CP Update 9 27 06

Community PROMISE: A Tri-County Intervention Targeted to Highest Risk MSM : 

Community PROMISE: A Tri-County Intervention Targeted to Highest Risk MSM Update: September 2006

What is Community PROMISE? : 

What is Community PROMISE? A community level intervention of… Peers Reaching Out and Modeling Intervention Strategies E (added to just make sense)

A community level intervention is designed to influence the  entire target  population, not  the individual  specifically. : 

A community level intervention is designed to influence the entire target population, not the individual specifically.

Community PROMISE seeks to:: 

Community PROMISE seeks to: Change attitudes, values, norms around risk behavior and health Example: create a norm to carry condoms or disclose serostatus Influence the social/environmental context of a behavioral risk activity Example: have condoms available at internet-initiated sex parties; post serostatus on one’s internet profile.

Intervention Core Elements : 

Intervention Core Elements Community Identification Process Peer Advocate Recruitment, Management, and Outreach Role Model Story Development and Distribution

Community Identification (CID): 

Community Identification (CID)

Community Identification : 

Community Identification Observations, interviews, lit review, data analysis, etc. Assess what’s happening in a target community from a variety of sources, mainly the people within it Process and outcome monitoring Occurs at the beginning, middle, and end of the intervention period because things are changing all the time.

Community Identification Asks: : 

Community Identification Asks:

Tri County MSM CID Process : 

Tri County MSM CID Process Analysis of local/regional data & research literature Interviews with 17 reps local ASO’s 5 focus groups; 4 for service providers who interact with MSM & 1 with MSM 15 gatekeeper interviews (business owners, bartenders, video store staff) 40+ key participant phenomenological interviews; recorded and transcribed. **

Interview Criteria: Anal sex Sometimes condom usersMultiple SP’sPSE hookups18+ years of age: 

Interview Criteria: Anal sex Sometimes condom users Multiple SP’s PSE hookups 18+ years of age

CID Findings: How We Got There: 

CID Findings: How We Got There Interview transcripts were analyzed by 3 analysts for themes related to five areas of interest: Risk Behaviors* Contributing Factors* Risk Reduction Behaviors Motivating Factors for Change Stage of Change Then, thematic reduction to compress themes and identify variations.

Preliminary Findings: Risk Behaviors: 

Preliminary Findings: Risk Behaviors Primary Themes: Unprotected Anal Intercourse with Partners of Unknown or Assumed HIV Status (UPAI PunkAss) Absence of Communication Before or During the Sexual Encounter

Preliminary Findings: Risk Behaviors: 

Preliminary Findings: Risk Behaviors Theme: UPAI Variations: I don’t use a condom unless my partner asks me to use one. I don’t use condoms when I’m drunk or high.

Examples from the Interviews: 

Examples from the Interviews “If it [condom use] doesn’t come up, it’s simply not addressed. Obviously they don’t care, is the perception that you think.” (Age 57, HIV+) “If the bottom doesn’t say that they want to use a condom, then I just don’t use one.” (Age 30, HIV Status Unknown)

Preliminary Findings: Risk Behaviors: 

Preliminary Findings: Risk Behaviors Theme: Absence of Communication about Sexual Encounter Variations: No communication about status No communication about condom use No communication about the kind of sex they’re going to have

Examples from the Interviews: 

Examples from the Interviews “There really isn’t room for that discussion…You know, most guys, if you go ‘hey, what’s your status?’ they are going to the next person. You say too many words, you aren’t going to get the dick. You know what I mean?” (Age 32, HIV-) “What if they aren’t wanting to have sex, then you make yourself look [stupid] [if you ask about a condom].” (Age 28, HIV-)

Preliminary Findings: Contributing Factor: 

Preliminary Findings: Contributing Factor A contributing factor is something that may or may not be risky in itself, but facilitates risky behavior. Many contributing factors identified. Six leading ones discussed here.

Contributing Factors, I: 

Contributing Factors, I Condom use/status disclosure is the other person’s responsibility: Because of HIV Status It’s the HIV+ person’s responsibility because he can transmit disease It’s the HIV- person’s responsibility because he should protect his health. Because of Position It’s the bottom’s/top’s responsibility because he’s more at risk of acquiring/transmitting.

