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Reaching Gay Men of Color: Special Initiatives.

Effective programs must provide culturally competency care to treat not only physical symptoms of HIV disease, but also meet their clients’ particular social and psychological needs.22 Ongoing disparities in HIV treatment outcomes and challenges related to linking and retaining gay men of color in care point to the need for continued efforts to develop and implement more effective strategies.23

The alarming infection rates among young minority gay men, especially young African-American men, have heightened the need to develop specific and effective programs for this community in particular. “What people miss among populations most impacted is the cumulative effect of various stigmas,” said Wilson.

Wilson explained that young, gay, Black men with HIV may feel discriminated against as a person of color and as a sexual minority. They may also feel marginalized within the gay community because they are Black and within the Black community because they are gay. On top of all of this is the stress that HIV stigma continues to carry, particularly within communities of color.

Looking to find models of care that address these challenges, HRSA’s SPNS program funded eight demonstration projects under the Outreach, Care, and Prevention to Engage HIV Seropositive Young MSM of Color initiative to create innovative models of reaching target populations who are not currently in care and linking them with ongoing primary care, support, and prevention services. SPNS programs create replicable models so that HIV providers across the country can learn from these projects and adapt them to their own practices, thus expanding the reach of such programs and furthering efforts among minority gay men.24

Evolving Epidemic Requires Continuing Innovation

The community of gay activists and supporters has always played a role in shaping the services, care, and support provided by the Ryan White HIV/AIDS Program. These committed individuals help the Ryan White HIV/AIDS Program respond to the evolution of and changes in the epidemic among gay men. Thirty years into the epidemic, many older gay men living with HIV are facing AIDS and treatment fatigue, which can significantly impact their mental health, treatment adherence, cognitive function, and sexual practices. Difficulty sustaining treatment over a long period may be heightened by isolation or depression, loss of social supports, drug side effects, and changes in physical appearance.25,26,27 A HRSA SPNS project supported research evaluation of 12 innovative clinic-based adherence models for a variety of populations and provided data about adherence support programs that maximize the benefits of HAART and should be incorporated into routine HIV medical care.28 Adherence support and counseling is now one of the core clinical HIV performance measures that HRSA encourages grantees to include in their quality management plans.

Adherence challenges, of course, are in no way limited to older gay men. These challenges are also an issue for some younger gay men, who may face many of the same mental health challenges and ongoing access to care. For both older and younger gay men, recreational substance use can be an important determinant of treatment adherence or non-adherence. The drug that has had the most dramatic impact on the gay community in recent years as related to HIV is crystal methamphetamine (meth), which causes the brain to release approximately 1,200 to 1,300 units of dopamine (more than the body can create naturally from any rewarding activity).29,30 Additionally, meth is relatively cheap, has a long half-life (typically 9 to 12 hours), creates sexual arousal, and produces a rapid high when ingested by smoking, nasal, or injection routes, making it highly addictive.31,32,33

Use of crystal meth is 5 to 10 times more common among urban gay, bisexual, and transgender persons than among the general U.S. population and is associated with risky sexual behavior; increased rates of transmission of HIV, other STDs, and hepatitis; serious adverse events; and poor adherence to antiretroviral treatment.34,35 Ironically, the constricting of blood vessels due to meth can cause temporary impotence and lead to use of sexual enhancement drugs like sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra), something that’s become very popular in the gay community.36,37 Constricted blood vessels, however, can lead to increase tearing of the skin during sex and thus increase HIV risk.

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