The Mpowerment Project: Young Black Men who have Sex with Men Creating New “Chosen” Families

1. The Mpowerment Project: Young Black Men who have Sex with Men Creating New “Chosen” Families Susan M. Kegeles, Ph.D✰ Emily A. Arnold, Ph.D✰ Michael L. Foster, Ed.D., M.P.H.✰ Jonathan Davis✪ ✰The Center for AIDS Prevention Studies ✪Mpowerment Detroit, Michigan AIDS Fund

2. Family of Origin, Sexual Risk Behavior, HIV Testing and HIV Treatment For Young Black Men Who Have Sex With Men Michael Foster, EdD, MPH Co-authors Susan Kegeles, PhD Greg Rebchook, PhD Emily Arnold, PhD Haqumai Sharpe Minority AIDS Project/Unity Fellowship Church

3. Methods • Six focus groups conducted with YBMSM, aged 18 to 29 years, in Los Angeles, CA. in 2006-07 • Two focus groups included HIV+ men exclusively • 10 participants • Used semi-structured protocol, with prompts for clarification

4. Methods • Sample questions: After testing positive, some young, Black men get into treatment right away while others don’t. Why do you think this is? What do you think prevents some young, Black men from getting into treatment? • How can we help men overcome those barriers? • Data were hand-coded and analyzed thematically

5. Results • Family of Origin—biological and extended kin • Significant force • Positive—attitudes, beliefs, behaviors that promote positive sense of self/ self-worth, and increase safe sexual behavior, encourage HIV testing and HIV treatment, if HIV+ • Negative—attitudes, beliefs, behaviors that discourage positive sense of self/self-worth, decrease safe sexual behavior, discourage HIV testing and HIV treatment, if HIV+

6. Positive influence of family of origin Definition • Attitudes, beliefs, behaviors that promote positive sense of self, self-worth, and increase safe sexual behavior, encourage HIV testing and HIV treatment, if HIV+ An illustrative vignette Themes • Unconditional support • Cross-generational sharing; role models • Motivation to care for oneself

7. Vignette One: Positive role of family of origin • I went kind of cuckoo…after they said, "You are positive," I didn't catch nothing…But I called my mother…Okay, I have this. I'm going to die. How much time do I have? But I didn't want to leave the doctor's office. And when my mother came down there and everything, because she had to come down [laughs] because I was a mess, she said, "Let's listen to the people." And I said, "What do they know? They’re still testing [treatments]. They're not sure themselves. • So she was like, "Just listen to them, listen to them." And then as I listened to them…[I] found out that the medication can slow it down, can stop it from progressing to AIDS…I got the understanding of that—how…we can use [medication] as a tool to prolong your life, and that it's not a death sentence anymore. Then, I was able to come around and start thinking about the future.

8. Positive: Unconditional support and strength to take advantage of treatment “…My mom was a strong person and it didn't matter if I had it [HIV] or not; she still was there for me and she showed me that love.”

9. Positive: Cross-generational, wisdom-sharing about HIV treatment and wellness “I had other relatives that died from it [HIV/AIDS] so I got the respect for it, by seeing what they was going through and how to take care of myself…that's the experience I had. “

10. Positive: Motivation to care for oneself; love others and love self “If his family is really there for him if he find[s] out he's positive…where [he says to himself] ‘I have a family that loves me, so if I die, they [are] going to be stressed out. So why not get it together?’ “

11. Negative influence of family of origin Definition • Negative influence—attitudes, beliefs, behaviors that discourage positive sense of self, contribute to low self-worth; decrease safe sexual behavior, discourage HIV testing and HIV treatment, if HIV+ Themes • Vulnerability to peer influences • Silencing and shame related to being an MSM • Missed opportunity to communicate and learn about self-care An illustrative vignette

12. Negative: Vulnerability to negative peer influences “If you don't have … a good … home … if you don't have your mind right, a boy could come into your life and tear you up, a rumor could tear you up, anything could tear you up...”

13. Negative—Silencing and shame of sexual orientation and increased risk behavior “Our generation, we rarely have our parents…they're not there…I couldn't go to my mom, ‘Oh, mom, I have this boyfriend and we're not going celibate…’ “

14. Negative: Missed opportunities to communicate about wellness and self-care “I wished to God in heaven that I could talk to both of my cousins that died of HIV when I found out that I had it, but I couldn't. It was too late. They was dead. They had done passed on. “

15. Vignette Two: The Consequence of Truth-Telling • The majority of us didn't have a biological family…We're still…trying to find our families...So a lot of people are very upset; do things that they might not do if they had some type of [role model…[Growing up] I was only around gang bangers and dope dealers…What..you see around you…[has] a big impact… • People don't sit and talk…no more. They'll just [say], "This is my house, my room…If you don't do it this way, you've got to go." And people…knowing that you gay, and you ain't got nothing to say… and your ma is trying to get it out of you…You keep lying and lying…"Oh, you can tell me; you can tell me." No use in saying, " Well, I'm dating Tom next door.” You gotta go. See if Tom momma will let you in. It's the truth. Your mother says, "Just go…I'm going to let you take the threads you got on your back, but you have to leave my house now.”

