We had the opportunity to interview Jonathan Radigan about funding HIV prevention initiatives like the Mpowerment Project. Jonathan works at the Vermont Department of Health. Jonathan is the Training and Technical Assistance Specialist for the HIV, STD and Hepatitis Program. Jonathan has 22 years experience in the HIV prevention field, the last 12 years at the Vermont Department of Health.
RELATED: What is the Mpowerment Project? Download Module 1: Mpowerment Overview.
RELATED: What is the Mpowerment Project? Download Module 1: Mpowerment Overview.
 |
| Carlos (GLAM), Jonathan Radigan (VT DOH) and Mike (GLAM) |
Do you think it is important that Health Departments (HD) continue to fund and fully support behavioral interventions like the Mpowerment Project (MP)?
Our state relies on CDC to fund nearly all of our HIV prevention efforts. There is an emphasis on biomedical interventions like antiretrovirals (ARV) adherence for PLWH and PrEP for negative people at high risk for HIV acquisition because they’re highly effective.
At the PrEP Forum in March of 2014 , Greg Rebchook of the Center for AIDS Prevention Studies (CAPS) pointed out that “bio-behavioral” might be a better
term for these medication-centric interventions. For PrEP or ARVs to work best,
people will engage in a host of behaviors to protect their health, avoid
transmission or improve outcomes. One needs to make and keep medical
appointments and take these meds as prescribed. Condoms or low risk sexual
behaviors will remain part of the mix for many patients to help stop the spread
of other STIs that PrEP and ARVs don’t address.
Based on all of this, it seems
logical and perhaps essential that HDs continue to fund and support behavioral
interventions like MP when they are inclusive of biomedical options.
How
can community level interventions like MP continue to be relevant given the
advent of PrEP and an increased focus on testing and treatment for HIV?
If PrEP, testing and ARV treatment
are viewed as having bases in behavior – and – if young gay, bi and other MSM
continue to represent a disproportionate number of HIV and other STI cases –
then community level interventions like MP are relevant.
MP has multiple entry points
for young MSM: as volunteers in Advisory Group, Formal Outreach and Core Group
and as participants in M-Groups or sponsored social events. These components offer
both structured and unstructured opportunities for gay and bi men to connect
and communicate.
Participation in MP components
can prompt conversations about PrEP, ARVs, boyfriends, hook-ups, hand-jobs,
condoms and more. This emphasis on peer-to-peer communication about health and
happiness enhances MP’s relevance.
 |
| Carlos, GLAM coordinator attending the Mpowerment Training. |
Have
you ever found yourself in the position of being a champion for MP? Have you
had to defend its continued use? If so
how did that go? What did you say?
Independent analysis
demonstrates that MP can be highly cost effective (Rand), yet the need for
anywhere from 1.5-2.5 FTE to run the intervention can give community planners
and HDs pause. I find that people recognize the value of this project once they
understand the premise.
"I don’t have to work to defend MP,
rather, I have to work to fund MP."
rather, I have to work to fund MP."
That said, it can be really
difficult to find the resources needed, simply because there’s so little
funding available to our state and the funding priorities aren’t a perfect fit
for our low incidence and prevalence. I don’t have to work to defend MP, rather, I have to work to fund MP.
The MP project we support has
taken initiative to include the full range of biomedical options into their MP
programming and conversations. They’ve been welcoming to all MSM regardless of HIV status and have brought HIV positivity out of the closet. Our MP provider
offers HIV/HCV testing and individual risk reduction counseling. They’ve linked
newly diagnosed participants to both medical case management and HIV care. These
efforts enable us (HD) to direct more federal funding to their MP project – as
they address a wider number of priorities (e.g.: condom distribution, testing,
linkage to care, etc.).
 |
| A GLAM Formal Outreach Event. |
We
receive a lot of requests from HD's asking about evaluation; what type of
evaluation do you expect of your Agency/MP?
We evaluate all of our funded
interventions in several ways that include process and outcome measures. With
MP specifically, we set targets for each of the project’s components and then
require quarterly reporting and data submissions from the agency that
implements the project. At the HD, we assess if process measures are being met
(e.g.: #s of MGroups/quarter; #s of MGroup participants/quarter, etc.).
We also require outcome
measures. For those, we provide our grantee with a pre-/post-assessment tool.
That pre-/post-assessment seeks to measure MGroup participants’ attitudes
toward risk reduction, toward talking to peers about risk reduction, intentions
to reduce risk in future and feelings about risk taking.
The MP project that we fund
collects the data. The HD analyzes it and passes along relevant, non-identifying
info to our funder, the CDC. We
perform annual site visits to all of our funded agencies including our MP
provider.
RELATED: 5 important questions for the Mpowerment Project to ask itself.
RELATED: 5 important questions for the Mpowerment Project to ask itself.
Sometimes we have seen agencies funded to do Mpowerment as one of a
whole slew of Evidence Based Interventions, seemingly without enough funding to
do all of them well (i.e. 2 staff given funding to do Counseling and Testing,
Mpowerment, Many Men Many Voices and PCC). What advice would you give to an
agency that finds them selves in this predicament?
I’ve shared how embedding
other programs into MP may be essential in the current funding and program
environment. However, there’s another part to your question that I find highly
problematic - the problem of under-resourcing an MP project. The implementing
agency and the funder both need to be cautious about including program goals
beyond MP.
