Homelessness – CHIPTS – Center for HIV Identification, Prevention and Treatment Services

24Jan

Community Health Study

There have been few attempts to monitor the risk behaviors and HIV seroprevalence among the general population.

Understanding the HIV epidemic in Los Angeles requires establishing an integrated, multilevel surveillance system for HIV, sexually transmitted diseases (STDs), and the Hepatitis C virus (HCV). Information about sexual and substance use risk behaviors, HIV seroprevalence, and public knowledge, attitudes, and norms regarding HIV are needed for public health planning. A surveillance system will be required in order for Los Angeles to maintain funding for Ryan White and other federal and state funding sources. To begin to develop a method for mounting a comprehensive surveillance system, the City of Los Angeles is planning a study examining the acceptability of anonymous HIV testing and volunteering information about one’s risk behaviors in order to allow planning for HIV-related services.

Most studies of HIV seroprevalence and risk behaviors have been conducted with subgroups identified at high risk for HIV: young gay men, injecting drug users, homeless adolescents, or seriously mentally ill adults. There have been few attempts to monitor the risk behaviors and HIV seroprevalence among the general population (not necessarily from identified high-risk groups). Before any comprehensive surveillance system can be established, the ability to monitor HIV in community settings and among households in neighborhoods with high rates of AIDS cases must be established. To fill this gap, a two-phase project is being initiated by the city in order to assess the acceptability of HIV testing and reporting one’s risk behaviors when approached: 1) in a household survey; or 2) in a neighborhood setting such as a shopping mall, grocery center, theater, or church.

First, the acceptability of gathering HIV-related information from a household will be examined by conducting a supplement to the Los Angeles Health Survey that will be mounted this summer. An anonymous telephone interview will be conducted with random digit dialing of households within the City of Los Angeles. Randomly selected telephone numbers (n=100) will be surveyed on knowledge of transmission of HIV, attitudes and norms towards members of high-risk groups (e.g., gay men) and infected persons, and willingness to anonymously be tested for HIV. All responses will be recorded unlinked from telephone numbers selected by random digit dialing; therefore the identify of all respondents will be unknown and can never be traced. From gathering this information, the acceptability of a household approach as a method of gathering information about HIV-related information will be assessed.

Second, a community with a high rate of AIDS cases will be selected. In this neighborhood, local leaders will be consulted to identify a strategy for sampling community members anonymously and in settings accessible to all community members. In shopping malls in both communities, adults will be asked to anonymously volunteer to participate in a survey of attitudes and norms regarding HIV prevention activities, recent sexual and substance use risks acts, and consent to a saliva-based HIV test. The results of any individual test results will not be available; unmarked samples will be collected in order to indicate a community seroprevalence rate. Interested individuals will be offered an incentive for participating in the survey and test. The willingness of adult members of the community to participate in a study anonymously will be evaluated. Similar to the telephone household survey, no identity of any participant will be obtained. Overall, community rates will be obtained, but no individual information regarding risk or infection status.

The results of these two activities will be used to inform the Los Angeles County Board of Supervisor’s decisions regarding the best method for establishing surveillance methods for HIV infection and predictions regarding the future routes and subgroups for HIV infection. Currently, the County is considering adopting a method of practitioners informing public health officials of all persons testing seropositive for HIV or for a system of unique identifiers for persons who test seropositive for HIV. Both of these systems rely on the identification of seropositive persons, an event that typically occurs about 10 years after a person has become infected. Alternative strategies for monitoring the epidemic, especially among communities with an emerging epidemic must be identified. These studies will inform the strategy selected by the County and may become a national model.

24Jan

Hep-Safe Hollywood

Homeless, stimulant-using gay/bisexual men and transgender women are at high risk for hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV infection due to high rates of injection drug use and high-risk sexual behaviors. Thus, use of stimulants threatens to intensify homeless persons’ risk of exposure to hepatitis B, C viruses and HIV; therefore, research focused on this group is critical. A contingency management (CM) intervention may be particularly well suited for this high-risk population. CM is an intervention that attempts to modify a targeted behavior by providing incentives for changing that behavior (in simple terms, positive reinforcement). CM interventions have been successfully implemented among stimulant-using gay and bisexual men to reduce drug use and concomitant sexual risk behaviors.

