Adapting Community PROMISE with Older MSM &Transgender Individuals of Color

Hanna Tessema, MPH, MSW

Background: HIV & Aging

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

NYC DOHMH HIV Epidemiology and Field Services Program Semiannual Report: March 31, 2011http://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

25% of new cases in 2008 were diagnosed concurrently with AIDS. Among persons aged ≥ 50 years, the proportion of

concurrent diagnoses was 39%

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

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.

“There are no reliable data on the number of

transgender people living in the United States.”

--Transgender Law Center

Of the newly diagnosed transgender population in

NYC:90% are Black or Hispanic, 7% white4% other

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).

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+)

Community PROMISE

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 StoriesShort 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 AdvocatesVolunteers from the target population who have access to the community. They distribute the role model stories in places where they congregate.

4. EvaluationProviding evidence of the effectiveness of the intervention at the agency. Reveals whether the proven intervention was implemented with fidelity.

Community PROMISEACRIA 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.

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

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*

RMS DistributionThe 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

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

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

Lessons Learned

• HIV+ older MSM & transgender individuals are largely stigmatized by HIV-phobia, homophobia, transphobia, and ageism.

• Integrating HIV treatment and care into the RMSs has been essential in targeting older adults living with HIV.

• Social isolation & loneliness are important factors in sexual risk taking and need to be considered when developing RMSs targeting older MSM & transgender individuals.

• Important factors influencing behavior :

– perceived susceptibility

– self-efficacy

– communication & negotiation

– cultural norms about sexuality & gender roles

• Evidence Based Interventions work with Older Adults and should continue to be implemented

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

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