Assessment of Minnesota HIV/AIDS Prevention Services
for Gay, Bisexual, Transgender
and Other Men who Have Sex with Men (MSM)
Final report
February 21, 2011
Table of Contents
I.
Executive Summary
II.
Introduction
III.
Epidemiology
IV.
Methods
V.
Findings
a.
b.
c.
d.
Current Status of HIV/AIDS Prevention
HIV/AIDS Prevention Successes
HIV/AIDS Prevention Challenges
Moving Forward with HIV/AIDS Prevention for Gay and Bisexual
Men and other Men who Have Sex with Men (MSM)
VI.
Acknowledgments
VII.
Appendices
a.
b.
c.
d.
Key Informant Interview Summary
Focus Group Summary
Partner Services Summary
Online Survey with Results
2
I.
Executive Summary
In 2009, the HIV/AIDS epidemic continued across the United States and around the
world. In the United States, the largest transmission risk continues to be male-to-male
sex. Further, this transmission risk was the only one to continue to increase. As a result of
this concern, CDC made funds available to states to support assessments of MSM HIV
Prevention Programs and Services. Minnesota was awarded funds for this purpose and
contracted with John Snow, Inc. (based in Boston) and Bob Tracy Consulting (based in
Saint Paul) to conduct the assessment.
Between June and December, 2009, a series of data collection activities were initiated
and completed. The first round of assessment comprised 15 key informant interviews
with leadership and staff from community-based organizations, AIDS service
organizations, County and State Health Officials, academics and political leadership. In
September, an online survey was developed and launched in October with support from
many community-based organizations that urged their membership to complete the
survey. A total of 214 completed surveys were received and analyzed. Seven focus
groups were held with 33 gay, bisexual, transgender males and other MSM, with a
special effort made to engage men who were younger, African American,
Latino/Hispanic and transgender males. Finally, a staff person within the MDH STD/HIV
Section interviewed 17 clients of the Partner Services program with the guidance of the
study leaders.
Findings
a. Prevention Programs
A new framework for HIV prevention programs in the gay and bisexual MSM
community is needed that recognizes the fact that HIV is endemic, particularly in the gay
and bisexual male community. With this population, HIV is no longer an epidemic that is
emerging in impact, but has become more of a permanent reality that affects at all ages,
social and economic groups and across all racial and ethnic groups. This new framework
should include policies meant to combat homophobia. It is homophobia which reinforces
stigma and social isolation and limits the ability to provide comprehensive sex education
inclusive of male-to-male sex.
MDH should review HIV/AIDS prevention funding to ensure that it allocates resources in
a fashion proportionate to the burden of the epidemic on the gay and bisexual male
community. Any administrative barriers to achieving proportionate funding should be
reviewed and reconsidered.
HIV/AIDS Prevention Assessment among Gay, Bisexual
and Other Men who Have Sex with Men (MSM)
John Snow, Inc.
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The Internet is now a primary source for both online information about HIV/AIDS and
for meeting sexual partners and creating supportive social networks. It is increasingly
important that both MDH and community organizations work to increase their presence
in new media to improve the accuracy and accessibility of information about HIV/AIDS
prevention and utilize new outreach strategies on sites for gay and bisexual men’s
communities..
As new media emerges as an added venue for HIV prevention, established approaches to
communication remain relevant. More aggressive social marketing campaigns are needed
to raise the visibility of HIV/AIDS prevention targeting the gay and bisexual male
communities. These may include media campaigns on television, radio or the Internet. It
can also include posters, billboards, flyers as well as organized meetings and outreach
into communities that are not reached by traditional or new media that demonstrate
renewed commitment to fighting the epidemic in this community.
The Young MSM Summit held early in 2010 was a good step to raise general awareness
about HIV. However, it should be emphasized that because HIV is endemic in all gay and
bisexual men’s communities (adult, older, African-American, Latino/Hispanic, White,
transgender male), that ALL communities need added attention and strategic thinking.
Initial planning and discussion should take place over the next year with respect to state
policy with respect to PEP and PREP. As more information becomes available on the
efficacy of these practices, the state must take a leadership role in providing guidance to
both providers and consumers with respect to whether and how to utilize these practices
in an ethical and effective fashion.
