AIDS Community Action Program (ACAP) - Year in Review

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Output Data

Funding Summary

The ACAP program supports both operational and time-limited projects in all six regions. Operational funding supports the continuing local, regional and provincial/territorial communitybased response to existing and emerging issues associated with HIV/AIDS. It is generally provided over a longer period of time compared to time-limited project funding, and can support more organizational overhead costs such as personnel or rent. It is only available to organizations whose principal mandate is HIV/AIDS.

Time-limited project funding is intended to support specific activities that address unmet needs and priorities around HIV/AIDS. The activities may be local, regional or provincial/territorial in scope. Funding is available for both organizations whose primary mandate is HIV, as well as organizations who address HIV/AIDS, but not as a primary mandate.

A new ACAP funding allocation framework was implemented in 2006 in order to disburse funding to the six ACAP regions across Canada. The formula directs funding to geographic areas that have the highest proportion of populations vulnerable to HIV/AIDS and is evidence based.⁸ The framework uses data related to burden (prevalence of HIV), vulnerability (incidence of related diseases, indicators of determinants of health, and estimates of vulnerable populations), and equity (general population at risk and level of remoteness).

The following table describes the number of operational and time-limited projects funded by region.

Table 1. Number of Projects and Funding by Region

1 21 projects were funded in BC, but 13 projects are included in the data analysis that follows. 2 15 of 16 time-limited projects from Ontario are included in the data analysis that follows. 3 48 projects were funded in Quebec, but 45 are included in the data analysis that follows.
Region	Operational Projects	Time-limited Projects	Total Projects	Operational Funding	Time-limited Funding	Total Funding
BC1	9	12	21	964,286	551,423	1,515,709
AB	11	11	22	701,323	204,806	906,129
SK/MN	4	5	9	768,634	252,656	1,021,290
ON2	29	16	45	1,741,810	1,263,196	3,005,006
QB3	25	23	48	1,510,783	777,914	2,288,697
AL	8	7	15	1,066,923	305,962	1,372,885
TOTAL	86	74	160	$6,753,759	$3,355,957	$10,109,716

 

Partnerships

In the ACAP Evaluation Framework, partnerships are an output under all four funding approach logic models. They are an essential step in order to: reach target populations and to strengthen the response to address HIV/AIDS (Prevention); influence organizations that support the health of those living with or affected by HIV/AIDS (Health Promotion); enhance the ability of organizations to take a population health approach to HIV/AIDS that can lead to change in broader systems (Strengthening Community-Based Organizations), and; facilitate intersectoral action to address broader system barriers (Creating Supportive Environments).

The definition for collaborative partners found in the PERT is “two or more groups/organizations sharing responsibility and working together on a common goal.” The total number of collaborative partnerships for operationally funded projects was 884. The total number of collaborative partnerships for time-limited projects was 481, providing a total of 1365 partnerships.

Partnerships for both operational and time-limited projects involve partner agencies that work in the public, private, and not-for-profit sectors. Partnerships exist with agencies that work within different areas of focus, including: health, social services, justice, education, and housing.

Contact with Target Populations

In the ACAP Evaluation Framework, contacts are an output for two funding approach logic models. Contacts reflect the number and diversity of people reached (Prevention), the number of PLWH reached who are receiving services, and the number of caregivers and service providers who received training to better support their clients (Health Promotion). The target populations in Table 2 correspond with the eight vulnerable populations set out in the FI. An additional target group – practitioners, professionals, service providers – is included due to the contact this group would have with vulnerable populations, and the individual and social outcomes that can result.

Table 2. Contacts by Target Population

NOTE: Due to data collection differences, data from Alberta is largely missing from Table 2, and data from Ontario and Quebec is likely under-reported.
Target Population	Contacts Operational	Contacts Time-limited	Total
Youth at risk	28,122	7,054	35,176
Gay men / MSM / GLBTQ	14,694	10,014	24,708
Women at risk	9,961	4,582	14,543
People living with HIV/AIDS	11,322	2,933	14,255
People who inject drugs	11,362	342	11,704
Practitioners, professionals, service providers	7,071	4,366	11,437
People in prison	2,192	966	3,158
People from endemic countries	751	1,495	2,246
Aboriginal people	1,293	602	1,895
Other	2,343	966	3,309
TOTAL	89,111	33,320	122,431

 

There is a strong possibility of double-counting where individuals fall into more than one risk category, such as being an Aboriginal woman who is HIV positive. There is also the possibility that target populations reached through both workshops and community programs were doublecounted.

