S P N S

Special Projects of National Significance
2005 Report to CARE Act Grantees

Young MSM of Color Initiative

Outreach, Care, and Prevention to Engage HIV-Seropositive Young MSM of Color

Background

The leading cause of HIV infection among racial/ethnic minority men is sexual contact with other men. Additionally, while minority men represent a majority of MSM cases, non-Hispanic black MSM and Hispanic MSM account for an increasing proportion of MSM AIDS cases. Despite the tremendous gains in health and lifespan attributable to antiretroviral therapy (ART), black and Hispanic MSM are less likely to receive ART than are whites and thus have benefited less.

Other studies have found that MSM of color appear to become infected at earlier ages than do whites and are more likely to learn that they are HIV-positive later in the course of infection. In an analysis by the CDC of 1996-98 surveillance data, the proportion of men whose age at initial diagnosis was 13-24, was 16 percent among blacks, 15 percent among Asian/Pacific Islanders, 15 percent among American Indian/Alaskan Natives, 13 percent among Hispanics, and nine percent among whites. Additionally, in the same age group, a much higher proportion of minorities had already progressed to AIDS at initial diagnosis.

Although race/ethnicity itself is not a risk factor for HIV infection, social and

 

economic factors facing young men of color such as discrimination, high rates of poverty and unemployment, and lack of access to health care, are associated with high rates of HIV risk behavior. Generally, challenges facing young MSM of colorand their service providersin HIV prevention or access to HIV testing, diagnosis, and treatment fall into the following categories:

· Stigma or fear of condemnation/discrimination

· Historically poor access to care

· Negative perceptions of the health care system

· Self-perceptions of sexual orientation

· Youth perspectives that make it difficult to assess risks and critically understand and adopt preventive behaviors

The benefits of accessing HIV care and prevention services are well established. Learning one's HIV status and accessing care if infected is clearly effective in improving lives. Additionally, treatments including combination antiretroviral therapy have greatly reduced HIV/AIDS morbidity and mortality. The Young MSM of Color Initiative was designed as a demonstration initiative to see what works in addressing the challenges faced by young MSM of Color to ultimately decrease risk behaviors and improve the health of this population.

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2005 REPORT young msm of color initiative

The Young MSM of Color Initiative

The SPNS program recognizes that there is no single approach for ensuring that HIV-seropositive YMSM of color are linked and maintained in care and provided with prevention services. A variety of interventions will likely be effective in reaching this target population. This initiative seeks to identify model interventions for reaching, linking and maintaining this population in HIV/AIDS primary care and prevention services. In order to determine what is effective, eight demonstration sites, assisted by an evaluation/technical assistance center, will set out to provide an array of services directed toward young MSM of color. Grantees of this initiative were notified in September 2004, and will be awarded funds for five years through 2009.

While each grantee will have specific goals and strategies, the overarching theme of this initiative is to provide services to young MSM of color in order to increase access to care and decrease risk behaviors related to HIV infection/transmission.

Contact Information

The Evaluation and Support Center

George Washington University
School of Public Health and Health Services
YES Center
2021 K Street, NW, Suite 800
Washington, DC 20006

Manya Magnus, PhD
Phone: 202-994-3024

HRSA Project Officers

Special Projects of National Significance
5600 Fishers Lane, Rm 7C-07
Rockville, MD 20857

Melinda Tinsley, MA
Phone: 301-443-3496

Grantees

AIDS Project East Bay (Oakland, CA)

The Community Involvement Project (CIP): Retaining Young African American MSM in Care through Community Participation

Target Population: African American MSM between the ages of 13 and 24 living in all parts of Alameda County, California

Goal: 1. To improve health, well-being, and quality and length of life; 2. To increase medical adherence and decrease unsafe sexual practices

Strategies: 1. Youth-directed, community-based outreach activities; 2. On-site and mobile rapid HIV testing; 3. Comprehensive youth case management and linkages with care; 4. Prevention with positives and self empowerment activities; 5. Cross-training of agencies staff

Evaluation: Key outcomes will be compared among intervention subjects and similar subjects not receiving the intervention; variables to be examined include quality of life, medical adherence, and overall well-being, in addition to use of HIV primary care, engagement in support activities, and sexual risk behaviors

Contact Information:

Hazel Wesson, Executive Director
1755 Broadway, 2nd Floor
Oakland, CA 94612
Phone: 510-663-7950

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2005 REPORT young msm of color initiative