With respect to Community Planning, there should be ongoing efforts to expand
engagement of men from gay, bisexual and transgender men’s communities and to build
capacity through member selection, training and education.
b. Counseling and Testing
MDH should work with gay and bisexual men’s communities to expand access to HIV
counseling, testing and referral (CTR.) Bolder efforts to normalize HIV counseling,
testing and referral in routine medical care and increase access and use of emerging HIV
screening and testing technologies to create more options for individual to learn their
status, while retaining standards of confidentiality are needed. Emphasis should be
placed on directing CTR resources in ways that follow the course of the epidemic and
increase access to services in venues where those at highest risk are most likely to seek
CTR services.
MDH should ensure that clinicians in private physician’s office receive adequate training
in the provision of counseling and referral services related to HIV testing. The increased
4
interest in offering routine HIV testing in medical settings is logical provided that gay,
bisexual, transgender and other men who have sex with men have access to health care.
It is through routine health care access that trusting relationships with providers get
established, and the trusting relationship with a provider is a significant factor that
establishes a willingness to get an HIV test in a medical clinic. It is also important for
providers and their staff to be able to speak competently and with confidence about issues
related to HIV transmission, prevention, living with HIV and the general wellness of gay,
bisexual, transgender men or other men who have sex with men, or else they will not be
regarded as safe places for testing.
c. Partner Services
The Partner Services program should continue to work to increase cultural sensitivity
towards the gay and bisexual men’s communities including having staff with experience
working in the community or who are from the community. Many members of the gay,
bisexual and trangender men’s communities lived through times in history when
community members have been prosecuted as criminals. They continue to feel that public
policies are often discriminatory or foster stigma against their community. This
contibutes to feelings of suspicion or distrust of government, or a sense of having been
abandoned by their government. Overcoming this visceral sense of resentment may
require sustained training and accommodation, as would be similarly appropriate to shape
and deliver services in a culturally-relevant manner to reach any other target population.
Clear information about partner services, using laymen’s terms, should be used to explain
the purpose and scope of Partner Services and ensure that recipients of the services
understand that Partner Services are part of a comprehensive HIV prevention services
program.
MDH should recognize that increased attention to the provision of referrals and linkage
to services to people newly diagnosed with HIV helps support the notion that there is
concern for the quality of their lives and that the focus on them is not simply as
transmitters of disease.
It is clear from the findings that gay and bisexual men, as is the case for many who are
newly diagnosed with HIV, do not adjust to an HIV diagnosis according to a time frame
that corresponds to when disease intervention staff (DIS) staff are likely to contact them.
Due to this, some individuals may find the services intrusive and “painful” when they are
not yet ready to face their illness. The program should understanding this and adopt
strategies that may minimize discomfort, such as use of email or snail mail rather than inperson or telephone contacts.
HIV/AIDS Prevention Assessment among Gay, Bisexual
and Other Men who Have Sex with Men (MSM)
John Snow, Inc.
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II. Introduction
In 2009, the HIV/AIDS epidemic continued across the United States and around the
world. In the United States, the largest transmission risk continued to be male-to-male
sex. Further, this transmission risk was the only one to continue to increase. In the
CDC Fact Sheet entitled “HIV and AIDS among Gay and Bisexual Men” the CDC
states, “MSM [men who have sex with men] is the only risk group in the U.S. in
which new HIV infections are increasing. While new infections have declined among
both heterosexuals and injection drug users, the annual number of new HIV infections
among MSM has been steadily increasing since the early 1990s.” 1
As a result of this concern, CDC made funds available to states to support
assessments of MSM HIV Prevention Programs and Services. The Minnesota
Department of Health (MDH) was awarded funds for this purpose and contracted
with John Snow, Inc. (based in Boston) and Bob Tracy Consulting (based in Saint
Paul) to conduct the assessment.
Between June and December, 2009, a series of data collection activities were initiated
and completed. The first round of assessment comprised of 15 key informant
interviews with leadership and staff from community-based organizations, AIDS
service organizations, County and State Health Officials, academics and political
leadership. In October and November, an online survey was developed and launched
with support from many community-based organizations that urged their membership
to complete the survey. A total of 214 completed surveys were received and analyzed.
In November, five focus groups were held with 22 gay, bisexual and other MSM
including many African-American men. One of the groups was specifically for
younger gay and bisexual men. Two additional focus groups were held in August and
September 2010 to collect input from Latino/Hispanic men and transgender men.
Finally, in December, 2009, an MDH intern conducted a telephone survey of clients
of the Partner Services Program.
