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Community-based HIV Prevention Intervention



HIV Prevention Intervention

Baltimore was first dubbed Charm City around 1975. Yet, today, with HIV pandemics raging on, it does not have the hallmarks of a Charm City anymore. On the contrary, it looks more like a hotbed for HIV/AIDS and other concomitants sexually transmitted infections. According to the data of the Centers for Disease Control and Prevention, nearly 38% of Baltimore’s MSM are HIV-positive and 73% do not know about their infection. Moreover, HIV disproportionately affects poverty-stricken gay men of color, especially those who are young and sexually active.

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To bring HIV in Baltimore under control, a bevy of measures should be taken. The goal of the current program is straightforward: to reduce HIV prevalence among Baltimore’s MSM. To this end, it offers to implement a combination of approaches consisting of behavioral, biomedical, and structural interventions on a community-based level. Within the framework of this approach, outreach workers hired for the current program will enlighten Baltimore’s MSM about the dangers of HIV, teach them how to correctly use condoms and condom-compatible water- and/or silicone-based lubricants, provide HIV testing and counseling services, distribute free condoms and lubricants, screen Baltimore’s MSM for other sexually transmitted infections, refer HIV-positive MSM to clinics, and other measures.

The estimated budget for the program is $390,000 in direct costs and $1,640 in indirect costs. A thorough analysis of the mission of CDC and that of the present program shows that their interests dovetail. Since the timing for such a program is critical, it should be implemented in the nearest future.


Baltimore, Maryland, is a vibrant city that offers homosexuals a variety of ways to have a great quality of life. According to Wong (2014), Baltimore is a city with “a bustling waterfront, quirky neighborhoods, and a surprisingly diverse lesbian, gay, bisexual and transgender (LGBT) cultural and nightlife scene”. Indeed, homosexuals can drink coffee and relax at gay-orientated cafes in the daytime and beguile balmy nights of dancing at gay nightclubs. Baltimore’s gay community is very active, with plenty of cultural and political events held monthly. The avenues of the city burst into a carnival of purple every summer as the annual Pride Parade takes place.

On the face of things, it looks as if Baltimore is well-deserving of its nickname Charm City. Yet, beneath the thin veneer of charm flows the undercurrent of vulnerability caused by the steadily growing incidence of HIV/AIDS among the members of Baltimore’s LGBT community. As of 2006, roughly 100,000 self-identified gays, lesbians, and bisexuals lived in the Baltimore-Columbia-Towson Metropolitan Statistical Area, making it the 18th largest LGBT community in the U.S. (Gates, 2006). The figures have grown since that time, and so has the percentage of Baltimore’s gay men infected with and affected by HIV. Today, 33 years since HIV/AIDS was first discovered, this pertinacious malady continues to ravage the gay community.

According to the data divulged by the Centers for Disease Control and Prevention (CDC) in 2010, nearly 38% of Baltimore’s gay men are HIV-positive (cited in Friedman, 2011). What is more appalling, approximately 73% of Baltimore’s HIV-positive gay men are unaware of their infection (Friedman, 2011). Thus, there are ample grounds to assert that HIV/AIDS is a scourge that is devastating to the gay community in Baltimore. Considering that effective treatment of HIV/AIDS is nonexistent, a community-based HIV prevention intervention is needed.

The present grant proposal offers a comprehensive community-based HIV prevention intervention for homosexual men in Baltimore City. It has a neatly designed structure. The statement of need will expatiate upon the issues raised at the end of the previous paragraph, describing the population that will be served. Relevant evidence will be adduced to justify the need for the proposed HIV prevention program. After this, an explanation of how the objectives of the program align with the funder’s priorities will follow. In the next phase, a detailed description of the project will be offered. The goals and objectives of the program merit a separate section and will be described in measurable terms, addressing the academic and technology needs of the project.

Next, the author elucidates the timeframe for the research project and explains how it will be implemented, thereby helping the funder to understand the planning and feasibility of the project. A plan to evaluate the research process will be developed as well. The author will compose a list of the desired outcomes and include information on how they will be accomplished. The grant proposal will then segue into an evaluation of the potential impact of this project, describing the metrics that will be used.