The Hep-Safe Hollywood study will implement a CM intervention to increase successful HAV/HBV vaccination completion programs among homeless, stimulant-using gay/bisexual men and transgender in Hollywood. This randomized, control trial will assign 500 homeless, stimulant-using gay and bisexual men to either an enhanced nurse case managed program, which includes specialized education and CM, or a standard program, which includes brief education and CM. This study is innovative in that it will allow us to look at the effect of an enhanced nurse case management and CM program versus a standard brief education and CM program. The study will evaluate the effectiveness of homeless, stimulant-using gay/bisexual men and transgender women on completion of the HAV/HBV vaccine and, secondarily, on reduction of risk for hepatitis and HIV. Additionally, the study will assess the relative cost of these programs in terms of completion of the vaccine series. The study combines best strategies to approach, engage and intervene with this hidden and high-risk population and to assess the feasibility and efficacy of interventions that may prove beneficial in preventing hepatitis A, B, C and HIV infections.

This study is a collaboration between UCLA School of Nursing and Friends Research Institute, with Dr. Adeline Nyamathi, as the principal investigator.

23Jan

Project i (Prevention Among Homeless Youth)

A number of studies have informed us about the substantial risk for HIV associated with chronic homelessness among youth in both the U.S. and Australia, even though these studies have typically been cross-sectional or samples of convenience. To understand the high seroprevalence rates among older homeless youth, the developmental trajectories into and out of risk for HIV and homelessness can best be understood from longitudinal studies of first time runaways, in which contextual factors (the national, community supports, street experiences, peers, and family) that influence these trajectories can be identified and observed over time.

The National Institute of Mental Health (NIMH) funds this study of new homeless young people. The purpose of the study is to understand the life course of new homeless youth and runaways. The study focuses on the many sources that are influencing youths pathways into and out of homelessness and risk for HIV, such as a youth’s family background, individual characteristics, personal resources, street experiences, peer social networks, interactions with social service providers, and informal support systems.

PROJECT i is following new homeless youth over time to see if they become more similar or dissimilar to experienced homeless youth. We know that among homeless youth, remaining homeless may only serve to increase their risk for HIV. This suggests a critical need to find ways to divert new homeless youth from the path of chronic homelessness and greater risk for HIV infection. The results of the study will be used to design interventions for new homeless youth to reduce their risk for HIV and to help inform service providers who may influence the life course of runaways and homeless youth and as a result help decrease their risk for HIV and becoming chronically homeless.

Approximately 240 youth, ages 12 to 20 years, are being recruited throughout various parts of Los Angeles County. A similar sample is being recruited in Melbourne, Australia. Youth who report having left home no more 180 days are eligible to participate in the study. An additional 200 youth per year, ages 12 to 20 years, who report having left the home for more than 180 days and who do not meet the above criteria, are eligible to participate in a one-time interview as part of a comparison group.

Following a baseline interview, study participants are interviewed at three months and then every six months for a total of eight interviews over a three-year period. Interviews take approximately one hour to complete. The baseline interview is conducted at the shelter or center where the youth was recruited. Follow-up interviews are conducted at a place convenient for the youth.

20Jan

Voucher-based Incentives in a Prevention Setting (VIPS)

Interventions, Training Manuals, etc. :

[Download not found]
[Download not found]
[Download not found]

Homelessness is a significant problem plaguing American cities and homeless substance abusers face increased risks. Homeless, gay and bisexual male abusers suffer approximately 80% seroprevalence and often engage in exchange sex and resist treatment for substance abuse. Contingency management interventions, which provide positive incentives for behavior change, may be particularly well suited for this disenfranchised, high-risk cohort. Specifically, voucher-based incentive therapies may be effective since they have established potency for increasing prosocial behaviors that successfully compete with taking drugs and for reducing drug use.

A randomized, controlled trial assigns 131 non-treatment seeking gay, bisexual or MSM substance users to either voucher-based incentive therapy or control groups for 24 weeks, with follow-up evaluations at 7, 9 and 12 months post randomization. The voucher-based group earns vouchers in exchange for completing prosocial and healthy behaviors, and/or submitting drug-negative urine and alcohol-negative breath samples, and/or attendance in a standard HIV prevention program, OAPP-funded The G.U.Y.S. Program. The control group receives feedback regarding behaviors performed and urinalysis and breathe alcohol tests, but does not receive voucher points for these behaviors, but does receive vouchers for attendance in a standard HIV prevention program, The G.U.Y.S. Program. Vouchers are redeemable for goods located in an onsite voucher store or purchased for the participant.