The category “other” includes: churches, two-spirited individuals, people living with HCV (hepatitis C virus), students, and ASO (AIDS Service Organization) board and staff.

Barriers to Reaching Target Populations

Barriers to reaching target populations were provided in rich detail by all regions. Five of six regions provided their data differentiated by operational and time-limited projects. The data presented below, however, are combined into theme areas that were common among the regions and between time-limited and operational projects. The number of regions that provided evidence for each theme is mentioned to demonstrate the degree of commonality of the theme.

The barriers are presented below as a theme area, followed by a few examples from the regional data to illustrate the theme. What becomes clear is the barriers faced by individuals and agencies are often multiple and interrelated.

Access (6 regions):

• Reaching people living with HIV/AIDS in rural areas
• Requiring assistance with child care and transportation
• Population spreading beyond the downtown core, compelling us to extend our services and outreach initiatives to suburbs
• Difficult to get access to target populations and staff in correctional centres.

Discrimination/Stigma/Fear (5 regions):

• Stigma and discrimination faced by PLWH is apparent
• Stigmatization makes it difficult to recruit vulnerable groups in outlying regions
• Aboriginal people who inject drugs fear association with ASO (being seen as HIV+)
• Fear of being “outed” for women who are HIV+ and from countries where HIV is endemic
• Double life that some closeted MSM lead make them hesitant to communicate
• Continue to face challenges in finding ways to improve accessibility of our services for gay, bisexual, transgender and two-spirited men

Language/Culture/Settlement (5 regions):

• Two main barriers to outreach were peoples’ immigration status, and language
• Language and cultural competence (Mi’kmaq)
• Immigration issues – some clients are at the brink of deportation
• There is a need to have some of the programs delivered in French as well, though we provide services in other languages like Swahili, Luganda and Shona.
• Reaching immigrant and/or refugee women due to limited knowledge of the organization and limited cultural understanding on the part of staff and volunteers.

Basic Needs (5 regions):

• Our clients continue to be challenged by the basics of food, shelter and addictions
• Systemic issues, such as homelessness, poor housing, poverty and transient lifestyles create barriers to reaching those most at risk
• Supportive housing continues to be a challenge for PLWH who require supportive housing but for whom there are long waits
• Limited income and access to education to make informed decisions

Reaching Women (5 regions):

• Gaining access to women working in the massage parlours
• Difficulty bringing women together due to diversity of lifestyles, confidentiality issue, lack of staff hours, transience of some of the target population, lack of referrals from medical facilities

Staff and Volunteers (4 regions):

• Staff turnover or staff challenges
• Staff and funding not adequate to meet demand for services
• Volunteer management challenges and keeping a strong volunteer base

Successful Approaches

The approaches that were successful in reaching target populations are also grouped into theme areas, with examples provided to illustrate the theme:

Partnership (6 regions):

• Partnership with other agencies to provide childcare for clients accessing our services
• Developed an agreement with agencies to supply home care and support to HIV positive clients
• A strong partnership with the local HIV clinic to reach PLWH
• Partnering with new youth drop-in centre to facilitate off hours access to at risk youth.

Cultural Awareness (6 regions):

• Incorporating Aboriginal traditional ways of learning and sharing information
• We are working on new client information in various African languages including audio information on MP3 players to have in our library and make available on our website
• Our staff members speak and read various Asian languages. We also asked volunteers to help as interpreters/translators in languages staff cannot speak or read
• The addition of the Newcomer Support Coordinator is enabling us to better serve the refugee/immigrant/migrant population.

Communications/Media (6 regions):

• Using the media to raise awareness
• Population specific marketing materials and prevention messages
• Newsletter mail-outs are important in creating awareness as well as promoting events
• Minimum two months notice to promote an activity with target populations improves participation rates – word on the street takes some time.

Accessibility (5 regions):

• Location is easier for them to access services because it’s central
• Extended hours of operation at the centre so that members of the target population could speak with a nurse
• Internet and toll free access

Outreach (6 regions):

• Providing outreach in places where target population social networks gather (e.g. bathhouses, bars, outdoors, internet chat rooms)
• Outreach to youth through YouTube and Facebook
• Traveling to off-reserve communities where Aboriginal youth reside
• Rural and transient youth in urban areas were engaged through word of mouth on the street.

Peers (6 regions):

• Peer led programs
• When engaging ethnic communities, community peer advocates are crucial to spread the knowledge while generating interest and support
• Training of Aboriginal inmates in federal institutions has led to peer education program within those institutions
• Use of peer support counselling to youth in rural areas.

