Transcript Non-Metro MSM HIV Prevention Profile

Non-Metro MSM Strategic Planning Meeting, January
23, 2009
Epi Overview
Jan 2007 – Dec 2009
• 1,244 HIV infections newly
reported to CDPHE
• 804 (64.6%) cases occurred
among MSM including MSM IDU.
• 129 (16.0%) of MSM cases
resided outside metro Denver.
HIV cases among NonDenver MSM
• 15 (11.6%) had hx of IDU.
• 36 (27.9%) discovered late in the course of
their infection.
• Median age interval: 30-34 years
• Majority of cases were White-NH (68.2%),
Hispanic (18.6%), or Black-NH (11.6%).
HIV Prevention in Colorado: A
Snapshot of Men Who Have Sex
with Men residing Outside of
Denver
Walls, N.E., Seelman. K., Ware, G. & Luerssen, S. (2010)
Survey Overview
• Internet and hardcopy survey available
in late summer, fall 2009
• Targeted MSM living outside metro
Denver
• 143 MSM participants
Participant
Characteristics
• Gay 93.7%; Bi 4.9%; Other 1.4%
• White 89.2%; Afr Amer/Black 1.4%; Asian Pac
Islander 4.3%
• Hispanic ethnicity 9.9%
• 49.6% had education beyond high school.
• 75% resided in an urban area (>25,000
population).
HIV Risk Behaviors
Among MSM
Unprotected insertive
anal sex
Never/Not in the past 12 months
55.0%
Once or twice in past 12 months
24.3%
About Once a month
9.8%
About once a week
4.3%
Twice a week or more
6.4%
Unprotected receptive
anal sex
Never/Not in the past 12 months
58.2%
Once or twice in past 12 months
28.4%
About Once a month
5.7%
About once a week
5.7%
Twice a week or more
2.1%
Unprotected sex with person
of different or unknown HIV
status
Never/Not in the past 12 months
75.5%
Once or twice in past 12 months
18.7%
About Once a month
2.9%
About once a week
0.7%
Twice a week or more
2.1%
Sex while drunk or high
Never/Not in the past 12 months
64.0%
Once or twice in past 12 months
23.0%
About Once a month
10.1%
About once a week
2.2%
Twice a week or more
0.7%
Context of Risk
Behaviors
Wider
Sociocultural
& Structural
Environment
Individual Level
Immediate
Social &
Structural
Environment
Political Environment
& Policy
Classism
Economic
Environment
Availability
of Resources
Racism
Religious
Ideals
Sexism
Homophobia
Physical Environment
(including HIV)
Cultural
Processes
Media
Main Partner
Teachers
Family
Friends
Mentors
Community
Peers
Sex
Partners
Faith
Community
Service
Providers
Character
of Settings
Internet
Contacts
Coworkers
Cultural Processes
Political Environment
& Policy
Main Partner
Economic
Environment
Age
Family
Availability
Classism
Gender
Friends of Resources
Mentors
Race/Ethnicity
Sexual Orientation
Community
Racism
Peers
Socioeconomic Situation
Religious
Personality
Ideals
Sexism
Personal History
Physical Status/Genetics
Faith
Sex
Community
Partners
Substance Use
Mental Status
Character
Homophobia
Cultural
Service
Spirituality
Of Settings
Providers
Processes
Teachers
Coworkers
Physical Environment
(including HIV)
Internet
Contacts
Media
Lifetime Experiences of
Psychosocial Risks
Victimization experiences in
past 12 months
Alcohol consumption
n=143
Never
12.6%
At least once in past 12 months
26.6%
2-4 times per month
27.3%
2-3 times per week
17.5%
4 or more times per week
16.1%
Consumed 5 or more
drinks in one sitting n=143
Never
51.7%
Less than monthly
28.7%
Monthly
9.1%
Weekly
8.4%
Daily or almost daily
3.1%
Drank or used drugs
more than meant to n=142
Never
66.9%
Less than monthly
22.5%
Monthly
5.6%
Weekly
2.1%
Daily or almost daily
2.8%
Alcohol and drug use in
the previous 12 months
Alcohol
87.4%
Downers
5.1%
Marijuana
40.4%
Meth
4.9%
Painkillers
25.5%
Crack
0.7%
Poppers
19.7%
Non-injected
heroin
0.7%
Injected heroin
0.0%
Powder cocaine
9.9%
Ecstasy, GHB, etc.