Last, but certainly not least, the project will particularize the staff qualifications, certifications, and skills, as well as project costs. A table with a detailed budget and a budget narrative will catalog and explain various expenses. Although “MSM” is a broader category than “gay men”, because it includes bisexuals and transgenders, the terms have been used interchangeably for this project, to avoid repetition.

Problem Statement

The need for a comprehensive community-based HIV prevention project in Baltimore is great and indisputable. In 2008, CDC conducted a study that tested 8,000 gay men ages 18 to 29 years old in 21 cities across the U.S. and found that the incidence of HIV among the members of the gay men’s community was on the rise (Centers for Disease Control and Prevention [CDC], 2010). According to the statistics released by the agency, 20% of all gay men in America carry HIV (CDC, 2010). Yet, Baltimore stands out against the background of other American cities.

Thus, 38% of Baltimore’s MSM, a medical and social research designation for men who have sex with men, are HIV-positive, making the city the most infected in the U.S. (CDC, 2010). Sexually active gay men, especially those belonging to minority groups, are often unaware of their adverse health status. African Americans and Hispanic Americans are not only the least likely to know about their infection but are also the most vulnerable to HIV (CDC, 2010).

These findings look even more disconcerting when compared to the findings of the National Health Behavioral Study of 2004-2005, in which the incidence of HIV among gay men of African and Hispanic extraction increased from 40% and 18% in 2005 to 46% and 23% respectively in 2008 (Finlayson, Le, Smith, et al., 2011).

It appears that among all gay, bisexual, and other MSM, men of color are the most vulnerable group. Even though gay men of color use condoms twice as often as white gay men, CDC’s study indicates that the infection rates among the representatives of the former category are higher (CDC, 2010). What is more important, the prevalence rate among black gay men in Baltimore would probably compare even less favorably against other cities if more blacks were included in the study.

Indeed, many critics animadvert upon CDC’s study results and dismiss them as flawed and too positive, because the study did not pay due attention to venues frequented by black gay men (Marimow, 2010). One way or the other, the problem is acute for both white and black gay men in Baltimore. Thus, while HIV rates among such risk groups as intravenous drug users and heterosexual couples are dropping, the rate among those who identify themselves as MSM is steadily climbing, the need for early detection and prevention outreach is clear.

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The groups targeted for outreach through the current project are among the most underserved MSM: gay men of color and homeless gay men, all of whom are poverty-stricken. Indeed, Baltimore is a city with dense poverty. CDC found that HIV rates in impoverished neighborhoods were double that of the U.S. overall (cited in Wright, 2010). Again, gay men of color are disproportionately impacted by HIV, because they are generally poorer than their white counterparts. According to the 2012 U.S. Census, 23% of all Baltimore citizens live below the poverty line, compared to 9% of citizens living below the federal poverty line in Maryland in general (U.S. Census Bureau, 2012). Paraphrasing the data of the U.S. Department of Agriculture, Wright (2010) argues:

Nine out of every 10 Black Americans who reach the age of 75 spend at least one of their adult years in poverty. By the age of 25, the findings show, 48,1% of black Americans will have experienced at least one year in poverty. By age 40, the number grows to two-thirds and more than three-fourths by age 50. More than 90% will have lived below the poverty line by age 75.

It has also been established that MSM, irrespective of their ethnic background, are significantly more likely to live in squalid conditions. Although skin color remains an important factor, its significance diminishes when it comes to the age of HIV-positive MSM. CBC found that infection had increased to a certain degree in MSM aged 23 to 28 years (CDC, 2010). The finding implies that young MSM is more susceptible to HIV than their chronologically gifted counterparts, thereby shattering the hitherto-prevalent stereotypes that older MSM is safer in their sexual relationships.