16. Parting thoughts… • Family of origin—A powerful, influential force that remains a largely untapped resource in HIV prevention work with young Black MSM • Imperative that HIV prevention efforts involve families of origin, particularly mothers and grandmothers, as well as other supportive family members who are knowledgeable about HIV

17. Thank You Michael Foster, EdD, MPH The Center for AIDS Prevention Studies michael.foster@ucsf.edu 415.597.8123

18. Working with “constructed” families and young African American MSM: The Ballroom Community • Emily A. Arnold, Ph.D. and Abram Jackson, M.A. • Center for AIDS Prevention Studies, UCSF

19. Young African American MSM have many families • Immediate Biological Families • Extended Biological Families • Gay Families • The Ballroom Community and House Families • Families within HIV Prevention Programs

20. Methods • Pilot Study February-September 2006* • Oakland, San Francisco, Los Angeles • 15 in-depth interviews • Participant observation at balls, house meetings, community agency, clubs, bars • Data analyzed using Grounded Theory *Funded by Innovative Grants Program at Center for AIDS Prevention Studies, NIMH grant P30 MH62246

21. What did we talk about? • Personal history • Current living situation • History of ballroom community involvement • Current house, dynamics and relationships • Walking Categories • HIV-related risk and drug use in Community • HIV-related messages and social support in the community

22. What is the Ballroom Community? • Clandestine community of African American and Latino/a (in some places) LGBTQ youth (ages 13-24 and predominantly male) • Historically connected to 1920’s drag balls in Harlem • Ballroom communities exist in every major city in the US: Chicago, Atlanta, Baltimore, DC, New York, Los Angeles, Cleveland, Philadelphia, Charlotte, Detroit, and also the Bay Area • There has been little to no scholarly work done with the ballroom community

23. The Balls • Regular events occurring in cities nationally • Balls are regional: The Bay Area ballroom community travels to Los Angeles to attend balls and participate in houses • Elaborate categories and event descriptions are described in event flyers or call sheets, distributed via the Internet or house networks prior to the ball.

25. Houses as Families • Family structure of houses: house mothers and house fathers, and children • Houses organize and compete in the balls to win trophies, adding to their prestige. • House reputation and stature: national and local • Houses prepare the children to walk • Houses also function as homes, providing nurturing and support to men sometimes estranged from their biological families

26. HIV Prevention and the Houses • House Mothers and Fathers take different roles • Siblings provide support where the “rubber hits the road….” • HIV prevention: condom distribution, safer sex negotiation skills, support for safer sex, testing, and knowing your status • Support for HIV positive members: emotional support for treatment and coping with positive status

27. Houses are Families for Young Black MSM • “I like how we’re not just a house and it’s not just about competing. We do stuff as a family…When they first met me like, “Hey do you need this? Do you need that? You’re more than welcome to come and kick it with us.” And they just made me feel welcome, like out the back door just welcome.” Member West Coast House of Cavalli • “Mizrahi’s the best. Cause we’re just always unified; we all get along. We always have each other back, we always do what we need to do as being a house. Cause it’s like we’re more than a house, we’re like a family. And everybody click. It’s like a puzzle. It’s like everybody pieced together.” Oakland member House of Mizrahi

28. House Parents and Caring “My house mother…is a wonderful, wonderful person. Very, very caring. And she’s really taken on that kind of like really a mother role you know. She calls me all the time to check up on me and see how I’m doing and when I’m down there [in Los Angeles] I always have a place to stay. I always have a hot meal to eat…A lot of people have the perception that people want to be in those higher positions just for the name, and the status. But she truly, really cares about taking care of her house members.” -Member of the West Coast House of Prodigy

