[Dr. Antonia Novello] In our second segment from Puerto Rico, we will hear from a program in the Rio Pedres area. Coai, Incorporated is serving men who have sex with men, young transgenders, and sex workers. Their programs include an adaptation of the Mpowerment intervention that we heard about earlier in today's program.

[Jose Mulinelli] Coai is a community-based organization established in 1991, located in En Bayamon, that’s a town closer to San Juan, the capital of Puerto Rico. And since the very beginning, we have been working with MSM, straight men and women, and with transsexual and transgender persons, specifically sex workers. We are acting under the program of 04064 Mpowerment that we created for just MSM, and we are adapting and tailoring for MSM ages 25 through 49. We are offering as public health strategies: CTR - counseling, testing, and services; and we also offer CRCS - comprehensive risk counseling and services for MSM and transgender people both (HIV) positive and negative. And we are also offering health education and risk-reduction services for the same populations. In terms of our success, we have developed different services in one stop, such as the adaptation of Mpowerment, doing some social and recreational activities for MSM, and also offering our services, such as CTR and CRCS. Other things that we have done is to train people, peer people, to serve as outreach workers to motivate others to know a little bit more about HIV and know the importance of getting tested and let then other people know that we have services, our CTR services, through the linkages that we have with other CBO’s (community-based organizations) in Puerto Rico and let the people know through their CRCS providers that we are working with that community. We offer people the CTR services in place and also, we move to the places that people are having sex or they are just socializing, like bars or pubs, or those places. And we offer Orasure testing. And one of the things that we are doing to motivate people to get back and have their results, is that we are offering some incentives and vouchers and things like that just for them, to make it easier to get their results.

[Dr. Raul Romaguera] Puerto Rico Concra is an organization located in the Garcia Ubarri, Rio Piedres area of Puerto Rico. This organization delivers integrated services for youth, including an adaptation of the Sista intervention for women.

[Marta Figueroa Santos] Concra is a community-based organization located in Rio Piedras, Puerto Rico. We have many services available downstairs, because we are a two-floor building. We have the HIV specialty clinic where we treat people that live with HIV, 25 years and older. And up here, we have the youth center where we have a program – Ryan White Title IV program - that works with youth living with HIV between the ages of 13 to 24 years. We also have our CDC program called Companeras de Hoy. Our target population is young women between the ages of 13 and 24 years. Under CDC, we have three interventions: counseling, testing, and referral; comprehensive free counseling services; and our Sista intervention called Alas. We adapted this intervention into a four-day residential retreat, and this has been very effective because the girls can go to this place to get this information for four days and just focus on the information that we're giving them. We also added one session to work the topic of sexually transmitted diseases, because here in Puerto Rico we see that as a very important topic that the regional intervention didn't have, so that's why we added it. We also have a graduation date that's six months after the completion of the residential retreat, where they can celebrate their successes during the intervention. With CTR – counseling, testing, and referral - we go to the streets. We always know where they are - the young people - are hanging, so we offer them testing, where they – we don’t wait for them to come here. We have Rapid Testing available also, so that's a very big incentive for them, because they can get their result the same day. We are the first organization in Puerto Rico that implemented rapid testing. As far as other services, we also have a once-a-month HIV specialty clinic where all our youth comes to receive their services and in that day, we get them to receive CRCS. If a person gets a positive result and the counselor, the CRCS counselors, need some backup or support, we always have a psychologist on board and she supports the client and the counselor if there is a crisis, so she can intervene in case that happens. In terms of getting them into care, we have an advantage over other agencies in that we have a HRSA Title IV program here where we can provide them with all the clinical services that they need. We have a clinic downstairs where the HIV treaters are nurses, nutritionists, and dental services are available for them in the same building so they don't have to go anywhere else to access treatment. In case they don't want to get it here, we have collaboratory agreements with the Department of Health and with the Municipality of San Juan and with other agencies that provide clinical services to people that live with HIV. So, we refer them to these clinics so they can access the care that they need.

[Dr. Antonia Novello] The last program that we will highlight from Puerto Rico is a faith-based program called La Perla in the Flora-Park area of Hato Rey. This organization serves women and others living with HIV and includes a behavioral intervention called Healthy Relationships.

[Lizette Caparros] La Perla de Gran Precio is a community-based organization, established in 1991, formally directed especially to females - pregnant women, women with children - in order to avoid taking the children from their mothers. Since our population served here is all persons living with AIDS and HIV positive, we have developed an open – this premise here - where we offer not only an intermediate place for women that are living to have their own homes, but also give alternative medicines and all the services to a mixed population. We are CDC-funded for the CRCS program and the Healthy Relations programs. In the CRCS, we have a person-to-person meeting - they’re intimate - into the behaviors, and we have a – it lasts from three months to six months - approximately. In the Healthy Relationships, we form small groups of peers – from 5 – 10 persons, and we have – it’s supposed to be 5 sessions, but here in Puerto Rico, to adapt it to our cultural realities, we have to add another session – a sixth session - because Hispanics love to talk and, at the same time, love fiestas, so we do the five session and the sixth session; we do the graduation where we give out the certificates to the ones who complete the course and we offer a money incentive. We give them gifts and a very nice place – environment - to talk to each other and feel as friends.

The main challenge that we confronted was that all the material that was given us was in English, so in order to service our population, we had to translate everything into Spanish. That was our main challenge. At the same time, we had to use the examples that the people here could relate to - photos, cards, etc - with local settings, with local activities. And we also did a video film in order to use the video clips, with local actors and actresses, in order for our population to relate to them and the places were known to them -- the ones that they usually go to. And, so, it was kind of making it closer to them. And the experience was better for them. In the sessions, we thought at first that they wouldn't speak out, but in a peer group they were able to speak. In fact, they spoke so much that we had to lengthen the sessions, but the challenge turned out to be a pro situation. In Puerto Rico, the state health department is usually the one to promote the testing for HIV. What we do is collaborate with them, as we also join other organizations in their efforts to give the test to different communities around Puerto Rico. Especially, there's a set date on our calendar that is done throughout Puerto Rico. This is the day to have your test done. We participate here on the premises, and also, when we do outreach, we take a trailer and do the test right there at the community. And what we try to do is have the environment very comfortable, and make it real easy in terms of explaining to them that having the results given to them, it's not a matter of life or death. That it is a matter of future, of quality of life that they want to live. And they must come back to have their results, that we will give them all the support that they need, and they'll be able to take charge of their own lives and live a better life for themselves and their families.

When a person has tested positive to the HIV, we link them directly through our CRCS counselors to have treatment in the clinic of their preference. We offer them access to the services provided by government and other organizations through transportation, case managers. People from our staff can accompany them to have their treatment given. But most of all, we try to maintain a close relationship with our patients, with our participants, in order for them to feel we are family, that here is home, that they can come here every time they need something that, even if they need a hug, a kiss, you know, somebody to talk to about their feelings, their inner feelings, they can come here. We always -- even though a specific service is not given by us, they can come here, and we will take them to have treatment. But we are the link between the result and the treatment, and we get them together.

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