Bronx AIDS Services, Inc. (Bronx, NY)

Boogie Down Bronx Project

Target Population: HIV-positive young MSM of color living in the Bronx

Goal: To connect HIV-positive YMSM of color to medical care and to assist them in achieving measurable goals associates with risk reduction related to re-infection and/or transmission

Strategies: 1. Use of a community-organizing model emphasizing interviewing and organizing skills and techniques to build connections with members of the target population; 2. Mapping of YMSM networks to identify staffing needs and ways to reach the target audience; 3. Trained Community Ethnographer-Organizers (CEOs) will convey information to the target concerning risks of infection and importance of knowing one's serostatus and encourage/facilitate access to services, including medical services for those who are HIV positive

Evaluation: The program will use a social network evaluation, with mapping of the target population and mapping of young MSM of color

Contact Information:

SJ Avery
540 East Fordham Road
Bronx, NY 10458
Phone: 718-295-5605

Harris County Public Health and Environmental Services (Houston, TX)

Positive Outlook

Target Population: HIV-positive African-American men who have sex with men who are not engaged in clinical care

Goal: 1. To identify the target population, link them to clinical, supportive, and preventive services, and maintain their use of these services; 2. To enhance the quality of life and prevent secondary HIV infection

Strategies: 1. A Client Management Team (CMT) to employ a combination of case management, outreach, peer counseling, medical care coordination, and health education/risk reduction; 2. The CMT will consist of a Medical Care Coordinator, Service Linkage Worker, and two Peer Outreach Educators

Evaluation: Comparison of outcomes among those clients who are in the system but not enrolled in the program to those who are enrolled in the program

Contact Information:

Leo Nosser, Program Manager
2223 W. Loop South
Houston, TX 77027
Phone: 713-439-6295

 

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THE SPNS MANDATE

The purpose of the Special Projects of National Significance (SPNS) program is to advance knowledge and skills through the support, development and evaluation of innovative models of HIV care for financially disadvantaged and medically underserved populations. The SPNS program, administered by the Health Resources and Services Administration (HRSA) HIV/AIDS Bureau (HAB), is part of the Ryan White Comprehensive AIDS Resources Emergency Act, also known as the CARE Act.

SPNS models of innovative care for HIV-positive patients have been designed to respond to the needs of the HIV epidemic. Currently, it is estimated that about 650,000 to 950,000 persons are infected with HIV and approximately 40,000 new infections occur every year in the United States. Only about one-third of HIV-infected adults are currently receiving regular or ongoing medical care for HIV infection. The most affected populations are traditionally underserved and hard-to-reach groups, particularly women, injection drug users and their heterosexual partners, gay and bisexual men of color and youth. HIV/AIDS is now most heavily impacting minority communities and individuals living in poverty.

SPNS response to the epidemic began in 1991 with some of the first Federal grants to target adolescents and women living with HIV. Today, a portfolio of 72 grants funded either solely by the HIV/AIDS Bureau or in partnership with other Federal agencies addresses the cutting-edge issues in HIV care.

The SPNS program is an integral link to all CARE Act programs. While it provides an opportunity to develop and evaluate new services, the program places great emphasis on the dissemination of these services. SPNS promotes the dissemination and replication of effective models of care relevant to the present challenges of the epidemic. These models include the integration of HIV primary care services to the needs of individuals who present with multiple diagnoses such as substance abuse, mental health, and other psycho-social burdens that complicate the effective delivery of health care.

As CARE Act grantees develop innovative services, the SPNS program will provide the funding and technical assistance for grantees to evaluate innovations and disseminate findings to the HIV community.

Within each multi-site SPNS initiative, grantees focus their interventions on a specific population or treatment issue, either by implementing components of existing interventions or designing new models. These models are evaluated for effectiveness, efficiency, and replicability. An important corollary is an examination of the contextual issues that contribute to the success or failure of an intervention in a particular setting or with a particular population.

Evaluation of Models

The structure of most of the multi-site initiatives is designed to collect data and evaluate interventions across sites. The projects are grouped by type of intervention or topic (e.g., outreach, prevention) with the guidance of an evaluation center, whose tasks include:

· facilitating cross-site evaluation, with technical assistance provided

· developing standardized data collection instruments

· assuring data quality

· disseminating findings

· and assessing policy implications of study findings.