The fact that younger MSM who have embarked on an independent path in life are more vulnerable to poverty exposes this group to additional risks. Hence, people working with HIV prevention programs should be particularly concerned about this particular population. With a view of establishing healthy behaviors in the 23-to-28 age group early on, community workers must reach this group with prevention strategies as soon as possible.

Young MSM in Baltimore is the hardest group to control and monitor. The rationale behind their unwillingness to get tested for HIV at least once a year is based on the social stigma associated with being infected with HIV. In communities of color, the effects of such stigma can be even more deleterious. Another reason is that young MSM, just like other young individuals, tends to be more mobile and, thus, less available for testing. Young MSM who are afraid that they might have contracted the infection find it difficult to open up. As a corollary of all this, the need to carry out a comprehensive community-based HIV prevention program, targeting MSM in Baltimore and especially those who are most likely to be infected with HIV, is urgent.

Data Justifying Need for Program

Nothing could bring what Wong (2014) calls “unity to the community” as effectively as a comprehensive community-based program. According to a snapshot of Baltimore’s MSM community released by the Centers for Disease Control and Prevention, no gay, bisexual or other men who have sex with men in Baltimore are immune to HIV unless health officials manage to stem or otherwise escape the epidemic. It is proverbial that MSM is 59 to 75 times more likely to contract HIV than the general public of reproductive age (Purcell, Johnson, Lansky, et al., 2012).

Young MSM, especially those of color, bear the biggest burden of HIV. Judging by the highest standards, they are the most neglected population in Baltimore. Of all Baltimore’s men who have sex with other men, African American adolescents make up the biggest segment of the new infections in MSM and account for more instances of infection than any other subgroup. The fact that no organization in Baltimore would strive to alleviate the desperate plight of young gay men of color, considering the existing needs, is especially telling.

So far, governments have under-prioritized research and outreach programs targeted at MSM. As a result, MSM has limited access to HIV interventions. The exact percentage of Baltimore’s MSM who have access to basic HIV-prevention services is unknown but is believed to be contemptibly small. On the face of things, it seems that Baltimore – which receives the lion’s share of Maryland’s $95 million earmarked to combat HIV – should have one of the most effective and efficient health programs in the U.S. As numerous studies show, Baltimore has the most noisome reputation for HIV in MSM, compared to other American cities (CDC, 2010; Finlayson et al., 2011). Whereas HIV prevalence has been stable in Los Angeles, Miami, New York, and San Francisco, it has risen in Baltimore (CDC, 2010).

Stigmatization is yet another aspect associated with HIV that justifies the need for an HIV prevention program. According to Neff (2006), “stigmatization linking HIV and homosexuality has been rife since the inception of the HIV epidemic in the 1980s when the disease was initially labeled ‘gay-related immune deficiency’ and considered ‘a gay man’s disease’” (p. 112). It is unnerving to realize that people who have to deal with the torments of HIV daily are, in addition to that all, subjected to the pressure from society. Indeed, Baltimore’s MSM often experiences ostracism and discrimination on the part of the general public. Sometimes, Baltimore’s HIV-positive MSM are ostracized even by their HIV-negative counterparts.

The fact that many MSM also has sexual intercourse with female partners and serve as a bridge to broader tiers of society is yet another reason to be worried about HIV prevalence among them. Thus, a comprehensive community-based HIV prevention program for Baltimore’s MSM must be implemented with urgency. Today, there is a growing body of evidence to prove that HIV prevention interventions targeted at MSM can reduce incidences of HIV.

In the past, group-based and community-based behavioral interventions resulted in a 43% decrease in unprotected sex among MSM. Similarly, it has been proven that group-based interventions can lead to an 81% increase in the frequency of condom use among MSM. On the whole, the data presented above clearly demonstrates that the failure to deliver a package of HIV prevention services to Baltimore’s MSM will have the panoply of negative effects, short-term and long-term, direct and indirect.

