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Black Heterosexual Men & HIV Prevention


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FORGOTTEN POPULATION IN HIV PREVENTION - Beyond The DL: Black/African American Men Who Have Sex With Women

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Black Heterosexual Men & HIV Prevention

  1. 1. FORGOTTEN POPULATION IN HIV PREVENTION Beyond The DL: Black/African American Men Who Have Sex With Women Camille A. Abrahams, MS Dorcey Jones, MPH Adam Viera, MPH Harm Reduction CoalitionMonday, November 9, 2009 American Public Health Association Meeting 1
  2. 2. Presenter Disclosures Camille A. Abrahams, MSThe following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No relationships to disclose 2
  3. 3. Harm Reduction Coalition Founded in 1994 to work with individuals and communities at risk for HIV infection due to drug use and high-risk sexual behaviors. Committed to reducing drug-related harm by initiating and promoting local, regional and national harm reduction education, interventions and community organizing. Offer specific expertise in how to best incorporate the principles of health and safety promotion for drug users. 3
  4. 4. HRC Programs & Services Policy Advocacy  Lifting the Federal Ban on Needle Exchange National and Regional Conferences  Next conference: Austin, TX. November 16-21, 2010 The Institute @HRC – Training & Capacity Building  Harm Reduction Training Institute  Skills and Knowledge on Overdose Prevention (SKOOP)  LGBT Project  CBA for Communities  CBA for CBOs (formerly the African American 4 Capacity Building Initiative (AACBI))
  5. 5. Examples of (Free!)CBA Services from HRC Providing skills-building trainings and technical consultation in the following areas:  Organizational Infrastructure and Program Sustainability  Evidence-based Interventions and Public Health Strategies  Program and Outcome Monitoring and Evaluation  Community Mobilization 5
  6. 6. Outline for Today’s Presentation  Overview  Problem Statement  Why is HRC addressing this issue?  What have we uncovered?  Capacity Building Assistance (CBA) Strategies  Closing Remarks 6
  7. 7. Overview Behavioral interventions, government funding, social services and media attention targeting HIV prevention among heterosexual Black/African American men lag far behind their representation in the epidemic. It is necessary to rethink the approach that targets women engaged in high-risk sexual behavior without considering their sexual partners. 7
  8. 8. Problem StatementHow can we utilize capacity building assistance strategies to address the lack of prevention efforts for Black men who have sex with women? 8
  9. 9. Why Are we AddressingThis Issue? 9
  10. 10. The Facts… 45% of new HIV infections (56,300 people annually) are among Blacks/African Americans HIV is the 2nd leading cause of death for black men ages 35-44 (CDC, 2006) Of all black men living with HIV/AIDS, the primary transmission category was sexual contact with other men, followed by injection drug use and high-risk heterosexual contact. (CDC, HIV/AIDS Surveillance Report, 2007) 10
  11. 11. More facts… Over one-fourth (28%) of all AIDS cases among men in the US occurred through injection drug use and heterosexual sexual contact. Over three-fourths of those cases were among men of color, with African- American men comprising more than half (55%). CDC HIV transmission patterns among Black men vary from those of white men. Although both groups are most likely to have been infected through sex with other men, white men are more likely to have been infected this way. Heterosexual transmission and injection drug use account for a greater share of infections among Black men than white men. (CDC, HIV/AIDS Surveillance Report, 2008) 11
  12. 12. Transmission rates for black adult &adolescent men living with HIV/AIDS,2005 CDC, 2006 12
  13. 13. Purpose of FormativeResearch Raise awareness and increase knowledge about this issue in the community Understand the factors that influence the HIV risk of Black/African men who have sex with women Solicit feedback from community stakeholders and key informants to determine the HIV prevention needs of African American heterosexual men Strategize and develop capacity building assistance solutions that can support the work of community based organizations and health departments implementing HIV prevention strategies with African13 American heterosexual men
  14. 14. Assessing the SituationIn order to better understand the views of our CBA consumers regarding the HIV prevention needs of Black men: Hosted two interactive forums on this issue in 2008  Regional Community Advisory Group Webinar, January 23rd  In partnership with the NYS Dept. of Health, February 15th Conducted an extensive Literature Review re: Heterosexual African American men and HIV Prevention 14
  15. 15. Assessing the Situation Organized and facilitated an institute for the United States Conference on AIDS (Fort Lauderdale, 2008).  Expert Panel Discussion  Key Informant Interview Video, “Forgotten Population”  Solutions-based Focus Groups Gathered information from primary population  Target Population Survey (February 2009)  Discussion Group (Albany, NY. September 2009) Coming Soon…  Modified target population survey, Fall/Winter 2009 15
  16. 16. What Have We Uncovered?Via Community Advisory Forums, Focus Groups, Key Informant Interviews and Literature Review 16
  17. 17. Key ThemesFactors that Influence HIV Risk of African American Men Who Have Sex With Women  Healthy Relationships  Masculinity & Sexuality **  Class & Poverty  Substance Abuse & Drug Policy  Incarceration/Prison System  Mental Health 17
  18. 18. Black Men: Healthy Relationships Key Findings HIV prevention interventions/strategies targeting African American heterosexual men should:  Define what healthy relationships are  Explore what intimacy means in a relationship  Explore one’s identity as a parent, a romantic partner and a member of a family unit  Teach and promote honest, effective interpersonal communication  Develop alternative outlets of communication about relationship issues 18
  19. 19. Black Men: Masculinity & Sexuality Key Findings HIV prevention interventions/strategies targeting African American heterosexual men should:  Deconstruct old norms about masculinity WHAT IT MEANS TO BE A MAN  Develop new norms around masculinity In the US there has been a significant history of sexual exploitation and objectification of the Black male. Black men often are referred to by their presumed sexual preoccupation and/or prowess rather than being seen as complex multi-dimensional beings with strengths as well as weaknesses. (Frimpong, 2009) 19
