Introduction:

This document was prepared by the Maine HIV Prevention Community Planning Group (CPG) to update the Maine Bureau of Health, and thereafter HIV prevention providers, about the recently revised list of CPG Prioritized Populations. The Prioritized Populations described here replace those found in the 1999 State of Maine Comprehensive HIV Prevention Plan. Please note that the Prioritized Interventions and Population Descriptions found in the 1999 Plan remain current, and should be used in conjunction with the new Prioritized Populations presented here.

Background::

Prioritized Populations are used to describe those individuals most at risk for HIV infection, and therefore most in need of HIV prevention services. The CPG decided to undertake a process to reprioritize populations at risk for several reasons. Most importantly, populations have not been reprioritized since 1996 and CPG members felt that a more up-to-date prioritization would better reflect recent epidemiological data and trends. The CPG also wanted to integrate the recently completed CPG Needs Assessment in order to provide more up-to-date information about populations at risk and available HIV prevention services. In addition, the previous list of prioritized populations contained population configurations that indiscriminately mixed behavioral and demographic elements, sometimes combining seemingly unrelated groups. Finally, the CPG wanted to make recommendations about prioritized populations that could be employed during the Request for Proposal (RFP) process, which will be initiated by the Bureau of Health during Year 2000.

The prioritization process itself took place between November 1999 and March 2000 and was conducted both at monthly CPG meetings and supplementary subcommittee meetings. The group chose a prioritization model it felt would best allow for prioritization based on behaviors, while also integrating appropriate demographic and population-specific information. The selected model was implemented through a series of worksheets that helped CPG members to categorize and prioritize populations. In addition, two primary tools were used to assist the process: epidemiological data provided by the Bureau of Health, and a compendium of CPG Needs Assessment data that included information about populations at risk and current interventions. These tools, along with the expertise of individual CPG members, informed the prioritization process. A synopsis of this process will be included in the next update of the CPG Plan.

The resulting prioritization represents a paradigm shift for describing people at risk for HIV transmission. The previous prioritization used a combination of both risk behaviors and demographic characteristics to define those people most at risk for infection. The new prioritized list is based solely on three at-risk behaviors: unsafe sexual contact, both partners male; sharing needles; and unsafe sexual contact, partners of the opposite sex. In addition, to better describe each of these prioritized behaviors, associated demographic characteristics were prioritized by the CPG. Each prioritized behavior is listed below, with associated demographic characteristics and recommendations for targeting specific populations with appropriate HIV prevention interventions.

Some of the recommendations below emphasize the importance of prevention efforts that reach youth, racial and ethnic minorities, and people living with HIV. The CPG hopes that these recommendations are implemented both through the creation of specific programs targeting these groups, and also through integration of culturally competent activities into more mainstream interventions that work with many populations to target HIV risk behavior change.

The three prioritized, behaviorally-defined populations are listed below:

Because of the shift to behaviorally-based prioritization of risk, the populations listed above do not directly coincide with the current Population Descriptions and Prioritized Interventions contained in Section 7 of the 1999 State of Maine Comprehensive HIV Prevention Plan. For this reason, the following new table has been provided. This table lists prioritized behaviors and associated population characteristics, and refers to at least one corresponding subsection in the1999 Plan. Because of overlap, many of the populations associated with each prioritized risk behavior are found in more than one place in the 1999 Plan; the new table does not contain all possible listings for each given population.

During the coming 12-18 months, the CPG will be reconfiguring its list of population descriptions and interventions to integrate this new, behaviorally-based list of prioritized populations.

* In the past, males who engage in unsafe sexual contact with females were not prioritized by the CPG. As a result, no specific documentation exists in 1999 State of Maine Comprehensive HIV Prevention Plan about this population. Epidemiological data and field experience suggest that most HIV-positive men who have sex with women were infected either through injection drug use or sexual contact with other men. Pertinent information about these behaviors may be found in Subsections 7.2.1 (Males Who Have Sex with Males) and 7.2.3 (Injection Drug Users). Such information may be useful when designing interventions.

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