Non-Metro MSM Strategic Planning Meeting, January 23, 2009
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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 Non-Denver MSM.

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Non-Metro MSM Strategic Planning Meeting, January 23, 2009

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Non metro msm strategic planning meeting january 23 2009

Non-Metro MSM Strategic Planning Meeting, January 23, 2009


Epi overview

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 non denver msm

HIV cases among Non-Denver 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%).


Non metro msm strategic planning meeting january 23 2009

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

Survey Overview

  • Internet and hardcopy survey available in late summer, fall 2009

  • Targeted MSM living outside metro Denver

  • 143 MSM participants


Participant characteristics

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

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 insertive anal sex


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 receptive anal sex


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%

Unprotected sex with person of different or unknown HIV status


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%

Sex while drunk or high


Context of risk behaviors

Context of Risk Behaviors


Non metro msm strategic planning meeting january 23 2009

Wider Sociocultural

& Structural Environment

Individual Level

Immediate Social & Structural Environment


Non metro msm strategic planning meeting january 23 2009

Political Environment

& Policy

Economic

Environment

Classism

Availability

of Resources

Racism

Religious

Ideals

Sexism

Cultural Processes

Homophobia

Media

Physical Environment

(including HIV)


Non metro msm strategic planning meeting january 23 2009

Main Partner

Family

Teachers

Friends

Mentors

Community

Peers

Sex Partners

Faith

Community

Service

Providers

Character

of Settings

Internet

Contacts

Coworkers

Cultural Processes


Non metro msm strategic planning meeting january 23 2009

Economic

Environment

Political Environment

& Policy

Main Partner

Family

Age

Gender

Race/Ethnicity

Sexual Orientation

Socioeconomic Situation

Personality

Personal History

Physical Status/Genetics

Substance Use

Mental Status

Spirituality

Availability

of Resources

Teachers

Classism

Friends

Mentors

Racism

Community

Peers

Religious

Ideals

Sexism

Faith

Community

Sex Partners

Character

Of Settings

Homophobia

Cultural Processes

Service

Providers

Coworkers

Internet

Contacts

Physical Environment

(including HIV)

Media


Lifetime experiences of psychosocial risks

Lifetime Experiences of Psychosocial Risks


Victimization experiences in past 12 months

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%

Alcohol consumption n=143


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%

Consumed 5 or more drinks in one sitting n=143


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%

Drank or used drugs more than meant to n=142


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%

Powder cocaine

9.9%

Injected heroin

0.0%

Ecstasy, GHB, etc.

7.8%

Alcohol and drug use in the previous 12 months


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%

Felt the need to cut down on drinking or drug use n=140


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


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

27.0%

Panic attack – physical

24.8%

Depressed, sad, or blah mood most of the time for two years

17.9%

Mental Health Symptoms in past year continued


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

3.1%

Health needs

11.5%

Violence/Fear of violence

5.7%

No concerns

3.3%

Biggest concerns of gay men


Types of desired relationships

Types of Desired Relationships


Barriers to 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.%

Reasons for engaging in HIV risk behaviors


Other reasons for engaging in hiv risk behaviors

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%

Perceived frequency of HIV status disclosure n=140


What affects whether or not men discuss hiv status with sexual partners

What affects whether or not men discuss HIV status with sexual partners


Places for meeting sexual partners

Places for Meeting Sexual Partners


Use and perceptions of hiv prevention services and activities

Use and Perceptions of HIV Prevention Services and Activities


Hiv testing history

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

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


Helpfulness of hiv prevention services and activities1

Somewhat/Very Useful

Free condoms, safer sex kits (n=97)

79.4%

Talked to someone from health department (n=53)

79.2%

Group to learn HIV prevention skills (n=73)

78.0%

HIV pamphlet/brochure (n=96)

74.0%

Talked to substance use counselor (n=14)

71.4%

Helpfulness of HIV prevention services and activities


Helpfulness of hiv prevention services and activities2

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


Helpfulness of hiv prevention services and activities3

Somewhat/Very Useful

Talked to mental health worker about HIV (n=31)

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%

Helpfulness of HIV prevention services and activities


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%

Where respondents would likely use HIV prevention services (n=143)


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%

Other preferred prevention venues


Non metro msm strategic planning meeting january 23 2009

Focus groups and interviews of MSM living outside metro Denver

John Peters-Campbell


Growing up

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


Non metro msm strategic planning meeting january 23 2009

Mental health

  • Two bipolar; five had depression; several had history of trauma

  • Influences on risk behavior

  • Low self-esteem common


Non metro msm strategic planning meeting january 23 2009

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

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, non-accepting of some gay men, not political around important issues, etc.

  • Partners found on Internet, bars, public sex environments, baths


Sexual activities

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 activities1

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

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

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 activities2

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 services1

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

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


Recommendations1

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


Recommendations2

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

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

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

Estimated Population Size (Range Estimates*)

At Risk, Rural MSM All Races: 5,078 – 5,372


Estimated population size range estimates1

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

Basic Epidemiological Information

Cumulative* Number of Living HIV/AIDS Cases:

Rural White MSM: 508

Rural African American MSM: 60

Rural Latino MSM: 124

Rural Native American/ American Indian MSM: 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 information1

Basic Epidemiological Information

Number of HIV/AIDS cases reported in 2008:

Rural White MSM: 23

Rural African American MSM: 1

Rural Latino MSM: 5

Rural Native American/ American Indian MSM: 0


Description of funded programs that target non metro msm

Description of Funded Programs that Target Non-Metro MSM

Please refer to handouts for program descriptions


Description of funded programs

Description of Funded Programs


Description of funded programs1

Description of Funded Programs

Result: Approximately 48.7% of the estimated population at risk to be served


Description of funded programs2

Description of Funded Programs


Description of funded programs3

Description of Funded Programs


Description of funded programs4

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 programs5

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 programs6

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 programs7

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 programs8

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 programs9

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 information1

Contact Information

Anne Marlow-Geter, CDPHE, STI/HIV Section, Planning Unit Supervisor

Phone: 303-692-2736

E-Mail: [email protected]


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