Milwaukee Partnership to Respond to 2009 EPI AID Study in Milwaukee

1. Milwaukee Partnership to Respond to 2009 EPI AID Study in Milwaukee Brenda ColeyDiverse and Resilient, Inc.

2. Current HIV Data MSM: MSM continue to be severely affected by HIV. In 2009, 63% of reported HIV cases in Milwaukee were among MSM (4% were also IDU). African American MSM: In Milwaukee, among MSM reported with HIV infection in 2009, 49% were African American, 35% were White and 13% were Hispanic. Young African American MSM: Adjusted reported cases of HIV in Black MSM age 13-29 years tripled between the years 2000 and 2008 in Wisconsin.

3. Response Committees • Thirty-one providers participated in two meetings and generally endorsed a behavioral-environmental model and debated testing vs other interventions • Twenty-eight African American MSM participated in two meetings and expanded a behavioral-environmental model to include MSM psycho-social factors

4. Other Committees Advisory • 18 Members • One Meeting • Reviewed and analyzed all other committee results Steering • 9 Members • Two meetings • Determined committee membership • Reviewed and analyzed committee results and recommendations Working • 4 Members • Six meetings • Structured committee content • Prepared and reviewed notes • Prepared agenda for other meetings

5. Understanding HIV Prevalence in Milwaukee

6. Understanding HIV Prevalence in Milwaukee

7. Understanding HIV Prevalence in Milwaukee

8. Understanding HIV Prevalence in Milwaukee

9. Expanded Audiences for this information • Young African American MSM, African American MSM, MSM • Family and Friends • Schools, educators, youth-serving agencies • Juvenile Justice and Foster Care • Faith Communities

10. Misalignment of Resources • Many successful HIV prevention programs have been funded among general African American or Latino populations and/or for women at risk of substance abuse or incarceration. • There has been less organizational readiness among groups conducting prevention services for MSM and less prevention funding was directed toward this population. • In the past 10 years, City of Milwaukee funding support to HIV programs through contracts has decreased by 81%. • The Wisconsin AIDS/HIV Program estimates that 20 to 40% of Black MSM ages 15-59 in Milwaukee County may be HIV positive, compared with 8 – 16% for white and Latino MSM. • In contrast, the HIV prevalence among Black females and non-MSM males is 0.7%. • Although 55% of reported HIV cases are among MSM, 10% of health education and risk reduction funding was spent on this population in 2009.

11. Social Determinants Young Black HIV-positive MSM had: • A higher proportion of same-race partners • A greater frequency of feelings indicative of internalized homophobia, • A greater frequency of negative reactions by family members, and were less likely to report feeling that they could be open about their sexuality; • A greater frequency of economic and housing instability; • A greater frequency of having been pressured to have sex against their will.

12. Psychological and Personal Factors Some MSM • have difficulties maintaining consistently safe behaviors over time, • underestimate personal risk, and • have inaccurate perceptions that because of treatment advances, HIV is no longer a serious health threat.  Personal resiliency factors appear to contribute to other men in similar situations remaining HIV negative. These factors may include: • comfort with self, • mental health, • avoidance of alcohol and drug use, • and skills associated with self-efficacy.

13. ENDHIV Program Recommendations • Develop or adapt and implement group interventions specifically tailored to young African American MSM • Improve program outreach to MSM in general and African American MSM in particular • Re-examine events hosted by organizations to assure the inclusion of men, MSM, young MSM and MSM of color. • Identify and support two or three Black churches to exercise leadership in justice for gay and bisexual men.

14. ENDHIV Content Recommendations • Communicate that the virus is more prevalent in MSM and African American MSM populations and therefore it is transmitted more readily. • Address low self-esteem, depression and isolation as factors in irregular adherence to HIV prevention methods • Create positive approaches to communicating with and about MSM. • Address low self-esteem, depression and isolation as factors in irregular adherence to HIV prevention methods • Create healthy approaches to relationship development. • Create approaches for families and friends to learn how to be allies and for allies to disclose their favorable disposition to LGBT people.

15. ENDHIV Structural Recommendations • Significantly increase resources in Milwaukee to address HIV prevention needs of MSM, particularly young African American MSM • Develop safe venues for MSM to be themselves. • Create positive approaches to communicating with and about MSM. • Address economic disparities, education, lack of life skills, lack of access to health care. • Reduce the barriers and stigma associated with seeking medical care for HIV. • Confront homophobia, racism, and the social exclusion of gay and bisexual men – both from the African American community and the LGBT community.

16. The Challenges • Limited existing infrastructure to do major coordinated projects. Current programs are barely networked. • Community readiness for change • Strength of community norms • Familiarity with evidence-based practice • Cultural blindness of likely partners • Historic funding systems

17. The Plan

18. ENDHIV Gary Hollander Brenda Coley Mark O’Neil 414-390-0444