Explanation of how Program Aligns with Funder’s Priorities

The Centers for Disease Control and Prevention is a vast multifarious organization that strives to, inter alia, unite HIV-prevention activities at grass-roots, national, and international levels. The Division of HIV/AIDS Prevention at CDC hereafter referred to as DHAP, is charged with the mission of keeping HIV-positive people healthy, reducing HIV prevalence, and disseminating information about the virus. DHAP is versatile enough to provide such a broad range of services effectively. Yet, in an ideal situation, it would prefer to prevent the spread of HIV in the first place rather than tackle its detrimental effects. Having scrutinized DHAP’s Strategic Plan for 2011-2015, there is no doubt whatsoever that the purposes of the organization overlap with those of this program.

The immediate design of the current program is to reduce the number of new HIV infections occurring among Baltimore’s MSM. The task meshes perfectly with DHAP’s blueprint of achieving its mission. Although DHAP treats all populations impartially, it focuses on those groups that are most affected, including MSM, people of color, poverty-stricken persons, and sexually active youths and adults. Being as susceptible to HIV as they are, Baltimore’s MSM can often be pigeonholed as belonging to one or more of the abovementioned categories. Indeed, many of Baltimore’s MSM targeted by this program are African American, live in pecuniarily embarrassed circumstances, and have many sexual relationships, especially transient ones.

Thus, by delivering a package of high-impact prevention services to Baltimore’s hard-hit MSM community, this program will help DHAP to fulfill one of its sacred obligations: to minimize the number of new HIV infections and reduce the associated risks among one of the most diverse and vulnerable populations.

Additionally, the purposes of the CDC and those of this program have two more points of contact. First, CDC seeks to bring other sexually transmitted infections (STI) under control. The present program would, among other things, screen Boston’s MSM for such STIs as syphilis and chlamydia, because they could provide a springboard for HIV. Persons diagnosed with STIs would be referred to clinics and other community-based organizations for further care, in conformity with CDC’s strategic plan. Likewise, persons who test positive for the virus would be referred to clinics for further consultations and treatment, in line with CDC’s “ideal continuum of prevention and treatment” principle.

Second, the present program would address the disparities that persist within Baltimore’s MSM community by focusing on the disproportionately affected groups. CDC is as much about redressing disparities among populations and within communities as it is about preventing the spread of HIV. In addition to that, the current program would make use of individual-, group-, and community-based interventions developed or approved by the CDC. Hence, it would not be difficult to dovetail the interests of this program with those of the CDC.

Detailed Program Description

Today, there is a plethora of interventions that can stop or at least decelerate the spread of HIV. Each intervention boasts its strengths that other interventions do not have. Yet, no single intervention by itself is good enough to put an end to HIV transmission among a specific population, such as MSM. Thus, the conclusion arises that a combination of mutually reinforcing interventions should be implemented at the same time for a prevention program to yield tangible results. Among the most common categories of interventions are behavioral, biomedical, and structural.

Behavioral approaches run the gamut of importance from behavior change communication delivery to healthy behaviors promotion. Biomedical prevention efforts aim to reduce the risk of HIV acquisition and transmission through the distribution of condoms, HIV testing, and counseling, STI prevention, etc. Structural approaches are designed to foster social change in the general public by eliminating the social stigma attached to HIV-positive MSM and others like barriers that impede the successful prevention of HIV. Each of these interventions needs to be tailored to the specific needs and risks of the targeted population, whether or not it is used individually or in combination with other interventions.

As explained before, the need for a comprehensive HIV prevention program targeted at MSM is critical. The program developed for this project consists of the five core components, which subsume under one of the aforementioned categories of interventions. These components are community-based outreach, distribution of condoms to HIV-negative members of Baltimore’s MSM community, HIV testing and counseling, targeted information sharing, and STI prevention.

Community-based outreach is by far the most complex, yet very effective, prevention measure. An extreme and irrational aversion to Baltimore’s MSM, especially those who are young, on the part of the general population makes it difficult for them to disclose their sexual orientation to healthcare professionals and seek help from HIV prevention programs. MSM in Baltimore, just like those in any other American city, are afraid to disburden themselves to healthcare providers. To remedy this troubling state of affairs, the current program would employ peers and other trusted individuals who have a way with MSM. Members of this fragile community must be reached in their milieu.