  20. 20. Black Men: Class & PovertyKey FindingsHIV prevention interventions/strategies targeting African American heterosexual men should: Address the fact that HIV/AIDS not a priority for most individuals Recognize that homelessness & joblessness are at the forefront of concerns Increase access to available resources Build new resources for African American men that address ALL of their needs Should partner with job training, GED and other educational/vocational programs Black and African American men face discrimination in education and employment. Because of this, Black men often cannot obtain gainful employment, putting them at a significant disadvantage in our technological economy. Lack of employment is linked to increased involvement in activities that can increase risk of HIV infection such as substance use, commercial sex, 20 homelessness and incarceration. (Frimpong, 2009)
  21. 21. Black Men: Substance Abuse &Drug PolicyKey FindingsHIV prevention interventions/strategies targeting African American heterosexual men should: Focus on non-Injection Drug Users (IDU), i.e. crack cocaine, prescription drugs, alcohol, etc. Address stigma associated with drug use Partner and collaborate with needle exchange programs Recognize the sexual activity of substance users Incorporate harm reduction strategies Be inclusive of Black heterosexual males during the development and implementation process 21
  22. 22. Black Men: Incarceration/ThePrison SystemKey FindingsHIV prevention interventions/strategies targeting African American heterosexual men should: Work to build the representation of Black heterosexual men in service organizations (as employees, clients/consumers, CAB members, etc.) Recognize incarceration as a fluid experience Develop effective recruitment and retention strategies to engage this population Recognize the impact of media on perception of Black men Work to destigmatize HIV/AIDS in the correctional system Nearly one-third of all Black men have been incarcerated either as adolescents or adults. Cycling in and out of the prison system can negatively affect Black mens ability to keep and maintain jobs and relationships. 22
  23. 23. Black Men: Mental HealthKey FindingsHIV prevention interventions/strategies targeting African American heterosexual men should: Start at home (focus on building support within families and other existing relationships) Educate society on the importance of mental health Validate the concerns of Black heterosexual men Build self-esteem and self-worth Address the social norms among Black men Address drug use and concurrent issues Build support systems (mentoring, communication, education, etc.) Creating safe spaces for Black heterosexual men to express the problems in their lives Increase stress management/coping skills Address family origins and explore past life experiences 23
  24. 24. Video Screening What are Black men’s roleHow did you get to know in lowering their risk foryour sexuality as a Black HIV in theseman? communities? Forgotten Population: Voices of Heterosexual Black/African American Men How do you think drug policy (such as mandatory minimum sentencing on drug charges, drug free school zone laws, etc.) has played a role in Black men rebuilding their communities that have been broken because of the war on drugs? 24
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  32. 32. Capacity Building Strategies New skills-building training: Black Heterosexual Men & HIV Prevention  Pilot tested, June 2009  Goal to increase the ability of direct service providers to understand the lack of HIV prevention services, and address the hierarchy of needs of, Black heterosexual men through developing a sense of why they are at risk for HIV, and formulating best practices for prevention intervention strategies for this population.  How to engage the target population 32
  33. 33. Other Possible CBA Strategies  Training  Strengthening HIV Prevention Interventions  How to Recruit and Retain Skilled Staff That Reflect The Target Population  Holistic Screening & Assessment: Meeting All the Client’s Needs (e.g. Education, Unemployment, etc.)  Client Recruitment & Retention  Engaging Hard to Reach Population (incentives)  Cultural Competency  Addressing Role of men in African American community  How to Develop Home-Grown Interventions  Sexy Harm Reduction  How to Develop and Implement Effective Behavioral Interventions in the Corrections System 33
  34. 34. Other Possible CBA Strategies  Technical Assistance (i.e. adapting interventions, mentoring and coaching)  Strengthening HIV Prevention Interventions  Adapting existing interventions for heterosexual African American men  Community-Based Needs Assessment  Population-Based Needs Assessment  Developing Home Grown Interventions (i.e. partner-level, family-level interventions)  Organizational Development & Program Sustainability  Staff Development: Hiring Culturally Competent Peers and Staff  Strategic Planning  Partnership & Collaboration: Help Organizations learn how to collaborate with non-traditional organizations (e.g. faith based, corrections, job training, youth-serving organization, law enforcement) 34
  35. 35. Other Possible CBA Strategies  Community Mobilization  Ex-offenders and incarcerated men re: right to health care in the corrections system  Develop norms among Black men around seeking preventive healthcare and social services  Resource Sharing/Information Dissemination  Sexual Harm Reduction/Risk Reduction  Media Strategies: How to Diversify the Perception of African American men in Popular Culture  Incarceration and HIV Prevention 35
  37. 37. AcknowledgmentsThe African American Capacity Building Initiative (AACBI) would like to thank the following people and institutions for contributing to our work on this important issue: Jagadisa-devasri Dacus, Harm Reduction Coalition Rona Taylor, Ms. Foundation Natalie Baptiste, SUNY Downstate Andrea Brooks, Camillus House Allen Kwabena Frimpong, Youth R.I.S.E. Peter Thomas, PhD, MPH, Centers for Disease Control and Prevention Darrell Wheeler, PhD, MPH, MSW, Hunter College School of Social Work Sy Belfor and Niyah Rahamman, Mr. Man Productions Samantha Franklin, Columbia University Dr. Williams, SUNY Albany Kelvin Sapp And all the key informants and community stakeholders who participated in our formative research. 37 Funded by the Centers for Disease Control & Prevention
  38. 38. For More InformationHarm Reduction Coalition22 West 27th Street, 5th FloorNew York, New York 10001Tel: 212-213-6376Fax: 212-213-6582Website: 38