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Adapting Community PROMISE with Older MSM &Transgender Individuals of Color

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  • 1. Adapting CommunityPROMISE with OlderMSM &Transgender Individuals of Color Hanna Tessema, MPH, MSW
  • 2. Background: HIV & Aging
  • 3. HIV/AIDS in New York• New York State reported 125,718 Living HIV/AIDS cases as of December 2008• 109,446 known PLWHA as of 06/30/2010 in NYC• NYC is the HIV/AIDS epicenter in the U.S.• 80% are persons of color• Half are African-Americans 25% of new cases in 2008 were diagnosed concurrently with AIDS. Among persons aged ≥ 50 years, the proportion of concurrent diagnoses was 39% NYC DOHMH HIV Epidemiology and Field Services Program Semiannual Report: March 31, 2011 http://www.nyc.gov/html/doh/downloads/pdf/dires/2011-1st-semi-rpt.pdf http://www.health.state.ny.us/diseases/aids/statistics/annual/2008/2008-12_annual_surveillance_report.pdf
  • 4. NYC: HIV Among MSMAs of June 30, 2010:• 109, 446 PLWHA• 33.5% MSM• 62% of newly diagnosed males in the first half of 2010 were MSM
  • 5. Transgender Transgender persons are those whose current gender identity differs from their sex at birth. May or may not receive hormone therapy May or may not have had surgery to change their anatomy May have any sexual orientation Research studies on samples of transgender persons have demonstrated high rates of HIV/AIDS in this population in the US and NYC.
  • 6. “There are no reliable data on the number oftransgender people living in the United States.” --Transgender Law Center
  • 7. Of the newly diagnosed transgender population in NYC:90% are Black or Hispanic,7% white4% other
  • 8. The highest numbers of newly diagnosed transgender persons lived in Bedford Stuyvesant–CrownHeights, West Queens, Chelsea–Clinton, and Fordham–Bronx Park (areas in dark red).
  • 9. Community PROMISE
  • 10. Community PROMISE CDC Evidence Based Intervention (Community Level Intervention) Peers Reaching Out and Modeling Intervention Strategies for HIV/AIDS Risk Reduction in their Community First time implementing CDC DEBI: Community PROMISE for Older Adult populations (50+)
  • 11. Community PROMISE: Four Core Elements1. Community Identification Process (CID) An ongoing community needs assessment of the targeted population. Allows us to better understand specific risk taking and risk reducing behaviors as well as circumstances & environments where they take place.2. Role Model Stories Short stories based on real experiences of people in the target population who have made or are planning to make a risk-reducing behavioral change. (Stages of change)3. Peer Advocates Volunteers from the target population who have access to the community. They distribute the role model stories in places where they congregate.4. Evaluation Providing evidence of the effectiveness of the intervention at the agency. Reveals whether the proven intervention was implemented with fidelity.
  • 12. Community PROMISE ACRIA chose to implement Community PROMISE within the over 50 target population because:• DEBI’s are proven evidence based interventions• Currently none of the CDC-funded prevention interventions specifically target older adults.• NYCDOHMH Funding allowed PROMISE to target the highest risk groups in NYC (including MSM & Transgender)• Felt OA would be more inclined to engage in behavior change based on messages which resonate with them via relevant RMS.
  • 13. Unique Effort• ROAH Study Results established target population• We trained and prepared our partners on HIV & Aging well before the implementation of the intervention• CID process began before PROMISE & is ongoing• Partners continue the CID process as well…and receive input from the community• Many peers were referred via partners• Linked to HIV testing campaign for 50+• Fully bilingual program: English & Spanish
  • 14. Unique Effort• Online recruitment for interviews beyond Facebook: Adam4Adam• Focus groups reviewed stories focusing on MSM & Transgender• More intense trainings for peer advocates because: Knowledge levels lower, Stigma & Ageism More myths *Focus more on how to engage populations because this is a taboo topic for OA generally*
  • 15. RMS Distribution The peers told us where to distribute rather than us telling them – they had the information on where the target population congregates.• Areas mentioned in the stories (i.e. near hospitals, intersections, subway stations, etc.)• Barbershops & beauty salons• Gay Bars• Senior Centers (lunch time)• Syringe Exchange – IV drug users within MSM & Transgender groups• Ex-sex worker transgender peers had access to OA transgender sex worker populations
  • 16. Challenges: Implementing PROMISE–Limited Time (less than 1 year) to implement due to funding–Recruiting for interviews via online sex sites (i.e. Adam 4 Adam)–Training peers and ensuring their HIV knowledge was up to par prior to distributing stories in the community
  • 17. Challenges: Implementing PROMISE• Ensuring all staff were properly trained to implement DEBI with fidelity• Choosing images to represent stories• Engaging OA can be more difficult than younger people because they are not usually targeted with these types of messages
  • 18. Lessons Learned• HIV+ older MSM & transgender individuals are largely stigmatized by • Important factors influencing behavior : HIV-phobia, homophobia, transphobia, – perceived susceptibility and ageism. – self-efficacy – communication & negotiation• Integrating HIV treatment and care into – cultural norms about sexuality & the RMSs has been essential in gender roles targeting older adults living with HIV. • Evidence Based Interventions work with• Social isolation & loneliness are Older Adults and should continue to be important factors in sexual risk taking implemented and need to be considered when developing RMSs targeting older MSM & transgender individuals.
  • 19. Next Steps• Implementing evidence based prevention strategies which target older MSM & transgender adults. (Including HIV/STD primary and secondary prevention.)• Ensuring RMS & prevention messages are culturally sensitive and age appropriate• More education among service providers & peers to increase knowledge and skills to help older adults negotiate risk-reduction behaviors
  • 20. Contact Information If you have any questions regardingCommunity PROMISE at ACRIA, please feel free to contact: Hanna Tessema, MPH, MSW htessema@acria.org 212.924.3934 x135