Each grantee is required to participate in development of the evaluation plan for the overall initiative and most collect uniform data that can be analyzed and compared across programs. The SPNS initiatives have demonstrated that collaboration for multi-site evaluation of care programs is possible and rewarding, and that it requires time and effort on the part of all stakeholders: the evaluation centers, HRSA/SPNS, and the projects.

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Current SPNS Initiatives

To date, SPNS sponsors a variety of demonstration programs, each with a set of unique, yet initiative specific goals and strategies designed to have the greatest impact on their respective targets. While SPNS has funded numerous innovative programs over the past decade, the table below summarizes eight initiatives that are currently funded through 2009.

Lessons learned from these and other initiatives are helping the HIV/AIDS Bureau develop effective strategies for addressing the demand for HIV services among underserved infected populations.

Current priorities include:

US-Mexico Border: Demonstrating and evaluating models that advance HIV service innovation along the US-Mexico Border

Outreach: Evaluating effective outreach strategies for bringing individuals into HIV primary care treatment

Information Technology: Assessing and evaluating the use of information technology to improve HIV medical care

American Indian/Alaska Native: Supporting the coordination and integration of existing services for Native Americans/Alaska Natives living with HIV and other co-morbidities

Caribbean: Improving care and treatment of HIV-infected persons of Caribbean descent through culturally appropriate strategies

Prevention with Positives: Assessing prevention strategies in primary care settings for HIV-positive persons

Buprenorphine: Developing, implementing and evaluating innovative methods for integrating Buprenorphine Opioid Abuse Treatment in HIV primary care settings

Young MSM of Color: Implementing and evaluating models of outreach, care and prevention targeted to young HIV seropositive men who have sex with men (YMSM) of color

Initiative Topic Grantees Funding Period
Demonstration and Evaluation Models that Advance HIV Service Innovation Along the US-Mexico Border US-Mexico Border 6 2000-2005
Targeted HIV Outreach and Intervention Model Development and Evaluation for Underserved HIV-Positive Populations Not in Care Outreach 11 2001-2006
Evaluating the Impact of Information Technology on Improving Delivery and Quality of Care for HIV-Seropositive Individuals Information Technology 6 2002-2006
American Indian/Alaska Native (AI/AN) Initiative AI/AN 7 2002-2007
Models of Peer Support for Caribbeans Living in the U.S. Caribbean 6 2003-2007
Prevention with HIV-Infected Persons Seen in Primary Care Settings Prevention
w/ Positives		 16 2003-2007
An Evaluation of Innovative Methods for Integrating Buprenorphine Opioid Abuse Treatment in HIV Primary Care Settings Buprenorphine 11 2004-2009
Outreach, Care, and Prevention to Engage HIV-Seropositive Young MSM of Color Young MSM of Color 9 2004-2009
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2005 REPORT young msm of color initiative

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Los Angeles County Department of Health Services, Office of AIDS Programs and Policy (Los Angeles, CA)

YMSM of Color Integrated Prevention and Care

Target Population: Young HIV-positive African American and Latino MSM

Goal: To bring previously undiagnosed youth into care and increase skills building, foster treatment adherence, increase prevention action, and decrease risk behavior

Strategies: 1. Outreach conducted by a peer outreach worker, who will interface members of the target where they frequently congregate and encourage HIV testing in co-located mobile testing vans; 2. Active referrals for those who are HIV-positive into an Integrated Case Management Program (ICM), a two year course which consolidates psychosocial, medical, and prevention case management principles

Evaluation: A control group design comparing key outcome variables among subjects who are referred into traditional case management versus those who participate in ICM

Contact Information:

Michael Green, PhD, Director
600 South Commonwealth Avenue, 6th Floor
Los Angeles, CA 90005
Phone: 213-351-8171

Men of Color Health Awareness Project, Inc. (Buffalo, NY)

The MOCHA Collaborative to Engage HIV-Seropositive Young MSM of Color

Target Population: Young men of color who have sex with men

Goal: To increase testing of YMSM and enrollment of HIV seropositives in enhanced HIV services and care

Strategies: 1. Outreach to identify HIV-seropositive YMSM and their peers; 2. Theory based and culturally appropriate HIV prevention interventions at the individual (Rochester STD/HIV Behavioral Counseling model) and group levels (Many Men Many Voices curriculum); 3. Establishment of a healthcare collaborative which includes referral linkages between MOCHA and several other community-based organizations