This report presents findings from a comprehensive effort to look at the state of
HIV/AIDS prevention programs for gay men, bisexual men, transgender and other
men who have sex with men (MSM) in Minnesota. Information gathered for this
study will be used by the Minnesota Department of Health to guide future program
development in this area going forward.
1
See CDC Fact Sheet, “HIV and AIDS among Gay and Bisexual Men,” at
http://www.cdc.gov/NCHHSTP/newsroom/docs/FastFacts-MSM-FINAL508COMP.pdf August, 2009.
6
III. Epidemiology
In Minnesota, the number of annual infections among gay, bisexual and other MSM had
been fairly consistent. The table below, taken from the 2008 epidemiology report
indicates that the largest transmission risk for men with HIV in Minnesota is sexual
transmission between men 2 :
Overall, MSM constitute 88% of the HIV infections (or first diagnosis of AIDS) from the
years 2007-2009. 3 However, in 2009, MDH reported the first substantial increase of
HIV/AIDS cases in several years. MDH reported in January 2010 that HIV infections
jumped 13% in 2009 (compared to 2008), the largest such increase in 17 years. Further it
was estimated that the bulk of these additional infections were attributable to an increase
in the number of young MSM who had become infected. There were 77 young MSM
infected in 2009.
Based on these historic and recent trends prevention efforts for HIV/AIDS should be
examined closely and MDH and community-based providers should adjust their approach
to these services. The goals should be to reduce the historic impact of HIV among MSM,
and reverse the short but troubling trend of increased infections among young MSM.
Before the recent jump in infections attributed to a rise among young MSM, it is
important to recognize that the annual number of new infections among MSM within
Minnesota has remained at a fairly constant and high rate over the first decade of this
century. As stated by MDH in its accompanying text to the power point presentation on
2009 HIV epi data:
“Since the beginning, men have driven the HIV/AIDS epidemic in Minnesota and
male-to-male sex has been the predominant mode of exposure reported. The
number and proportion of new HIV infections attributed to MSM have been
decreasing since 1991 reaching an apparent plateau in 2000 at just under 130
cases per year. Since 2000, the number of new cases diagnosed among MSM has
increased steadily and in 2009, MSM accounted for 55% of all new infections
(69% among males.)” 4
Recognizing the highly endemic nature of the epidemic in this community is important.
While 55% of all new infections are among MSM (and this doesn’t include infections
attributable to MSM/Injection Drug Use combined), only an estimated 4-6% of the male
2
Epidemiological Profile of HIV/AIDS in Minnesota, Epidemiology and Surveillance Unit, Minnesota
Department of Health, July 2008, Chapter One, p. 23
3
Minnesota HIV and AIDS Surveillance System, HIV/AIDS Surveillance Report, 2009. Power Point
Presentation, Slide 36.
4
Minnesota Department of Health, “Companion Text for the Slide Set: Minnesota HIV Surveillance
Report, 2009” available at http://www.health.state.mn.us/divs/idepc/diseases/hiv/stats/inctext.html .
HIV/AIDS Prevention Assessment among Gay, Bisexual
John Snow, Inc.
and Other Men who Have Sex with Men (MSM)
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population is engaging in male-to-male sex.5 This means that throughout the course of
the epidemic, the gay and bisexual male community has been disproportionately
burdened by the disease.
Looking at cases of new HIV infections diagnosed from 2005-2007 among MSM, a
substantial percentage of cases has been diagnosed among MSM of color. Specifically,
out of 527 cases among MSM during that time period, 64.5% were among Caucasian
men; 17.8% were among African American and African born men; 14.4% were among
Latino/Hispanic men; 1.9% among Asian men and 1.3% among American Indian men.
Thus the epidemic of HIV/AIDS disproportionately affects gay and bisexual men,
including African-American and Hispanic men.
5
Epidemiological Profile of HIV/AIDS in Minnesota, Epidemiology and Surveillance Unit, Minnesota
Department of Health, July 2008, Chapter One, pp. 5-6.
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IV. Methods
As described briefly in the introduction, there were four methods of primary data
collection:
A.
B.
C.
D.
Key Informant Interviews
Online Survey
Focus Groups
Interviews with Partner Services Clients or Potential Clients
a. Key Informant Interviews
Potential key informants were individuals designated to have a stake in MSM HIV/AIDS
prevention services in Minnesota. That list included leadership or staff at communitybased organizations, AIDS services organizations, County and State health departments,
academia and the Minnesota Legislature. Key informants were selected to assure the
diverse array of HIV among gay, bisexual, transgender and other men who have sex with
men in Minnesota were addressed in the interviews.
