Comments from the AIDS Foundation of Chicago (AFC) to the Centers for Disease Control and Prevention on Guidelines for HIV Prevention Community Planning

Karen A. Reitan, Director of State Affairs
AIDS Foundation of Chicago
March 6, 2002

Community planning is an essential component of efforts to ensure that HIV prevention programs are tailored to the particular needs and populations of local communities. As Illinois' leading advocate for people living with and at risk for HIV, the AIDS Foundation of Chicago applauds the CDC for seeking comments on the current guidelines for the development and implementation of more efficient and effective HIV prevention community planning.

Observations:

• The process of convening community-based HIV prevention planning groups provides a critical opportunity for providers and consumers of HIV prevention services to have input into the distribution of limited resources.
  
  
• The current guidelines clearly outline the roles and responsibilities of all partners involved in the planning process.
  
  
• The "essential components" of a prevention plan are excellent and provide a thorough and clear check-list for developing plans that are responsive to the community and epidemiology, and that can be realistically implemented. The "essential components" also provide a mechanism for accountability.

Challenges to Community Planning:

• The community planning process has been hindered by tension between the lead agencies - health departments - and community members. This tension has occurred over issues related to power and control over the planning process, the utilization of consultants in the development of priority plans, and over the prioritization of interventions that may present political obstacles for health departments to support.
  
  
• Although the guidelines include provisions for group members to concur/non-concur with final plans, this process has not always operated smoothly. Group members submitting letters of non-concurrence have been accused of jeopardizing funding and have been pressured into withdrawing their letters so that the planning group presents a united front.
  
  
• As the CDC has increasingly moved toward funding intervention targeted toward high-risk populations, planning groups have experienced tension between members representing populations defined by race, gender or sexual orientation. As members work to insure that their population receives as much funding as possible, the planning process risks polarization between members who should be working together.
  
  
• The requirement that planning groups be truly representative of the epidemic has challenged the Illinois statewide Prevention Planning Group. Although diversity of representation is easily achieved within the Chicago-metropolitan region and other smaller cities throughout the state, much of Illinois is rural and recruiting individuals that represent high-risk populations has been difficult.

Recommendations for Improving Guidelines:

• The guidelines should be revised to include provisions for establishing independent grant review panels that are comprised of some reviewers who are not directly involved in providing HIV prevention services.
  
  
• The CDC should consider options for funding lead agents that are not public agencies (health departments) so that priority setting and funding is not hampered by political concerns.
  
  
• The CDC should create protocols that allow group members to provide constructive criticism of community planning and mechanisms to ensure that such critiques are taking into consideration by the body and the lead agency.
  
  
• The guidelines should continue to require that planning groups be truly representative of the epidemic but should include provisions for statewide and regional planning bodies to appeal this requirement if they are unable to recruit a truly diverse membership.
  
  
• The CDC should consider revamping the planning process to more closely mirror the Ryan White Title I priority setting process, which would provide for true community consensus on prevention priorities. Doing so would mean that interventions and populations served would receive a set percentage of funds based on their ranking determined by priorities set by the entire planning group, rather than leaving the ultimate decision on funding to the local or state health departments.
  
  
• The guidelines should be revised to include accountability standards so that funding decisions truly reflect the priorities set by the entire planning body. Lead agents should be required to report back funding decisions before the awards are made and provide an explanation for funding decisions that do not reflect the priorities set by the planning group.
  
  
• The CDC should conduct an exhaustive evaluation of the community planning process to date to assess its effectiveness in both directing prevention funds to the most at-risk communities and in preventing the spread of the epidemic.

For more information, contact Karen A. Reitan, at 312-922-2322 or kreitan@aidschicago.org