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A community needs assessment to inform HIV and substance abuse prevention services for young men who have sex with men of color (YMSMOC) in New York City.

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Presentation on theme: "A community needs assessment to inform HIV and substance abuse prevention services for young men who have sex with men of color (YMSMOC) in New York City."— Presentation transcript:

1 A community needs assessment to inform HIV and substance abuse prevention services for young men who have sex with men of color (YMSMOC) in New York City Matthew B. Feldman, Ph.D., LCSW Assistant Director, Health Outcomes GMHC

2 Substance Abuse and Mental Health Services Administration Center for Substance Abuse Prevention 5-year grant to provide HIV and substance use prevention services to high-risk populations Target population: year old Black and Latino MSM living in the 5 boroughs of New York City

3 HIV among YMSMOC in New York City New HIV diagnoses in males years old increased by 9%, from 829 in 2006 to 901 in 2007—75% of these diagnoses were made in MSM 37% of the new infections among MSM in 2006 were people under 30 years-old. Almost half of the newly infected MSM under 30 were black (45%) and 34% were Latino NYC DOHMH, 2008

4 Strategic Planning Framework Needs Assessment Capacity Building Strategic Plan Implementation Evaluation

5 Community Needs Assessment The nature and extent of the problem The conditions that contribute to the problem The resources that currently exist The gaps in resources

6 Guiding Principles Empirical evidence will be used to inform the development and implementation of the CSAP program. YMSMOC will be included in all five phases of the strategic planning framework as collaborators in developing the CSAP program. The CSAP program will complement existing services for YMSM in New York City by offering programs that address gaps in care for this population.

7 Specific Aims To define the nature and extent of HIV infection, HIV sexual risk behavior, and substance use among YMSMOC in the five boroughs of NYC To identify neighborhoods statistically associated with HIV infection by examining incidence and prevalence data among YMSMOC in NYC To identify the underlying risk and protective factors for HIV infection and HIV sexual risk behavior among YMSMOC

8 Specific Aims. 4. To identify programs at GMHC that currently work with YMSMOC, in addition to the steps that need to be taken to increase the capacity of the organization to provide services to this population 5.To identify existing services for YMSMOC in NYC in addition to potential gaps in care for this population 6.To identify recommendations for the CSAP program based on the findings of the needs assessment

9 Methods Epidemiological data from the New York City Department of Health and Mental Hygiene (NYC DOHMH): HIV surveillance data Community Health Survey Peer-reviewed literature (The Young Men’s Survey, The Community Intervention Trial for Youth) Focus groups with target population Interviews with staff who work with YMSMOC at GMHC and other organizations in NYC

10 Objective 1 To define the nature and extent of HIV infection, HIV sexual risk behavior, and substance use among YMSMOC in the 5 boroughs of NYC

11 Testing history reported at the time of HIV test

12 HIV status reported at the time of HIV test

13 HIV test results

14 YMSMOC who received an HIV-positive test result (n= 26)

15 Community Health Survey YMSMOC, years

16 Hepatitis B among YMSM

17 Sexually Transmitted Infections among YMSM

18 Unprotected anal intercourse among YMSMOC

19 Recent drug use among YMSM (Thiede et al., 2003)

20 Lifetime drug use among YMSM (Harawa et al., 2004)

21 Recent alcohol use among YMSM

22 Objective 2 To identify neighborhoods statistically associated with HIV infection by examining incidence and prevalence data among YMSMOC in New York City

23 Residence patterns of YMSMOC by United Hospital Fund (UHF) neighborhood in NYC, 2008

24 New HIV diagnoses in YMSMOC in NYC by UHF neighborhood, 2007

25 YMSMOC in NYC living with HIV/AIDS by UHF neighborhood (as reported to the NYC DOHMH by September 30, 2008)

26 Objective 3 To identify the underlying risk factors for HIV infection, HIV sexual risk behavior, and substance use among YMSMOC

27 Risk and protective factors for HIV among YMSMOC What explains the disproportionately high prevalence of HIV among YMSMOC compared to white YMSM? Identifying risk and protective factors for HIV infection among YMSMOC to guide intervention development and implementation

28 Black YMSM and White YMSM Black YMSM are just as likely or less likely than white YMSM to: Engage in unprotected anal intercourse Have multiple sexual partners Use club drugs, alcohol, injection drugs, crack cocaine Engage in sexual activity because of drinking

29 Black YMSM and White YMSM Black YMSM are more likely than white YMSM to be: HIV-infected unaware Diagnosed with Hepatitis or Herpes Black YMSM are just as likely as white YMSM to get tested for HIV

30 Black YMSM and White YMSM Sexual networks: race, age, level of risk of sexual partners Assortative mating: engaging in sexual contact with people from the same background Dissortative mixing: engaging in sexual contact with people who are at a higher or lower risk for HIV/STI infection

31 Latino YMSM and White YMSM Latino YMSM are just as likely as white YMSM to: Engage in unprotected anal intercourse Use alcohol, injection drugs, crack cocaine Use drugs or alcohol during sex. Latino YMSM are just as likely as or less likely than white YMSM to: Have multiple sexual partners Use club drugs

