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2010 Metro Denver MSM Strategic Planning Meeting

2010 Metro Denver MSM Strategic Planning Meeting. Montview Presbyterian Church January 29, 2030. Today’s Activities. Review Current epidemiology of HIV infection among MSM living in the metro Denver area HIV risk behaviors among metro Denver MSM and the context of those behaviors

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2010 Metro Denver MSM Strategic Planning Meeting

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  1. 2010 Metro Denver MSM Strategic Planning Meeting Montview Presbyterian Church January 29, 2030

  2. Today’s Activities Review • Current epidemiology of HIV infection among MSM living in the metro Denver area • HIV risk behaviors among metro Denver MSM and the context of those behaviors • MSM use of HIV prevention services. • MSM HIV prevention-related recommendations • CDPHE funded HIV prevention services for MSM

  3. Today’s Activities Small group discussions • Identify important HIV prevention issues affecting metro Denver MSM. • Examine the capacity of existing resources to address the HIV prevention needs of metro Denver MSM. • Recommend HIV prevention strategies to decrease HIV infections among metro Denver MSM.

  4. Epi Overview January 1, 2007 – December 31, 2009 • 1, 244 cases of HIV infection (HIV and AIDS) were newly reported statewide to the CDPHE. • 804 (65%) occurred among MSM. • 675 (84%) of MSM cases occurred among men living in metro Denver (Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas, Jefferson counties).

  5. Metro Denver HIV cases among MSM, 2007-2009 Race/Ethnicity White, non Hisp 409 (61%) Black, non Hisp 49 (7%) Hispanic, all races 201 (30%) Asian/Pac Islander, non Hisp 7 (1%) Amer. Indian, non Hisp 5 (<1%) Multi race, non Hisp 4 (<1%)

  6. Age Range (years) N (%) 15-24 109 (16) 25-34 235 (35) 35-44 174 (26) 45-54 115 (17) 55-64 32 (5) 65 and older 10 (1) Metro Denver HIV cases among MSM, 2007-2009

  7. Metro Denver HIV cases among MSM, 2007-2009 (N=675) • 45 (6.7%) had a history of injection drug use. • 214 (31.7%) were likely diagnosed late in the course of their infection.

  8. HIV Risk-Related Behaviors among MSM

  9. National HIV Behavioral Surveillance: Men who have Sex with Men – Denver • Denver Public Health – one of 26 participating sites in the surveillance project. • 2004-2005, 2008 NHBS focus: MSM • 981 MSM in metro Denver were surveyed in 2004-2005; 597 MSM in 2008.

  10. Denver NHBS MSM Findings Partner Type (2004-2005) Main partner last 12 months 650 (66.3%) Casual partner last 12 months 580 (59.1%) Main and casual partner 376 (38.3%) • MSM reported meeting casual sex partners in bars/clubs (~48%) more frequently than on the Internet (~10%) or in a bathhouse (~10%).

  11. Denver NHBS MSM – Sexual Risk

  12. Denver NHBS MSM – Discussion of HIV Status Presented to CWT by Mark Thrun, MD, June 3, 2005

  13. Denver NHBS MSM Findings, 2008 Alcohol Use • 557 (93.3%) of MSM respondents drank alcohol in the past 12 months. • Of those, 322 (57.8%) had five or more drinks in one sitting on a monthly or more frequent basis in the past 12 months.

  14. Denver NHBS MSM Findings Drug Use • In 2008, 67 (11%) MSM respondents reported a history of injection drug use. • Among MSM who had ever injected, 22 (32.8%) had injected in the past 12 months. • Among all MSM respondents, 294 (49.3%) reported using non-injection drugs.

  15. Marijuana 216 (73.5%) Smoked, snorted cocaine 112 (38.1%) Poppers (amyl nitrite) 104 (35.4%) Ecstasy 74 (25.2%) Stimulant (meth, amphetamine) 65 (22.1%) Denver NHBS MSM Findings Most Frequently Used Non-Injected Drugs Past 12 Months (2008) n=294

  16. Denver NHBS MSM Findings 2004-2005 Presented to CWT by Mark Thrun, MD, June 3, 2005

  17. Denver NHBS MSM Findings 2004-2005 • Eleven percent of MSM sample used meth. • Compared to non meth users, MSM who used methamphetamines were more likely to: Be HIV positive. Have been arrested in past 12 months. Have used erectile dysfunction drugs. Be homeless. Report unprotected sex last 12 months. Presented to CWT by Mark Thrun, MD, June 3, 2005

  18. Denver NHBS MSM Findings HIV Testing Histories • The majority of MSM survey participants (93%-94%) had previously tested for HIV. • Among MSM reporting an HIV test, 17%-18% reported testing positive.

