The document summarizes a program called "Change Matters" that aims to increase economic self-sufficiency among people living with or at risk of HIV. It found that the program helped participants: 1) Improve their ability to navigate structural issues like accessing resources, education, and managing finances. 2) Gain greater access to resources and education that supported financial independence. 3) Experience improved self-efficacy and self-esteem as they developed money management skills and felt more in control of their lives.

1. Why “Change Matters”:
Building Economic Self-Sufficiency
among People living with and at-risk
for HIV Infection
Paula M. Frew, MA, MPH, PhD
Emory University

2. Co-Investigators
Carlos del Rio, MD
Emily McCollum, MPH
Takeia Horton, MPH
Marcus Bolton, MA
Jeffery Roman
Mary Helen Borck, RN
Garcelia Burchell
Michael Banner

3. Epidemiology of HIV Infection in Georgia and Louisiana
•Georgia: 8th in nation AIDS cases •Louisiana: 4th in nation AIDS cases of
•Atlanta: 60% of prevalent HIV cases large metro area
•African Americans: 78% newly •Baton Rouge: highest rate of AIDS
diagnosed HIV/AIDS cases (2008) cases in state
•African Americans: 72% of newly
diagnosed HIV cases (2007)

4. Theorized Socioecological Factors
Influencing HIV Risk
•Housing issues
•Economic policies
Structural/Policy •Health disparities
•Healthcare access
• Socioeconomic challenges
• Educational access
Community • Environmental issues
• Access to resources
• Financial dependency
• Concurrency
Relational • Domestic violence
• Condom negotiation
•Financial insecurity
Individual •Self-esteem issues
Denning et al., 2011; Gillies et al., 1996; Schwartz et al., 2011; Behrer, 2007;
Sumartojo et al., 2000; Gilbert, 2003; Adimora et al., 2006; Greene et al., 2010; Ezzy et al., 1999

5. Program Aims
• Increase opportunities for participants to become
financially self-sufficient and improve well-being.
• Increase knowledge and skills to negotiate many
socioecological factors associated with HIV risk
(housing instability , educational attainment,
financial dependency, self-esteem issues).

6. Building the “Change Matters” Program
Curricular Examples: Curricular Aims:
• “Hope and Power” • Basic financial
(National Coalition management
against Domestic • Setting achievable goals
Violence) • Self-sufficiency
• “Moving On” (Sudie
Pollack)
• “Will the Dollars Stretch?
Teen Parents Living on
Their Own” (Sudie
Pollack)

7. “Change Matters” Topics
• Taking a financial inventory
• Finding a job
• Paying bills
• Managing a household
• Building a financial base
• Saving for emergencies
• Helping with big problems
• Looking toward the future

8. Intervention Sites
• Baton Rouge, LA (N=48), 2008 - 2009
– Recruited at Family Services of Greater Baton
Rouge
– Program: 8 week one-hour sessions plus facilitator
follow up at 1-, 3-, 6-months
• Atlanta, GA (N=15), 2009
– Recruited at Stand, Inc
– Program: 1 day class

9. Inclusion Criteria
• Persons ≥18 years
• Able to read and write English
• Reside in designated areas of Baton Rouge or
Atlanta with high HIV prevalence and poverty
• Clients of designated partner CBOs

10. Data Collection
Quantitative variables: Qualitative topics:
• Gender • Knowledge gains related to
• Age program topics
• Race and ethnicity • Attitudes towards topics
• Education • Behavioral impact
• Income • Engagement with topic
• Employment status • Program pedagogical approach
• General well-being • Program impressions
• Self-efficacy • Program design feedback
• Attitudes towards money

11. Analytic Approach
Content Analysis
•Interim Reports
•Final Reports
Quantitative Data Qualitative Data
•Baseline and Follow-up Conclusions •In-depth interviews with staff
Surveys •Client narratives
•Session Questionnaires •Field observations

12. Group Characteristics*
Atlanta Baton Rouge
(N=15) (N=48)
Black/African American 14 (93%) 48 (100%)
Gender (Male) 15(100%) 15 (31%)
Heterosexual 13 (87%) 40 (83%)
Unemployed 15 (100%) 31 (66%)
Annual Family Income <$20K 12 (86%) 38 (84%)
Educational Attainment 12 (80%) 32 (67%)
(HS/GED)

