2010 metro denver msm strategic planning meeting montview presbyterian church january 29, 2030
TRANSCRIPT
2010 Metro Denver MSM 2010 Metro Denver MSM Strategic Planning MeetingStrategic Planning Meeting
Montview Presbyterian Church
January 29, 2030
Today’s ActivitiesToday’s Activities
Review • Current epidemiology of HIV infection among
MSM living in the metro Denver area• HIV risk behaviors among metro Denver MSM
and the context of those behaviors• MSM use of HIV prevention services.• MSM HIV prevention-related recommendations• CDPHE funded HIV prevention services for MSM
Today’s ActivitiesToday’s Activities
Small group discussions• Identify important HIV prevention issues affecting
metro Denver MSM.• Examine the capacity of existing resources to
address the HIV prevention needs of metro Denver MSM.
• Recommend HIV prevention strategies to decrease HIV infections among metro Denver MSM.
Epi OverviewEpi Overview
January 1, 2007 – December 31, 2009• 1, 244 cases of HIV infection (HIV and AIDS) were newly
reported statewide to the CDPHE.
• 804 (65%) occurred among MSM.
• 675 (84%) of MSM cases occurred among men living in metro Denver (Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas, Jefferson counties).
Metro Denver HIV cases among MSM, Metro Denver HIV cases among MSM, 2007-2009 2007-2009
Race/Ethnicity
White, non Hisp 409 (61%)
Black, non Hisp 49 (7%)
Hispanic, all races 201 (30%)
Asian/Pac Islander, non Hisp 7 (1%)
Amer. Indian, non Hisp 5 (<1%)
Multi race, non Hisp 4 (<1%)
Metro Denver HIV cases among MSM, Metro Denver HIV cases among MSM, 2007-20092007-2009
Age Range (years) N (%)
15-24 109 (16)
25-34 235 (35)
35-44 174 (26)
45-54 115 (17)
55-64 32 (5)
65 and older 10 (1)
Metro Denver HIV cases among MSM, Metro Denver HIV cases among MSM, 2007-2009 (N=675)2007-2009 (N=675)
45 (6.7%) had a history of injection drug use.
214 (31.7%) were likely diagnosed late in the course of their infection.
HIV Risk-Related Behaviors HIV Risk-Related Behaviors among MSMamong MSM
National HIV Behavioral Surveillance: National HIV Behavioral Surveillance:
Men who have Sex with Men – DenverMen who have Sex with Men – Denver
• Denver Public Health – one of 26 participating sites in the surveillance project.
• 2004-2005, 2008 NHBS focus: MSM• 981 MSM in metro Denver were surveyed in
2004-2005; 597 MSM in 2008.
Denver NHBS MSM FindingsDenver NHBS MSM Findings
Partner Type (2004-2005)
Main partner last 12 months 650 (66.3%)Casual partner last 12 months 580 (59.1%)Main and casual partner 376 (38.3%)
• MSM reported meeting casual sex partners in bars/clubs (~48%) more frequently than on the Internet (~10%) or in a bathhouse (~10%).
Denver NHBS MSM – Sexual RiskDenver NHBS MSM – Sexual Risk
Any unprotected anal or vaginal sex last 12 months, n=981 456 (46.5%)
UAV Sex by Partner Type last 12 months
Main Casual
Anal, n=981
Vag, n=89Anal, n=981
Vag, n=89
335 (34.2%)
28
(31.5%)169
(17.2%)13
(14.6%)
Denver NHBS MSM – Discussion of HIV Denver NHBS MSM – Discussion of HIV StatusStatus
Discussed with main partner, n=650
511 (78.6%)
Discussed with casual partner, n=580 393 (67.8%)
Discussed HIV with any partners, n=981 628 (64%)
Presented to CWT by Mark Thrun, MD, June 3, 2005Presented to CWT by Mark Thrun, MD, June 3, 2005
Denver NHBS MSM Findings, 2008Denver NHBS MSM Findings, 2008
Alcohol Use
• 557 (93.3%) of MSM respondents drank alcohol in the past 12 months.
• Of those, 322 (57.8%) had five or more drinks in one sitting on a monthly or more frequent basis in the past 12 months.
