Rugged, Rural, Resourceful:

1. Rugged, Rural, Resourceful: Delivering HIV and STD Messages to gay men and other MSM through Community Building Groups. A Maine Model.

2. Maine “The Way Life Should Be” • Maine is a large and sparsely populated State • As of 2007 the population is estimated at 1,317,207 • About 55% of residents live in rural communities • About a third live in one of the 3 MSAs • Portland, Lewiston/Auburn and Bangor • Nearly a third of population is under 24 • Per capita income is below the US amount ($19,533 vs $21,587)

3. Where we live…..

4. Northern 321,824 Central 500,745 Southern 452,354

5. HIV in Maine • 65% MSM transmission over the last 5 years • 55% MSM transmission over the last 10 years • 56% of PLWHA are MSM, 15% IDU, 10% Heterosexual contact with at-risk partner • 91% White • 36% of Maine HIV diagnoses were late (converted to AIDS within 1 year of HIV diagnosis) 2004-2008 • About 450 HIV +individuals are undiagnosed in Maine • During 2008 46 HIV diagnoses, 28 MSM (61%)

6. Estimate of 1,800 PLWHA in Maine1,355 diagnoses reported

7. Estimate of 1,800 PLWHA in Maine 1,355 diagnoses reported Race 91% White 8% African American <1% Native American <1% Asian/PI Ethnicity 5 % Hispanic

8. How we used to purchase MSM services…..

9. The shift began in 2006…

10. MSM Services in Maine 2006

11. Maine MSM HIV Prevention Community Building Program • Not an intervention • Strategy to deliver HIV and other prevention messages • Approach to reach program goals/mission, and deliver messages in a broader context • Make Testing- Routine Testing available • Effort to provide tools to our partners

12. The Groups…. Only part of the MSM programming- • Outreach in traditional PSE continue • Testing occurs during non-group hours, off site, etc. • Other statewide activities

14. What we put into it…… • Commitment to community! • Elements of “Mpowerment” • Focus on community building, peer development, peer-to-peer education • Recommendations from the CPG and MSM needs assessments • MSM Coordinator to oversee, provide technical assistance • Health Department provides resources- • i.e. messages, materials, tests, etc.

15. What the groups have in common • Community Building Activities • Place to gather • Testing • peers • Web pages • Resources • Open invitation to other groups • Educator to lead • Outreach

16. What’s different about the groups…. • How many times they meet…. • Where they meet…. • Activities….. • How they meet… Uniqueness of group comes from the dynamics of the men and the educator

17. Message development • Program messages • Know your Status.. Know the status of the guys you meet…disclose your status • Get tested routinely • Get Screened for STDs routinely • Hepatitis vaccination • Program Messages are developed by the HD with input from community

18. HD includes other health messages such as screenings, smoking, alcohol/drug use, mental health etc. • Other health messages allows educators to develop their own , use national messages and resources, etc. - be creative!

19. Tools Developed Stand Alone Messages D2K Website Code Red

20. AdViews (Total):    7226 Posted for three months AdClicks (Total):   143

24. CODE RED Video coderedsample.wmv Click on link to play video

26. DineOut - Monday, March 23rd - 5:30 PMNinety-Nine Restaurant, 34 Topsham Fair Mall, Topsham Monthly  Movie Night - Monday, March 23rd - 7:00 PMSenter Place, 124 Maine Street, 2nd Floor across from Suite 212, Brunswick BECOMING MEN (2008)Nothing equals that feeling of ultimate conquest like our first sexual experiences. It is a time of mystery, wonder and new adult responsibilities. Here are real-life stories of young men taking the final step on their journey from boyhood to manhood. Superb photography, spectacular guys and candid interviews capture the joys and fears of sexual awakening and evoke memories of those early experiences that define our lives. Tony Award® winning Broadway and film star, Alan Cumming, narrates this sensitive look at the challenges and glories of youthful passion, including current information for making safer choices. A must for all men. We hope to see you at one or more of the events next week.See our calendar for more upcoming events. AIDS WALK WEEKEND - BRUNSWICK Please mark your calendar for Saturday, May 2nd for the AIDS Walk Weekend event in Brunswick.  You can visit http://www.aidswalkweekend.com for more information.  We have created a team for Guy2Guy.  Click the Brunswick page and click JOIN TEAM. 

32. just guysviews letter The Great Easter Egg Raffle:prizes, prizes, prizes! First prize: a $50 gift card! Gift cards, DVD’s, CD’s! Drawing: Wednesday, April 29. You must be present to win. Winners will be drawn from tickets you can collect starting right now!* The purple Easter Bunny sits on a basket in Lew’s office, and will be brought to meetings. The basket is filled with jeweled Easter** Eggs and each one contains from 1 to 5 raffle tickets. Win an egg to enter into the raffle. (There are a limited number of eggs, so your chances of winning a prize are good!) How do you win an Easter Egg? Or two? Or more? Here’s how to win your own jeweled egg: You can: • Get an HIV test with Lew (and you still get a $10 gift card right there!) • Refer a new test candidate to Lew (who will need to state you sent him). • Get any of the tests on the “ask your doc” card available at meetings. (For your information: here are the recommended testsJ 1. HIV test, if you do not know your status* 2. Syphilis serology 3. Anal Pap smear 4. Oral test for gonorrhea 5. Rectal gonorrhea and chlamydia culture. 6. Hepatitis C  test, if you inject drugs 7. Hepatitis A & B vaccinations 8. Urine test for both gonorrhea and chlamydia Three ways to enter, enter as many times as you like. Now, the fine print… *drawing dependent on three dozen eggs won. (four have already been won, so make your appointment right away.) **The use of the word “Easter” does not constitute endorsement of any religious observance. Actually the holiday was named after a Saxon pagan fertility goddess, and its date is decided on phases of the moon. Finally, all prizes are donated.

34. “…..where fairies learn to fly…..” “...I can fly… I can fly… I can fly…”

35. “To observe without evaluating is the highest form of intelligence.”J. Krishnamurti(1895 - 1986)

36. Why we like it… • Newly Identified Positives • Eight newly identified positives from groups in 2006 • 5 from one group • Over 1,000 MSM are reached on a weekly basis with messages through email lists, Face book pages, etc. • 150-200 men attended weekly groups across the state • 35-50% of men routinely test

37. Why we like it… • Saves on resources • HIV program is seen as a “partner” • Addresses social needs that are hard to find in rural areas… • Hits many predictors of risk.. • Empowers and mobilizes community • “just friends”, gay pride • How the community responds..

38. Moving Forward…. 2009 • MSM Strategic planning 2009 • Work group of CPG members, Educators and HD – • Identifying priorities • Development of common evaluation tools • Enhancement of D2K site • Development of on-line referral list • Educators blog • Increase Health Department State and Community Sponsored events • 2008 held one event in different parts of state • New HIV and Hep messages

40. Suggestions…. • Health Department has to be committed • HIV needs to collaborate with other State Programs • Staff • Create a brand “D2K” • Flexibility • Involve the community, CPG, AND the educators • Look for opportunities (staff changes, messages, etc.) • Value creativity • Build on-going collaborations • Empower community and educators!

41. Gratuitous picture of the children…

42. Contact information: James Markiewicz Jayson Hunt HIV Prevention Program Manager MSM Program Coordinator James.Markiewicz@maine.govJayson.Hunt@maine.gov