  19. Received free condoms 403 (67.5%) Individual-level counseling 141 (23.6%) Group-level counseling 64 (10.7%) Denver NHBS MSM Findings HIV Prevention Activities Past 12 months (2008)

  20. Opinions and perceptions about HIV-related issues among MSM

  21. 2006 Needs Assessment: Major Issues Affecting Gay/Bi Men • Discrimination against gay/bi men • Mental health related issues (e.g., feelings of isolation, loneliness, depression, shame) • Substance use and abuse particularly meth use • Access to health insurance and health care • Internet survey: STDs • Focus Group, Interviews: Meeting basic needs, relationships, disclosure, exposing others

  22. 2006 Needs Assessment: Substance Abuse • Use of alcohol and other drugs is common and a problem. • Accepted as a norm in the gay community. • Strongly associated with unprotected sex and failure to disclose HIV status. • Methamphetamine: easy to obtain, strongly addictive, associated with unprotected sex and multiple partners.

  23. Why Gay/Bi Men Use Drugs • Bars are main venues for socializing. • Alcohol companies target the gay community. • Easy access to drugs in bars and bathhouses. • Drugs are fun. • Means to escape life’s problems. • Used by some men to deal with the realities of HIV disease.

  24. 2006 Needs Assessment: Emotional Well-Being • Low self-esteem, loneliness, depression reported to be common among gay/bi men. • Attributed to lack of social acceptance, homophobia, discrimination. • Depression following an HIV diagnosis. • Affects whether men will protect themselves, disclose HIV status • Sex used to avoid emotional pain

  25. Recommendations Related to Emotional Well-Being • Accessible mental health services, therapy and support groups • Someone to listen • Greater societal acceptance • Interventions that address stigma. • Interventions involving the wider gay community • Targeted public information campaigns • Multiple services available at one agency

  26. 2006 Needs Assessment: “Coming Out” and HIV • “Coming out” characterized as a time of experimentation. • Exciting period but may involve confusion, shame, and rejection • Often involved engaging in high risk behaviors • Especially difficult time for men of color, bisexual men, and men living in rural areas

  27. Recommendations Related to Coming Out • Support from friends, family, other gay and bisexual men • Positive role models and mentors to make coming out a safer, less stressful period

  28. 2006 Needs Assessment: Relationships and HIV • Dimensions of” healthy relationships:” trust, respect, love, communication, friendship, fun • May include long-term monogamous as well as short and long-term open relationships.

  29. Barriers to Healthy Relationships • Lack of societal support • Prestige of having multiple partners • Invisibility of healthy gay relationships/lack of role models • Lack of suitable venues • Differences in SES, education, age, HIV status • Substance abuse • Emotional instability

  30. 2006 Needs Assessment: Healthy Relationship Recommendations • Better, more visible models of healthy relationships • Social acceptance and legal sanctioning of same sex relationships • Social outlets and venues that are consistent with forming substantive relationships (e.g., places to meet outside of bars and sex venues)

  31. Behaviors within the Context of Anonymous Encounters • “Barebacking” is a common occurrence. • Frequently involves sex without HIV status disclosure. • Internet plays a “huge” role in anonymous encounters with many men looking for partners willing to “party and play” (i.e., use drugs while having sex).

  32. Reason for Unsafe Sex • Use of drugs and alcohol • Not caring about self or others • “Bug chasing” or trying to become HIV infected • Belief that HIV infection is inevitable • Condom dislike, condom/safe sex fatigue • Misperception of risk (e.g., what behaviors are safe, faulty partner choices based on appearance, SES, insertive/receptive sex practices)

  33. 2006 Needs Assessment: HIV Status Disclosure • HIV status is not commonly discussed. • Many gay/bi men are not disclosing or lying about their HIV infection. • Disclosure is infrequent at the bathhouse or when drunk/high. • Reasons for not disclosing : fear of rejection, shame, fear of violence, inability to ensure confidentiality, not knowing how to disclose, vindictiveness, assumptions about partner’s status

  34. Views on Disclosure • All men living with HIV should disclose their status. • HIV negative men should ask partner’s status/assume partner is HIV positive and act accordingly. • No need to disclose if condoms are used. • Few of the participants living with HIV reported that a partner had disclosed his status prior to having sex.