It is interesting to note that there is some degree of alignment between barriers to reaching target populations and the approaches that worked in reaching target populations. For example, there is awareness about issues of accessibility, and activities such as changing location and longer hours reported as approaches to increase accessibility. Awareness of barriers regarding language and culture may be addressed through approaches such as having material in other languages and staff able to speak other languages. Finally, barriers in reaching women and gay men are potentially addressed through outreach or peer based support.

Workshops and Programs

In the ACAP Evaluation Framework, workshops are an output for three of the funding approach logic models: they increase the knowledge of target population members on how to prevent new infections (Prevention); they increase knowledge and social support (through peer-based education) for PLWH, as well as increasing the understanding of caregivers of issues relevant to living with HIV (Health Promotion), and; they help individuals and systems to understand and respond to system-wide barriers (Creating Supportive Environments). Programs are an output under the Health Promotion logic model; they contribute to social support opportunities and networks for PLWH through programs such as peer retreats, peer counselling and groups, community kitchens and practical assistance.

The following table provides the frequency of activities and the number of target population members reached by both operational and time-limited projects in offering programs and workshops.

 

Table 3. Activity Frequency & Target Population by Type of Activity

NOTE: Due to data collection differences, Alberta’s target population reached data is under-reported and no target population data from Quebec is included.
Type of Activity	Activity Frequency Operational	Activity Frequency Timelimited	Activity Frequency Total	Target Population Reached Operational	Target Population Reached Timelimited	Target Population Reached Total
Community Programs	1,258	864	2,122	49,705	5,600	55,305
Workshops/ Presentations	2,303	1,418	3,721	52,599	12,875	65,474
TOTAL	3,561	2,282	5,843	102,304	18,475	120,779

 

In reviewing Table 3, there may be double-counting since individuals reached during the second reporting period may be the same as those reached in the first reporting period. In addition, individuals reached in one activity may also have been reached in a second activity (e.g. through peer support and also a workshop).

Regions provided detail regarding workshops and community programs that offers further description of the work counted in the table above. There was consistency in the types of programs listed across regions. The types of community programs included:

 

• Peer education, counselling & support
• Hospital visit program for PLWH
• Support for PLWH and caregivers
• Community kitchens
• Peer mentoring programs for inmates
• PLWH supportive transitional housing
• Drop-in programs
• Programming for women from endemic countries
• Bar outreach
• Training seminars
• Telephone support
• One-on-one counselling
• Natural helpers
• Anonymous testing and counselling
• Life skills training
• Support groups

Topics for workshops and presentations included: HIV 101, harm reduction, HIV and immigration, sexual health, homophobia, oral sex, Hepatitis A,B & C, safer sex for MSM, human rights, train the trainer, safer body art, and living with HIV.

Products

Products (materials and resources) are an output in three funding approach logic models: products increase the knowledge of target population members on how to prevent new infections (Prevention); they increase knowledge for PLWH, as well as increasing the understanding of caregivers of issues relevant to living with HIV (Health Promotion), and; they help individuals and systems to understand and respond to system-wide barriers (Creating Supportive Environments).

Both operational and time-limited projects create, use, produce and distribute a variety of documents designed for various purposes and populations. Table 4 below illustrates the number and distribution of the various types of documents developed through ACAP.

Table 4. Documents Produced & Distributed by Type of Product Developed (This link opens in a new browser window)

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The category “other” includes items such as reviews, t-shirts, safer sex kits, contact cards, rave cards, playing cards, DVDs and videos.

Examples of products included:

• Volunteer Screening Tool
• Drug Sensitivity Training Kit
• Online Advocacy Action Kit
• Bad date newsletter
• Sexual Health Resources brochure
• Street Hype newsletter
• HIV and Immigration Training Module
• World AIDS Day Info pack
• Prevention video for gay men
• Stigma and HIV Presentation
• HIV 101 Presentation
• Hepatitis C Awareness Pamphlet
• IDU Survey Results Report
• Needle Exchange Study

Training

Training is an output under the Strengthening Community-based Organizations funding approach logic model; training strengthens the ability of board members, volunteers and staff to do strategic planning as well as to plan, implement and evaluate programs. Training staff and volunteers is a key activity geared towards ensuring that those providing services have the training required to do their work effectively, as well as enhanced or ongoing training in dealing with emerging issues or trends. It is possible that staff and volunteers attended more than one training event and were double-counted.

