Appendix I-1

• Workshops like these are part of a trend where you go to the clients themselves and find out how to best serve them. It puts the prevention community in that direction, which is where it needs to go. Different prevention messages are required for different populations. The training showed the importance of that. 1
• As an HIV test counselor, it was a very, very important training because now I am more informed enough to know what I’m talking about. I can give clients more information. 6
• People have the training, and they see a new way to think about things which is useful. 11
• We've all become more sensitive to the psychological and mental health issues. We are better able to review a situation, to see the big picture without jumping to conclusions. 13
• It improved how we screen our residents, how we address patient issues, and how we address safety issues. 42
• It only changed the overall knowledge of staff regarding AIDS-related mental disorders. 38
• The training allowed for the educating of service providers, which affects how they deliver care. 87
• There are now more people who are prepared and available to provide services in different communities. There has been a diffusion of information and services to others. 90
• It enabled all clinics to take care of patients rather than having to refer them to a specific clinic. 95
• The doctors get the message probably collectively. They are more sensitive in bringing them to deal with it. Programmatically and institutionally, they are already into that. But with incoming residents, the individual sector where the doctors come in for their education in HMOs and PPOs, and that kind of thing, the training would be most useful. 132
• Only a few attended the training. It helped them. Orientation helps the new staff too. 142
• A lot of the people that were coming in were not aware of the specific needs of the youth, in getting education to them. Many did learn that from the training, it’s just that I didn't because I had known that already. 153
• The confidentiality. The staff on a whole is more careful of what they say and where. 154
• I learned the pharmacology of it and it helped tremendously to learn and realize how important it is, how extremely important it is to take their medications how they should. The training gave us pamphlets in a better language to understand everything. It was important for me too to get across to the inmates. To know what happens when you stop or if you don't take the medication as you are supposed to, how you can go back to square one or worse. 157
• It improved because we have people more knowledgeable about the disease process. 162
• The nurses that did go to the training thought it was an excellent seminar to learn ways to explain to the patients what's happening to them. 164
• People have an increased knowledge base. Nurses and other clinical associates treat patients more professionally. They know treatment choices now that we didn't know before. 175
• There is a little bit more understanding about the disease. 184
• I am possibly more sympathetic and considerate. We don't consider them as hopeless. We dismiss that and give them the normal standard of care. 205
  
  
  

• We have had to revamp all policies in conjunction with the meetings and follow through (such as for labor and delivery to rewrite total policies; for pharmacy, how drugs are made available, distributed, and dispensed; for laboratory work, how important turnaround time is for testing). 9
• We were practically providing no care before the training. 17
• There is a broad scale network with guidelines of perinatal care that were made available to all institutions and were put in place to individualize to their institution. I have a better assurance that all the institutions have these basic guidelines in place. For example, we have some type of guideline on comprehensive testing also, guidelines on the availability of that and other drugs should they decide that they will keep a patient. 46
• Now the staff is instructed to have gloves available when they deal with clients in the field and to be cautious of handling bodily fluids. 50
• Before we didn't consistently screen. We didn't know who was HIV positive and who wasn't. 59
• It was a big thing because it is now a common issue of education. It's not a hidden diagnosis. There is more standard care. All patients are getting information and education that comes along with the testing. 104
• It helped us because we are going to offer the training to all other agencies in the county and that is a lot of agencies. So when we go out and speak to youth, everyone is on the same page and young people don't get mixed messages. 105
• There has been a positive effect. For example, one practitioner had a problem and called back the presenter of the training to know what to do. Before the training, they didn't really know what to do. 106
• Some policies have been changed. We've concentrated our efforts to get patients in and do more screening. We do verbal screening to determine risk factors and use the HIV blood test. 109
• We have a policy on pre- and post-test counseling in the obstetrics department which was implemented as a result of our newly formed task forces. We were able to get the pharmacy to change its policy of the disbursement of medications so mothers could get all doses up front at once for the newborn syrup. 112
• We tracked performance using surveys and found that now more women are educated, are offered more testing, more women are accepting the test, and now more women are aware of their HIV status and receiving care earlier as a result. 114
• We established a policy. We implemented documentation in the obstetrics admissions form. Before, there was nothing on HIV/AIDS. We didn't ask before. 119
• It has changed how testing is done. Before and after, there is counseling. It is a change on the positive side. 124
• I have seen large-scale facilities decide to adopt pre- and post-test counseling and to add it to their procedures. It promotes this for women who are pregnant, drug abusers, etc. Anytime, service providers can provide that, no matter what race you are, they can add that service. Then, they've made another dent in reducing the spread of the virus. I want to encourage mothers to be tested and educate them on why they should be tested - because their babies could be at risk. Testing and knowing early is important, how a mother can start at during her pregnancy for example. It gives them the knowledge. If she is negative, they can give her literature, condoms, etc. to promote education. 129
• Pediatric and labor and delivery nurses have set universal counseling with the same basic guidelines on counseling and testing. 143
• Our hospital adopted new policies regarding what needs to be documented and what education patients should receive before the delivery of a child. 145
• The procedures before were confusing, but the policy has been expanded to identify how staff can get the job done better. 149
• After the training, we have had new policies and procedures come into place. There is a much more positive attitude about working with HIV patients. This is a result of the training that enabled us to become more knowledgeable about the disease. 195
• It is more aggressive now as far as knowing to start medicine sooner, to keep cd4s high and viral loads down. 196
• We enforced policies of patient confidentiality and patient education. 163
• With Medicaid reform, we were able to change a lot of the negative issues it tried to inflict upon women. We changed it so that the co-pay for women for medications was reduced from $2 per drug to $0.50. 238
  