  35. Recommendations related to HIV Status Disclosure • Peer support groups • Educational sessions allowing men to role-play • Targeted public information campaigns to normalize disclosure • Messages appealing to men not to spread HIV, respect others’ rights to remain negative • Allow couples to test and receive their results together. • Encourage serosorting.

  36. 2006 Needs Assessment: Perceptions of the Gay Community and Culture Frequently men expressed negative views of Denver’s gay community: • Divided based on age, ethnicity, class, HIV status, tops vs. bottoms, etc. • Obsessed with looks and status symbols • Overly focused on partying, substance use, Internet “hook ups” • Glamorizes meth use and barebacking

  37. Perceptions of the Gay Community and Culture, continued Gay community perceived as: • Not welcoming to bisexual men. • No longer concerned about HIV. • Not supportive of long-term relationships. • Not supportive of HIV status disclosure. • Indifferent to instances where individuals spread HIV.

  38. Recommendations Related to the Gay Community • Gay men need to support each other and promote emotional well-being and physical health. • The gay community needs to re-familiarize itself with HIV and take an active role in its prevention. • Provide opportunities for older gay men need to act as role models and mentors. • Confront issues such as stigma, challenge stereotypes. • Facilitate community forums, group discussions

  39. BCAP MSM Community Assessment, 2006-2007 • Attitudes and perceptions of safer sex practices among MSM differed by age. Men who were 40+ spoke more fearfully about HIV; more judgmental toward those not practicing safer sex. • Discussions about HIV with potential partners will frequently derail the possibility of a sexual contact. HIV status and safer sex discussions are more likely to occur within the context of a potential relationship.

  40. Urban Latino MSM Community Assessment, JSI, Inc. (2009) • Latino MSM expressed the importance of a “sense of community” and that their lack of feelings of belonging to mainstream Latino or MSM communities may impact HIV prevention planning and implementation. • Services that need to be in place to address risk behaviors among Latino MSM include integrated positive prevention messaging, skills building, and should be comprehensive and coordinated, addressing mental health and substance use issues using culture, art and community JSI, Research and Training Institute, Inc.

  41. For More Information George Ware george.ware@state.co.us (303) 692-2762

  42. 2010 Metro Denver MSM HIV Prevention Profile Content: • Estimated Population Size • Basic Epidemiological Information • Description of Funded Programs that Target Metro Denver MSM • Potential Impact of the Funded Service Metro Denver MSM Strategic Planning Meeting, January 29, 2009

  43. Estimated At Risk Population Size (Range Estimates*) Urban White MSM 4,175 – 9,607 Urban Latino MSM 904 – 3,793 Urban African American MSM: 912 – 1,044 Urban Young (13-24 yrs) MSM: No data available

  44. Estimated Population Size (Range Estimates) * The population estimates were obtained from the document, “CWT Prioritized Population Estimates, 2004.” Applied various recognized scientific methodologies for estimating the sizes of target populations as enumerated in the 2000 U.S. census. Estimation likely to underestimate the size of some risk populations due to the limitation of the data, estimation techniques, and accurate disclosure of risk behaviors to CDPHE.

  45. Basic Epidemiological Information Cumulative* Number of Living HIV/AIDS Cases: Urban White MSM: 4,731 Urban African American MSM: 602 Urban Latino MSM: 1,035 Urban Young MSM 83 (diagnosed at age 19 or younger): *Refers to the total number of HIV, AIDS or HIV/AIDS cases reported in Colorado since surveillance for this condition began in 1982.

  46. Basic Epidemiological Information Number of HIV/AIDS cases reported in 2008: Urban White MSM: 128 Urban African American MSM: 25 Urban Latino MSM: 83 Urban Young MSM 6 (diagnosed at age 19 or younger):

  47. Description of Funded Programs that Target Metro Denver MSM • Please refer to handouts for program descriptions

  48. Description of Funded Programs

  49. Description of Funded Programs

  50. Description of Funded Programs

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