The study will assess the efficacy of the voucher-based intervention for increasing prosocial and healthy behavior and reducing substance abuse among these non-treatment seeking gay, bisexual and MSM substance users receiving standard HIV prevention services. The study will also assess the impact of the voucher-based incentive therapy on other measures of therapeutic change consistent with a harm reduction approach, including reduction of psychiatric symptoms, decreased injection drug use and high-risk sexual behavior, increased participation in The G.U.Y.S. Program, and improvement in different domains of overall functioning (medical/social/vocational). Additionally, the study will examine whether baseline participant characteristics predict voucher-based outcomes.

Applying voucher-based incentive therapy to non-treatment seeking gay, bisexual and MSM substance users as well as integrating the intervention into a county-funded HIV prevention program with a harm reduction philosophy are both highly innovative. The VIPS study has the potential to have a significant impact on the public health of the Los Angeles homeless, gay and bisexual substance-using community. If voucher-based incentive therapy is efficacious for motivating non-treatment seeking gay, bisexual and MSM substance users in a community-based HIV prevention program to increase prosocial and healthy behaviors and decrease drug/alcohol use, established prevention programs may modify their approaches to include contingency management, and use it to address the staggering public health problems non-treatment seeking homeless substance users face on a daily basis.

20Jan

Guys Understanding Your Situation (G.U.Y.S. Program)

Interventions, Training Manuals, etc. :

GUYS Skills Building Manual: Health Education and Risk Reduction Intervention
[Download not found]

The G.U.Y.S. Program offers a multi-tier health education/risk reduction (HE/RR) intervention – utilizing both individual and group-level interventions – designed to reduce high-risk sexual and drug behaviors among homeless, substance-using gay men and non-gay identified men who have sex with other men, and with women, and with transgender women. Most specifically the intervention targets sexual risk behaviors that are most likely to occur while using methamphetamine, particularly unprotected anal intercourse, as well as exchange sex risks and injection drug risks.

The program consists of a comprehensive, culturally appropriate, continuum of services that includes outreach, individual-level interventions (ILI), skills building group-level interventions (GLI) and art support GLIs. Follow-up ILI assessments are conducted at 30, 60 and 90 days. Face-to-face street outreach is conducted in identified high-risk areas of Hollywood and West Hollywood and in the natural settings where homeless, substance-using men congregate. The program has successfully worked with these populations in highly charged sexual arenas and developed non-invasive outreach and intervention strategies for these venues, which vary based on the safety and atmosphere of each public or commercial sex environment. The skills building GLI component of the intervention serves to increase knowledge and awareness of HIV risk behaviors and develop skills to decrease HIV risk behaviors. Concurrently, the art support GLI component of the intervention serves to increase social support and self-esteem. Art is used as a harm reduction strategy by offering an opportunity for participants to closely identify their feelings and work towards understanding many of their high-risk behaviors. The art support GLI provides a space to cultivate their voice and express their experiences through art. Both the skills building GLI and art support GLI – working concomitantly with the outreach encounters and ILI – motivate ongoing and maintained HIV risk reductions and gear participants’ towards HIV testing to identify their HIV status and, finally, develop skills for disclosing HIV status.

20Jan

Street Smart Uganda; UYDEL

Targeted Risk Group:

Urban Ugandan youth (UYDEL)

Street Smart was an intensive HIV/AIDS program for slum youths whose behaviors place them at risk of becoming HIV infected. It was implemented in collaboration with Uganda Youth Development Link.

Based on the fact that adolescence is a time of experimentation and developmental change in behavior, thoughts and emotions, Street Smart linked feelings, thoughts, emotions and attitudes to behavior change.

In 2007, nearly 1 million young people became infected with HIV in sub-Saharan Africa. Existing prevention programs have not been effective, prompting more attention toward the social determinants of HIV, such as unemployment. Without hope for the future, it is unlikely that young people will be motivated to remain free of HIV, as poverty creates vulnerability to survival sex or sex without condoms. The Street Smart intervention was developed in the United States to eliminate or reduce HIV risk behaviors among young people. Despite its success, it does not address the problems of economic vulnerability and investment in the future. The aim of this study was to test the added value of vocational training provided to urban Ugandan youth, in addition to the Street Smart HIV prevention program.