Denver NHBS MSM FindingsDenver NHBS MSM Findings
Drug Use• In 2008, 67 (11%) MSM respondents reported a
history of injection drug use.• Among MSM who had ever injected, 22 (32.8%)
had injected in the past 12 months.• Among all MSM respondents, 294 (49.3%)
reported using non-injection drugs.
Denver NHBS MSM FindingsDenver NHBS MSM Findings
Marijuana 216 (73.5%)
Smoked, snorted cocaine 112 (38.1%)
Poppers (amyl nitrite) 104 (35.4%)
Ecstasy 74 (25.2%)
Stimulant (meth, amphetamine) 65 (22.1%)
Most Frequently Used Non-Injected Drugs Past 12 Months (2008) n=294
Denver NHBS MSM Findings 2004-2005Denver NHBS MSM Findings 2004-2005
Drug Users
N=465
Non Users
N=516
UAV sex past 12 months
52.7% 40.9%
Ever HIV Tested 96.6% 91.7%
HIV+ 20.5% 12.9%
Presented to CWT by Mark Thrun, MD, June 3, 2005Presented to CWT by Mark Thrun, MD, June 3, 2005
Denver NHBS MSM Findings 2004-2005Denver NHBS MSM Findings 2004-2005
• Eleven percent of MSM sample used meth.• Compared to non meth users, MSM who used
methamphetamines were more likely to:Be HIV positive. Have been arrested in past 12 months.Have used erectile dysfunction drugs.Be homeless.Report unprotected sex last 12 months.
Presented to CWT by Mark Thrun, MD, June 3, Presented to CWT by Mark Thrun, MD, June 3, 20052005
Denver NHBS MSM FindingsDenver NHBS MSM Findings
HIV Testing Histories
• The majority of MSM survey participants (93%-94%) had previously tested for HIV.
• Among MSM reporting an HIV test, 17%-18% reported testing positive.
Denver NHBS MSM FindingsDenver NHBS MSM Findings
Received free condoms 403 (67.5%)
Individual-level counseling 141 (23.6%)
Group-level counseling 64 (10.7%)
HIV Prevention Activities Past 12 months (2008)
Opinions and perceptions Opinions and perceptions about HIV-related issues about HIV-related issues
among MSMamong MSM
2006 Needs Assessment: Major Issues 2006 Needs Assessment: Major Issues Affecting Gay/Bi MenAffecting Gay/Bi Men
• Discrimination against gay/bi men• Mental health related issues (e.g., feelings of
isolation, loneliness, depression, shame)• Substance use and abuse particularly meth use• Access to health insurance and health care • Internet survey: STDs• Focus Group, Interviews: Meeting basic needs,
relationships, disclosure, exposing others
2006 Needs Assessment: Substance 2006 Needs Assessment: Substance AbuseAbuse
• Use of alcohol and other drugs is common and a problem.
• Accepted as a norm in the gay community.• Strongly associated with unprotected sex and
failure to disclose HIV status.• Methamphetamine: easy to obtain, strongly
addictive, associated with unprotected sex and multiple partners.
Why Gay/Bi Men Use DrugsWhy Gay/Bi Men Use Drugs
• Bars are main venues for socializing.• Alcohol companies target the gay community.• Easy access to drugs in bars and bathhouses.• Drugs are fun.• Means to escape life’s problems.• Used by some men to deal with the realities of
HIV disease.
2006 Needs Assessment: Emotional Well-2006 Needs Assessment: Emotional Well-BeingBeing
• Low self-esteem, loneliness, depression reported to be common among gay/bi men.
• Attributed to lack of social acceptance, homophobia, discrimination.
• Depression following an HIV diagnosis.• Affects whether men will protect themselves,
disclose HIV status• Sex used to avoid emotional pain
Recommendations Related to Emotional Recommendations Related to Emotional Well-BeingWell-Being
• Accessible mental health services, therapy and support groups
• Someone to listen• Greater societal acceptance• Interventions that address stigma.• Interventions involving the wider gay community• Targeted public information campaigns• Multiple services available at one agency
2006 Needs Assessment: “Coming Out” 2006 Needs Assessment: “Coming Out” and HIVand HIV
• “Coming out” characterized as a time of experimentation.
