CDC expects HIV prevention community planning to improve HIV prevention programs by strengthening the: (1) scientific basis, (2) community relevance, and (3) population- or risk-based focus of HIV prevention interventions in each project area. Beginning in 1994, CDC changed the manner in which federally-funded state and local level HIV prevention programs were planned and implemented. State, territorial, and local health departments receiving federal prevention funds through CDC were asked to share with representatives of affected communities and other technical experts, the responsibility for developing a comprehensive HIV prevention plan using a process called HIV Prevention Community Planning. The basic intent of the process has been threefold: to increase meaningful community involvement in prevention planning, to improve the scientific basis of program decisions, and to target resources to those communities at highest risk for HIV transmission/acquisition. The CDC remains committed to supporting HIV prevention community planning.
A. CDC HIV Prevention Strategic Plan
HIV Prevention Community Planning plays an important role in achieving the goals of CDC’s “HIV Prevention Strategic Plan Through 2005”*
(and subsequent strategic plans). CDC’s Overarching National Goal for HIV prevention in the United States is to:
Reduce the number of new HIV infections in the United States from an estimated 40,000 to 20,000 per year by 2005, focusing particularly on eliminating racial and ethnic disparities in new HIV infections. To accomplish this goal, CDC expects:
- By 2005, to decrease by at least 50% the number of persons in the United States at high risk for acquiring or transmitting HIV infection by delivering targeted, sustained, and evidence-based HIV prevention activities.
- By 2005, through voluntary counseling and testing, increase from the current estimated 70% to 95% the proportion of HIV-infected people in the United States who know they are infected.
- By 2005, increase from the current estimated 50% to 80% the proportion of HIV-infected people in the United States who are linked to appropriate prevention, care, and treatment services.
- By 2005, strengthen the capacity nationwide to monitor the epidemic, develop and implement effective HIV prevention interventions, and evaluate prevention programs.
CPGs should be familiar with the CDC Strategic Plan and should work to address the national goal within their jurisdiction’s community planning process. However, the local epidemic and needs of the jurisdiction must be a priority for each CPG. Two major components from the strategic plan must be considered by CPGs: (1) targeting populations for which HIV prevention activities will have the greatest impact, and (2) reducing HIV transmission in populations with highest incidence. CPGs must consider the unique issues related to providing HIV prevention for persons living with HIV/AIDS (PLWHA).
*Centers for Disease Control and Prevention HIV Prevention Strategic Plan
Through 2005. Centers for Disease Control and Prevention, National Center for
HIV, STD, and TB Prevention, Atlanta, GA: January 2001 (see CDC’s website:
B. Advancing HIV Prevention Initiative
CPGs should also be familiar with CDC’s Advancing HIV Prevention (AHP) Initiative. Through Advancing HIV Prevention, CDC is refocusing some HIV prevention activities to reduce the number of new HIV infections in the United States.*
Through Advancing HIV Prevention, CDC is putting more emphasis on counseling, testing, and referral for the estimated 180,000 to 280,000 persons who are unaware of their HIV infection; partner notification, including partner counseling and referral services; and prevention services for persons living with HIV to help prevent further transmission once they are diagnosed with HIV. In addition, since perinatal HIV transmission can be prevented, CDC is strengthening efforts to promote routine, universal HIV screening as a part of prenatal care. All of this will be accomplished through four strategies: (1) making HIV screening a routine part of medical care; (2) creating new models for diagnosing HIV infection, including the use of rapid testing; (3) improving and expanding prevention services for PLWHA; and, (4) further decreasing perinatal HIV transmission.
Advancing HIV Prevention will impact the HIV Prevention Community Planning priority setting process. Because of its potential to substantially reduce HIV incidence, HIV Prevention Community Planning Groups will be required to prioritize HIV-infected persons as the highest priority population for appropriate prevention services. Uninfected, high-risk populations such as sex or needle-using partners of PLWHA, should be prioritized based on local epidemiology and community needs.
*Advancing HIV Prevention: New Strategies for a Changing Epidemic — United States, MMWR 2003; 52 (15):329- 332
C. Goals of HIV Prevention Community Planning
The CDC has set three major goals for HIV Prevention Community Planning. The goals provide an overall direction for HIV prevention community planning. In addition, in “Section IV: Monitoring and Evaluation” of the
Guidance, there are eight objectives that delineate specific processes and products expected for each goal. The three major goals for HIV Prevention Community Planning are:
Goal One — Community planning supports broad-based community participation in HIV prevention planning.