7.8%
Felt the need to cut down
on drinking or drug use n=140
Never
70.0%
Less than monthly
17.1%
Monthly
5.0%
Weekly
2.9%
Daily or almost daily
5.0%
Mental Health Symptoms in past
year
Experienced or witnessed traumatic events
63.1%
Loss of interest in pleasurable activities for more
than 2 weeks
44.3%
Sad, blue, depressed for more than 2 weeks in a
row
43.6%
Felt frightened, anxious, or worried for more
than one month
34.3%
Extremely energetic, irritable, more talkative
than usual
31.4%
Mental Health Symptoms in past
year continued
Panic attack – emotional
29.8%
Took meds for depression or nerve problems
28.4%
Flashbacks, nightmares about past
traumatic experiences
Panic attack – physical
27.0%
Depressed, sad, or blah mood most of the
time for two years
17.9%
24.8%
Biggest concerns of gay
men
Isolation/need for community
27.0%
Anti-gay bigotry/prejudice
23.8%
Contracting HIV/other STI
15.6%
Need for legal protection/civil rights
14.8%
Financial concerns
Health needs
3.1%
11.5%
Violence/Fear of violence
No concerns
5.7%
3.3%
Types of Desired
Relationships
Barriers to Desired
Relationships
Reasons for engaging in HIV
risk behaviors
Caught up in the heat of the moment
65.%
Want to feel close to someone
30.%
Don’t like condoms
30.%
Get drunk or high
28.%
To demonstrate, love, affection, trust
22.%
Feel pressured to have sex without a condom
22.%
Have trouble talking to partner about sex
13.%
Uncomfortable asking partner to use a condom
13.%
Afraid partner may think I don’t trust him/I’ve been unfaithful
9.%
Other reasons for engaging
in HIV risk behaviors
•
•
•
•
•
Don’t have control over my life
Condoms are not easily available.
HIV is not important to me.
HIV meds make HIV more manageable.
HIV meds makes it harder to transmit HIV.
Perceived frequency of
HIV status disclosure n=140
Never happens
2.1%
Rarely happens
18.3%
Happens Occasionally
45.8%
Pretty common
25.4%
Very common
7.7%
What affects whether or not men discuss HIV
status with sexual partners
Places for Meeting
Sexual Partners
Use and Perceptions of
HIV Prevention Services
and Activities
HIV Testing History
• 93.6% of respondents had been tested for
HIV.
• 51.7% had been tested in the past year.
• 48.3% had never tested or tested more than a
year ago.
Reasons Reported for Not Being Tested in
Prior 12 Months (Percentages)
Helpfulness of HIV prevention
services and activities
Somewhat/Very
Useful
Tested for HIV (n=95)
94.7%
Written Information (n=123)
83.7%
Info at community events (n=92)
83.7%
Talking with a medical worker (n=89)
83.1%
Helpfulness of HIV prevention
services and activities
Somewhat/Very
Useful
Free condoms, safer sex kits (n=97)
79.4%
Talked to someone from health department
(n=53)
Group to learn HIV prevention skills (n=73)
79.2%
HIV pamphlet/brochure (n=96)
Talked to substance use counselor (n=14)
78.0%
74.0%
71.4%
Helpfulness of HIV prevention
services and activities
Somewhat/
Very
Useful
Info from school or college (n=41)
68.3%
Picked up bleach kit (n=3)
66.6%
Needle exchange/free needles (n=3)
66.6%
Approached in a public place to talk about HIV
(n=36)
61.1%
Helpfulness of HIV prevention
services and activities
Talked to mental health worker
about HIV (n=31)
Somewhat/
Very
Useful
53.8%
Info on radio or TV (n=91)
52.7%
On the Internet (n=91)
47.2%
HIV info in prison or jail (n=8)
25.0%
Where respondents would likely use
HIV prevention services (n=143)
Healthcare clinics
57.3%
Community-based organizations
51.0%
Internet
46.9%
Bar or nightclub
34.3%
Health department
34.3%
Drop-in center
26.6%
High-risk behavior venues (e,g., bathhouses, parks)
25.2%
Radio, television
22.4%
With mental health services
16.1%
Other preferred
prevention venues
In someone’s home
14.7%
In my own neighborhood
11.2%
On the street/other public place
10.5%
With basic services
10.5%
Substance use treatment centers
9.8%
Places of worship
9.1%
Focus groups and interviews of
MSM living outside metro Denver
John Peters-Campbell
Growing Up
• Homophobic environment affected
self-esteem
• Poor education about sexuality or
gay sex
• Taught being gay wasn’t normal
• No role models; didn’t see healthy
gay relationships
Mental health
• Two bipolar; five had depression; several had
history of trauma
• Influences on risk behavior
• Low self-esteem common
Sexual abuse
• Three sexually abused as children; two as adults
• Affected later risk behaviors and ability to
establish relationships
Substance use
• Past use and addictions associated with high-risk
behavior
• No current high-risk behavior with substance abuse
Social Environment and
gay community
•
•
•
•
•
•
•
•
Half currently live in conservative, homophobic areas
Many MSM aren’t out and those who are keep it quiet
Affects high-risk behavior, especially among NGI MSM
Few social outlets for gay men; few places to meet other gay
men
Bars not good for establishing healthy relationships
Difficult to form community as gay men stay invisible
Gay community seen as divided, not supportive, nonaccepting of some gay men, not political around important
issues, etc.