• Exciting period but may involve confusion, shame, and rejection
• Often involved engaging in high risk behaviors• Especially difficult time for men of color, bisexual
men, and men living in rural areas
Recommendations Related to Coming Recommendations Related to Coming OutOut
• Support from friends, family, other gay and bisexual men
• Positive role models and mentors to make coming out a safer, less stressful period
2006 Needs Assessment: Relationships 2006 Needs Assessment: Relationships and HIVand HIV
• Dimensions of” healthy relationships:” trust, respect, love, communication, friendship, fun
• May include long-term monogamous as well as short and long-term open relationships.
Barriers to Healthy RelationshipsBarriers to Healthy Relationships
• Lack of societal support• Prestige of having multiple partners• Invisibility of healthy gay relationships/lack of
role models• Lack of suitable venues • Differences in SES, education, age, HIV status• Substance abuse• Emotional instability
2006 Needs Assessment: Healthy 2006 Needs Assessment: Healthy Relationship RecommendationsRelationship Recommendations
• Better, more visible models of healthy relationships
• Social acceptance and legal sanctioning of same sex relationships
• Social outlets and venues that are consistent with forming substantive relationships (e.g., places to meet outside of bars and sex venues)
Behaviors within the Context of Behaviors within the Context of Anonymous Encounters Anonymous Encounters
• “Barebacking” is a common occurrence.• Frequently involves sex without HIV status
disclosure.• Internet plays a “huge” role in anonymous
encounters with many men looking for partners willing to “party and play” (i.e., use drugs while having sex).
Reason for Unsafe Sex Reason for Unsafe Sex
• Use of drugs and alcohol• Not caring about self or others• “Bug chasing” or trying to become HIV infected• Belief that HIV infection is inevitable• Condom dislike, condom/safe sex fatigue• Misperception of risk (e.g., what behaviors are
safe, faulty partner choices based on appearance, SES, insertive/receptive sex practices)
2006 Needs Assessment: HIV Status 2006 Needs Assessment: HIV Status Disclosure Disclosure
• HIV status is not commonly discussed.• Many gay/bi men are not disclosing or lying about
their HIV infection.• Disclosure is infrequent at the bathhouse or when
drunk/high.• Reasons for not disclosing : fear of rejection,
shame, fear of violence, inability to ensure confidentiality, not knowing how to disclose, vindictiveness, assumptions about partner’s status
Views on Disclosure Views on Disclosure
• All men living with HIV should disclose their status.
• HIV negative men should ask partner’s status/assume partner is HIV positive and act accordingly.
• No need to disclose if condoms are used.• Few of the participants living with HIV reported
that a partner had disclosed his status prior to having sex.
Recommendations related to HIV Status Recommendations related to HIV Status Disclosure Disclosure
• Peer support groups• Educational sessions allowing men to role-play• Targeted public information campaigns to
normalize disclosure• Messages appealing to men not to spread HIV,
respect others’ rights to remain negative• Allow couples to test and receive their results
together.• Encourage serosorting.
2006 Needs Assessment: Perceptions of 2006 Needs Assessment: Perceptions of the Gay Community and Culturethe Gay Community and Culture
Frequently men expressed negative views of Denver’s gay community:
• Divided based on age, ethnicity, class, HIV status, tops vs. bottoms, etc.
• Obsessed with looks and status symbols• Overly focused on partying, substance use,
Internet “hook ups”• Glamorizes meth use and barebacking
Perceptions of the Gay Community and Perceptions of the Gay Community and Culture, continuedCulture, continued
Gay community perceived as:• Not welcoming to bisexual men.• No longer concerned about HIV.• Not supportive of long-term relationships.• Not supportive of HIV status disclosure.• Indifferent to instances where individuals spread
HIV.
Recommendations Related to the Gay Recommendations Related to the Gay Community Community
• Gay men need to support each other and promote emotional well-being and physical health.
• The gay community needs to re-familiarize itself with HIV and take an active role in its prevention.
• Provide opportunities for older gay men need to act as role models and mentors.
• Confront issues such as stigma, challenge stereotypes.
• Facilitate community forums, group discussions
BCAP MSM Community BCAP MSM Community Assessment, 2006-2007Assessment, 2006-2007 Attitudes and perceptions of safer sex practices
among MSM differed by age. Men who were 40+ spoke more fearfully about HIV; more judgmental toward those not practicing safer sex.
