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Santa Clara County 2012-2014 Comprehensive HIV Prevention and Care Plan
Activity Tracking Form - Please fill out one form PER event that you complete.
The Santa Clara County HIV Planning Council For Prevention and Care thanks you for being a part of the continuum of prevention and care in our county.Please assist us by completing this form about activities or events your organization has sponsored. You may review our Comprehensive Plan by going to
http://www.sccgov.org/sites/sccphd/en-us/Documents/Santa%20Clara%20County%202012-2014%20Comprehensive%20HIV%20Prevention%20Care%20Plan.pdf
.
Please contact Planning Council Support if you have any questions at
hivplanningcouncil@phd.sccgov.org
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* Indicates required question
Name of Event/Activity:
*
Your answer
Date(s) of Event/Activity:
*
Your answer
Organization Sponsoring Event/Activity:
*
Your answer
Person(s) completing this form:
*
Your answer
Phone number:
*
Your answer
E-mail:
*
Your answer
Please select the following categories that apply to your event/activity. (Please check all that apply)
Goal 1: Reduce the number of new HIV infections.
1a. Conduct targeted outreach to youth (ages 13-24).
1b. Promote linkages to STD clinics where people can be tested/counseled/treated for all STDs.
1c. Maximize use of social media and internet mechanisms to reach targeted communities.
1d. Conduct targeted outreach to people living with or at risk for HIV or AIDS, with a special focus on men who have sex with men, older adults, injection drug users, African Americans, Asians/Pacific Islanders, Latinos, women, transgender individuals, and other populations.
Other:
Goal 2: Increase linkages into care.
2a. Promote linkages to care for people who recently tested positive for HIV.
2b. Promote linkages to care for recently-released incarcerated people.
2c. Promote linkages to care for people who have fallen out of care.
Other:
Goal 3: Provide comprehensive high-quality health care.
3a. Foster a network of providers across Santa Clara County that extends beyond the Ryan White-funded community.
3b. Minimize barriers for clients to receive services.
3c. Leverage volunteers to help PLWH/A and their caregivers navigate the system.
3d. Provide high-quality health care for PLWH/A.
Other:
Goal 4: Increase community awareness and involvement, and decrease stigma.
4a. Refine existing efforts for receiving continuous community input.
4b. Raise awareness about HIV among the residents of Santa Clara County.
4c. Engage PLWH/A to be advocates in the community.
4d. Engage AIDS service providers and other providers in issues facing PLWH/A.
4e. Measure and increase awareness about community HIV viral load.
Other:
Describe the event.
*
What activities did you do?
Your answer
Target Population for Event:
*
(i.e. African Americans, Latinos, Youth, MSM, etc.)
Your answer
Key outcome(s):
*
(i.e. number of people served and was it successful?)
Your answer
Next steps & follow-up:
Your answer
Comments:
Is there anything else you want to tell us about your event?
Your answer
If you have any additional notes and/or key documents pertaining to your event (e.g. meeting agendas, work plans, etc), please e-mail them to the Planning Council at
hivplanningcouncil@phd.sccgov.org
.
Thank you for your assistance in helping us monitor HIV prevention and care activities in Santa Clara County! We welcome any feedback that you can provide us about this survey to the Planning Council!
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