More than Crystal Prevention

1. More than Crystal Prevention Promoting Healthy Community for Gay Men June 24, 2008 Jim Pickett Project CRYSP and AIDS Foundation of Chicago Teleconference Training – “Overlapping Epidemics, Innovative Interventions: How Do Psychosocial "Syndemics" Drive HIV Among Gay Men - And What Can We Do About It?”

2. In the next couple… • Gay Men’s Health – a quickie • Project Crystal Prevention (CRYSP) • A holistic approach, rather than a singular focus is necessary • A pinch of data, a dash of rationale • Needs Assessment • Activities

3. The narrative around gay men • Mentally ill • Diseased, vectors of disease • Irresponsible • Reckless, Suicidal, Homicdal • Demon Nazis, hellbent on destruction

4. Gay Men’s Health Movement • Origins • Gay men's STD movement • HIV/AIDS prevention • LGBT health movement • Women’s health movement • Dallas, 1995: GLMA Summit formally identifies need for new generation of gay men's health work Eric Rofes August 31, 1954 – June 26, 2006

5. A brief GMH history Key Events • Philadelphia, 1997: Transformation of Safeguards from HIV focus to GMH • National Gay Men’s Health Summit I • Boulder in 1999: 300 participants • National Gay Men’s Health Summit II • Boulder in 2000: 500 participants • 2000-2002: Over 25 local & regional gay men’s health summits held in the U.S. • Gay Men's Health Summit III • Raleigh, NC in August 2003: 400 participants • Seattle & San Francisco 2003: Opening of Gay City's Health Clinic and Magnet • NGMHS IV Salt Lake City – 2005 • Seattle 2008 – October 17 – 21, 2008 • LGBTIs in between

6. www.gaycity.org

7. Gay Men’s Health • Characteristics • Focused primarily on the "G" in LGBTI • Decentralized, anarchistic and neotribal • De-professionalized • Community-based and subculture-based • Mobilization focused • Dependent upon the kindness of strangers

8. Gay Men’s Health 6 Foundational Principles of gay men’s health summits, projects, or campaigns • Replace the HIV-centric paradigm of health advocacy for gay men with holistic models that integrate (but do not default to) HIV • Exit the crisis paradigm of HIV work and embrace contemporary understandings, meanings, and implications of HIV for gay men of all colors & classes • Challenge deficit-based models for work with gay men and replace them with asset-based approaches

9. Gay Men’s Health 6 Foundational Principles of gay men’s health summits, projects, or campaigns 4. Strategically and politically confront structural forces challenging the well-being of gay & bi men 5. Embrace a “big tent” vision of community, respecting diverse ways of organizing sex and relationships among gay men – shame and guilt are the health hazards, rather than specific sex practices and sex cultures 6. Launch only efforts that are neither overtly or covertly sanitizing, sanctimonious or moralistic

10. Gay Men’s Health Address the 8 Core Issues Confronting queer men of diverse generations, ethnicities, races, locations, andsocial classes 1. Explore the longings for intimacy and connection with other men and the social structures, networks, and ideologies that promote or prevent such connections. 2. Understand the meanings of anal sex, penetration, & the exchange of semen and explore the relationships between various racial, ethnic, and class-based masculinities and anal sex practices 3. Grapple with the emotions, pleasures, & wounds emerging from childhood and adolescent experiences with boys & men 4. Tap into sources of resilience, creativity, determination, humor & playfulness in diverse gay men’s cultures

11. Gay Men’s Health Address the 8 Core Issues Confronting queer men of diverse generations, ethnicities, races, locations, and social classes 5. Support healing from trauma: violence, abuse, homophobia, racism, poverty, AIDS and addiction 6. Examine the ways transgression, risk, and the taboo interact with queer men's sexual desires, practices, and subcultures 7. Confront ways in which privileged masculinities of youth present challenges to & opportunities for well-being as men age 8. Revive and recreate community rituals, social structures, and networks to replace those lost during the most intense crisis years of AIDS

12. Key Features of the Gay Men’s Health Movement • It is not… It is… • HIV focused Holistic • Deficit-driven Asset-driven • Individual focus Relational focus • Directive Informative • Fear-based & Moralistic Trusting Celebratory • Monocultural Multicultural • Self-Esteem Building Community-Building • Professionalized Grassroots • Unitary Multiple

13. gaywisdom.org/academy BECOME A LEADER IN THE CUTTING-EDGE WORK OF THE GAY MEN'S HEALTH MOVEMENT

14. Work began Jan 1, 07 • 5 year project funded by CDPH – Special Project of Innovative Significance • Syndemics • Historic partnership among four local agencies • – AFC, COH, HBHC, TPAN = over 100 yrs experience • PREVENT THE USE OF CRYSTAL

15. Increase community knowledge about the connections between crystal meth use, Internet use, and unprotected anal sex Increase capacity amonghealthcare and other service providers to educate and assess for meth-related issues Change the target population’s community norms around meth use and unprotected anal intercourse

