The African American Capacity Building Initiative (AACBI) offers: technical consultation and training to enhance the effectiveness of HIV prevention interventions by assisting organizations in adapting and tailoring those interventions to best serve the needs of their clients. AACBI will work with organizations to adapt and tailor the CDC ’ s Diffusion of Effective Behavioral Interventions (DEBI) Projects for successful use in communities. These specifically targeted interventions have been developed and used with African Americans on individual, group, and community-level bases and have shown phenomenal success in reducing high-risk sexual and drug use behavior while also building the knowledge base and skill sets of African Americans at high risk for HIV infection.
Read Bullet #1 There is a need to change the framework under which current prevention intervention models operate. Currently, “priority populations” for prevention strategies are designated by how people infected with HIV identify their transmission risk and who among them have the highest rates of infection. This does not take into account those individuals who are infected in other ways (i.e. female-to-male sexual transmission). Nor does this address those individuals whose transmission risk is unidentified. Read Bullet #2
There is a need to generate awareness around this particular issue, and to solicit feedback on why there are gaps in services and resources for this population from direct service providers in community based organizations, health agencies, amongst researchers, policy-makers. As capacity building assistance providers, we decided to step forward and strategize about the best way to engage and connect heterosexual black men to HIV prevention services Caveat: We are talking about men who have sex with women only…not men on the down low. There are programs, services and research that are addressing that specific population. So, I want to be clear about who I’m talking about today. Glad to see that the topic of heterosexual transmission is all over the agenda at this conference. It’s about time!
Read highlights of stats We know how HIV is transmitted, be it among Black men or any other man: through unprotected anal or vaginal intercourse with an HIV+ person or sharing injection equipment with an HIV+ person. We know much less about how psychosocial, contextual, political and historical forces influence Black men's risk taking. Education, employment and incarceration must be addressed, especially with financially marginalized men.
METHODOLOGY AACBI hosted a community advisory group (CAG) forum with their consumers – staff of community based organizations and health departments – to determine how capacity building assistance can support them in developing and sustaining programs to meet the unique HIV prevention needs of heterosexual black/African American men. The CAG forum included an expert panel sharing research, best practices and strategies for developing HIV prevention programming for heterosexual black men. Afterwards, consumers shared their experiences and suggested potential strategies for engaging the target population. Lit Review – Adam Viera The literature review was conducted to broaden the picture and determine the factors that influence HIV risk among Black/African American heterosexual men. AACBI/HRC was able to generate ideas about potential partnerships and collaborative opportunities to address this issue through programmatic capacity building assistance. The Forgotten Population Institute included information on national demographics and statistics on rates of infection and transmission rates among Black men. The perspective of the target population in the New York Metropolitan area was shown through a documentary film put together by the African-American Capacity Building Initiative entitled The Forgotten Population . In addition, anecdotal experiences in program management, and advocacy working with this population was also explored through our panel discussion which featured speakers Dr. Peter Thomas from the CDC, who currently is doing research around this population, Ms. Andrea Brooks from a CBO called Camillus Health Concern who directly works with Black Men at risk who are homeless, and Mr. Allen Kwabena Frimpong, from Youth RISE, who at the time directly worked with HIV infected and affected youth under a Ryan White IV funded prevention intervention program. Now he works on international harm reduction issues. Lastly, breakout sessions based upon the Key Topics developed for the Forgotten Population documentary were used to brainstorm what the barriers were working with this population and also what could be done on a capacity building standpoint in assisting this population with their needs by coming up with best practices. Through the forum and consumer focus groups conducted, AACBI/HRC was able to identify barriers and solutions to designing interventions and providing capacity building targeting heterosexual African American men.