  
  

• There were some changes – just small things I've noticed. When I first started, the residents were not able to live on the grounds. There now is more leniency. I can, but this is not me personally doing this. This is what's going on. We are now more able to accommodate changes with patients. 10
• We haven't yet completed any laws, policies, or guidelines. We currently are working on guidelines for treatment by utilizing the project's procedures as the basis for future guidelines regarding HIV counseling and testing. 70
• We are now enacting policy and guidelines for pregnant women. 84
• It is a little easier to get people to be tested. It made it more familiar with the doctor. It did streamline the process. 130
• The facility is having someone come in and do monthly in-services, which started after the training feedback from me and another staff member who attended the training. 166
• It has improved because we are aware that there is HIV out there. How to stop the spread is by educating people, to let them know they can receive medication and counseling. They can help stop the disease from spreading. We are bringing across this very important and valuable message. 167
• I'm more aware of the laws and regulations pertaining to testing and notification of partners. I don't really know how it affected others. 176
• We don't have numbers. We can't really make real comments about that. In terms of our HIV patients, we just stress more pre- and post- test counseling and getting consent. We're much clearer on ways to improve our quality of care to obstetric/HIV-positive patients such as in prescribing treatment (pre- and post-delivery). 180
• More education is available, and we got handouts and pamphlets. There is probably more testing done. Preventive counseling has increased. 186
• It helped with the policies because now staff has to get training and they, in turn, train foster parents on HIV/AIDS policies that review state policies on HIV/AIDS with foster families. 204
• There has been a large impact in the areas of policy and participation in the planning process. 228
• That can't be measured yet, but what has been put in place is a secondary prevention initiative targeting HIV-positive women. 251
  
  
  

• At my level, there is more awareness about the psychiatric issues and consultations and about the drug interactions. Now there is a bigger opening for questioning. 14
• Clients know that they can get help and are more open to talk about HIV. As service providers, you feel good about it. 16
• It brought my awareness up and I'm a member of this agency, so yes, it contributed to large-scale changes in the way HIV-related care is provided. It could bring awareness up in terms of youth issues in the agency. 25
• The training was offered in the same depth and across the board to the community and allowed it health care providers to get a better knowledge of how HIV is treated. It increased people's awareness. It was only given to doctors and health care providers. It should be given to the community. If you want a public health impact, you need to use the community to get to the community. You need a public agency with some physicians’ help to effect large term. It needs to be done much more intensively with not just us talking about change. There would be more impact if we teach the community. People there know each other better. 47
• It helped emphasize education in general. It helps people realize what's out there. It was a good environment. 58
• Our agency is very aware of the needs in the community. We are constantly evaluating how to best provide services and the changes that need to be made to best meet clients’ needs. It has enhanced our factual information we are constantly trying to assess with each individual case using our newly educated nursing staff that goes out into the field with our workers. 67
• We have the same policies as before. But now, the staff just has more information for doing counseling and testing. 76
• The one-time training may not have brought about change, but the focus by the project is beginning to change the system. Patients are more aware about public health issues. Those not testing think their patients are not at risk. 83
• Awareness has been pulled out of the hat. The training was like a wake-up call about what is going on in different populations. 97
• It improved our awareness, and it taught us about new techniques and medication. We're not that organized yet in terms of establishing laws and policies at our community clinic. 115
• It has made the staff more aware of HIV. The staff is more willing to help and are receptive to HIV-positive inmates. 139
• It opened up awareness and lines of communication on this issue. 160
• I really don't know. I can say that people now know there is another group of women and they can get support. 250
  