Thus, properly trained peers would work in MSM-friendly environments to engage and retain this socially marginalized population in HIV prevention services. Such a move would encourage MSM to open up, thereby reinforcing MSM’s trust in the HIV prevention program. Within the framework of community-based outreach, an array of services would be delivered to Baltimore’s MSM. For example, outreach workers hired for this program would diffuse information about HIV risk reduction through diverse communication platforms, train MSM how to correctly use condoms, provide referrals to other components of this HIV prevention program, etc.

According to conventional wisdom, the regular use of latex condoms can substantially reduce the risk of HIV acquisition and transmission for sexually active MSM. By the same token, it has been shown that the increased availability of free condoms could save money that would otherwise go to HIV prevention programs because it averts medical costs by forestalling new HIV infections. Thus, this program would focus its attention on distributing free condoms to those MSM, who cannot procure them or neglect using them. It is recommended that condoms be used together with condom-compatible lubricants to minimize the odds of condom failure and rule out the possibility of HIV infection.

Curiously enough, scientific research has shown that oil-based lubricants are not compatible with condoms and, thus, should not be MSM. Consequently, condoms distributed within the framework of this program will go in pair with silicone- and water-based lubricants. To ensure that the maximum possible number of Baltimore’s MSM gets access to condoms and lubricants, they will be distributed in venues frequented by this target population, such as Club Hippo, Leon’s, Club 1722, etc. Similarly, considering the special focus of this program on the young pauperized gay men of color, free-condom stalls will be installed in Baltimore’s poverty-stricken neighborhoods.

To persuade Baltimore’s MSM to make use of distributed condoms and lubricants, outreach workers will harness the forces of social marketing. More importantly, it is necessary to distribute condoms permanently or at least long enough to inure MSM to safe sex. The current program would aspire to give Baltimore’s MSM an inexhaustible and ubiquitous source of condoms. Indeed, the more free-condom stalls are there in Baltimore, the more MSM will be reached.

Increasing the availability of HIV testing and counseling is yet another efficient intervention that will be implemented within the framework of this program. If a man who has sex with other men tests positive for HIV, he will likely refrain from getting involved in high-risk behaviors. As a result, the virus will not be transmitted to any other HIV-negative men who have coitus with him. When used in combination with high-quality counseling, HIV testing can significantly reduce the risk of HIV and other sexually transmitted infections among Baltimore’s MSM. To recruit MSM for HIV testing and counseling, this program would rely on a variety of strategies.

For instance, eminently qualified outreach workers would be embedded with community-based organizations and clinics of Baltimore to engage MSM in HIV prevention services. Similarly, they would conduct HIV testing and counseling on mobile vans, moving from one district of the city to another. Such a model would be especially useful vis-a-vis destitute MSM living in poverty-stricken neighborhoods. Apropos young MSM, outreach workers hired for this program would reach them in part through social networking websites.

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In the age of the Internet, such a strategy can bring results in ways unimaginable just one decade ago. The testing-and-counseling component of this program will emphasize gay men who are in established relationships. Providing counseling to established couples will have a stronger effect on their willingness to engage in high-risk behaviors. The first and foremost task of this intervention is to detect HIV-positive MSM and refer them to other health service providers.

To this end, firm linkages must be established between HIV testing and other HIV treatment programs. Those MSM who test negative for HIV would have the opportunity to learn from outreach workers how to avert the virus in the future. In both cases, this program would strive to cater to the needs of individual MSM and maintain their confidentiality.

At first blush, it seems that targeted information sharing is a futile endeavor because the risk factors for and effects of HIV infection have been repeated so often that they have taken on the aura of conventional wisdom. Yet, it would be an inconceivable folly to downplay the importance of targeted information sharing. By imparting targeted information to Baltimore’s MSM, this program would seek to raise their knowledge and awareness of HIV, encourage HIV testing, propagate risk-reducing attitudes and beliefs, foster healthy behaviors, etc.

