The implementation of evidence based intervention (EBI) seems to always cause more harm than good. As a new implementer of several EBI’s, I find myself constantly struggling with the fidelity components that are some prevalent in these curricula. Currently, under a grant from the AIDS Activities Coordinating Office (AACO), my agency is charged with the training of Opinion Leaders through the program D-Up: Defend Yourself. The format of the program is to identify leaders, or influential individuals, in the gay or men who have sex with men (MSM) population. By training these individuals through the D-Up program, their knowledge of HIV and prevention techniques will grow, and they will then take this information to their social circle and share how to reduce one’s risk of contracting HIV. There is also a secondary component where opinion leaders will identify 1 or 2 of their associates that they feel would benefit as well from the program.
The program in itself does a very good job of identifying social stigmas and norms, but in all its greatness for pointing out what the problems are it does a poor job of addressing them. There are plenty of missed opportunities to really delve in to some of the societal issues that plague gay men of color. Therefore, against the wishes of the curriculum, I have found it important to allow participants of the program to really lead the discussion about the different factors that contribute to transmission. I have found in my experience as an implementer that we have a tendency to guide discussion to the places that we would like to take them. Sounds familiar right? Yup, that’s because it sounds just like Constructivism.
Constructivism is basically a theory — based on observation and scientific study — about how people learn. It says that people construct their own understanding and knowledge of the world through experiencing things and reflecting on those experiences. I have found that this approach, especially when dealing with sensitive topics, is the optimal approach for learning. In my experience dealing with gay men of color, they have been beaten over the head with prevention messages like “Use Condoms” or “Get Tested”. However with programs such as D-Up, that takes an “innovative” approach by addressing unconventional risk factors including poverty, incarceration, familial rejection, and homophobia, it’s not just enough to put those factors out there. A facilitator needs to promote group discussion and draw from their experiences, especially since a lot of these experiences are shared when addressing MSM of color in urban areas. Constructivist learning moves from experience to knowledge and not the other way around.
The unfortunate part of D-Up and most EBI’s geared towards at risk populations is that they have high levels of fidelity, which hinders affective learning and comprehension of concepts. If I ever have the opportunity to work with the Feds, it will be my top priority to push that fidelity is the bane of EBI’s existence. Learning does not happen in a vacuum. A facilitator cannot not predict nor push for certain responses and expect participants to be fully invested in the program. At the end of the day these programs are created to benefit the populations that they are meant to serve, so ultimately it is counterproductive for EBI’s to say what those benefits are.