STEAM Focus Groups Jesse Chipps

The Basics The Seattle HIV/AIDS Planning Council wanted additional information about Black MSM, a high-risk group about whom there was little local information Focus groups were an adjunct to the 369 quantitative interviews conducted Men who participated in interviews were given the opportunity to be in a focus group

4 Focus Groups were held 25 men total participated 10 were HIV- (or status unknown) 15 were HIV+ 4 were non-gay or bisexually identified  All the NGI were HIV- (or status unknown)

Themes Explored Practices and attitudes about testing Practices and attitudes about using condoms Practices and attitudes about disclosure Drugs and their effect on sexual safety What, where and how should prevention messages be delivered

Testing: HIV- Men--How often Note: Men who perceived themselves to be HIV-, were often men who had not tested for over 6 months and engaged in risky behavior About half identified that they tested irregularly (some only testing once ever) Many had a routine – some tested annually, others every six months When we read them the every 3 month recommendation, the reaction was mixed—with some men assuming that they themselves didn’t fit the criteria for testing every 3 months (although they had risky behavior)

Testing: Where do you get tested? Urban league (Center for MultiCultural Health) Jail POCAAN van (former testing program) Anonymous clinic Private doctor

Testing: Where would you like to? More anonymous options Speed of results is important (rapid) Home test option (for anonymity)  A lot of discussion for and against this took place

Testing: Why were HIV+ guys tested? Most common response that they tested due to HIV-related illness Blood donation One learned status through regular testing

Condom Use: When they don’t use When giving or receiving blow jobs When desire/urgency for sex overrides thought With a concordant partner When being a top Perceiving AIDS as a manageable illness When they trusted the partner “It won’t happen to me” No condoms available in prison Condoms don’t fit or are uncomfortable When using drugs or alcohol

Disclosure: HIV “negative” guys Most in this group asked partners if they were HIV+, but not how recently they had been tested Most in this group felt the HIV+ partner should be the one to initiate the disclosure When men were asked if they told female partners that they also slept with men, the response was and emphatic “Hell no!”

Disclosure: The HIV+ guys “I’m not comfortable telling people my status” “It’s their (the HIV- guy’s) responsibility to find out” “I’m very open about it” “They (the HIV- guys) don’t want to know” “It’s my responsibility to tell, but they choose if they want to be safe or not”

Sex, Drugs and Rock ‘N Roll “Men use cocaine as a reason to have sex with me” (HIV+ man) “Crack makes me really (sexually) aggressive” “Meth works almost like crack, but not as fast” “When you sober, you got a better mind to say, ‘let’s use a condom’ but you got …crack cocaine and you got a hunk in front of you, you don’t give a It’s as simple as that.” “When I smoke cocaine…9 times out of 10, I’m just gonna stay at home and look out the window.”

Where should HIV info be targeted? Bath houses Bars Parks (Arboretum, Judkins, Volunteer) Bathrooms (malls, Value Village) Black churches Gyms (Seattle U, YMCA, Golds) Schools Prison TV

What should the messages be? “Before” and “after” pictures  Pictures of how bad AIDS can be Something short, and catchy “In your face” “Show some skin” Feature men from our community Talk about other STDs Integrate with other health messages such as prostate cancer, blood pressure

An extra note about the NGIs They noted that they didn’t specifically seek out sex with men, “It just happens” They did not in any way feel a connection to the gay community, and expressed contempt or distaste about gay men These men felt prevention efforts should be targeted in straight clubs frequented by African Americans, such as the Esquire but generally wanted more ads not targeting gay men— because that’s not them They were not less likely to test: two said they tested every 6 months and two said every year

The bottom line Men who identified as HIV-, had not tested for 6 months or more NGI men will in no way be reached by efforts targeting gay-identified men Men who identified as HIV- expected HIV+ men to disclose to them or initiate condom use Men who knew they were HIV+ expected HIV- men to determine whether they were going to be safe or not Drugs and alcohol definitely had an effect on safety, but so did general horniness High risk men were not testing every 3 months, and also didn’t perceive themselves as being part of the group that should

Recommendations In efforts to increase testing frequency for these men, efforts must be made to help them perceive themselves as “high risk” Providers should design specific outreach messages to NGI men that reach them as they perceive themselves: as straight men  To do this, providers may need to address their own issues about the internalized homophobia of these men