Among the U.S. Affiliated Pacific Island Jurisdictions, Guam was first to officially report a case of HIV infection. The first reported case was recorded in 1985. The island ranks forth in Oceania for HIV/AIDS cases. The present cumulative HIV/AIDS case is 185, with 96 persons living with HIV, 34 persons living with AIDS and 55 total deaths.

In 2003, Guam DPHSS prepared a comprehensive HIV Prevention Plan and identified interventions needed for specific target populations by priority, reflecting guidelines by CDC. The plan is published in the Guam HIV Prevention Project 2003 (17). The target populations were identified as: 1. Men who have sex with men; 2. High-risk heterosexuals; 3. Mothers with/or at risk for HIV; 4. injecting drug users; 5.youth at risk (under 25 years of age); and 6. the General population.

Ongoing efforts at the Guam DPHSS have focused on building capacity and expanding alternate OraSure testing sites through service contracts with other government entities and the GUAHAN Project (a community based organization) providing services to identified target populations. A culturally appropriate HIV/AIDS prevention media campaign was launched in 1999 as Prutehi-Hao (Protect Yourself) and has since become a very visible component of the agency.

The proposed increase of military personnel and their dependents and the projected population growth to the island over the next ten years presents a variety of potential social challenges that are only beginning to be addressed strategically. An increase in sexually transmitted diseases, specifically chlamydia, gonorrhea and syphilis are on the rise. Guam DPHSS has identified promising practices in two areas: STD interventions with youth and collaboration with Chuuk State Public Health to conduct prevention education and outreach with Chuukese migrant population on Guam.

PRUTEHI-HAO (PROTECT YOURSELF) FILM WORKSHOP

Reasoning for Intervention:

• By providing story telling and film making skills to at-risk youth, youth can potentially reduce their risk to STDs and HIV. Youth offenders or at risk youths often need a creative and artistic outlet as a way to help improve their lives. A film workshop, under the creative directorship of Alex Munoz - a noted Pacific Islander filmmaker - provided an opportunity for positive mentorship and role modeling.

Populations Served:

• Project was limited to 15 at-risk, runaway and troubled youth:
  • Institutionalized youth from Guam drug court system;
  • Clients of Sanctuary, Incorporated, a non-profit homeless and transitional living shelter for troubled and runaway youth.

Intervention Goals and Supporting Objectives:

• Promote safe-sex behaviors among Guam's at-risk youth.
• Increase knowledge about HIV/AIDS/STD through the creative arts and creative collaboration.
• Provide at-risk youth an opportunity to produce a short HIV/AIDS/STD prevention video through the department's Pruthei-hao Media Campaign.
• Teach positive life skills, team building and increase self-esteem and self-confidence so troubled and at-risk youth become reformed younger adults.
• Provide practical workforce exposure.

Desired Outcomes:

• 15 at-risk runaway and troubled youth within the drug court system and living at a homeless/transitional living facility increased their knowledge of HIV/AIDS/STD through a six-week, hands-on video production workshop.
• The health department has two (2) youth-produced films it can use to inform the general population and youths about HIV/AIDS that is both informative and entertaining.
• 15 at-risk youth were given the opportunity to experience job opportunities in video production, increasing transitions to stable environments.
• Youth demonstrated acquisition of positive life skills through team, self-esteem and self-confidence building.
• Youth demonstrated ability to write public service announcements and learn basics in creative writing for broadcast medium.

Core Elements:

• Collaboration with Guam Judicial System, Juvenile Drug Court and Sanctuary, Incorporated necessary to determine at-risk youth participation.
• At-risk, troubled and runaway youth eager to learn new skills must be given proper guidance and mentoring.
• Creative partnership with health department and film producer conducted over six week period. Participants expected to attend all sessions. Sessions should provide environment for experiential learning and acquisition of life and team building skills.
• Film premier. Suggested venues: TV, independent film festivals, local movie theaters and on-line.

Culturally Competent Characteristics:

• Youth participation open to all island youth, including Asian-Pacific Islanders.
• Youth at-risk are a subgroup whose troubled past can serve as a barrier to understanding.