13. Results
Improved
Navigation of
Structural
issues
Opened
Access to
Resources
Greater
Financial
Independence
Improved
Self-Efficacy &
Self-Esteem

14. Financial Skills
Navigating
Structural
issues
Question Pairs Mean– Mean – t df P-value
Pre Post
(0=No; (0=No;
1=Yes) 1=Yes)
Credit Report Assessment (Baton Rouge) 0.58 1.02 -3.57 47 .001
Net Worth Calculation (Baton Rouge) 0.31 0.90 -5.27 47 <.001
Personal Spending Plan (Baton Rouge) 0.43 0.91 -5.21 45 <.001

15. Addressing Economic Challenges
Navigating
Structural
issues
“About the 7 years statute of limitation for Louisiana. Deal with
the original creditor instead of collection people. ‘Don’t
Settle.’”
“That there programs to help me get work. That I don’t need to
stop living, because its help out there.”

16. Accessing Educational Resources
Navigating Opening
Structural Access to
issues Resources
Question Pairs Mean Mean t df P value
Baseline Follow Up
(1=Fair; (1=Fair;
3=Excellent) 3=Excellent)
Overall Impression of the Change 2.32 2.79 -3.64 46 .001
Matters Program (Baton Rouge)
Overall Impression of Change Matters 2.07 2.73 -3.57 14 .003
(Atlanta)

17. Accessing Educational Resources
Navigating Opening
Structural Access to
issues Resources
“They need many more like this class”
“I like to come back to see or talk about using what I learned. And how
it better my living arrangements.”
“This is such a helpful experience”

18. Fostering Economic Empowerment
Navigating Opening Greater
Structural Access to Financial
issues Resources Independence
Question Pairs Mean Mean t df P value
Baseline Follow-Up
(1=SA;6=SD) (1=SA;6=SD)
I am skilled at money management 3.74 2.76 3.72 41 .001
(Baton Rouge)
I am skilled at money management 4.00 3.27 2.58 14 .022
(Atlanta)
I am skilled at keeping my family’s money 4.07 2.49 5.96 44 <.001
records (Baton Rouge)
I feel that I lack education to manage my 3.85 4.79 -3.35 46 .002
money

19. Improving Self-Worth
Improved
Navigating Opening Greater
Self-Esteem
Structural Access to Financial
and Self-
issues Resources Independence
Efficacy
Question Pairs Mean Mean t df P value
Baseline Follow
-Up
Feelings in general over the past month 2.94 2.36 2.99 46 .004
(Baton Rouge)
My major accomplishments are entirely 2.05 1.52 2.56 43 .014
due to hard work and intelligence (Baton
Rouge)
Happy, satisfied, or pleased with personal 3.33 2.73 3.67 14 .003
life (Atlanta)
Anxious, worried, or upset during the past 3.91 4.45 -3.15 46 .003
month (Baton Rouge)

20. Self-Empowerment and Self-Efficacy
Improved
Navigating Opening Greater
Self-Esteem
Structural Access to Financial
and Self-
issues Resources Independence
Efficacy
“I’ve learned not to just settle less & continue to strive for higher goals.”
“I learned that it is good idea if go back to school”
“I can accomplish anything I put my mind to”

21. “Know that What You Do Can &
Does Change Lives”
• -Barry reentered the workforce and has a
monthly savings plan
• -Ary enrolled in community college and saved
$500 for emergencies
• Norman saved up enough money to purchase
a weed eater and provides lawn services

22. Study & Programmatic
Considerations
• Small samples
• Selection bias
• Social desirability bias
• Format length
• Additional content needs

23. What Did We Learn?
• Participants recognize their need for
improvement in financial areas
• Improved financial skills corresponded with
improved emotional well-being
• Future economic interventions could be
paired with HIV prevention programs

24. Thanks!
Program Participants
AIDS United (Formerly National AIDS Fund)
Emory University Office of University Community
Partnerships(OUCP)
Emory Center for AIDS Research (P30AI050409)