How long-term benefits override upfront costs: using research and evaluation to justify a female condom intervention

In a time where economic interests override public health concerns, a new study published in AIDS and Behavior shows that public health spending can reduce costs in the long run. In general, female condoms are more expensive than male condoms. However, after cost-analyzing an initiative that distributed 200,000 condoms to women in a neighborhood with high rates of HIV-diagnosis in Washington D.C., the authors found that for every $1 spent, $15 was saved.

D.C. has the highest prevalence of HIV in the United States. 1 in every 33 residents is infected with the virus, and 1 in 14 residents in their 40’s have tested positive. The sexual health initiative began two years ago after a report noted these high levels of HIV/AIDS diagnoses.

The campaign, called D.C.’s Doin’ It!, chose to target sub neighborhoods with high HIV-diagnosis rates. Officials justified the distribution using study findings that showed large numbers of African American heterosexuals in the District engaging in risky sexual behaviors: http://doh.dc.gov/doh/frames.asp?doc=/doh/lib/doh/pdf/dc_hiv_heterosexualstudy.pdf. (Something to consider: 92.3% of study’s participants self-identified as black. Is it possible to compare this to the other 7% of the study and make these same conclusions?)

The report also found that women had a higher HIV prevalence than men (6.3% versus 3.9% respectively). To empower and increase women’s autonomy, officials chose female condoms as the intervention. Female condoms give women the power to make healthy choices, even when a partner does not give them this choice.

The campaign dispensed these at convenience stores, beauty salons and community clinics and trained community members to discuss sexual health with peers in informal settings (UMN professor also used this approach, calling it “Barbershop Conversations”- check it out! http://www.advances.umn.edu/2011/06/barbersho/). The initiative plans to continue the project, by distributing between 250,000-300,000 female condoms a year.

Playing with issues of women empowerment, race, socioeconomic status, and class, critics argue that the intervention targeted a subgroup of D.C.  residents. Is this justified/ethical? Can public health interventions target subpopulations, rather than a community at large? Are there any other issues to consider when implementing a similar campaign?

Although there are concerns with the study and intervention, public health should not disregard evaluation results. Upstream care can and should be utilized to promote population health, including within the reproductive health sphere.

AHRQ profiles Aqui para Ti

The Agency for Healthcare Research and Quality (AHRQ) recently profiled Minneapolis-based healthcare clinic Aqui para Ti as part of their “Innovations Exchange” feature online. Aqui para Ti (“Here for you”) has provided a full range of services to Latino adolescents and their families–including medical care, health education, and referrals–since 2002.

As AHRQ notes, a 2009  evaluation of Aqui para Ti showed distinct improvements in health-related outcomes for program participants, the majority of whom (98.5% of the parent population and 80% of the adolescent population) were born outside of the United States. Latino families  can face extraordinary challenges during this transitional time, which may be compounded by high rates of teen pregnancy and inadequate support for parents and others who take on parenting roles within Latino households.

The clinic uses an innovative, family-centered approach, developed after community-led research from the non-profit Wilder Foundation identified a strong need from local parents who requested “guidance on how to talk to their children about healthy behaviors.” Aqui para Ti was designed with this need in mind, and incorporates a unique curriculum for parents delivered through regular, onsite parenting discussion groups.

As the evaluation results indicate, adolescent visitors increased their birth control use as a result of their interaction with Aqui para Ti, with half of all youth electing to use a highly effective birth control method  (i.e., IUD, birth control pill, or patch). 86% of all youth surveyed indicated that their “overall health had improved since initiating program services,” and 100% of respondents noted that they “trusted” Aqui para Ti clinicians.  Parents, too, reported improved communication with children as a result of their interactions with clinic staff, as well as increases in “their confidence in seeking guidance and support from providers [...to] support their children’s development.”

The full AHRQ article, which includes a comprehensive description of Aqui para Ti activities and useful suggestions for adoption, is available here: www.innovations.ahrq.gov/content.aspx?id=2784

For more on Aqui para Ti, including clinic hours and contact information, click  here: www.hcmc.org/depts/hcclinics/Aquiparatiprogram.htm

National Condom Week, February 14-21

As Planned Parenthood reminds us, February 14th-21st marks the 30-something anniversary of National Condom Week. To celebrate, we bring you an assortment of banned condom commercials. Please note: none of these are safe for work, but all of them are quite funny:

EC in Minnesota: some facts for minors

A recent comment from a visitor prompted this blogger to wonder–how accessible is emergency contraception in Minnesota, anyway?

The short (and uninformative) answer is, it depends. For women and their partners who are 17 and older, emergency contraceptive (commonly known as “the morning after pill,” branded as “Plan B” or “Next Choice”) is available over-the-counter.  Women can go directly to their pharmacist for purchase, but should be prepared to show ID.*  A map of Minnesota pharmacies that provide EC, searchable by zip code, is available here (call ahead to confirm stock): http://www.ecminnesota.org/

Women under the age of 17 can get EC with a prescription from a healthcare provider, thanks to a March 2009 federal ruling. For a searchable list of clinics that  will provide prescriptions for EC, click here: http://eclocator.not-2-late.com/search.asp.

Minnesota state law does not require clinics to notify parents when their child requests emergency contraception, so women under the age of 17 should be sure to call ahead to determine a) if clinics prefer parental notification and b) if an appointment is necessary.  Many clinics may call in a prescription to a local pharmacy without a visit.

If an appointment is necessary, minors who are concerned about confidentiality should pay in cash rather than use their family’s health insurance.

Publicly-funded Title X clinics will ensure patient confidentiality and also provide sliding scale services (both for EC, other birth control prescriptions, and additional services including  pregnancy option counseling). For a directory of Title X clinics (searchable by zip code), click here: http://nfprha.org/main/about_us.cfm?Category=Member_Clinic_Directory&Section=Main

*Undocumented individuals here in Minnesota still stuggle to receive equal reproductive care — the subject for another blog post.

“Trust” condom ads: from Kenya