While statistics show that HIV prevention programs are working, there’s a new trend nationally to make the focus of the programs wider and more comprehensive. In San Diego, for instance, a county-funded program called Positive Action not only educates positives about condom use, it also provides support in individual and group settings, designs and promotes social marketing and education events, and conducts outreach. Started in July 2002, Positive Action is a county-supported collaboration among The Center, Bienestar, APICAP and the Center for Social Support and Education (CSSE). The program is modeled after national prevention with positives programs, called P3s, developed in the last decade by the Centers for Disease Control. San Ysidro Health Center and Vista Community Clinic have similar programs in the area.

“We’re not just talking about condoms and safer sex, we’re taking a more broad look at a person’s life and concerns,” said Carolyn Hunt, The Center’s Positive Action coordinator. “We’re trying to promote the physical health of people living with HIV and AIDS, but also the mental and emotional health. We know that a person doesn’t make a decision to do a risky behavior or a less risky behavior based on whether or not they know what a condom is or how to use a condom. That’s part of it, but it’s also ‘are you feeling lonely; are you under the influence of drugs or alcohol; do you have stable housing; do you have friends that you can talk to; are you comfortable disclosing your HIV status?’ It’s a whole bunch of different factors that play into it.”

The Center works mainly with the HIV-positive GLBT community, CSSE primarily with the HIV-positive African American community, APICAP with the HIV-positive Asian Pacific Islander community and Bienestar with the HIV-positive Latino/a community.

“Our goal is to design and deliver culturally appropriate services that can prevent the transmission of HIV from infected individuals to others,” said Jess San Roque, executive director of APICAP. “APICAP prevention efforts address multiple issues including life context, taking responsibility for one’s own health, as well as taking responsibility for the health of others. … Also, to provide support to people living with HIV/AIDS, their friends and families.”

“This is kind of a new thing in HIV prevention,” Hunt said. “Traditionally, prevention programs have targeted people who are negative with messages like ‘protect yourself’ and ‘stay negative.’”

However, twenty-five percent of CDC’s HIV-prevention money is now earmarked for P3s.

Arvella Murray, executive director of CSSE, said the major focus of Positive Action is “taking charge of one’s health and protecting loved ones. The major focus is: embrace life!” Tuesdays through Thursdays, CSSE runs open HIV and addiction support groups for those recently diagnosed with HIV, HIV-positive men in recovery, and self-care support groups for both men and women.

Because The Center is the leading fiscal agent for Positive Action, Hunt gathers data from collaborators and submits a quarterly report to the county on the progress.

Hunt also runs a weekly drop-in discussion group for HIV-positive individuals, primarily men, at The Center called the Positive Action Steering Committee, where various workshops and classes are developed.

“Obviously, I’m not a gay man, so they’ve helped me kind of make sure that what I’m doing is appropriate,” Hunt said. “They provide a lot of guidance and insight. ... These guys have vast amounts of experience and they’ve seen what’s worked in San Diego and what hasn’t in the past, and they’re just a wealth of experience and I depend on them a lot; they’re the brains of the operation.”

Hunt, who worked previously for a P3 at the Southern Arizona AIDS Foundation in Tucson, said they are developing classes on everything from cooking and nutrition to creative writing. The steering committee meets Thursdays from 6:00 to 7:30 p.m. at The Center.

“I think everybody who is doing prevention with positives is really trying to feel their way; figure out what is the most appropriate way to go about doing this and how do we get these messages out without blaming,” Hunt said.

Though the safe sex and prevention messages remain constant, greater emphasis is placed on confidentiality and harm reduction in P3s.

“There is a higher sensitivity in the positive community that they have to shoulder all the responsibility, and I think you really just have to accept that responsibility is a two-way street: everybody has responsibility for preventing HIV transmission,” Hunt said. “I think if prevention with positives programs aren’t careful, you can end up alienating the very people you’re trying to reach.”

Issues specific to prevention in the HIV-positive community include co-infection and superinfection. Co-infection is a major concern because, due to a compromised immune system, people who are HIV-positive and have an STD are up to five times more likely to transmit HIV.

“People don’t realize that the syphilis you got in the ’70s and treated with pills might not be the same syphilis that you get now, and if you have a compromised immune system, it’s not going to be just a matter of a penicillin shot or whatever,” Hunt added. “You might wind up in the hospital. STDs are much more serious for people who are living with HIV.”

In the case of superinfection, an area of study that has been primarily theoretical until recent data has revealed its existence, an HIV-positive individual taking a certain course of medication contracts a new strain of HIV that causes them to become resistant to their current course of treatment. Hunt said researchers are also finding new strains of HIV that are resistant to all of the HIV medications currently on the market. Because the field of HIV/AIDS study is constantly changing, Positive Action organizes seminars where researchers, doctors, case managers, education and prevention specialists and the HIV-positive community gather to discuss issues related to HIV/AIDS and the latest developments in the field.

“The concern that’s coming out more and more is we’re getting a larger and larger HIV-positive community because of new infections and the fact that people are living longer combined with rising cost of services, combined with less and less funding for those services,” Hunt said. “So the theme of Positive Action has become cooperation between and among different agencies and different parts of the HIV community.” Poz Seminar Weekend, held April 9-10 at The Center, presented 26 different classes and workshops as well as a “Zen Room” coordinated by Positive Action and The Center’s Holistic AIDS Response Program (HARP) that featured soft music, incense, Reiki, chiropractors, massage, astrology, modalities and more. Still, Hunt said P3 programs only reach a limited segment of the HIV-positive population.

“There is a vibrant HIV-positive community in San Diego, but we know that there are many, many more who are living with HIV that don’t go to events; that don’t go to San Diego Pozabilities coffees; that don’t go to The Center to do yoga; and don’t access HIV-specific services or events because they’re worried about outing themselves.”

In an effort to expand their reach and reduce some of that worry, Positive Action and the Gay Men’s Health Program of Family Health Centers of San Diego are hosting “Poz 5-Minute Man”, a casual social event for HIV-positive men to meet other men, held June 26 at the Joyce Beers Community Center. “One of the big concerns for HIV-positive men and women is isolation and not knowing how to meet people, and trying to deal with disclosing their status every time they meet a potential partner or date,” Hunt said. “There is a lot of anxiety around that.”

There is currently no “Poz 5-Minute Woman”, but there are a number of services and groups for the HIV-positive women’s community that be found at APICAP, CSSE, Christie’s Place and Being Alive North County, among others.

“It’s a hard thing, because from a funding perspective, I know that at the state and county level they look at the numbers and say that it makes more sense to allocate more resources to the larger groups,” Hunt said. “I think San Diego has actually done a pretty good job of providing for women, but I think there needs to be more publicity around what those services are.”

For more information about Positive Action at The Center or Poz 5-Minute Man, contact Carolyn Hunt at (619) 692-2077 ext. 133 or chunt@thecentersd.org. For more information about Positive Action at APICAP, call (619) 229-2822; Bienestar, (619) 295-2192; and CSSE, (619) 325-2773.