1. Adapting Community
PROMISE with Older
MSM &Transgender
Individuals of Color
Hanna Tessema, MPH, MSW

2. Background:
HIV & Aging

4. 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

5. NYC: HIV Among MSM
As of June 30, 2010:
• 109, 446 PLWHA
• 33.5% MSM
• 62% of newly diagnosed males in the first half
of 2010 were MSM

6. 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.

7. “There are no reliable data
on the number of
transgender people living in
the United States.”
--Transgender Law Center

8. Of the newly diagnosed
transgender population in
NYC:
90% are Black or Hispanic,
7% white
4% other

11. The highest numbers of newly diagnosed transgender persons lived in Bedford Stuyvesant–Crown
Heights, West Queens, Chelsea–Clinton, and Fordham–Bronx Park (areas in dark red).

12. Community PROMISE

13. 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+)

14. Community PROMISE:
Four Core Elements
1. 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.

15. 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.

16. 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

17. 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*

18. 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

19. 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

20. 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

21. 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.

22. 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

23. Contact Information
If you have any questions regarding
Community PROMISE at ACRIA, please feel
free to contact:
Hanna Tessema, MPH, MSW
htessema@acria.org
212.924.3934 x135