In addressing STD/HIV/AIDS among its diverse community, the CNMI health department has identified two intervention strategies and a prevention campaign that has been successful in meeting the needs of clients, preventing further infection and promoting HIV/AIDS awareness. These include:

• STD Positive Referral System,
• Alien Health Screening Program and,
• World AIDS Day Awareness Month.

STD (+) POSITIVE REFERRAL SYSTEM

Intervention Development:

• Developed in collaboration with the HIV/STD physician and HIV/STD Prevention Program staff through a series of meetings and input sessions.

Populations Served:

• STD-positive clients, mainly women from prenatal clinic and their partner(s)
• Infants

Program Goals and Objectives:

• Prevention of lateral transmission from an STD positive mother to child.
• Track and treat partners of STD positive clients.
• To ensure that clients within the public health system (DPH and peripheral clinics) who test positive for STD are properly referred to the HIV/STD Prevention Program for:
  • Confirmation of false-negative results
  • Placement into the care service continuum
  • Partner contact notification.
• Increase STD positive client call-back by 80%.

Desired Outcomes:

• The number of referrals are measured against the number of call-backs and follow-up treatment of STD positive clients.
• No lateral transmission of STD from mother to child.

Core Elements:

• Effectiveness of program as a screening process to prevent mother to child transmission; concurrently offering treatment to STD positive client’s partner.
• Development of Standard Operating Procedures/Protocol in collaboration with medical professionals.
• Enactment of Public Law 12-75 mandates the Commonwealth Health Center to provide free HIV counseling and testing to all pregnant women receiving services at the health center.

Culturally Competent Characteristics:

• Cultural competence is demonstrated in the staff’s ability to work with a variety of cultures, ensuring confidentiality and addressing language barriers.

Budget and Staff:

• Oversight of referral system by the STD Case Worker and HIV Community Worker.

Lessons Learned:

• Cooperation with medical doctor and health professionals essential.

ALIEN HEALTH SCREENING PROGRAM

Intervention Development:

• Developed in partnership with HIV/STD Prevention Program staff.

Populations Served:

• Foreign-born workers, primarily from the Philippines, China, Bangladesh, Thailand, Russia and Southeast Asia.

Program Goals and Objectives:

• Identify HIV/STD status of alien workers.
• Prevent transmission of HIV and other STDs.
• Provide treatment.

Desired Outcomes:

• To increase foreign worker STD/HIV screening compliance on an annual basis.
• 90% of all referred Alien Health Workers testing positive for STDs will be seen by the HIV/STD Physician within 2 weeks of the initial referral for confirmatory testing, assessment of medical and social service needs, and appropriate referrals and/or treatments are given.

Core Elements:

• Enactment of mandatory alien screening through public legislation.
• Department of Labor and Ensuring compliance with health screening program through a collaboration with the Department of Labor and Immigration who oversees all alien work certification documents.
• Ensuring that 90 % of all referred Alien Health Workers are followed up by the HIV/STD Physician within 2 weeks of the initial referral by collaborating with business employers in assuring the compliance of the worker.
• Ensuring that a health certificate clearance is provided for all referred alien workers cleared by the HIV/STD Physician.

Culturally Competent Characteristics:

• Working with businesses involved in hiring of alien worker populations.

Budget and Staff:

• Initial STD screening is at the cost of the employers. Confirmatory tests are paid for through CDC HIV Prevention Grant.

Lessons Learned:

• Challenges with compliance maybe due to fears of deportation and government crackdown. Assessment of the STD positive alien worker’s compliance to treatment and prevention strategy is made by the HIV/STD Program Staff and the Physician on the basis of granting health clearance certification.

WORLD AIDS DAY AWARENESS MONTH

Campaign Promotion Development:

• Developed in partnership with HIV/STD Prevention Program staff and community based organization, Napu Life Foundation.
  • Convene committee meetings and determine tasks/responsibilities.
  • Develop timeline, outcomes and budget projections.

Populations Served:

• MSM, Youth and General population who maybe at risk for HIV/AIDS.

Campaign Promotion Goals and Objectives:

• Increase community awareness of HIV/AIDS, by publicly addressing issues of AIDS-denial, stigma and shame and dispel myths about through proper education.
• Promote abstinence and condom use and encourage testing and health screening.

Desired Outcomes:

• Increase community awareness of HIV/AIDS measured through the number of people in attendance.

Core Elements:

• Partnership with Napu Life Foundation created a bridge to communities in need and increased participant involvement through board member and volunteer support.
• Ensure and encourage youth participation.
• Conduct multiple media coverage (radio, television, newspapers and magazines) publicity within the community.
• Conduct outreach promotion at weekly Thursday Night Street Market by providing educational materials, red ribbons and general HIV/AIDS/STD information.
• Conduct event activities:
  1. Walk-a-thon
  2. Candlelight vigil
  3. Entertainment (singing, cultural and contemporary dancing, drumming, costume pageant and talent show by the gay community)
  4. Testimonials (NGO members, HIV/STD Physician and HIV/STD Prevention Staff)
  5. High school competitions (Most-Red-Ribbon-Made, Poetry and Essay contests)
  6. Incentives (snacks and drinks after the walk-a-thon donated by community partners; t-shirts from health department and NGO and red ribbons)

Culturally Competent Characteristics:

• Recognizing the importance of youth involvement in HIV/AIDS Awareness and their unique subgroup characteristics through peer-to-peer engagement. CNMI Youth are Most have been exposed to HIV prevention awareness through mandated Public School System HIV/AIDS curriculum and presentations by the HIV/STD Prevention Staff.
• Cultural competence demonstrated in the department’s partnering with grass-roots CBO, offering greater access and penetration to local communities, during regular attendance at once weekly Thursday Night Street Market in Garapan, Saipan. Event publicized in local newspapers and radio stations.

Budget and Staff:

• HIV/STD Prevention Staff (5), Napu Life Foundation board (5)
  • Food and drink donations
  • Banners- $350.00
  • Magazine advertisements- $300.00
  • Newspaper advertisements- $300.00
  • Radio advertisements- $650.00
  • T-shirts- $1,000.00
  • Contest prizes (most red ribbons made, essay, poetry)- $500.00