I would caution agencies about
taking on too much programming with insufficient staffing levels. And I
recognize just how difficult or unavoidable a situation that can sometimes be.
It can be particularly fraught for a non-profit to say to their health
department or funder, “No, we can’t do all of those things without additional
support.” I put the onus on funders to ensure that they avoid that situation in
the first place.
CAPS provides guidance on the resources needed to properly implement MP. Everyone should start there,
consider the resources needed for add-on programs and then fund adequately. Some
funders, HDs in particular, ought to consider how they’ll support all the
training needs that go along with all these disparate program components.
Who pays for travel to a PCC
or MP training? How is the program staff supported in accessing training for
other embedded components? These are questions that HD’s or other funders
should consider and address directly. As an aside, I have to mention that we’re
only able to fund our MP provider at the “copper” level; lower than ideal.
However, we provide additional funds to cover the other embedded components as
well as training.
 |
| GLAM Outreach. |
What
advice would you have for other HD's and contract monitors who want to know if their MP is being
implemented with fidelity?
These actions support fidelity:
- Fund adequately.
- Ensure MP training for program staff is accessible.
- Write contract objectives that match the full range of MP components.
- Make data collection relate to the grant objectives.
- Name fidelity in the contract and then support implementation.
We also try to be flexible about meaningful adaptation. To me, that’s adaptation based on client input or
the realities of the jurisdiction in which your MP is functioning. Vermont is
rural. We have few or none of the structural supports that MP counts on – like gay bars, gay media or gay-centric venues or neighborhoods. As a consequence,
our MP provider creates “pop-up” spaces at larger public venues and encourages
volunteers to host small events. That’s meaningful adaptation to the realities
of this locale.
RELATED: 8 ways to provide agency leadership for the Mpowerment Project.
RELATED: 8 ways to provide agency leadership for the Mpowerment Project.
We’ve
found in our research that agency staff can sometimes be afraid of their
Project Monitor and that this can interfere with honest dialogue that could
really help improve implementation. Do you have any best practices on encouraging
an open dialogue between funders and the agency ED, MP supervisor and,
Mpowerment Project staff ?
I don’t like that this
happens, but it’s understandable when someone’s job or a program you love is on
the line. The funder/grantee relationship is inherently unequal. Provide
ongoing support to the program leadership, coordinators and their program
components. Be respectful and encouraging. Provide meaningful feedback: name
what you see is working and offer guidance on what could make things better
from your perspective. At the end of the day, if you believe that the
implementing agency is relevant and connected to the young Gay and Bisexual men you hope
to see served, then step back and let them do their work.
 |
| Climbing higher with GLAM. |
How
do you foster trust so that Agencies and MP staff can come to you if problems
might arise?
Demonstrate openness and a
willingness to work through those problems each time they arise. Think of the
whole enterprise as a partnership between the HD and the implementing agency –
so that responsibility for achieving or maintaining success is a shared
experience.
People who monitor Mpowerment projects
can also build trust when they demonstrate a deep understanding of the program
components. It communicates that the
feedback is well-informed and can be trusted.
In
light of declining dollars going to community based programs, do you have any
advice about where else programs can look to fund their programs besides state
HDs—specifically, local government, county boards of health, certain
foundations?
I’m not well positioned to
answer this in any specific way. It’s been over a decade since I have found
myself in this place. My general advice would be to be sure to follow funders’
proposal guidance to the letter. Proposals that illustrate strong
connections with key partners (e.g.: medical services, case management) are
often viewed very favorably. Explain your premise in clear and concise
language. Reviewers love brevity and it’s rare.
Any
other advice would you have for other HDs who funding a MP? (What did we miss?)
I keep thinking about the Mpowerment Project guidance on conducting community assessment. It’s an essential first step for
new programs under consideration. I’d encourage existing projects to revisit
this step from time to time to stay relevant.
Through community assessment,
you can learn about the concerns of the young Bisexual and Gay men in your service area.
You’ll also learn where they gather, what media or apps they use, how they
recreate and much more. The assessment also helps identify key stakeholders,
potential collaborators and likely advisors if the process moves toward
implementation.
I’ve often thought about how a
thorough community assessment can be an opportunity for your agency to
demonstrate that you’re serious about cultural competence. First engage in respectful
and open dialogue with the men you hope to serve and then apply what you learn
from them to your project design. It’s one of the many things to love about MP.
RELATED: 16 steps for starting the Mpowerment Project in your community.
RELATED: 16 steps for starting the Mpowerment Project in your community.
+++++++++++
Mpowerment Project: GLAM, Burlington VT.
Agency funded: Pride Center of Vermont.
Vermont Department of Health, HIV, STD and Hepatitis Program.
+++++++++++
When you register for free at mpowerment.org you gain access to a 'Information for Funders' page. The page includes an audio-slideshow made specifically with funders in mind, annual suggested expenses and more.
Vermont Department of Health, HIV, STD and Hepatitis Program.
+++++++++++
When you register for free at mpowerment.org you gain access to a 'Information for Funders' page. The page includes an audio-slideshow made specifically with funders in mind, annual suggested expenses and more.
 |
| Go to mpowerment.org to access this page |
University California San Francisco: Making high impact prevention possible.
We are a member of the CBA Provider Network (CPN).
