This is a presentation given at the Road to Recovery Conference at Johns Hopkins University on September 23, 2013.

1. Treatment of LGBT Populations:
The Importance of a Sexual Health Framework
Jean-Michel Brevelle
Sexual Minorities Program Manager, Center for
HIV Prevention and Health Services
Maryland Department of Health & Mental Hygiene
Prevention and Health Promotion Administration
Road to Recovery: An Addictions Conference for Professionals
September 23, 2013

2. Mission and Vision
MISSION
The mission of the Prevention and Health Promotion Administration
is to protect, promote and improve the health and well-being of all
Marylanders and their families through provision of public health
leadership and through community-based public health efforts in
partnership with local health departments, providers, community
based organizations, and public and private sector agencies, giving
special attention to at-risk and vulnerable populations.
VISION
The Prevention and Health Promotion Administration envisions a
future in which all Marylanders and their families enjoy optimal
health and well-being.
September 23, 2013 2Prevention and Health Promotion Administration

3. Agenda
 Intersections of HIV and Substance
Abuse
 Environmental Influences on LGBT
People
 Trauma
 Why Sexual Health?
 Current PHPA Efforts
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4. National HIV/AIDS Strategy
(NHAS) July 2010
Goals:
 Reducing HIV incidence
 Increasing access to care and
optimizing health outcomes
 Reducing HIV-related health disparities
Prevention and Health Promotion Administration September 23, 2013 4

5. Maryland Reported Adult/Adolescent HIV
Diagnosis Rates by Jurisdiction, 2011
Using data reported through 12/31/2012
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6. 6September 23, 2013Prevention and Health Promotion Administration

7. Leading HIV Exposure Category
in Maryland
Year of HIV
Diagnosis
Number of
Years
Most
Common HIV
Exposure
Category
1981 - 1988 8 MSM
1988 - 2003 16 IDU
2004 - 2008 5 HET
2009 - 2012 4 MSM
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8. Environment
 Sexual shame
 Racism
 Sexism
 Heterosexism
 Homophobia
 Classism
 Absorbed attitudes toward self
 Absorbed attitudes toward others
Prevention and Health Promotion Administration September 23, 2013 8

9. Trauma
 Psychological trauma is the unique individual
experience of an event or enduring conditions, in
which
 the individual’s ability to integrate his/her
emotional experience is overwhelmed, or
 the individual experiences (subjectively) a
threat to life, bodily integrity, or sanity.
(Pearlman & Saakvitne, 1995, p. 60)
 An individual’s subjective experience determines
whether an event is or is not traumatic, not the
actual event.
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10. Trauma is Common and
Pervasive
 Between 55% and 90% of us have experienced at
least 1 traumatic event. Average is 5. (Fallot &
Harris, 2009)
 Disproportionately affects the most vulnerable
 People who are homeless, impoverished, diagnosed
with severe mental illness, struggle with addiction, or
who are developmentally disabled are at increased risk
of trauma.
 LGBT people may experience trauma at much higher
rates than the general population.
 Impact is broad, often deep and long-lasting
 Affects the way people approach helping
relationships
 Has often occurred within the service context itself
Prevention and Health Promotion Administration September 23, 2013 10

11. Adverse Childhood Experiences
 ACE Study (1998 & 2009)
 Kaiser Permanente, San Diego – 17,000 (1995-
1997)
 5 States via Behavioral Risk Factor Surveillance
Survey - 26,229 (2009) (AR, LA, NM, TN, WA)
 ACEs have been linked to a range of adverse
health outcomes in adulthood, including
substance abuse, depression, cardiovascular
disease, diabetes, cancer, and premature
mortality.
Prevention and Health Promotion Administration September 23, 2013
Centers for Disease Control and Prevention. MMWR, December 17, 2010 / 59(49);1609-1613
http://www.cdc.gov/ace/
13

12. ACE Study
 The ACE study found that the more
traumatic experiences had in childhood,
the more mental health issues, substance
abuse/addiction, and physical health
conditions emerged in adolescents and
adulthood.
 “Building emotional health and resilience is
building protections” (SAMHSA)
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13. ACE Comprehensive Chart
September 23, 2013Prevention and Health Promotion Administration
Column 1 Column 2 Column 3
Adverse Childhood
Experiences
Neurobiological Impacts
and Health Risks
Long-Term Health and
Social Problems
The more types of
adverse childhood
experiences…
the greater the
neurobiological impacts
and health risks…
the more serious the life-
long consequences to
health and well-being.
Abuse
Neglect
Trauma in the Household
Substance Use
Violence/Bullying
50+ Sex partners
Asthma
Liver Disease
Homelessness
HIV
15
*

14. ACE Survey Samples
While you were growing up, during your first 18 years of life:
Prevention and Health Promotion Administration September 23, 2013
Excerpted from Finding Your ACE Score, assessment tool. 092406RA4CR
1. Did a parent or other adult in the household often or very often…
Swear at you, insult you, put you down, or humiliate you?
or
Act in a way that made you afraid that you might be physically hurt?
Yes No If yes enter 1 ________
2. Did a parent or other adult in the household often or very often…
Push, grab, slap, or throw something at you?
or
Ever hit you so hard that you had marks or were injured?
Yes No If yes enter 1 ________
16