Partners found on Internet, bars, public sex environments,
baths
Sexual activities
• Most seemed to think they were low risk for HIV; most
episodes of unprotected sex occurred in the context of a
steady relationship.
• Sex had many meanings: pleasing physical act; best in
context of love or emotional connection; unprotected anal
sex more intimate; way to give pleasure and share pleasure;
associated with negative experiences such as rape or being
cheated on by a partner, etc.
• Majority thought sex very important; a few offered that
other ways of connecting were more important .
Sexual activities
• Wide range of sexual behaviors
• Sexual activities changed over time (types,
frequency, safe or unsafe, etc)
• Unsafe sex explained by: emotional stress;
inability to negotiate safer sex; insecurity; lack of
role models around sexuality; excitement of
coming out; heat of the moment; willingness to
accept some level of risk
Why men engage in high-risk sex
• High risk men have misunderstandings about HIV and
risks: think being a top is low risk; think their partners are
low risk; are too trusting when partners say they are
negative; don’t know what living with HIV is like
• Poor mental health influences high-risk behavior: lack of
confidence; low self-esteem; depression; loneliness; need to
be accepted
• High-risk behavior influenced by substance abuse,
especially alcohol and meth
• Condom fatigue, heat of the moment, complacency, and
fatalism also factors influencing high risk behaviors.
Opinions about HIV Services
• Prevention messages seen as non-creative, overly
sex-negative, and outdated
• HIV testing in unavailable in many areas and there
are barriers to testing in some places where testing
is available
• Condoms are not available in bars
• Public information about HIV is lacking
• Prevention services in general are lacking
Sexual activities
• Safer sex strategies included: condom use (mostly
for anal sex only); avoiding ejaculate in mouth and
anus; always being a top; always being a bottom if
positive; serosorting if positive.
• Most had no problems with condoms; important
for reducing risk.
• Condoms thought to reduce sensation and affected
ability to keep an erection for some.
Opinions about HIV Services
• ManREACH seen as: great new approach;
community-building; encouraging mutual support;
providing a sense of belonging; addressing
emotional needs; fostering open discussions in a
safe environment
• ManREACH hasn’t been good at attracting
younger men
• ManREACH and related activities do not happen
enough and in enough places
Recommendations
• MSM need: community building; opportunities
to socialize, establish meaningful relationships,
share stories, discuss issues, discuss their sexual
behaviors and reasons behind them, and learn
more about being safe
• Expand ManREACH so that gatherings are
more frequent and happen in more places
Recommendations
• Increase HIV and STI education: comprehensive
education in schools including sexuality; information on
testing; education around disclosure; safer sex and
risks; clear up misinformation; more specific
information (e.g., epidemiological trends, HIV
medications, oral sex risk, alternatives to condom use,
etc.)
• Increase awareness-raising activities: increase public
information; use various media, especially TV; promote
prevention; get HIV back on the radar screen
Recommendations
• Educate parents, doctors, legislators, immigrants.
• Disseminate information on available services.
• Get rid of traditional “use a condom every time”
message.
• Use more sex-positive and peer-based messages.
• Educate people better about the reality of living with
HIV.
• Involve PLWH in prevention and getting messages out
to people.
