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Linking Prevention for Older African Americans
The 15th National HIV/AIDS Update Conference held in Miami this spring
addressed, among other issues, the increase of HIV infection among older adults.
Many physicians "overlook" HIV symptoms in older patients and do not question
them about their sexual behaviors, according to Dr. Mervyn Silverman, chair of
the conference. "It's not on their radar screen and it needs to be. Rarely will
the patient bring it up," Silverman said to the Miami Herald (3/29).
African Americans age 50 and older in Detroit and Wayne County will now be
reached with a unique prevention program for both HIV and substance abuse. Adult
Well-Being Services, funded by a three-year service grant from the federal
Substance Abuse and Mental Health Services Administration (SAMHSA) is developing
and implementing the program. This service grant follows a one-year planning grant from SAMHSA that allowed for “The Older Adult Interagency Collaborative HIV
Prevention and Substance Abuse Prevention Planning Initiative”, which as the
name implies is a collaboration with local agencies.
The first year involved extensive needs assessment including 30 area agencies
and organizations, development of a Service Delivery Plan and it’s rollout in
the well-attended “Call to Action” in December 2002.
In the United States, (stats available through 12/02) 12% of black (not
Hispanic) males diagnosed with AIDS were over 50; and 8% of Black (not Hispanic)
females diagnosed with AIDS were over 50. 8% of black (not Hispanic) males
diagnosed with HIV were over 50; and 6% of Black (not Hispanic) females
diagnosed with HIV were over 50. Note: these are only the reported cases and
part of the problem is that HIV goes undiagnosed in this age group until late in
the course of infection.
Substance abuse is also a problem for Americans over 50. “An estimated 17% of
those 50 and older and 37% of “baby boomers” have a substance abuse problem.
Older adult substance abuse, particularly with alcohol and prescription drugs,
is one of the country’s fastest growing health problems, according to Adult
Well-Being Services.
Adult Well-Being Services in Detroit has been providing health promotion, which
incorporates substance abuse prevention, since 1985. It was the idea of AWBS
Executive Director Karen Schrock, formerly the Chief of Substance Abuse Services
for Michigan, to go for the grant. She recruited Thea Simmons to develop and
write the grant proposal for a program that would combine HIV and substance
abuse prevention for older African-Americans in Detroit and Wayne County.
The Center for Substance Abuse Prevention (CSAP) under SAMHSA said they were
looking for programs targeting youth and underserved populations of color.
Schrock saw African Americans over 50 as an underserved population and this
grant as an opportunity to target the dual need of HIV and SA prevention.
“We did exploration nationally,” said Simmons, now the director of Community
Health Promotion for Adult Well-Being Services. No formal curricula for HIV and
substance abuse (SA) prevention exist for this age group. “We thought it was
really stellar that CSAP decided to put (HIV and SA) together. And we are really
on the cutting edge in putting that together for older adults.
“In 2001, we proposed to devise an HIV and substance abuse prevention planning
initiative for older African Americans in Detroit and Wayne County.”
Adult Well-Being Services received the SAMHSA one-year planning grant. The
planning initiative began by bringing together a collaborative of 30 area
agencies, organizations and gatekeeper consultants. A needs assessment was
conceptualized and assessment methodologies were developed which used both focus
groups and written surveys. Two groups were involved in the assessment; the
multidisciplinary professionals who serve the target population in every
conceivable service arena and African-Americans aged 50 and older.
AWBS learned a lot from the needs assessment. “It’s so interesting to me, the
denial that we have experienced – the denial and the acceptance – but primarily
the denial, by providers and lay people,” said Simmons. She continued, “Many
have a hard time imagining that older folks do anything in bed besides sleep…and
substance abuse?! Not Granddaddy!!” They found that people (older adults and
service providers) simply did not realize older adults’ very real vulnerability
to HIV and substance abuse or make the connection between SA and HIV risk.
“This is a cutting edge issue; the rate of AIDS in older adults is growing
faster than for those in their 20s or 30s.’ That’s indisputable. And we’re
estimating 17 - 37% of older adults are abusing substances. Everything is
under-identified, underreported, under-estimated and of course, older adults are
an under-served population.”
The culmination of the planning grant was a ‘Call to Action’ inviting service
providers for the aging, public health and mental health providers, along with
faith-based organizations and the target population to talk about the realities
of HIV and substance abuse.
The Call to Action was held in December at U of D Mercy in Detroit. A panel of
elders discussed the truth about behaviors. “Older people don’t just knit and
jiggle their grandchildren on their knees,” said Simmons. The risks are there
for older adults; surprising things go on in retirement homes. They are still
having sex and using drugs, all kinds of drugs.
The Call to Action also covered the findings from the survey and focus groups
and the recommendations from the needs assessment, and rolled out the Service
Delivery Plan.
The purpose of publishing the service delivery plan was to share it with the
larger interdisciplinary community “so they can enhance their services and use
that tool to get additional funding,” said Simmons.
Now with the three-year service delivery grant from SAMHSA, the time has come to
develop the curricula and deliver the prevention services. Adult Well-Being
Services is developing community education for African Americans age 50 and over
and will also provide professional development for multidisciplinary service
providers who work with older African Americans.
