Exploring the Social Space of HIV-Positive English-Speaking West Indian Men who Have Sex with Men

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. 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. Acknowledgements