Download the UYDEL 2010 brochure here: Uganda Youth Development Link (UYDEL) (2010) - Brochure

Interventions, Training Manuals, etc. :

Intervention model:

Street Smart consists of a total of 10 sessions (eight two- hour group sessions, one individual session and a group visits to a community health resource), exposes youth to information regarding HIV/AIDS, drug abuse, condom use, personalized risks, negotiating safer sex, recognizing and coping with feelings and self talk. Intervention sessions included participatory discussions, role-plays & use of tokens. Participants were divided into groups consisting of 8 to 9 members per group. Each group attended 3 sessions a week, each session lasting an average of 2hrs and 30 minutes.

Research Methods:

The project included a total of 50 street and slum youth from two slum centers in Kampala. Participants completed a behavioral assessment at baseline and at 4-months. Twenty-five participants from one slum center initially served as the control group and received the intervention after their 4-month follow-up assessment. Twenty-five participants from the second slum center received the 10-session HIV prevention intervention immediately following their Baseline assessment.

Local Significance:

A total of 24 participants (96%) completed the entire 10 session intervention. The youth were also linked to important support services available to them. Given the small sample size and limited statistical power, longitudinal hierarchical linear models to examine the efficacy of the intervention were not appropriate. However, feedback gathered from both the youth participants and research staff, the intervention was very well-received. The youth’s engagement in the intervention is also apparent in the extremely high completion rate of the intervention.

International Significance:

There were two primary objectives to the collaboration with Uganda Youth Development. The first objective was to build the research capacity and skills among the team of Uganda collaborators. During the course of the project, the UCLA team conducted non-formal and formal training activities in Uganda. The second objective was to adapt, implement, and evaluate the efficacy of the adapted HIV prevention intervention with street and slum urban youth in Kampala, Uganda. This was accomplished through the collaborative effort of the UCLA researchers and the Uganda research team.

The Street Smart intervention continues to be implemented by the staff at UYDEL, demonstrating the staff support and commitment to the intervention and the work completed through the research. Mr. Rogers Kasirye has consulted with other Ugandan agencies regarding the development of interventions and research with street and slum youth in Uganda.

Despite some study limitations, the results suggest that at 4 months the vocational training program improved employment, satisfaction with life, and social support; and reduced delinquent behaviors. Vocational training plus Street Smart improved social support and reduced sexual risk-taking, delinquent behavior, and substance use at 2 years. Fewer than half had ever worked prior to the program, but over 80% were employed at 2 years. Larger trials of HIV interventions addressing social determinants are warranted.

20Jan

Support To Reunite, Involve and Value Each Other (STRIVE)

The STRIVE program aimed to improve residential stability and the quality of residential life, reduce the number of runaway episodes, as well as reduce HIV-related sexual and substance use risk acts. Family conflict is found to cause runaway episodes for youth. Targeting newly homeless youth, this study developed and implemented a 5-session family-based intervention. STRIVE sessions take place with families while youth are still in shelters and/or being served by community agencies, and as they transition back to the home.

Surveys and Scales Used:

Targeted Risk Group:

Newly homeless youth in Los Angeles

Intervention model:

A behavioral family-based intervention model was used to address family conflict and promote positive family-child interactions.

Research Methods:

This study consisted of two phases Phase 1 was focus groups and key informant interviews to develop research design, measures, an intervention activities. Phase 2 implemented family intervention sessions with baseline and 3, 6, 12, 18, 24 month follow ups.

Local Significance:

Positive outcomes for reducing HIV risk behaviors and improving mental health.

International Significance:

N/A

20Jan

Street Smart (US)

Runaway and homeless youth have a national seroprevalence rate of 2.3%, a rate about six times higher than adolescents in the major AIDS epicenters.

Links to Interventions, Training Manuals, etc. :

Targeted at homeless and runaway youth, the Street Smart intervention was designed to reduce high-risk sex and drug using behaviors that can lead to HIV infection. However, 12 months after the original intervention, relapse occurred in approximately 15% of those who had previously changed their behavior, and long-term effects were only found in girls. Street Smart: Skills Maintenance addressed the problem of relapse by delivering an additional intervention post-Street Smart, Stayin’ Street Smart. Stayin’ Street Smart was a website that provided skill training, social support, informational updates, and access to an expert for consultation, including problem solving for emerging crises.