Goal Two — Community planning identifies priority HIV prevention needs (a set of priority target populations and interventions for each identified target population) in each jurisdiction.
Goal Three — Community planning ensures that HIV prevention resources target priority populations and interventions set forth in the comprehensive HIV prevention plan.
D. Guiding Principles for HIV Prevention Community Planning
Guiding Principles for HIV Prevention Community Planning* — To ensure that the HIV prevention community planning process is carried out in a participatory manner, the CDC expects all CPGs to address the following
Guiding Principles of HIV Prevention Community Planning as they carry out HIV prevention community planning:
- The health department and community planning group must work
collaboratively to develop a comprehensive HIV prevention plan for
- The community planning process must reflect an open, candid, and participatory process, in which differences in cultural and ethnic background, perspective, and experience are essential and valued.
- The community planning process must involve representatives of populations at greatest risk for HIV infection and PLWHA. Persons at risk for HIV infection and PLWHA play a key role in identifying prevention needs not adequately met by existing programs and in planning for needed services that are culturally appropriate.
- The fundamental tenets of community planning are: parity, inclusion, and representation (often referred to as PIR). Although these tenets are not accomplished or achieved in a linear fashion, there is a strong relationship between each — with one building on another.
Representation is defined as the act of serving as an official member reflecting the perspective of a specific community. A representative should truly reflect that community’s values, norms, and behaviors (members should have expertise in understanding and addressing the specific HIV prevention needs of the populations they represent). Representatives must be able to participate as group members in objectively weighing the overall priority prevention needs of the jurisdiction.
Inclusion is defined as meaningful involvement of members in the process with an active voice in decision making. An inclusive process assures that the views, perspectives, and needs of all affected communities are actively included.
Parity is defined as the ability of members to equally participate and carry-out planning tasks/duties. To achieve parity, representatives should be provided with opportunities for orientation and skills building to participate in the planning process and to have equal voice in voting and other decisionmaking activities.
- An inclusive community planning process includes representatives of varying races and ethnicities, genders, sexual orientations, ages, and other characteristics such as varying educational backgrounds, professions, and expertise. CPGs should have access to:
- Persons who reflect the characteristics of the current and projected epidemic in that jurisdiction (as documented by the epidemiologic profile) in terms of age, gender/gender identity, race/ethnicity, sexual orientation, socioeconomic status, geographic and metropolitan statistical area (MSA)-size distribution (urban and rural residence), serostatus, and risk for HIV infection.
- State and local health department HIV prevention and sexually transmitted disease (STD) treatment staff; staff of state and local education agencies; and staff of other relevant governmental agencies (e.g., substance abuse, mental health, corrections).
- Experts in epidemiology, behavioral and social sciences, program evaluation, and health planning.
- Representatives of key non-governmental and governmental organizations providing HIV prevention and related services (e.g., STD, TB, substance abuse prevention and treatment, mental health services, homeless shelters, prisons/corrections, HIV care and social services, education agencies) to persons with or at risk for HIV infection.
- Representatives of key non-governmental organizations relevant to, but who may not necessarily provide, HIV prevention services (e.g., representatives of business, labor, and faith communities).
- The community planning process must actively encourage and seek out community participation. The community planning process should attempt to accommodate a reasonable number of representatives without becoming so large that it cannot effectively function. Additional avenues for obtaining input on community HIV prevention needs and priorities — especially for input relevant to marginalized populations or to scientific or agency representation that may be difficult to recruit and retain — include:
Holding well-publicized public meetings,
Conducting focus groups, and
Convening ad hoc panels.
- Nominations for membership should be solicited through an open process and candidates selection should be based on criteria established by the health department and the community planning group.
- An evidence-based process for setting priorities among target populations should be based on the epidemiologic profile and the community services assessment.
- Priority setting for target populations must address populations for which HIV prevention will have the greatest impact. Target populations should include populations in which the most HIV infections are occurring or populations with the highest HIV incidence. Moreover, CPGs should discuss the risk behaviors and prevention needs of PLWHA (as PLWHA are included across target populations, their unique needs may not be readily evident) and determine how PLWHA will be included in the priority setting process for target populations.
- The set of prevention interventions/activities for prioritized target populations should have the potential to prevent the greatest number of new infections. CPGs should conceptualize interventions/activities as a set or mix of interventions/activities versus one specific intervention/activity for each target populations.
* These guiding principles trace their origins to several sources, including various public health planning models; the experience and recommendations of health departments and non-governmental organizations; the health promotion, community development, behavioral and social sciences literature; and CDC and its partners’ experience in implementing HIV prevention community planning since 1994.