Evaluation: Each intervention will be evaluated on its own merits using criteria specific to its expected outcomes; a mix of quantitative, qualitative, and process data will be collected

Contact Information:

John Morgan
531 Virginia Street
Buffalo, NY 14202
Phone: 716-852-1142

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2005 REPORT young msm of color initiative

Wayne State University (Detroit, MI)

Motivation-Based Outreach to Young MSMs of Color

Target Population: Young MSM of color in the Detroit metropolitan area

Goal: To increase the number who know their HIV status and to increase the number of HIV-infected who enroll, engage, and remain in medical care

Strategies: 1. Internet outreach to identify barriers to HIV counseling and testing; 2. Field and internet outreach to identify young MSM of color and encourage HIV counseling and testing; 3. Motivational intervention concentrating on the issues of motivation along the stages of behavior change to engage participants in medical services and care

Evaluation: Process and outcomes evaluation will focus on documentation of contacts, receipt of HIV counseling and testing, returning for test results, readiness to change self-efficacy, engagement in care, quality assurance of the intervention, and feasibility/acceptability of the interventions

Contact Information:

Angulique Outlaw, PhD, Project Director
Children's Hospital of Michigan, Department of Pediatrics
3901 Beaubien Boulevard
Detroit, MI 48201
Phone: 313-745-3218

Working for Togetherness (Chicago, IL)

Chicago HIV Immediate Access to Care and Support Project

Target Population: African American YMSM in the Chicago metropolitan area

Goal: To link seropositive YMSM to HIV/AIDS care and prevention services and reduce HIV risk behaviors

Strategies: 1. Culturally and linguistically appropriate science-based messages on HIV prevention and education through a mobile van/multimedia approach to street outreach; 2. Provide access to the continuum of HIV care and services through a Health Education Risk Reduction component; 3. Prevention services delivered at an Empowerment Center for Youth

Evaluation: The evaluation component will determine differences between a control group and experimental group, and data will be collected on risk factors of HIV

Contact Information:

Clifford Armstead
6443 S. Lowe
Chicago, IL 60621
Phone: 773-224-6179

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2005 REPORT young msm of color initiative

University of North Carolina at
Chapel Hill (Chapel Hill, NC)

Demonstration Model of Outreach,
Care, and Prevention to Engage HIV-Seropositive Young Men of Color Who Have Sex with Men

Target Population: MSM of color attending college in the Raleigh-Durham metropolitan area (triangle)

Goal: To increase community awareness of HIV risk, encourage safer sex practices, and promote access to HIV testing and care

Strategies: 1. Initial elicitation research, focus groups, and community forums to inform development of an intervention; 2. Targeted outreach consisting of a media campaign, increased provision of HIC counseling and testing on college campuses, and community screening; 3. Disease Intervention Specialist, Community-Based Organization outreach workers, and local contracted case management services to work to promote access to and provide referrals to HIV care

Evaluation: Evaluation will assist in providing important information about the unique aspects of disease transmission in the student population as well as an assessment of the intervention model

Contact Information:

Lisa Hightow, MD
Department of Medicine/Division of Infectious Diseases
130 Mason Farm Road, CB #7030
Chapel Hill, NC 27599
Phone: 919-966-2536

George Washington University School of Public Health and Health Services
(Washington, DC)

Outreach, Care, and Prevention to Engage HIV- Seropositive Young MSM of Color: Evaluation and Support Center

Goal: Working with Young MSM grantees, the Center seeks to enhance sites' program development, facilitate inter-site communication, design, analyze, and disseminate evaluation findings, and provide ongoing technical assistance to sites in program implementation and evaluation

Strategies: 1. A multidisciplinary team of researchers from a variety of fields, YMSM care providers, program managers, IT experts, and a website designer to
address the Center's multifaceted needs;
2. Centralized technical assistance and training; 3. Identification of site needs and TA during biannual meetings, annual site visits, conference calls, and a dedicated website

Evaluation: In addition to an independent evaluation of the services provided by the Center, a multi-site evaluation will include:
1. Quantitative and qualitative techniques
to identify program and client level characteristics that act as barriers to or facilitators of entry and retention in care;
2. Comprehensive evaluation of services delivered, barriers and facilitators of service delivery, and client and site characteristics associated with outcomes of interest

Contact Information:

Manya Magnus, PhD
George Washington University
School of Public Health and Health
Services YES Center
2021 K Street, NW, Suite 800
Washington, DC 20006
Phone: 202-994-3024

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