In addition to measuring the effectiveness of the maintenance intervention, Street Smart: Skills Maintenance examined the program’s effect over time on multiple problem behaviors (sex work, conduct problems, delinquency, school/employment, violence, chronic homelessness), examined the acceptability of the strategies by youth, and documented patterns of maintenance over time.

Participants:

Approximately 474 homeless and runaway youth between the ages of 12-24 were recruited through community-based agencies and homeless shelters in Los Angeles, CA.

Targeted Risk Group:

Homeless and runaway youth between the ages of 12-24

Local Significance:

Research on the use of Street Smart documented positive outcomes in reducing sexual risk behaviors among females and substance use among both male and female runaways over 2 years (Rotheram-Borus et al. 2003). Outcomes from Street Smart: Maintenance have not been published.

International Significance:

Globally, there are approximately 100 million homeless youth (UNICEF 1989). Strategies to maintain reductions in sexual risk behaviors and substance use found to be effective in homeless and runaway youth in the United Stated could be adapted to help homeless and runaway youth in other countries

20Jan

CLEAR Uganda; SUUBI Project

Choosing Life Empowerment Action Results is a behavioral change research project being implemented by Uganda Youth development Link (UYDEL) in collaboration with support from University of California, Los-Angeles. It is a result project known as CLEAR tried in the USA in the cities of Los Angeles and New York by the Center for Community Health (CHIPTS) to assist young people living with HIV/AIDS. Uganda and Kampala in particular, face increasing numbers of HIV/AIDS infections among young people living on the streets and slums. This project targets street and slum youth, 13-23 years living with HIV/AIDS in Rubaga and Kawempe Divisions of Kampala district.

Interventions, Training Manuals, etc. :

Original RCT Protocol 1998-2002

Module 1

Module 2

Module 3

Workbooks

20Jan

Youth LIGHT

Youth LIGHT was a study to address critical gaps in research on HIV/AIDS prevention with high risk youth, offering an opportunity to shift patterns of sexual risk behaviors among delinquent youth at risk of becoming HIV seropositive adults. An intervention with established efficacy for high risk adults, Project LIGHT, was adapted for high risk adolescents. Youth LIGHT tested the hypothesis that a computerized version of Project LIGHT would be as efficacious as the interpersonal, small-group delivery of the intervention in reducing the sexual risk behaviors of delinquent youths. Youth LIGHT was intended to appeal to youth by changing the traditional methods for teaching and sharing information while getting them to think about their HIV and STI risk behaviors. The study was conducted in partnership with the Los Angeles County Office of Education, and the Juvenile Division of the Superior Court for the County of Los Angeles.

Targeted Risk Group:

Male and female at-risk youth between 14-21 years old, attending LA County alternative education high schools located in the community and in juvenile hall camps.

Interventions, Training Manuals, etc. :