  
  

• It offered an excellent framework regarding community development for HIV prevention. 19
• I know of a case where a patient being seen by a rural provider would come in every three months for medications, refills, and prescription, review, and blood work. The patient eventually needed to come in and have extensive inpatient care. Personally I feel he was mismanaged. It ended up costing the patient and the facility more money. 23
• My clinic is trying to get an HIV grant from the government. If we go to the trainings, it shows the government we can provide HIV services. This helps us get the grant so that we can support patients with medications and care. It's important to have money and that depends on grants. We need the grant to provide money for patient medications. 33
• Nothing has been written on paper. We've just increased our understanding of patient behavior. The staff now discusses the behaviors of patients and raises "red flags" to new staff regarding patient behavior/condition. 37
• We have an AIDS awareness council that discusses issues regarding the difference between HIV and AIDS. 55
• The training gave information about political trends going on so people can go back and inform their agencies about those trends and how they can become more involved. 89
• The training caused the program director to e-mail others about how important the training was and how to deal with HIV-positive clients in terms of what they learned. 98
• The input of the psychologist on the care plans has had a big impact. It makes us look and say that this is a mental health issue that needs to be addressed by the psychologist. We are able to "share the burden with the other disciplines". 102
• We have people from many disciplines and different backgrounds sitting at one table trying to solve problems. It is pretty amazing. Every month, we determine where we are dropping the ball. We seriously think about the whole process. Sometimes I think that it can't survive that long, with all the other diseases out there besides AIDS/HIV, but it keeps on going. 122
• I think of an 18-year-old, or maybe she was younger than that, I had met and continue to be in contact with beyond the training. The training sparked the younger people to think about what is good about their agency. It is good on an organizational level to start thinking that way, to spark collaborations and spark conversations. They usually complain about their organizations. Young people are distrustful because all they hear about HIV is "anyone over 25," etc. One young girl who used to work upstairs, she's about 20 years old, complained about this organization and she only stayed a couple of months working here. She kept moving around. When I last talked to her, she was at her third agency in 11 months! I told her that no agency is perfect. This is pretty typical. There are different perspectives, both positive and negative. You should look at who you can serve. This is not only in my area. I have seen it in two major cities in the United States too. 133
• The other person who went with me to the training was a health educator. She started going to do street outreach. She gave other people input about the training and about what she had learned. A lot got across. A lot of things have slightly changed for the better. Providers are more proactive in teaching others and we started street outreach, such as taking condoms to the street. So it has changed a little bit. 187
• It was a whole educational thing. I went from knowing my own personal story to meeting other women and their difficulties in obtaining services. Just talking to the women, in between the workshops and in the workshops as well, I learned a lot and that we feel the same way. You have to make a personal connection and because of that, you will be motivated to go to the meetings. A lot of people say that there are not enough women who attend the meetings. A friend of mine asked me to go and I said okay. I'm glad too because I made my personal connection. It is like a mentoring process on a larger scale. 234
• It has contributed to large-scale change by keeping women issues on the agenda. We have accomplished a lot in the past seven years from keeping the whole issue of women and HIV and the delivery of services to the funding of programs. Saying it over and over again, they finally got it. 235
  
  
  