Guided by these purposes, outreach workers would work with small groups of Baltimore’s MSM to make sure that all MSM receive sufficient attention and that all questions are answered. Likewise, they will conduct individual behavioral interventions and peer-education interventions to maximize the effects of the program. Even a brief tete-a-tete conversation is likely to be more productive than the most passionate speech about the dangers of HIV delivered to the crowd of disinterested MSM. In implementing educational activities, this program would try to allocate enough time to meet the needs of every MSM recruited.

Yet, such an approach may be too expansive and time-consuming in comparison with other HIV interventions. Outreach workers hired for this program would be advised to marry passion to reason and implement individual behavioral interventions only when other more cost-effective approaches fail.

A comprehensive community-based intervention program for MSM would be incomplete if it did not incorporate other STI prevention interventions. Sexually transmitted diseases, such as chlamydia, gonorrhea, and syphilis, are closely linked with HIV and, when undetected, can increase the risk of HIV acquisition. Thus, this program would convey information about the prevention of STIs to Baltimore’s MSM to bridge the concomitant HIV pandemic in the city. Similarly, it would provide screening services to Baltimore’s MSM.

Outreach workers would research the medical history of the target population to ascertain whether they are at a relatively high risk of contracting HIV. Additionally, physical examination, serologic testing, and sample collection would be conducted to screen MSM for STIs. Just like with HIV prevention approaches, outreach workers would take advantage of a variety of STI prevention models. Community-based, mobile-based, and social media-based interventions would all be used to screen Baltimore’s MSM for STIs, thereby preventing the spread of HIV in the city.

Goals and Objectives of the Program

The previous chapters have already shed light on the goals and objectives of this community-based HIV prevention program. Yet, those goals and objectives are scattered chaotically throughout the paper and are, thus, difficult to track. Before embarking on a detailed description of the goals and objectives outlined in this program, it seems logical to explain the differences between them. Whereas a goal is a broad, abstract, and often intangible statement of what is to be accomplished, an objective is a narrow, precise, and concrete step towards accomplishing that goal. Below is a list of goals and specific objectives within each of the goals that the current community-based HIV prevention program would attempt to accomplish.

  1. To promote healthy behaviors among Baltimore’s MSM.
  • To enlighten MSM living in the city on the effects of HIV on their health.
  • To improve the access to HIV testing for Baltimore’s MSM.
  • To promote regular use of condoms and condom-compatible lubricants among Baltimore’s MSM.
  1. To eradicate pervasive stigmatization and discrimination of HIV-positive MSM.
  • To raise awareness about the harmlessness of HIV-positive MSM to the general public.
  • To dispel common myths and misunderstandings about HIV acquisition and transmission.
  • To protect the confidentiality of those MSM who have agreed to HIV testing and/or counseling.
  1. To eliminate disparities within Baltimore’s MSM community.
  • To promote equal access of all MSM to HIV prevention and treatment services.
  • To engage and retain Baltimore’s marginalized MSM groups, including those of color and poverty-stricken, in HIV prevention services.
  1. To reduce HIV prevalence among Baltimore’s MSM.
  • To increase the availability of condoms to Baltimore’s MSM.
  • To provide counseling services to Baltimore’s MSM, with an emphasis on gay men who are in established relationships.
  • To screen Baltimore’s MSM for STIs and other related infections, and, depending on the results, provide necessary assistance to them.
  • To refer to Baltimore’s MSM, who test positive for HIV or any other sexually transmitted infection, to clinics and community-based organizations for further care.

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Process Evaluation Plan

The present community-based HIV prevention program for Baltimore’s MSM features a comprehensive process evaluation plan to ascertain whether or not the program is successful in meeting aggressive goals for reducing the number of new HIV infections in the city. The above section has delineated specific activities that would be carried out to achieve the main goals and objectives of the program. An internal evaluator would assess the progress of the program throughout the project period to enable outreach workers to introduce the necessary changes to raise program effectiveness.