An interview tool was developed with the goal of identifying current strengths,
challenges and potential future directions for HIV/AIDS prevention programs for MSM
in Minnesota. As part of each interview, respondents were asked to identify other
stakeholders who might be appropriate to interview. In this way, the intention was to
“complete the circle” of all key individuals with a special interest in MSM HIV
prevention.
Ultimately, the study team identified and interviewed 15 interviewees. The interviews
took place in person, with the exception of one individual who was located outside the
greater Twin Cities area. In addition, the study team interviewed two groups within the
Minnesota Department of Health – its STD/HIV Program Managers and the staff of the
Partner Services Program.
A summary of findings from the key informant interviews is in Appendix A. Also
included is list of organizations represented in the interviews and a copy of the interview
tool.
b. Online Survey
After completion of key informant interviews, an online survey was created. Key
informant interviewees were asked to help promote and distribute the online survey, as
were representative of other organizations and individual social networks.
The online survey consisted of 44 questions covering demographics, knowledge and
information sources with respect to HIV/AIDS, current sexual activity, safer sex
HIV/AIDS Prevention Assessment among Gay, Bisexual
and Other Men who Have Sex with Men (MSM)
John Snow, Inc.
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practices, use of prevention services, perceived barriers to using prevention services and
perceived impact of prevention services.
The survey was distributed through organizational and individual e-mail lists, Web sites
and individual Facebook postings. Participants in the key informant interviews received
assistance to promote the survey through e-mail lists and Web sites. Eleven additional
GLBT service groups were also asked to similarly promote the survey. These groups
were selected to reach individuals who were not currently using HIV prevention services
and more diverse groups of gay, bisexual, transgender and other men who have sex with
men, particularly in terms of race and geographic location. Finally, the survey was
promoted through a network of 75 men. This network included men who had previously
responded to the on-line survey and indicated they were willing to be contacted to help in
other ways with the study and men who were peer leaders in gay, bisexual and
transgender organizations and social networks.
The survey opened in mid-October, 2009 and was kept open until late November, 2009.
A total of 214 men completed the survey, all of whom identified as gay or bisexual. Five
women also completed the survey and were removed from the cohort for purposes of
analysis. There were no transgender respondents to the survey.
Approximately 90% of respondents were Caucasian, with the remaining 10% divided
evenly among Black/African American, Latino/Hispanic, Asian/Pacific Islander and
American Indian/Alaskan Native.
A little more than half of survey respondents were employed in professional/white collar
jobs (54.7%). Conversely, over 40% of respondents were students (13.6%), clerical
workers (7.5%), unemployed (7.5%), skilled laborers (6.5%) disabled (4.7%), retired
(3.7%), unskilled labor (1.4%) or other (6.1%).
In terms of education, many were college graduates (34.1%) or had done post graduate
work (27.1%) and fewer had some college or technical school (23.8%), were a high
school graduate or had a GED (7.5%), were a technical school graduate (6.1%) or had
some high school (0.9%.)
The demographic profile of the survey participants is reflective, in large part, of the level
of assistance distributing the online survey received by groups such as PrideAlive and
Positive Link at MAP and the Red Door at Hennepin County Public Health.
A summary of survey questions and results can be found in Appendix D.
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c. Focus Groups
A series of focus groups were conducted to amplify the survey results and to collect
information from affected populations that were under-represented among the survey
respondents. A special effort was made to recruit focus group participants from networks
served by groups connected with men in African American, Latino/Hispanic and younger
gay, bisexual and transgender communities.
Seven focus groups were hosted, one with open participantion, two for African
Americans and other men of color, one for younger men, one for Spanish-speaking
Latino/Hispanics and another for transgender males. Five of the groups met during
November, 2009, while the meetings for Latino/Hispanics and transgender males were
held during August and September, 2010.
Thirty-three men participated in the seven focus groups. Based on data collected from
the participants, 28 (85%) were male, one (3%) self-identified as transgender/female and
four (12%) identified as transgender/male. Six (18%) were ages 18 to 25, 10 (31%) were
26 to 35, 11 (33%) were 36 to 45, 5 (15%) were 46 to 55, and 1 (3%) was over 55. Eight
(24%) of the participants identified as African American, 7 (22%) as Latino/Hispanic,
and 3 (9%) as Asian/Pacific Islander. Fifteen (45%) were Caucasian. Three (9%) lived
outside of the Twin Cities metro area. Twelve (36%) were men living with HIV.