16. Target population Gay and MSM living in one of six zip codes on Chicago’s north and near north side

17. Year One - 2007 • CHAT - NHBS • Needs Assessment • Data dump • Asset Map • Think Tank • Survey • Focus groups

22. The majority of gay men do not use crystal.

28. Qualitative snapshot

29. Think Tank • June 28, 2007 – all day • Increase knowledge about evidence-based and promising interventions to prevent crystal meth use and HIV infection among gay/MSM. • 30 invited participants day-long (various community leaders) • Morning presentations, afternoon group exercise to determine key findings/messages

30. Think Tank Think Tank Nationally recognized experts presented on the following • Engaging providers around crystal use among gay men – awareness, effective interventions in variety of settings (Dr. Sarz Maxwell). • Preventing crystal meth and other s. use among gay men (Ms. Susan Kingston). • Reaching gay men with health messaging and interventions via Internet (Dr. Brian Mustanski). • Attention grabbing health and wellness social marketing that works for gay men (Mr. Les Pappas).

31. What are the necessary elements for an effective provider training plan to prevent meth use among MSM? CMEs and incentives Screening tools + simple tools + provide practical information to the provider Easy to deliver and share + web-based interactive trainings Utilize other staff Define training goals “You already know this” Learn how not to appear judgmental Provider and patient involvement Think Tank Think Tank

32. What are the necessary elements for an effective internet intervention and social marketing campaign? Define target group Create sticky messages Sex positive, non-judgmental, holistic Develop effective methods Interactive, motivational interviewing for internet outreach Promote visibility Utilize existing community resources – Asset Map Evaluate and provide feedback Think Tank

33. Key Word • Holistic • Holistic • Holistic • Holistic

34. Project CRYSP Needs Assessment – A Peak How often is methamphetamine used by those who use the drug and in combination with what other drugs is it used? • Use of substances other than meth among Chicago gay men is common. • Poppers (20% past-year prevalence) and marijuana (36%) are more frequently used by Chicago gay men than meth. • The past-year and 6-month prevalence rates of cocaine and club drugs, while lower than the reported prevalence rates of marijuana and poppers, are within the same approximate range (12% to 18%) as meth use. • Alcohol use is also very common with 30% of Internet survey respondents reporting drinking on 3 or more occasions weekly; 20% have a high likelihood of meeting diagnostic criteria for lifetime alcohol abuse or dependence.

35. Project CRYSP Needs Assessment – A Peak How often is meth used by those who use the drug and in combination with what other drugs is it used? • Meth users had the highest rates of use for almost all substances except alcohol. • Strong relationship between meth use and the use of drugs used to treat erectile dysfunction (ED; e.g. Viagra®) • 52% of meth users reporting using an ED drug in the past 6 months compared with 19% of non-users.

36. Project CRYSP Needs Assessment – A Peak How do important co-factors such as childhood sexual abuse, serious mental illness, and social disenfranchisement (i.e., “syndemic factors”), contribute to methamphetamine use among Chicago gay men? • Serious mental illness (SMI) and, to a lesser extent, loneliness, are positively related to meth use. • Prevention efforts should include those who are psychologically vulnerable by virtue of being depressed and lonely and offer outreach, support, and opportunities for engagement in the gay community. • None of the other measures examined such as childhood sexual abuse or social disenfranchisement were statistically significant.

37. Project CRYSP Needs Assessment – A Peak Why do MSM start using methamphetamine? • For many gay men, meth use does not begin primarily to enhance sex, although first use can and does occur in sexually charged contexts such as bathhouses. • For some, meth is perceived as a quintessential part of being gay and being attractive to and accepted by other gay men, sometimes in the context of a social scene, such as circuit parties, that was perceived as being fun and glamorous and attended by “role models”; popular, successful, and attractive members of the gay community.

38. Project CRYSP Needs Assessment – A Peak Why do MSM start using methamphetamine? • As noted by Parsons et al.: “Members of the public health community designing methamphetamine prevention campaigns should not solely focus on the link between methamphetamine and sex, as this is likely to miss a significant number of gay and bisexual young methamphetamine users.” • A prevention campaign needs to address the multiple social aspects of trying and using methamphetamine, especially the need to feel one belongs to a community and that one is wanted and desirable.

39. Project CRYSP Needs Assessment – A Peak Why do MSM not use methamphetamine? • The majority of MSM never use methamphetamine and that many of those who do, never progress past the experimental/recreational phase. • Two reasons for not using or ever trying methamphetamine predominated among the MSM who reported they had never used the drug: they did not take drugs generally (76%) and they cared too much about their health (74%).

40. Project CRYSP Needs Assessment – A Peak Topics of interest to gay men in Chicago • How to be a better lover • Men’s physical sexual health (e.g., testicular cancer and prostate health) • Building a healthy relationship • Keeping a long term relationship • Understanding my sexual history and how it affects me • Developing an intimate relationship • Ways to improve how I feel about my body • Aging as a gay man • Ways to feel better about myself • How to have anal sex without pain • How to date men offline (i.e. in real life) • Dating men online

42. www.LifeLube.org

44. So what is so sweet about this spot on the net? • Sex and Drugs • Physical Health • Spiritual Health • Relationships and Communication • Your best friend

47. Community Mobilization • April 17, 2008 • Over 100 participants • 18 – 70 y/o • 6,000 podcast downloads

48. Community Mobilization

49. Community Mobilization

50. Podcast it!