32 Latino YMSM and White YMSM Latino YMSM are just as likely as or more likely than white YMSM to be HIV-infected unaware Latino YMSM are just as likely as or less likely than white YMSM to have a sexually transmitted disease. Latino YMSM are just as likely as white YMSM to get tested for HIV

33 Protective factors against HIV sexual risk behavior Black YMSM: Family Support Peer norms around condom use Latino YMSM: Education Family Support Ethnic identification/ethnic community attachment

34 Focus Groups 2 focus groups with the target population Total of 22 YMSMOC (82%, Black; 6%, Latino) Discussed perceptions and feelings about HIV in communities of color, risk behaviors, and their recommendations around developing HIV prevention services for YMSMOC

35 HIV among YMSMOC I think black men are at a particularly high risk [for HIV]. I only know what I see. I have a lot of Black and Spanish friends and they seem to be more promiscuous and fast. I know some year-old guys who are having sex with different people. This wasn’t how it was when I was coming up. Minority kids are so fast and they are not using condoms, or they don’t know how to use condoms properly. They are so vulnerable and insecure that if someone that they are dealing with doesn’t want to use a condom, then they won’t use a condom properly year-old Black male

36 HIV among YMSMOC It’s messed up to ostracize them [HIV-positive individuals] for their status. I have no problem talking to her. You don’t know how she got it. There are things out there, like prevention, so you don’t have to catch it. They are a person, to shut them down is really wrong, it really hits me. I had a friend who was HIV-positive. he passed away, people used to treat him so bad, it was like why would you treat him so bad, he’s such an awesome person, messed up circumstances how he caught it. A lot of people who he thought was his best friends left him, and I was one of his only friends who stuck by him. It’s wrong to say, “he’s got the kitty this, he’s got the kitty [HIV] that.” That really hurts them year-old Black male

37 HIV among YMSMOC Hell to the hell to the hell to the no. If you are in a monogamous relationship, I’m sorry I’m still not going to do it. My life is more important and you never know. I guess I have trust issues. People are really fierce these days. No shade, safe sex all of the time, my life is more important. If people are going take time out of their day to print up a fake HIV test, saying they are negative, but knowing the are positive and then go into a hook-up, or whatever purposely. I don’t know if people do that, but they are crazy people. You say I’m not going to munch him, and then a guy tells you he is HIV-negative, and then you say you’re going to munch him down w/o a condom year-old mixed race male

38 Objective 4 To identify programs at GMHC that currently work with YMSMOC, in addition to the steps that need to be taken to increase the capacity of the organization to provide services to this population

39 Serving youth at GMHC Identification of programs that currently serve YMSMOC Creation of youth workgroup to develop a plan to increase agency capacity to provide services to youth Staff that have experience working with youth

40 Objective 5 To identify existing services for YMSMOC in NYC in addition to potential gaps in care for this population

41 Community Agency Assessment Contacted providers at 15 agencies in NYC that provide services to YMSM to discuss program structure and capacity and perceptions of unmet needs for YMSMOC

42 Agency type

43 Services offered

44

45 What the providers are saying Services for “aging-out” populations, ages 23 and older (e.g., long-term case management) Mental health and substance abuse services Services for transgender youth

46 Conclusions High prevalence of unrecognized HIV infection among YMSMOC Evidence suggesting the prevalence of STIs, particularly among Black YMSM Importance of partner choice and social/sexual networks

47 Recommendations 1.HIV and STI testing should be integrated into the assessment and reassessment phases of the CSAP program 2.Prevention efforts should focus on social networks and partner choice, rather than exclusively focusing on risk behaviors 3.Outreach efforts should focus on Brooklyn and Queens

48 Recommendations 4.GMHC should develop partnerships with agencies that provide services to YMSMOC in New York City. 5.GMHC should continue their efforts to build capacity to provide services to YMSM 6.Intervention components should focus on protective factors for HIV sexual risk behavior and HIV infection (e.g., peer norms, social support)

49 Recommendations 7.More information is needed around the contexts in which YMSMOC use alcohol and drugs and practice unsafe sex.

50 Did we use this information to guide the development of the CSAP program?

51 CSAP program development HIV and STI testing will be provided at assessment and 6-month reassessment phases Clients will fill out measures that monitor progress in terms of substance use and sexual risk behavior Care coordination will be provided to connect clients with concrete services at GMHC or at other agencies in the city (e.g., entitlements, vocational services)

52 CSAP program development Mental health services will be provided by a Master’s level clinician A drama therapist will also facilitate a weekly group that focuses on mental health/substance abuse related issues D-up: Defend yourself (DEBI). This intervention integrates social network and popular opinion leader elements.

53 CSAP program development Youth Community Advisory Board Providing mentors from the Barbershop program (adult MSM of color)

54 Acknowledgements Jessica Diamond Stephen Hile Terri Jackson Gregg Weinberg


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