15. ACE Survey Samples
September
23, 2013
Prevention and Health Promotion Administration
While you were growing up, during your first 18 years of life:
4. Did you often or very often feel that…
No one in your family loved you or thought you were important or special?
or
Your family didn’t look out for each other, feel close to each other, or support
each other?
Yes No If yes enter 1 ________
3. Did an adult or person at least 5 years older than you ever…
Touch or fondle you or have you touch their body in a sexual way?
or
Attempt or actually have oral, anal, or vaginal intercourse with you?
Yes No If yes enter 1 ________
Excerpted from Finding Your ACE Score, assessment tool. 092406RA4CR
17

16. 18
ACE Pyramid
September 23, 2013Prevention and Health Promotion Administration

17. 19
Trauma /
Oppression
HIV Risk
Power / decision-making authority
perceived as outside self:
• No testing • No serostatus discussion
• No condom negotiation
Substance Abuse as Self-Care
• sub-optimal behavior under the
influence
• regret / shame
• addiction
• anxiety
• depression
• self-loathing
• isolation
• low self-esteem
Mental Health Outcomes
Mental
Health
Services
Substance
Abuse
Services
HIV Prevention Services

18. Self-Efficacy
 Self-efficacy originates at the level of self-
identity.
 Any action or situation that challenges,
dismisses, stigmatizes, or annihilates
one’s identity, reduces or eliminates self-
efficacy in ways that impact every
decision-point in daily life.
 Witnessing or experiencing the annihilation
of another’s or one’s own identity is
traumatizing.
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19. Premises: All Populations
 Syndemics / HIV travels with oppression.
 Our advertising and popular culture are
highly sexualized, yet we give people very
little information about sexuality.
 Before we can make progress with
providers and clients on addressing sexual
HIV risk reduction, we have to overcome
shame, discomfort, silence, judgment, and
ignorance.
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20. Sex Sells
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21. 23
Sexual Health
What is Sexual Health NOT?
Sexual health is more than:
 Not having an STI
 Not having an unplanned pregnancy
 Not being made to do things you don’t want to do
Sexual health assumes that desire is a natural,
healthy part of life—across the lifespan—and that
everyone has the right to pursue safe, consensual,
fulfilling sex.
September 23, 2013Prevention and Health Promotion Administration

22. Sexual Health in Recovery
 Multisession curriculum for people in
recovery
 Based on the work of Douglas Braun-
Harvey, MFT, CGP
 Supports people in recovery to maintain
sobriety by addressing sexual behavior,
thoughts, and feelings that may be related to
substance use
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23. Sexual Health in Recovery
 Sessions include:
 Making Healthy Sexual Choices
 Suspending Judgment About Sexuality
 Sexual Functioning in Recovery
 Sexual Boundaries in Recovery
 HIV/STI Myths, Facts, and Safer Sex
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24. Current Efforts
SAMHSA Branch
Source
CSAT CMHS, CSAT, CSAP
Award Type Block Grant Competitive Award
Project Name Integration of Sexual Health in
Recovery
No Wrong Door
Jurisdictional Targets Anne Arundel County
Baltimore County
Charles County
Harford County
Howard County
Montgomery County
Prince George’s County
Washington County
Anne Arundel County
Baltimore City
Interventions/Practices Screening & Referrals
HIV Testing & Linkages
Sexual Health in Recovery
Screening & Referrals
HIV Testing & Linkages
Sexual Health in Recovery
Training Mechanism PHPA Staff
IHV Contractors
PHPA Staff
OETAS Contractors
Type of Grantee Support Jurisdictional awards based on HIV
funding formula
Funding for Infectious Disease Testing
Training for Sexual Health in Recovery
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25. 27
No Wrong Door Vision
September 23, 2013Prevention and Health Promotion Administration

26.  To ensure that targeted racial, ethnic and
sexual minority communities in the Baltimore-
Towson Metropolitan Statistical Area, who are
at high risk for or have a mental and/or
substance use disorder and are most at risk
for or living with HIV/AIDS and other
infectious diseases, receive culturally
competent and integrated behavioral health,
prevention and care services.
NWD Project Goal
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27.  Meet unmet MH, SA and infectious disease
prevention and treatment needs.
 Increase the number of persons living with
HIV with MH and SA needs who are aware of
their HIV status.
 Create an integrated service delivery system
that is equipped to meet the MH, SA and
infectious disease needs of clients.
 Create a provider referral network.
The NWD Project Seeks to:
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28. NWD Project Activities
Pursue integration of behavioral health with infectious disease
 Expand and standardize screening for mental health, substance
abuse disorders in infectious disease settings in all
clinical/treatment settings
 Testing and linkage to care and treatment; case management
 Capacity building for better climates for discussion of sexuality
 Skills for Competent/Comfortable Conversations about Sex
 SAMHSA: A Provider’s Introduction to Substance Abuse
Treatment with LGBT
 Working with MSM
 Living Out Loud: How to Serve Transgender Clients Where
They Are
 Sexual health risk reduction counseling interventions
 Sexual Health in Recovery
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29. NWD Partners
 Alcohol and Drug Abuse Administration
 OETAS
 Baltimore Mental Health Systems
 Baltimore Crisis Response, Inc.
 Baltimore Substance Abuse Systems
 Total Health Care
 University of Maryland, Baltimore County, Dept. of
Psychology Center for Community Collaboration
 University of Maryland, Baltimore, STAR TRACK
 Coppin State University
 Morgan State University
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30. Contact Information
 Jean-Michel Brevelle
Sexual Minorities Program Manager,
Center for HIV Prevention and Health
Services
(410) 767-5016
jean-michel.brevelle@maryland.gov
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31. 33
Maryland
Prevention and
Health Promotion
Administration
http://phpa.dhmh.maryland.gov
September 23, 2013Prevention and Health Promotion Administration