A summary of the key themes that emerged in the focus group discussions is presented in
Appendix B, along with questions that were used to facilitate the group discussions. The
findings from the five groups held in 2009 are combined, while the findings of the groups
held in 2010 with Latino/Hispanics and transgender men are presented separately. 6
d. Partner Services Interviews
In order to learn more about the MDH Partner Services program, an MDH staff person
was assigned the task of calling and interviewing three groups of clients. The first group
comprised clients who had accepted help from Partner Services. The second group
comprised clients who had refused services from this program. The third group
comprised partners of index clients. An interview protocol was designed and edited and a
member of the MDH STD/HIV Section staff developed a list of potential interviewees
going back over the past 12 months.
6
The findings from the focus groups held in November 2009 were aggregated. The subsequent focus
groups held in 2010 are presented separately only because these were conducted after the first phase of the
assessment process as part of an effort to capture input from two key parts of the community that were
initially under-represented .
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John Snow, Inc.
and Other Men who Have Sex with Men (MSM)
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Ultimately, interviews were conducted with 10 former clients who had accepted services,
3 clients who had refused services and 4 clients who were partners of index clients. The
summary report of these interviews is attached as Appendix C.
A note about the language used in this report
The study was designed to gather input from “gay, bisexual and transgender men as well
as other men who have sex with men (MSM) in Minnesota.” For the purposes of this
report, we refer to these diverse communities of men as “gay and bisexual men” or “gay
and bisexual men’s communities.” The reference will be more specific when referring to
a particular community, for example Latino/Hispanic men or transgender males.
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V. Findings
Findings are organized into four sections: a. The Current Status of HIV/AIDS Prevention;
b. HIV/AIDS Prevention Successes; c. HIV/AIDS Prevention Challenges; and d. Moving
Forward with HIV/AIDS Prevention for Gay and Bisexual Men and Other Men who
Have Sex with Men (MSM). In addition, sub-sections of these sections looks at general
HIV/AIDS prevention services including health education and risk reduction (HERR),
counseling and testing services, and the Partner Services program. The findings section
reflects a consolidation of information obtained through the four primary data collection
methods—the key informant interviews, on-line survey, focus group interviews and
Partner Services survey and interviews. Charts and tables come from the online survey,
unless otherwise indicated.
a. Current Status of HIV/AIDS Prevention
i. Lack of visibility
Among all stakeholders, there was a sense that HIV/AIDS prevention was not a priority
based on its absence from the mainstream media. In particular it was felt that there was
no visible sign that there was concern about the gay and bisexual communities with
respect to advertising on billboards, television, or other outlets.
There is a sense that HIV/AIDS awareness activities for gay and bisexual men’s
communities had become fairly predictable and less relevant to gay and bisexual men.
There are certain events that happen regularly and garner media attention on HIV, such as
the AIDS Walk, Oscar Night, Red Ribbon Ride or Dining Out for Life. There is a sense
that not only have these become routine events on many people’s calendars, but they no
longer have any significant content with respect to HIV awareness or prevention that
speak to gay and bisexual men.
African American and Latino/Hispanic participants in focus groups also noted the
importance of television in building general awareness in their communities. They cited
the unusual impact of information about HIV/AIDS when it is integrated into
entertainment programming, either as part of programs or through commercials.
Beyond the lack of visibility of HIV prevention in the media, all stakeholders noted
HIV/AIDS did not tend to be a topic of discussion among their friends or within their
social networks. The reasons for this varied, but it was clear that social networks in gay
and bisexual men’s communities are engaged with conversation to promote awareness
and prevention at a much lower level than what occurred during the earliest years of the
HIV/AIDS epidemic.
HIV/AIDS Prevention Assessment among Gay, Bisexual
and Other Men who Have Sex with Men (MSM)
John Snow, Inc.
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ii. Stigma and mental health
Most individuals continue to see HIV/AIDS as a mental health issue. Specifically, people
are assumed to have basic information (although the information they have may not be
specific to the sexual practices of gay and bisexual men or transgender males), but are not
willing or able to change behavior because of mental health problems that may or may
not be complicated by substance abuse and stigma.
Stigma affects the community in many ways. Fourteen percent of survey respondents
were “afraid HIV/AIDS prevention staff will make negative judgments about me due to
my culture or lifestyle.” In a general way, gay and bisexual men’s communities still feel
singled out and disproportionately affected when it comes to HIV/AIDS, yet there were
many comments from key informants about how government has not been openly
supportive or responsive.