• There is a lot less fear when you have the information you need to deal with mental illnesses. 18
• The only thing that has changed is the attitudes of the staff, specifically our residents. 61
• The interaction between our doctors and nurses and patients is more at ease and much better in general. 62
• Staff attitudes have changed a lot. It has also opened another avenue for patients to get the health care they need. 63
• It decreased the amount of fear and apprehension among staff and patients. The staff no longer stigmatizes people with HIV/AIDS, and they are more comfortable working with patients with HIV/AIDS. Patients with HIV/AIDS are treated like any other patients, but we take the necessary precautions that we learned about. 78
• Probably my co-workers’ attitudes have changed. Other people, such as friends who took the training, were deeply impacted and the effect was personal. 85
• As far as this training, it has helped my attitude and my nurses’ attitude. As far as the training's effect on others, we haven't been in contact with other institutions except with medical records. In terms of funds, medications are available. We've had no problems getting medications. But I know the drug bill for HIV medications is as high as mental health drugs. 179
• It changed people's outlooks and attitudes on HIV. We educated ourselves on how to protect ourselves. 199
• I think that the taboo and fear surrounding HIV/AIDS has been greatly eliminated. Providers now see HIV as an acute/chronic illness/disease instead of its relationship to social taboos such as IV drug use, sexual promiscuity, which may or may not be the case. Providers now deal with the illness and not so much with the taboos. 200
• There is more of a comfort level in talking with them. They don't think that we can touch them. 208
• I’ve noticed that with the people who go through it, their attitudes have either changed completely or improved. But the way we give care to patients, there is not much of a difference. 209
  
  
  

• No. 8
• I don't think it has improved this. 21
• It has not contributed to large-scale changes. 22
• No. 26
• No. 30
• No. 35
• There have been no changes in practices related to our provision of care. 39
• It hasn't changed this. 41
• I’m really not sure. It’s been a positive change but I don't know how deep. 43
• There was no effect. 48
• The training hasn't affected this at all. 52
• There has been no impact on this. 53
• There have been no changes that have been made that I have seen. 57
• This is the same; no changes have occurred. 60
• It hasn't changed how HIV-related care is provided. 69
• There have been no changes in HIV-related care. 71
• There have been no large-scale changes that have been made. 73
• It hasn't changed. 80
• There have been no changes in HIV-related care. 81
• Nothing large-scale has resulted. 96
• There was no effect. 100
• Nothing new has been implemented. 110
• No changes have been made. 111
• It hasn't changed. 113
• I have not really found any change in my area. 120
• There was not too large scale of a change. We still provide the same type of care. 123
• It hasn't changed the provision of HIV-related care. 107
• I am only aware of what happens within my institution. 118
• We already had a good attitude and policies are set by the state. 134
• There were no changes. 146
• There were no changes. 148
• There was no change. 158
• There were not a whole lot of changes in this area because of the training. 170
• There were no new laws or policies since the training. 171
• There were no changes. 172
• There were no changes. 173
• I don't know of anybody else who's done self-study. 177
• No. 181
• No. 182
• None. 189
• No. 190
• No. 191
• There has been no large scale or policy change. 198
• There has been no impact that I’m aware of. 202
• No. 203
• It hasn't changed. That change has to come from the governor. We are pretty advanced in our treatment. We offer everything that the "free-world" offers. It made a couple of the staff who deal with HIV-positive patients on a daily basis more comfortable. 206
• It was only really just me that took the training through a mail-in catalogue type thing. My hospital in general is more cautious to wear their coats and masks in delivery. 126
• The training did not actually have the providers to patients there. It introduced the topic to those who do not work with HIV-positive individuals. They should've included people who work more with HIV-positive people, like social workers. 131
• We have same policies and ways to do treatment as we did before. 194
• No policies have been changed where I am. I feel like I am pretty open-minded when it comes to dealing with people who are HIV-positive. 197
• I haven't met with anybody, done anything, or talked to anybody. Things really haven't changed in terms of care to patients. I haven't really seen anything. I know in terms of the hospital setting, infectious control have protocols established. We haven't changed protocols. But we make sure that the documentation is there. 192
• It didn’t affect large-scale changes that much. 212
• No. 218
• No large-scale changes have been made. 220
• I don’t think it had any effect. 222
• I don’t know. 227
• It hasn’t had much of an effect based on what I see, although I haven’t looked for any change. 231
• No changes have occurred. 242
• No changes have been made. 244
• It's getting a little better, but they system still needs to improve because a lot of services that are available are not advertised properly. A lot of women complain about service providers and that case managers need to be retrained on services that are available to women with HIV/AIDS in the area. 237

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