Table 5. Staff and Volunteer Training by Operational and Time-limited

NOTE: Due to data collection differences, data from Ontario and Alberta are missing or incomplete for number of sessions and numbers trained.
	Staff Training Sessions	Staff Trained	Volunteer Training Sessions	Volunteers Trained
Operational	385	491	124	1059
Time-limited	127	396	101	296
TOTAL	512	887	225	1355

 

Many of the same general topics and specific events were listed for both operational and timelimited projects, so the topics list presented below is combined. Training for time-limited projects was often more focused on a particular population or appeared to be specific to the focus of the project. Operationally funded projects reported more attendance at national and international conferences than time-limited projects. Training for staff and volunteers included both in-house training and external workshops and conferences. Training topics included:

• Needle exchange program training
• HIV 101
• Dynamics of HIV
• Outreach and best practices
• Leadership training
• Grief, loss and transition
• Core peer training/peer counsellors
• Assisting youth at risk
• Women and HIV
• Ethics and confidentiality
• Harm reduction
• Evaluation

Many regions reported a variety of conferences, workshops and symposiums attended by staff and volunteers:

• International AIDS Conference 2006
• Alberta Harm Reduction Conference
• International Harm Reduction Conference
• Epidemics in Our Communities Conference
• HIV/AIDS Skills Building Ceilidh
• 2nd National Conference on Methamphetamine and HIV
• IDU Scan Workshop
• HIV and Sex Work Conference
• Universal Precautions Conference
• Canadian Association of Nurses in AIDS Care Conference

Volunteers

While the number and contribution of volunteers is not directly an output in any ACAP funding approach logic model, volunteers support the activities and outputs for all of the funding approaches. Volunteers are a key feature in the work of not-for-profit agencies generally and, as the numbers below will attest, ACAP-funded projects are no exception to this. Table 6 below provides the number of volunteers reported, as well as the number of hours contributed by volunteers.

 

Table 6. Number of Volunteers and Volunteer Hours by Operational and Time-limited

NOTE: Due to data collection differences, Table 6 includes no data from Alberta for volunteer hours, and incomplete data from Ontario for number of volunteers and hours.
	Number of Volunteers	Volunteer Hours
Operational	3,912	87,905
Time-limited	2,012	29,361
TOTAL	5,924	117,266

 

Volunteers were engaged in a wide variety of activities, including:

• board and committee work
• peer support
• outreach
• public speaking
• education/community development
• fundraising
• administration
• special events
• on-line outreach
• support/assistance for PLWH

Target Population Involvement

 

While target population involvement is not an output or activity under any ACAP funding approach logic model, it does embody the ACAP principles of population health, health promotion and community development, in addition to supporting the activities and outputs of all four funding approaches. ACAP-funded projects are expected to involve target population members in their operational or time-limited project activities to ensure that projects meet the needs of the populations they are serving. Table 7 illustrates the number of operational and time-limited projects that involved target population members in various activities.

 

Table 7. Number of Operational and Time-limited by Nature of Target Population Involvement

Nature of Target Population Involvement	Number of Operational Projects (n=81)	Number of Time-Limited Projects (n=68)
Target population did not contribute to management and/or delivery	6	4
Target population was given informal opportunities to express their view or opinions about the project	35	28
Target population was given formal opportunities to express their view or opinions about the project	45	34
Target population played a volunteer role in delivery of programs	44	34
Target population was directly involved in a committee or group that provides advice to the governing body	34	28
Target population was directly involved in making decisions about the project	46	29
Target population was employed by the projects	42	25
Other	22	5

 

Summary of Output Data

The data presented above represent a sample of outputs from each of the four ACAP funding approach logic models, in addition to two data elements that support the activities and outputs of all four funding approaches (volunteers and target population involvement). The data reveal a great deal of activities conducted by ACAP-funded operational and project agencies. Workshops and programs were offered to target populations, providing 3721 presentations and 2122 programs in 2006/2007; there were 120,779 people reported as reached through these workshops and programs. Funded agencies reported a total of 582 products developed or used, with a reported distribution of 344,577. There were 122,431 contacts reported with the various target populations. A total of 1365 collaborative partnerships were reported, and 5924 volunteers supported the work of the agencies in delivering HIV/AIDS programming. Volunteers and staff were well trained to provide quality services, with a total of 225 volunteer training sessions and 512 staff training sessions reported.

These outputs demonstrate concrete actions towards preventing new infections, promoting the health of PLWH, strengthening community-based organizations’ capacity to respond to HIV and creating supportive environments.

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⁸ San Patten and Associates. (2006). AIDS Community Action Program (ACAP) Grants and Contribution Allocation Project 2005: Final Report.

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