Discussions about HIV with potential partners will frequently derail the possibility of a sexual contact. HIV status and safer sex discussions are more likely to occur within the context of a potential relationship.
Urban Latino MSM Community Urban Latino MSM Community Assessment, JSI, Inc. (2009)Assessment, JSI, Inc. (2009)
Latino MSM expressed the importance of a “sense of community” and that their lack of feelings of belonging to mainstream Latino or MSM communities may impact HIV prevention planning and implementation.
Services that need to be in place to address risk behaviors among Latino MSM include integrated positive prevention messaging, skills building, and should be comprehensive and coordinated, addressing mental health and substance use issues using culture, art and community
JSI, Research and Training Institute, Inc.
2010 Metro Denver MSM 2010 Metro Denver MSM HIV Prevention ProfileHIV Prevention Profile
Content:Estimated Population SizeBasic Epidemiological InformationDescription of Funded Programs that Target
Metro Denver MSM Potential Impact of the Funded Service
Metro Denver MSM Strategic Planning Meeting, January 29, 2009
Estimated At Risk Population Estimated At Risk Population Size (Range Estimates*)Size (Range Estimates*)
Urban White MSM 4,175 – 9,607
Urban Latino MSM 904 – 3,793
Urban African American MSM: 912 – 1,044
Urban Young (13-24 yrs) MSM: No data available
Estimated Population Size Estimated Population Size (Range Estimates)(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 Basic Epidemiological InformationInformation
Cumulative* Number of Living HIV/AIDS Cases:Urban White MSM: 4,731Urban African American MSM: 602Urban Latino MSM: 1,035Urban Young MSM 83 (diagnosed at age 19 or younger):
*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 Basic Epidemiological InformationInformation
Number of HIV/AIDS cases reported in 2008:
Urban White MSM: 128
Urban African American MSM: 25
Urban Latino MSM: 83
Urban Young MSM 6
(diagnosed at age 19 or younger):
Description of Funded Description of Funded Programs that Target Metro Programs that Target Metro
Denver MSMDenver MSM
Please refer to handouts for program descriptions
Description of Funded Description of Funded ProgramsPrograms
Description of Funded Description of Funded ProgramsPrograms
Description of Funded Description of Funded ProgramsPrograms
Ethnicity
51%49% Hispanic or Latino
Not Hispanic or Latino
Description of Funded Description of Funded ProgramsPrograms
Race
0%
0%
20%
0%
69%
1%
10%American Indian/ Alaska Native(0%)
Asian (0%)
Black or African American(20%)
NH/API (0%)
White (69%)
More than one race (1%)
Race not targeted (10%)
Description of Funded Description of Funded ProgramsPrograms
Program Content Testing
Only the Atlas Program includes a formalized testing strategy
Description of Funded Description of Funded ProgramsPrograms
Program Content Behavioral Interventions:
All programs are considered a Community Level Intervention: Addressing community norms and attitudes related to HIV related risk behaviors.
Description of Funded Description of Funded ProgramsPrograms
Program Content Behavioral Interventions:MPowerment model: 2 program 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 Description of Funded ProgramsPrograms
Program Content Behavioral Interventions:Popular Opinion Leader (POL) model: 3 program Identifies, enlists, and trains key opinion leaders
to encourage safer sexual norms and behaviors within their social networks through risk-reduction conversations.
Description of Funded Description of Funded ProgramsPrograms
Program Content Behavioral Interventions:Matrix (Stimulant Treatment) model: 1 program Clients receive information, assistance in structuring a
substance-free lifestyle, and support to achieve and maintain abstinence from drugs and alcohol. The program specifically focuses on clients who are dependent on methamphetamine and cocaine and their families.
Project also explores interaction of stimulant use with HIV risk behaviors related to self-identification/ community norms.
Description of Funded Description of Funded ProgramsPrograms
Program Content Behavioral Interventions:D-Up model: 1 program Community-level intervention designed for and
developed by Black men who have sex with men (MSM). d-up! is designed to promote social norms of condom use and assist Black MSM to recognize and handle risk related racial and sexual bias.
Contact InformationContact Information
Anne Marlow-Geter, CDPHE, STI/HIV Section, Planning Unit Supervisor
Phone: 303-692-2736E-Mail: [email protected]