The process evaluator would collect information about the effectiveness of the undertaken activities to determine whether or not they have been implemented as planned. In other words, he/she would explain the effects of the program activities on Baltimore’s MSM, benchmarking the results of the current program against those of similar programs in other cities. The process evaluator would begin collecting and analyzing formative data in September 2015 when the program is scheduled to start. Given the nature of the evaluation plan, it may provide unpredicted insight into ameliorating the outcomes of the program.

The collected data would be presented to program coordinators so that they could make certain changes to improve the outcomes of this community-based HIV prevention program. Similarly, the evaluator would meet with other vital staff to provide formative feedback to them.

Outcome and Impact Evaluation Plan

The outcome and impact evaluation plan is also designed to determine the effectiveness of the program in reaching stated goals, but in comparison to the process evaluation plan, focuses on measuring outcomes rather than ongoing progress against program goals and objectives. The evaluator would not necessarily have to make observations about the program throughout the funding cycle. On the contrary, he/she would focus on analyzing the outcomes of the program when it is finished. In contrast to the process evaluation, the outcome and impact evaluation can be in the form of an afterthought.

The number of new HIV infections that occur during the program period would be compared to the figures observed during the same period previously that year and the same quarter in preceding years. The outside evaluator would analyze the observed changes to deduce whether the program has yielded any tangible results. Unlike the process evaluation, the outcome and impact evaluation would consist of two parts, namely formative and summative. The evaluator would pinpoint both strengths and shortcomings of the program. Overall, the outcome and impact evaluation would answer three major questions concerning the program:

  1. Were the program activities executed as planned? What barriers militated against the implementation of the planned activities?
  2. How effective was the community-based HIV prevention program for Baltimore’s MSM in attaining its goals and objectives?
  3. What is the impact of the undertaken activities on Baltimore’s MSM, including a detailed breakdown of the target population?

Budget, Facilities and Personnel Requirements

Naturally, the budget may vary wildly, depending on the prevention approach chosen. For instance, the annual “Know Your Status” Free Ball held at Baltimore costs organizers only $7,000, “a tiny portion of the city’s $1,4 million outreach budget” (Boes, 2014). While the ball is a cheap way to test Baltimore’s MSM for HIV, it is limited in its basic function since HIV-positive persons do not receive further assistance. The current program, on the other hand, would bring a richer harvest of results by using a combination approach. Usually, combination approaches are the most expensive, but they are also the most effective.

The budget of this program is composed of both direct and indirect costs. The direct costs needed to implement a comprehensive community-based HIV prevention program for Baltimore’s MSM total roughly $390,000, with the purchase of condoms and condom-compatible lubricants and salary for outreach workers being the most costly articles of expenditures. Average American salaries for the corresponding professionals have been used as a yardstick against which to calculate salaries for the outreach workers hired within this program

Assuming that the average annual salary for a social worker in the U.S. is $40,800, a monthly salary of an HIV counselor was estimated to be $3,400. The U.S. law obliges employers to pay a variety of taxes and benefits for an employee, including federal unemployment taxes and state unemployment taxes. Fringe benefits average about 25% in the U.S. and have been included in the table. Whereas the direct costs account for the lion’s share of the budget, only a small portion of the funding will go to cover indirect costs. Some articles of expenditure, such as transportation, are difficult to calculate ahead of time and they have been excluded from the budget blueprint. An exhaustive list of direct ($390,000) and indirect ($1,640) costs is needed to implement the current program.


Having analyzed a cascade of literature, it appears that the plight of Baltimore’s MSM is desperate indeed. Nearly 38% of them are HIV-positive and serve as a threat to MSM who are HIV-negative. Yet, not all MSM in Baltimore is equally affected by HIV. Those who are young, sexually active, and live in impoverished neighborhoods, and are MSM of color constitute the most vulnerable group.

To halt the spread of the devastating virus in Baltimore and save local MSM from the scourge of HIV, a comprehensive community-based HIV prevention program should be taken. The cost of such a program for four months would be approximately $390,000 in direct costs and $1,640 in indirect costs. The timing for such a program is critical because no organization in Baltimore would cater to the needs of MSM.

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