29. HIV Prevention and House Parenting Teaching them…what are low risk behaviors; what are higher risk behaviors. Or what can keep them safe; what may keep them safe; what won’t keep them safe…Not labeling or pointing the finger but, “I know you girls are doing that. I know you girls are sleeping with other people in the ball scene. You have to be very careful. Things are out there; you can easily acquire them.”…..And then to…see the statistics for myself in a number of cities. And then to know these cities are also ballroom cities and then it’s just like, “Well if CDC has these stats and they’re just talking about these cities and states in general and I know these are ballroom cities and states, I can gather the majority of these people, if not fifty percent of them, are ballroom people. They have to be walking around positive as well, or with something. Gonorrhea, syphilis, something.” So universal precautions always. You have to think that everybody has it. House Mother, Oakland House of Ultra Omni

30. Siblings and HIV prevention You know what? I don’t know about most of them but I know some people – well I know my closest, closest sisters are really serious about using condoms. They don’t really use them as much as for like sucking, but like doing the do it’s always like a condom’s used. Oakland member of the House of Infiniti

31. Support for HIV Positive Family Members Because like a couple of my brothers and sisters have HIV and so – and like we all are aware of that. And so you know we’ve got to keep them consoled and stuff you know and talk to them. At least I try to keep them consoled because I’m sure that’s not something easy to live with. Oakland member of the House of Mizrahi

32. Broadening Definitions of Family • Rethink heteronormative notions of family, one size does not fit all, particularly with queer youth of color • Collaborating with “constructed” families, including those within the ballroom community, has the potential to establish meaningful, sustainable relationships with dynamic youth communities, supporting HIV prevention work already taking place within these families. • Partnering with multiple forms of families as a way to disseminate HIV prevention and support into the community

33. Thank you! Emily A. Arnold, Ph.D. The Center for AIDS Prevention Studies emily.arnold@ucsf.edu 415.597.8124

34. Constructed Families Among Young Black MSM in Detroit as it relates to HIV Prevention Programs Jonathan Davis, Director Mpowerment Detroit Michigan AIDS Fund

35. Ball House History & Prevention in Detroit, Michigan • The House culture reached Detroit in the 1990’s. • The House structure often replaces the support of young men who are rejected by their biological families. How is a House Family related to HIV prevention? • Many members are involved in high risk sexual behaviors. • There is a high prevalence of alcohol and other substance use. • Because of the high HIV prevalence in the young black / same gender loving men’s community.

36. Mpowerment Detroit • Established in 2003. • Oversight by Michigan AIDS Fund, funded through the Michigan Department of Health, but situated separately in it’s own space. • Trained & have received technical assistance regarding the Mpowerment Project from CAPS. • Focusing on young Black MSM, 15 - 29 years of age. Young Brothers United

37. Mpowerment Detroit Adapted the intervention to our community (young black MSM living in Detroit). Small groups focused on safer sex, formal & “informal” outreach. Outreach Includes: • Social events • Movie nights • Outreach at bars • Safer sex is promoted at all activities

38. Young men come to the project • They have a place to call their own. The space is a safe haven. • It’s a peer-lead project. • Provides mutual support in an accepting atmosphere. • To gain knowledge.

39. Organizational Structure • One adaptation: incorporate family into the intervention. • Project run by a group of young men - Young Brothers United (YBU) • New members earn a position on the group through completing an internship regarding HIV prevention & skills training

40. Project has resulted in another kind of constructed family. • Estimated 400 young men participate in the project annually, 25 new young men come into the project monthly, and 50 men regularly attend events. • Close-knit group is Young Brothers United. • Creates a sense of family.

41. Family Created through Mpowerment Detroit Intervention is brought to the community and not “organically grown”. The project builds on sense of family that pre-existed. Family is expressed through: • Unity • Self-awareness and focus on common goals. • Acceptance and Love • Education Young men often talk about project as providing family.

42. Mpowerment Detroit’s success is tied to Family • Mpowerment Detroit project is not a ‘House’ yet it’s a vital link to the House community. • Many members of Mpowerment Detroit have been involved (or are involved) with the Ball / House community. • The project supports multiple forms of family. • New forms of family are created and made within the program. • The project addresses many similar community challenges in a new way. It builds unity, brotherhood and creates common, achievable goals. • It values the culture of young gay / bi / same gender loving black men. • Each member of the project expresses emotional bonds which creates more harmony in the community.

44. Why is it Good to Create Family for Young Black MSM? It resonates culturally, given importance of family structure within the African American LGBTQ community. This structure is helping to fight HIV in Detroit because: • It is establishing a common dialogue. • Encourages members to watch out for each other. • Creates a space where important conversations about HIV take place.

45. Creating a Diverse Family is also Good Because… • It builds self-esteem. • Establishes trust. • Encourages lasting friendships. • It’s empowering. • Allows for a larger, more vibrant project.

46. Thank you! Jonathan Davis, Director jdavis@mpowermentdetroit.org 313.963.9402