1. Exploring the Social Space of HIV- Positive English-Speaking West Indian Men who Have Sex with Men Jessica Adams-Skinner, Ed.D. Grand Rounds June 26, 2008 HIV Center for Clinical and Behavioral Studies

2. Introduction: MSM in NYC MSM in NYC continue to be at increased risk for HIV In 2006, the number of new HIV diagnoses attributed to MSM in NYC was 1,144, a 4.9% decrease from 2001 MSM under age 30 now account for 44% of all new diagnoses in 2006 among MSM in NYC, up from 31% in 2001 Source: NYC DOHMH (2007)

3. Introduction: MSM in NYC Caribbean Region has the highest HIV prevalence in the Americas – approx. 2% West Indian immigrants constitute 25% of the NYC population 23% of New Yorkers newly diagnosed with HIV/AIDS are foreign-born, and of these, 50% originate from the Caribbean/West Indies Source: NYC Dept of City Planning, 2004

4. Introduction: WI MSM Migration Migration provides an escape from the homophobia in native countries The WI migration experience is likely to increase sexual risk for WI MSM Many who maintain undocumented status report that they find themselves at increased risk for HIV since they engage in unsafe sexual behaviors for economic reasons, food, and shelter Source: HRSA/SPNS Caribbean Initiative – Focus Group (2007)

5. Background HRSA-funded study targeting HIV+ English-speaking Caribbeans Recruitment challenges – “hidden” population marked by stigma, immigration issues (undocumented and fear of deportation), not accessing care Quadruple threats – gay, Black, immigrant, HIV+

6. Research Questions Given the fact that WI MSM is a “hidden” population, where do they socialize? What can we find out about their personal and sexual experiences in the venues where they “hang out”? How do the socialization venues mitigate or exacerbate HIV risk behavior, stigma, disclosure, and the economic realities of WI MSM?

7. Specific Aims Examine the migration experiences of 20 men identified from 5 types of spaces related to 3 basic themes (1) HIV stigma & discrimination, (2) HIV disclosure, and (3) economic stability Explore how their experiences relate to or are shaped by the respective spaces and how these experiences, in turn, intersect with sexual risk behaviors and HIV primary care-seeking behaviors Explore the social spaces as potential venues for recruitment for future interventions

8. Methods Qualitative study Social space sites were identified with assistance from senior researchers Informal conversations with key informants from the WI community in Brooklyn Met with representative from target population – WI MSM Two WI MSM will be trained as interviewers

9. Measures Characteristics of social spaces – physical layout, risk behaviors taking place, & nature of support & networks among members HIV disclosure Stigma of HIV/AIDS and being gay Barriers and facilitators to accessing health care Socio-demographic & socioeconomic characteristics

10. Eligibility Criteria At least 18 yrs of age Migrated to the US at age 18 or older Self-identify as being of West Indian descent Has had anal sex with a man at least once in the past 2 yrs HIV+ Conversant in English

11. Social Space Recruitment Sites Entertainment – e.g., nightclubs, bars Recreation – e.g., cultural clubs and sporting events Semi-private social gatherings – e.g., balls, private parties “Cruising for sex” venues – e.g., public parks, bath houses Places of worship – e.g., Christian and non- denominational churches

12. Project Activities IRB Approval – NYSPI and Columbia University Certificate of Confidentiality Instrument Development Piloting of Instrument Palm Cards – recruitment

13. Study of Social Space of West Indian MSM

14. Talk to us about where you hang out Are you a West Indian/Caribbean man, at least 18 years of age, living with HIV, who has migrated to the US, and who has had sex at least once with a man in the past two years? Participate in a research study about the place where you socialize or hang out. Earn cash for your time! Call the WI MSM Project at 212-543-5513.

15. Future Grant Ideas Pilot data findings – further exploration Quantitative Survey – examine HIV prevalence, predictors of unprotected sex, risk behavior, and entering/staying in care Participatory intervention development – 3 year grant for developing and piloting Interview partners of HIV+ WI MSM Examine differences among WI MSM in different cities

16. Conclusion Excellent mentoring support Research career – shift from directing research studies to developing and conducting my own Field is virgin territory – hope to make significant contribution Identify with MSM target group on 3 levels

17. Acknowledgements HIV Center HIV Intervention Science Training Program (HISTP) Team Mentors Anke Ehrhardt, Ph.D. Susie Hoffman, Dr.PH Theo Sandfort, Ph.D. Jose Bauermeister, Ph.D. Miguel Laboy-Munoz, Ph.D. Jennifer Hirsch, Ph.D. Nabila El Bassel, DSW Elwin Wu, Ph.D. Aimee Campbell Gina Espinoza Cohort I and II Joanne Mantell, Ph.D. Susan Wittee, Ph.D.