Since none currently exists, AWBS will be developing the curricula for skill
building and empowerment with the two specified target audiences. As an example,
many who participated in the needs assessment felt women were at greater risk
for HIV but did not have the interrelationship power to reduce their risk.
“We’re talking about negotiation and power issues,” said Simmons.
“The problem is there are so many issues that compete for older adults
attention. People are worrying about diabetes; or about being diagnosed with X,
Y, and Z. We talk about ageism. We know older people are not as valued in our
society. If you look at almost any prevention pamphlet or brochure those faces
are probably no older than 28,” said Simmons. One of the first things ABWS did
was to update a fact sheet for HIV/AIDS and adults over 50.
Part of the grant program will be offering 8 hours of professional development,
so there will have to be a curriculum developed especially for that. “Some of
our partners, DHD (Detroit Health Department) and MDCH (Michigan Department of
Community Health) and the Bureau of Substance Abuse already have wonderful
training. We will just have to make it age and culture specific,” said Simmons.
The program will divide the targeted audience into two age groups, those aged 50
– 64 and 65 and over. For the first group they will be working with churches,
fraternity groups, and service groups.
“We are going to have to make some inroads with these ‘younger’ older folks,”
said Simmons. “With them we are going to do just straight out HIV and SA
prevention. From our experience, observations and literature review…. this age
group is amenable to straight on education without candy-coating it.”
For the 65 and over, group AWBS will offer a four-part health promotion series.
Two of the sessions will cover HIV/AIDS and substance abuse. The additional two
will cover health topics such as aging successfully, cardiovascular health, or
diabetes care, which Adult well Being Services has been doing for years.
In the third year of funding the Initiative will be putting together a
physician’s tool kit “because it’s time to get physicians involved in this,”
said Simmons. “Older adults are very responsive to interventions. Especially
with substance abuse, if a doctor intervenes early on … there is a much higher
recovery rate. But there generally is a reluctance, with physicians, to avoid
addressing issues related to both substance abuse and HIV.”
Simmons brought quite a broad public and mental health background to her
position with Adult Well-Being Services and at one time actually trained
clinicians on how to give a patient-sensitive gynecological exam.
Simmons also has a long history with HIV prevention. She worked at United
Community Services when it was the planning body for the United Way in Detroit.
At that time they had a Venereal Disease Action Coalition, where she worked with
many of the “elders” of HIV prevention in the metro area – “a handful of people
who came together and got funding to do lay, professional and clinical education
on (STDs). They used the name VD Action coalition. “We did a yearly conference,
and were about to do a conference on Chlamydia, this was in ’82, when something
called “Gay-Related Immune Disorder (GRID),” later renamed AIDS, came onto the
radar screen.”
Not only is Simmons well prepared to develop the physician’s tool kit, one of
the planning group members, Dr. Dexter Shurney, is also an AWBS Board member and
former medical director for Blue Cross Blue Shield of Michigan.
“We have to get doctors on board” with this prevention and education program
said Simmons. Due to ageism, a diagnosis of HIV disease is often missed. “AIDS
dementia is often mistaken for Alzheimer’s, she said.
The grant program will also work with local ‘wrap-around services’ at various
agencies providing services to older African Americans. Upon request, the
Initiative will work with various service agencies to revise screening tools.
So, for example, a mental-health services intake worker would have a more
appropriate tool with which to screen for SA and HIV risk.
The Call to Action was to start the dialogue between service providers and older
African Americans. “Real collaboration is the only way we are going to address
this issue. It’s respecting what older people tell us about how to provide them
with life-enhancing prevention information” as well as respecting what the
agencies have shared in the needs assessment with regard to their limitations.
“It’s about strategizing together.”
Importantly, Adult Well-Being Services is currently recruiting older peer
educators to work with the 50-64 year olds in Detroit and Wayne County. Peer
education positions are “very” part-time, involving intensive certification
training and then a commitment of at least 2 series annually. Those interested
in Peer Educator positions should contact Education Coordinator, Stephanie
Kitchen at (313) 825-2524.
Kitchen is also the contact if you are a Wayne County agency or consumer and
would like to arrange substance abuse and HIV prevention workshops for older
African-American consumers, staff or volunteers (who work with them).
Though this program specifically targets the Detroit and Wayne county population
of older African American adults, Simmons said professionals from around the
country are interested in the program and it’s applicability in other areas. For
more information or to obtain a copy of the Service Delivery Plan, contact the
ABWS Community Health Promotion Department at (313) 825-2519 or e-mail
abosman@awbs.org.
Related programs
CHOW Links
Community Health Outreach Workers Linking Individuals into Networks for
Knowledge and Services (LINKS) is a voluntary multi-disciplinary coalition of
service providers and community leaders committed to improving the health status
of African Americans (and others) at risk of or living with HIV/AIDS, STD, TB,
Mental Illness and/or Substance Abuse within the City of Detroit. To learn more
about this, see the
PowerPoint presentation from the April MHAC meeting
or call CHOW (313) 963-3352.
CHAG Point of Change
African Americans in the City of Detroit who are at-risk for HIV infection
through drug use are now able to get everything they need through one
organization. On March 18 Community Health Awareness Group (CHAG) held an open
house celebration of the new substance abuse program, Point of Change, at it’s
own satellite location, on the eastside of Detroit. See the
Village Drum,
Spring 2003 or call CHAG (313) 872-2424 for a copy.
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