1 / 14

HIV prevention among African American MSM: the U.S. Context

HIV prevention among African American MSM: the U.S. Context. Darrell P. Wheeler, PHD, MPH Dean & Professor Loyola University Chicago. Drivers of HIV epidemics in United States . “Poverty may be the most important risk factor for HIV infection among heterosexuals living in urban areas.”

molly
Download Presentation

HIV prevention among African American MSM: the U.S. Context

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. HIV prevention among African American MSM: the U.S. Context Darrell P. Wheeler, PHD, MPH Dean & Professor Loyola University Chicago

  2. Drivers of HIV epidemics in United States • “Poverty may be the most important risk factor for HIV infection among heterosexuals living in urban areas.” • “People of color are disproportionately affected by HIV/AIDS because they are more likely to be poor and not because of their race or ethnicity.” • “People living in high-poverty neighborhoods face a number of other challenges as well, including high rates of violence, social isolation, poor infrastructure, high levels of incarceration, and a lack of HIV and sexual health literacy, all of which contribute to the epidemic in distinct and overlapping ways. An inability to meet basic health and nutritional needs worsens HIV, increasing the risk of contracting other infections and hastening the onset of full-blown AIDS. And as viral loads increase from lack of access to care, so does the risk of infection to sexual partners, thereby further fueling the epidemic.” Source: Center for American Progress

  3. HIV epidemic drivers among US Black MSM • Younger age at first sexual encounter • Sexual abuse during childhood • Older sex partners

  4. Drivers – Conceptual Approaches • Individual/Behavioral • Internalized homophobia, stigma and “flawed personal character” • AIDS awareness & knowledge • HIV fatigue, fatalism or adaptive responses • Trauma • Sexual, physical & emotional • Mental health & illness • Other Sexually Transmitted Infections • Gender identity and identifications • Substance Use and Abuse

  5. Drivers – Conceptual Approaches • Interpersonal - • Partner selection (demographic by race, age and/or geography) • Sero-sorting • Inter Partner Violence • Physical and virtual Networks • Locale (urban, suburban, non-urban, rural) • HIV+ Reservoir • Internet • “House ball” • Circuit Parties • Transgender • Social Exchange • Housing, food and money

  6. Drivers – Conceptual Approaches • External, systemic, structural and environmental • Economics • Racism • Criminalization of SGL • Incarceration • Homophobia and Heterosexism • Stigma • Housing and Community Deprivation

  7. Given this context what do we do to improve HIV outcomes for BMSM- the cultural analysis • Attending to who is telling the story of the BMSM What questions are being asked; What tools & methods are being used; Positionality of the researcher to the research. • Address resilience as well as pathology. • Human Rights, Civil Rights and race in the U.S. - the myth of a post racial society! Including a critical analysis of the presumptive neutrality of race categories.

  8. Given this context what do we do to increase activism by BMSM- the cultural analysis • Recognition that what it takes to activate a response may not be the same things it takes to sustain the activism. • Must address hierarchy of human needs and not just HIV prevention. • Must recognize that all barriers are not benevolent or circumstantial. • Must address the tendency to of “essentialize” groups to one category can be self defeating

  9. HPTN061: The Brothers Study • To determine the feasibility and acceptability of a multi-component intervention for Black MSM, including peer health system navigation • Study data collected between 7/2009 and 10/2010. • Gave rise to the HPTN Scholars program to increase number of researchers from underrepresented racial and ethnic groups.

  10. HPTN 061 & BMSM • Structural, behavioral, and biological factors (e.g. unemployment, unprotected anal sex with multiple partners, and STDs) were associated with new infections among American BMSM • Given the rates (2.8% overall; 6% for YMSM; 5% UAI) of HIV infection among BMSM, culturally-tailored programs that encourage repeated HIV/STD testing, engagement in care, and innovative prevention strategies addressing social and environmental factors are urgently needed to decrease further spread.

  11. HPTN O73 Pre Exposure Prophylaxis (PrEP) Uptake and Adherence among Black Men who have Sex with Men (BMSM) in Three US Cities • In protocol development • An open label demonstration study to assess the uptake, acceptability, safety, and feasibility of PrEP for Black men who have sex with men (BMSM) in three cities utilizing client-centered care coordination (C4) model.

  12. Acknowledgements • FHI360 • Sponsored by NIAID, NIDA, NIMH under Cooperative Agreement # UM1 AI068619 • For those studies under HPTN I funding such as HPTN 035, HPTN 059, HPTN 027*, HPTN 046*, HPTN 057*, use Cooperative Agreement # U01 AI46749* Also acknowledge NICHD

More Related