Contributing Factors II: 

Contributing Factors II Assumptions About Other Person’s Status: Person is HIV Positive because... Person is HIV Negative because…

Examples from the Interviews: 

Examples from the Interviews “He never asked to use a condom, so I think, if he didn’t want to, if he wants to bareback and he doesn’t want to use a condom, then he’s positive. Although we never talked about it.” (Age 61, HIV+) “When I’m with someone that by default we’re not using condoms, that seems ok… they seem less risky than if they are in the bareback room” (Age 30, HIV status unknown) “[Before I became HIV positive] I was truly, I was stupidly trusting. Thinking, you know, well I’m sure if he was HIV positive, he’d tell me.” (Age 30, HIV+)

Contributing Factors, III: 

Contributing Factors, III Timing of negotiation is important. If someone cares about condom use/status disclosure, he’ll discuss it upfront. Inertia is strong. It’s hard to stop sex once it’s started. “Pleasure is too strong a force…Once you’re into it, there’s not, you know, not many ways to turn around (Age 31, HIV+).”

Contributing Factors, IV & V: 

Contributing Factors, IV & V Primacy of Pleasure Condoms decrease sensation Condoms decrease pleasure because they kill the fantasy of sex as consequence-free. Condoms are Difficult to Use Condoms difficult to use/hassle Condoms cause or exacerbate erectile difficulties/hard to stay hard

Contributing Factors, VI: 

Contributing Factors, VI Substance Use and Risky Sex are Intertwined Drugs & alcohol help me live in the moment/not care about consequences. Drugs and alcohol help me deal with social anxiety/help facilitate sex Can’t stay hard when drinking or using, so don’t use condoms (e.g. crystal dick) Condoms interfere with primacy of pleasure

Examples from the Interviews: 

Examples from the Interviews “I was drunk and I didn’t care…it felt liberating because then all of a sudden I was just in the moment. I didn’t have to worry about anything else, any repercussions for my behavior…” (Age 25, HIV-) “It’s hard for me to wear a condom and stay hard when I’m high…When you get high and you get hard, you just have to fuck right away.” (Age 30, HIV Status Unknown)

Highest Risk MSM Defined: UPAI with Partners of Unknown or Assumed Serostatus Internet/Bathhouse Sex SeekersHIV-Positive MSM & Sex NetworksAfrican-American/Black MSM: 

Highest Risk MSM Defined: UPAI with Partners of Unknown or Assumed Serostatus Internet/Bathhouse Sex Seekers HIV-Positive MSM & Sex Networks African-American/Black MSM

Peer Advocate Management/Outreach (PAMO): 

Peer Advocate Management/Outreach (PAMO)

PAMO Contract: 

PAMO Contract After a competitive RFP issued 5-06, CAP won the award to recruit and manage peer advocates: Internet and Bathhouse Sex Seeking MSM African American and Black MSM, and HIV-Positive MSM and their Sexual Networks CAP is subcontracting with Brother to Brother to reach AA/Black MSM.

PAMO Services: 

PAMO Services Recruitment, training, & management of active members of a social network to become advocates for their peers. Peer advocates are: Naturally in situations/venues where the TP congregates & high risk activity occurs Not consistently engaging in risk reduction, but believe it’s important Distributors of role model stories and risk reduction supplies Recruiters for local HIV/STD counseling & testing Supported by agency outreach workers.

Role Model Story Development & Distribution : 

Role Model Story Development & Distribution

Graphic/Media Contract : 

Graphic/Media Contract After a competitive CPQ issued 8-06, this core element has been awarded to Behavior Works to: Develop graphic/media (including role model stories) for each of the target groups, and Design project logos/brands for community recognition.

Examples of Project Brands/Logos: 

Examples of Project Brands/Logos Long Bch, CA New York, NY Dallas, TX Seattle, WA

Role Model Stories : 

Role Model Stories Creation of graphic/media Based on personal accounts from members of the TP who have made, or are planning to make, risk reduction change. Distributed and supported by peer advocates.

Gay Men’s Health ProjectSouthern Arizona AIDS Foundation : 

Gay Men’s Health Project Southern Arizona AIDS Foundation

Minneapolis CP Plus: 

Minneapolis CP Plus

MSM Community PROMISE Project Coordination: 

MSM Community PROMISE Project Coordination MCHD, WCHD & Clackamas CHD staff, MCHD vendors for PAMO (CAP/B2B) and graphic design (Behavior Works). Training, review of CID data, cooperative planning and sharing of intervention challenges and accomplishments.

Tri-County HD StaffMSM COMMUNITY PROMISE : 

Tri-County HD Staff MSM COMMUNITY PROMISE Ben Anderson-Nathe & Kelly Jurman (WCHD) Kim Toevs, Alison Goldstein, Jessica Guernsey Camargo, Ronnie Meyers, Linda Drach, Claire Smith (MCHD)

How to Stay Informed : 

How to Stay Informed Information is posted at http://www.man2manpdx.us/ Check in with involved CHD staff Written report on the detailed findings of the MSM Community Identification Process available Fall/Winter 2006