDS), then the program would last 12 sessions or about 2 months. Thus, Pinkerson et al.’s model can be applied to this scenario. In Philadelphia, this program could be installed at YMCAs across the city. In particular, the YMCAs in West Market, 19139, the North East, 19121, and center city, 19102, would address some of the poorest pockets of Philadelphia. Perhaps each YMCA could run this program twice a year, so that YoPAA is always running in at least one location throughout the year. Using Pinkerson et al.’s estimations, this program would require $40,200 for University staff and 24,600 in materials. If the bartenders are equivalent to the community leaders in the CHAMP model, and each CHAMP intervention had two community leaders, then YoPAA would spend $5,784 in compensation for the leaders. In all, a YoPAA would cost $70, 584. Yet, Pinkerson et al. argue that, from a social standpoint, this community prevention method is cost saving because they spent $40 on each of the 449 participants, whereas the cost for lifetime treatment for HIV is between $7100 and $11900.[xv] Most importantly, though, YoPAA would provide an extensive and engaging prevention message to an economically specific age group.