Budget and Staff:

• Total Budget: $29,000.00
  
  Budget Breakdown:
  • Production Crew and Director: $12,000.00
  • Research Development: $2,000.00
  • Preproduction, production, post production: $12,000
  • Film Premier: $2,500
  • Distribution: $500.00

Lessons Learned:

• The Prutehi Hao Film Workshop provided at-risk youth and youth offenders more than film and STD/HIV training. It provided skills for critical thinking, cooperative learning and organizational development. Participants expressed that the workshop while provided them an outlet for positive self-expression and personal transformation.
• Youth produced films inspired local communities and other Asia Pacific Islander communities abroad.
• Replicate program with public/private school systems, to include youths from other backgrounds.
• Determine outcome indicators for viewing audience and its campaign effectiveness.
• Determine measurable outcomes of participating youth's increase of HIV/AIDS/STD knowledge through pre-post testing, with 70% competence.

MULTI-PARTNER INTERVENTION FOR GUAM'S CHUUKESE COMMUNITY

DPHSS, Chuuk State Public Health and the GUAHAN Project (Guam's only AIDS CBO) conducted a five day STD/HIV/AIDS outreach education and prevention among Chuukese immigrant communities living on Guam. The intervention brought awareness to free STD health screening and HIV testing services and discussions about HIV/AIDS and other sexually transmitted diseases. The collaboration took months to prepare and involved a visit by the Chuuk CPG. Health professionals, doctors and public health officials from Chuuk participated in outreach activities and worked toward strengthening ties with the local public health to identify populations at-risk and provide services to underserved populations. In total, approximately 500 people were reached through door-to-door outreach, town hall meetings and village social gatherings. In addition to public and non-profit partnerships, the collaboration also included support from prominent Chuukese members, Roman Catholic priest and interns from the University of Guam and Guam Community College. Guam DPHSS also used the intervention as an opportunity to penetrate Chuukese community through Chuukese community network in preparation for upcoming SPC Second Generational Survey assessment.

Intervention Development:

• Committee planning group to determine community cluster areas of target population; discussed necessary resources, collaborations and work plan through teleconference and email correspondences.

Populations Served:

• Chuukese male and famales of all ages living in Guam's northern villages (Yigo and Harmon).

Intervention Goals and Supporting Objectives:

• Increase awareness and education of STD/HIV/AIDS, subsequently addressing issues of AIDS-related shame and denial.
• Promote safer-sex behaviors.
• Increase awareness of health services – free HIV testing and STD screening.

Intervention Outcomes:

• Approximately 100 people participated in listening and Q&A session with public health officials regarding HIV/AIDS services, prevention and education.
• Partnership with CBO, DPHSS and Chuuk Public Health strengthened and can serve as model for other regional alliances.
• Intervention helped to increase trust and partnership with Chuuk Health Department via case conferences, teleconferences, faxes, face to face meetings.
• Helped both public health departments to strengthen partner notification process and identify partners needed for STD/HIV testing and treatment among Chuukese community.
• Increased CDC collaboration through PIJAAG and PIJ participation: standardize collection HIV test form for PIJs to be implemented by 2008, training phase conducted in Atlanta, Georgia, August 2007.
• Increased STD site visits by CDC, comprehensive assessments for laboratory and medical services.
• Increased in HRSA support for PIJs AIDS education training center collaboration.

Core Elements:

• Partnership with civic and community leaders necessary for community participation and buy-in.
• Partnership with CBO and faith-based organization essential to penetrate target population.
• Distribute flyers to target communities and conduct door-to-door outreach.
• Organize town hall meetings and social gatherings at a convenient time and location, providing participants with hot meal and cold beverage.
• Display culturally and linguistically appropriate materials.
• Construct town hall meetings and social gatherings to include figurehead of authorities, using coordinated staffing outfits and uniforms.

Culturally Competent Characteristics:

• Acknowledge gender differences and specific roles of men and women.

Budget and Staff:

• Total Budget: $2200.00 (food and transportation)

Lessons Learned:

• Even with best efforts to publicize event and work with Roman Catholic priest attendance was lower than anticipated. Possibilities:
  • Clan affiliation may serve as a barrier;
  • Cultural gender bias.
• Results of Chuukese receiving public health services as a result of intervention need to be processed.