Contact Information
George E. Ware, CDPHE, STI/HIV Section,
Research and Evaluation Unit Supervisor
Phone: 303-692-2762
E-Mail: [email protected]
Non-Metro MSM
HIV Prevention Profile
Content:
• Estimated Population Size
• Basic Epidemiological Information
• Description of Funded Programs that
Target Non-Metro MSM
• Potential Impact of the Funded
Service
Non-Metro MSM Strategic Planning Meeting, January 23, 2009
Estimated Population
Size (Range Estimates*)
At Risk, Rural MSM All Races:
5,078 – 5,372
Estimated Population
Size (Range Estimates)
* The population estimates were obtained
from the document, “CWT Prioritized
Population Estimates, 2004.”
Applied various recognized scientific
methodologies for estimating the sizes of
target populations as enumerated in the
2000 U.S. census.
Estimation likely to underestimate the size of
some risk populations due to the limitation
of the data, estimation techniques, and
accurate disclosure of risk behaviors to
CDPHE.
Basic Epidemiological
Information
Cumulative* Number of Living
HIV/AIDS Cases:
Rural White MSM:
Rural African American MSM:
Rural Latino MSM:
Rural Native American/
American Indian MSM:
508
60
124
4
*Refers to the total number of HIV, AIDS or HIV/AIDS
cases reported in Colorado since surveillance for
this condition began in 1982.
Basic Epidemiological
Information
Number of HIV/AIDS cases
reported in 2008:
Rural White MSM:
Rural African American MSM:
Rural Latino MSM:
Rural Native American/
American Indian MSM:
23
1
5
0
Description of Funded
Programs that Target
Non-Metro MSM
• Please refer to handouts for
program descriptions
Description of Funded
Programs
Description of Funded
Programs
Proportion of At Risk Non-metro MSM and Population Projected to
be Served
At Risk, Rural MSM All Races:
5,078 – 5,372
Projected to be served (n=2,545)
Result: Approximately 48.7% of the estimated population at risk to be served
Description of Funded
Programs
Ethnicity
8%
13%
Hispanic or Latino (n=327)
Not Hispanic or Latino
(n=1,915)
Not Targeted (n=207)
79%
Description of Funded
Programs
Race
2%
1%
1%
1% 4%
1%
American Indian/ Alaska Native
(n=19)
Asian (n=24)
Black or African American
(n=87)
NH/Asian Pacific Islander
(n=19)
White (n=1,912)
More than one race (n=20)
Race not targeted (n=44)
90%
Description of Funded
Programs
Program Content
• Geographic Reach
In theory, all rural counties of Colorado
will be targeted by these programs,
although final attendance results
may present a different picture. (Data
confirming actual participation by
county is not available.)
A description of specific counties
targeted for services are included in
the handouts.
Description of Funded
Programs
Program Content
• Testing
– Approximately 410 MSM will receive free
HIV testing (this year)
– 4 (possibly 5) out of 7 programs contain
a testing strategy as a component of the
program
– An additional 1,715 test kits were
distributed to CBOs and non-Metro health
departments in early 2010
Description of Funded
Programs
Program Content
• Behavioral Interventions:
All programs, except for the Atlas
program, are based on the
Colorado ManREACH program
Both Atlas and the ManREACH
programs are based on
Mpowerment model
Description of Funded
Programs
Program Content
• Behavioral Interventions:
Mpowerment model:
• Community-level intervention for young
MSM
• Uses informal and formal outreach,
discussion groups, creation of safe spaces,
social opportunities, and social marketing
to reach a broad range of young gay men
with HIV prevention, safer sex, and risk
reduction messages.
Description of Funded
Programs
Program Content
• Behavioral Interventions:
ManREACH:
• Colorado ManREACH was developed
by and for Colorado MSM who reside
outside the Denver metropolitan
area.
• It is an adaptation of the
Mpowerment Program Model
Description of Funded
Programs
ManREACH – Gatherings:
Intent:
1. Increase sense of community and increase
in self esteem
2. Increase HIV-related knowledge
3. Healthy changes in attitude, beliefs, and
behaviors
4. Decrease feelings of isolation
5. Decrease substance abuse
6. Reduce number of sex partners and other
high-risk transmission behaviors, including
unprotected receptive intercourse
Contact Information
Anne Marlow-Geter, CDPHE, STI/HIV
Section, Planning Unit Supervisor
Phone: 303-692-2736
E-Mail: [email protected]