Positively Healthy has been very clear throughout its life that time is short. In fact since 1897 58 people involved with Positively Healthy have died from AIDS related diseases. Clearly, for many of our members there is not enough time to waste in outdated ways of working or in providing services that do not have a positive and direct impact on the lives of its members or service users. To this end Positively Healthy has built up a large pool of experience and of knowledge about what works. This knowledge comes from Positively Healthy's own experience as well as the work of many other people.

In their report of 1996 PACE(6) recommended that:

"HIV prevention initiatives engage in a model of on-going cumulative change and development, at the levels of the individual, their sexual relationships, and the gay male community as a whole, rather than pursing a dramatic quick-fix"

This is exactly the belief that lies behind the work of Positively Healthy. The telephone line introduces people to the workshops and from there participants develop long-term support relationships with each other and the organisation.

Further in their 1995(7) report the UK Coalition of People Living with HIV and AIDS state:

"We recommend that people living with the virus should be encouraged to engage with the specific organisations whose purpose is to provide for them. In the end, this will depend on their willingness to speak up."

Positively Healthy believes that in order for people to speak up they must have sufficient support and skills. It is the services that Positively Healthy provides that seek to develop service users' knowledge base as well as providing the necessary skills for them to make good use of that knowledge.

This is borne out by the recent publication from Camden and Islington Health Authority(8). In this document they state 7 key factors(9) that influence health behaviours around HIV and AIDS. These are:

1. Sufficient knowledge of the infection and of transmission
2. Acceptance of how severe the infection can be
3. Perception of personal risk to infection
4. A firm belief in effective change behaviour
5. Skills and motivation to make and sustain change
6. Availability of the means to change
7. Social influences

Positively Healthy actively seeks to ensure that these factors are developed in its community based services. We carry the most up-to-date information and concentrate as much on skills as information giving. In their report Camden and Islington state, in relation to community based action:

" Evaluation of this work shows it to be self sustaining in a way that is not always possible with formal approaches".

We believe that in developing the evaluation tools for these services it has been difficult to build tools that are relevant to the particular services that we provide. The medical tool of the randomised control trial is not always suited to these services because:

The service has often been provided by those most at risk and the necessity for immediate action has negated long term research(10) . In this model of evaluation the use of observational data is not considered a measure of effectiveness. Positively Healthy believes that this reductionist tendency loses much personal data that cannot be turned into mere numbers.

New tools need to be developed if this kind of work is to be evaluated on its own terms rather than in competition with purely statistical processes. In their publication Using Outcomes in HIV Prevention(11) Bonell and Devlin outline a number of possibilities for evaluation; controlled trials, single group time series analysis, cross sectional time series analysis and various qualitative methods.

Positively Healthy is willing to develop a process with Kingston and Richmond Health Authority (KRHA) that meets its purchasing needs and reporting responsibilities.

Research has shown that peer-led AIDS education and empowerment of the kind that is provided by Positively Healthy can be effective in both reducing risk related behaviour and in the increased use of protective action such as the use of condoms(12) . We also know of the research that shows that although there is a high awareness of knowledge about the risks of transmission amongst men who self-identify as gay or bisexual there is also a significant level of unsafe sexual practice in the community(13) .

In the document "Developing the Agenda"(14) there is the acknowledgement of the kind of community work of which Positively Healthy is a part, and the above services contribute to as well as the need for further and continued research and evaluation. It is with these arguments in mind that Positively Healthy is confident that its services are effective and that therefore this is AIDS money well spent.

Evaluation by Positively Healthy of its services.

A breakdown of the service users shows the following:

Further:

85% of service users are HIV positive or diagnosed with AIDS and
15% are not-tested or not declared.

In addition to collecting numerical data Positively Healthy provides an evaluation form for every session that it holds. Responses from participants on these forms includes the following:

"I have found this group a unique opportunity to gain support, share information and relax, encouraging healthier living, unlike other groups I've attended." 28 year old HIV positive man living in Richmond.

"This group has given me support in times of depression and severe emotional stress providing understanding and empathy. It's a place of cheering up, fun and happiness." 44 year old HIV status unknown man living in Richmond.

"The group allows you to exchange ideas that you may not have met before". 30 year old HIV positive man living in Kingston

"Tuesdays are now the centre feature of my week. My doctor cannot believe how well I am doing after having been so ill" 42 year old man diagnosed with AIDS living in Richmond.

"This group has helped me to communicate and interact with other gay men. It is also very useful for vocalising the way I feel" 22 year old HIV positive man living in Richmond.

"This is a non-judgemental, non-blaming space in which everything I say is totally validated and appreciated. More, much more, please." 33 year old man diagnosed with AIDS living in Kingston.

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