Youth Light Workbook

Session 1: Introductory education/preparedness – basic information about HIV/AIDS; motivation for self-protection
Know one another, and begin to learn each other’s names.v Learn about the project (schedule, ground rules, payment). Begin to develop a sense of group cohesion, identity and ownership by participating in group activities and developing group rules and rituals. Group activity to distinguish facts and myths about AIDS. Identify personal values and positive reasons to stay healthy through group brainstorm. Identify one personal risk factor for AIDS. Identify positive changes they have already made in their lives. Begin to learn about AIDS prevention strategies including condom use and HIV testing.	Meet the animated characters featured throughout the programv Learn about the project Introduce and explain the workbook Identify personal values and positive reasons to stay healthy by computer activity and workbook Play game to distinguish facts and myths about AIDS. Complete computerized personal risk assessment and receive feedback regarding likely risk of contracting HIV or other STD. Learn facts and statistics regarding HIV transmission and infection Complete quiz regarding HIV transmission
Session 2: Identifying triggers – personal vulnerability; identifying personal antecedents to risk behavior
Relate one example of HIV/AIDS content encountered since the last session.v Watch video of persons living HIV Verbalize one personalizing comment indicating heightened vulnerability. Learn to define and identify “trigger” through a group brainstorm. Identify one past incident of personal risk behavior on worksheet. Identify one personal risk trigger on worksheet. Identify one personal goal for the coming session. Read and seriously consider signing a Contract of Commitment given by facilitators.	Watch video of young people living with HIVv Record in workbook one personalizing comment indicating heightened vulnerability. Learn to define and identify “trigger” through computer interaction. Record in workbook one past incident of personal risk behavior. Record in workbook one personal risk trigger. Choose one personal goal from a list to try before logging on again. Read and seriously consider signing the Contract of Commitment contained in the workbook. Complete quiz regarding triggers
Session 3: Controlling triggers – problem solving and cognitive self-instruction
Learn the basic steps of problem solving related to HIV risk reduction through a group exercise. Apply the problem-solving steps to a variety of hypothetical situations generated by the group that require the handling of risk triggers. Generate ask a group a personal list of self-statements to guide behavior change efforts. Set personal goal for handling at least one personally relevant trigger for next session.	Learn the basic steps of problem solving related to HIV risk reduction through interacting with animated character.v Apply the problem-solving steps through modeling from animated character and computer guided workbook exercise. Play game about strength of self-statements to guide behavior and record personal list of self-statements in workbook. Choose a goal related to handling a common and relevant trigger to try before logging on again. Complete quiz regarding steps to problem solving
Session 4: Condom skills – practice use of male and female condom; needle cleaning skills
Sort sexual activities by their safety level as a group.v Identify the safest condom and lubricant types available. Demonstrate the proper way to place and remove a male condom. Demonstrate the proper way to place and remove a female condom. Describe the proper way to clean needles.	Sort sexual activities by their safety level in a game.v Watch a demonstration of the proper way to place and remove a male condom Watch a demonstration of the proper way to place and remove a female condom Choose one personal goal from a list related to proper condom choice and use to try before logging on again Complete quiz regarding steps to proper use of male and female condoms
Session 5/6: Protecting myself– assertive communication
Identify “unwritten rules” of social behavior that can influence people to be unsafe.v Learn the three types of communication: assertive, aggressive, passive. Apply the TALK tools for refusing unsafe sex and/or requesting safe sex through role-play with other group members.	Learn how “unwritten rules” of social behavior can influence people to be unsafe.v Learn the three types of communication: assertive, aggressive, passive. Watch video of youth negotiating for condom use Apply the TALK tolls for requesting safe sex through interaction with avatar that is recorded and played back.
Session 6: Maintenance and relapse prevention – reinforcement of previous skills and advocacy
Identify situations that might lead to relapse.v Learn to deal effectively with potential relapse situations. Identify self-rewards for maintaining safer sex behavior Identify ways to make safer sex more enjoyable. Learn ways in which to “spread the word” about what was learned in the group	Learn how skills of problem solving and self talk can help one effectively deal with relapse through interacting with animated character.v Watch as animated characters identify self-rewards maintaining safer sex behavior. Watch as animated characters identify ways to make safer sex more enjoyable Learn steps with modeling from animated characters about ways to “spread the word” about what was learned from the program

Intervention model:

To illustrate the operations of the computer intervention, we have constructed a table which illustrates the parallel structure between the small group Project Light, and Project Light delivered via computer.

Research Methods:

Students aged 14 to 18 years attending 22 alternative education high schools located in the community and in juvenile hall camps were assessed at baseline and 3, 6 and 12 months. The baseline and follow-up assessments required about 1.5-hour to complete. Each recruitment school was randomized into one of three study conditions: 1) Interpersonal Intervention, 2) Computerized Intervention or, 3) Control. Students attending the same school received the same intervention condition.

Local Significance:

Results from the pilot of this study support the use of computers as a tool for HIV prevention. Youths receiving the computerized intervention were successful in reducing their sexual risk behaviors.

International Significance:

Computerized interventions, which are relatively easy to implement and sustain, appear to be a potentially effective means of promoting reductions in HIV-related sexual risk behaviors. Interactive computer programs may help youths learn skills to prevent HIV infection and instill in these youths the self-efficacy to apply these new skills. These attributes may be particularly useful in international settings where concerns of cost-effectiveness and ease in dissemination are of paramount importance.

Start of Project:

January 1, 2002

Posts classified under: Homelessness

Download the UYDEL 2010 brochure here: Uganda Youth Development Link (UYDEL) (2010) - Brochure