Based on the data collected thus far, there are 5 key issues that are influencing factors for the HIV risk behaviors of Black/African American heterosexual men. They include: (1) healthy relationships with black women, (2) class and poverty, (3) substance use/drug policy, (4) incarceration, and (5) mental health issues. These factors need to be addressed in effective behavioral interventions (EBIs) for the target population, either through the adaptation of existing EBIs or the promotion of “home grown” interventions. The Key Topics developed with questions from the film were: On Healthy Relationships… Give me some words to describe what it means to be a Black Man in America. What do the words Black Masculinity mean to you? How did you get to know your sexuality as a Black man? Where do you think people get their ideas and perceptions about the sexuality of Black men from? How do you think these things influence Black Men as well as Black Women? From a scale of 1-5 (1 being Excellent to 5 being the Worst), where would you say the state of affairs between Black Men and Women stand? Why? What is your idea of a Healthy Relationship? What does being “intimate” with your partner look like/ how does that play out? What does having “instant gratification” with you partner look like/play out? Do you think intimacy and/or instant gratification is important in establishing a healthy relationship with your partner? Why? Give me some words to describe Black Women? Black Men who have men as their partners? Does the gender of a person that a man chooses to have sex with affect how a man is seen as masculine/’manly’? If so, in what ways? On Class and Poverty… With all the knowledge and outreach with the availability and increase in the usage of condoms, HIV rates in predominantly Black urban communities are still on the rise – What do you think drives the increasing rates? What is Black men’s role in lowering their risk for HIV in these communities? Given speeches from those such as Bill Cosby and Barack Obama about Black Men taking personal responsibility for their actions – Where do you think the idea that Black Men from poor urban communities are not capable of being responsible comes from? How does personal responsibility look for financially stable Black Men? What does being socially responsible look like for Black Men that want to improve the quality of life in their communities? Do you think Black men that identify as heterosexual see themselves at risk for HIV? Why? What are the barriers that you think Black men face when it comes to accessing medical services? On Substance Abuse and Drug Policy… With the wave of the crack and heroin in urban communities many still face the aftermath of the damaging effects from the war on drugs – How do you think the drug war has influenced Black men participation in the selling of illegal drugs? In what ways do you think drugs have played a role in the increase of HIV rates? 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? On the Prison System… With the alarming rate of incarceration of Black men in America’s prison system, how do you think their incarceration contributes to HIV prevention efforts? What are your thoughts on Black men who are incarcerated being tested mandatorily for HIV infection? Do you think that men who are incarcerated should have access to condoms? Why? How do we begin to prepare Black men who are being released from prison to maintain healthy relationships with their partners? On Mental Health How do you feel when you hear the statement that “Black men are hypersexual and violent individuals”? Why do you feel this way? How do you cope with your feelings and emotions as a Black man? Do you think your ways of coping work for you and are healthy? What is your opinion on the statement that “Black men hold their feelings and emotions inside, and so they act out in violent ways”? Do you agree/ disagree? Why? Are Black men receptive to mental health services? Yes/No? Why? What are the struggles and barriers with dealing with your identity as a Black man? How have you overcome these struggles and barriers?
We are not going to go through all of these. However, I want to highlight some of the ideas that stood out that came from community stakeholders and members of the target population.
What it means to be a man
HIV/AIDS not a priority Homelessness & joblessness is at the forefront Desperation amongst African-American women (regardless) to find partnership Access to Resources limited Quality of services offered to people is based on class status
The perspective of the target population in the New York Metropolitan area was shown through a documentary film put together by the African-American Capacity Building Initiative entitled The Forgotten Population .
CONCLUSION Open safe spaces for Black Men need to be made available. HIV prevention agencies must acknowledge underlying social, political, and economic factors that Black men deal with in their communities and in their lives. With the complexity of problems and the vulnerability of our social political climate, programs for Black men should tackle the intersecting issues of employment, education, incarceration, drug abuse and bad drug policy, as well as HIV stigma related to drug use and sexual behaviors. HIV prevention programs targeting Black heterosexual men must meet their immediate needs, increase their access to available resources and build new resources for African American men where unavailable. These programs must operate on various levels, from individual-level to community-level, and understand the unique needs of Black heterosexual men in HIV prevention.
Black Heterosexual Men & HIV Prevention
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
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
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
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))
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
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
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
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
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
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
Transmission rates for black adult &adolescent men living with HIV/AIDS,2005 CDC, 2006 12
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
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
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
What Have We Uncovered?Via Community Advisory Forums, Focus Groups, Key Informant Interviews and Literature Review 16
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
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
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
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)
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
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
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
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
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
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
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
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
Closing Remarks WE WILL NOT SOLVE ALL PROBLEMS!HOWEVER, WE ARE TAKING THE FIRST OF MANY STEPS TOWARDS A SOLUTION 36
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
For More InformationHarm Reduction Coalition22 West 27th Street, 5th FloorNew York, New York 10001Tel: 212-213-6376Fax: 212-213-6582Website: www.harmreduction.org 38