Generally, gay, bisexual and transgender males believe that most health and public health
providers are poorly informed about their health issues, especially health concerns
beyond HIV/AIDS. This lack of knowledge is perceived to be reflective of stigma, and a
discriminatory failure to include their general health needs as part of routine health care.
For some, this point is reinforced by the fact that health disparities based on sexual
orientation are not recognized by the Office of Minority Health, and accommodation of
political pressures that lead health and public health professionals to act in ways that
reinforce the joined stigma of gayness and HIV/AIDS. African American and Latino
gay, bisexual and transgender males experience an elevated level of stigma associated
with their sexual orientation because of anti-gay stigma within their communities.
iii. Generational differences
There is clearly a perceived “generation gap” with respect to HIV/AIDS prevention in
Minnesota. Key informants and focus group participants in the “baby boomer” generation
consistently claimed that young gay and bisexual men didn’t believe HIV/AIDS was a
“big deal” or had an “I don’t care” attitude about becoming infected. The two reasons
most frequently cited were the fact that there were treatments for HIV/AIDS today and
that the younger generation has not had the trauma of watching their friends die at a
young age.
However, when youth were interviewed the picture painted by the older generation is
only partially true. While there is less stigma or concern associated with being HIV
positive among younger individuals, there is much passion and conviction among youth
with respect to preventing themselves from becoming HIV infected. Younger men tended
to describe desires for relationships and wishing they had been provided sexual health
education when they were young that was specific and would help them grow through
adolescence and young adulthood. One commonly repeated story is about youth
abandoning condoms after a relationship becomes steady, with a “steady” relationship
defined in terms of dating as a couple for a few weeks or a few months. For some, this
14
seems to be a reflection of increased interest in relationships but gap in specific
information about how to have healthy and fulfilling sexual relationships with other men.
However, an equally compelling factor is an assessment of risk based not on applying
knowledge about transmission, but feelings of trust that reinforce desire for unprotected
sex. Younger and older participants cited the need for comprehensive sexual health
education for all young people, including information for young people who want to
know about sex between men.
iv. Power of the Internet
The Internet has become a dominant force in how people obtain information about
HIV/AIDS and also how those in gay and bisexual men’s communities connect with
partners.. Chart 1 describes the people and/or places where respondents received
information “that helped you most in HIV/AIDS Prevention.” The Internet was the top
named source of help.
Chart 1. Sources of help in HIV/AIDS Prevention
This point was reinforced in key informant interviews and in all of the focus group
discussions, as well. The Web and internet were a primary resource for information and
for connecting with other men or supportive social groups of others who share similar
experiences. This point was evident in the key informant interviews, the response to the
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and Other Men who Have Sex with Men (MSM)
John Snow, Inc.
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on-line survey, and in all of the focus group discussions. New media – Web, Internet,
and cell phone text message use is common practice in all gay and bisexual men’s
communities, regardless of social, economic or other demographic characteristics.
v. Peers
The role of peers is important for gay and bisexual men of all ages. As one man described
how he relied upon friends to learn about sex and navigating risk, “Friends tell friends
what they do and lean on them for ‘unsafe’ things.” In addition, prevention programs
where an individual was “trained to be a peer educator” had the highest ranking (83%)
with respect to the percentage of individuals who found the service useful in “helping me
change my behavior to be less risky.”
The value of getting information from peers was cited in all of the focus groups. We
heard from a transgender man who turned to a friend they knew who was a public health
professional, groups of gay men who were trained volunteers and reach out to friends and
did community outreach, Latino/Hispanic men who looked up to HIV prevention staff as
role models, and an African American man who made it a personal mission to keep
himself well-informed and to reach out to other men in his community as a mentor. It was
common for participants to describe how a peer educator, whether a professional,
volunteer or informal, self-identified educator, supported their own approach to riskreduction and health promotion. Others cited the importance of having visible role
models or friends they could turn to for health information.
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b. HIV/AIDS Prevention Successes
i. Prevention Programs (HERR)
In the online survey, there were indications that MSM utilized many of the HIV
prevention services offered. In general, respondents found services that offered one-onone communication more helpful, than other types of prevention services (see Table 1.)
Table 1: Usefulness of Prevention Services
Service
% of those who used the service who
found it helpful in reducing risky behavior
Trained to be a Peer Educator
77.8%
Called a Hotline
66.7%
Received one-on-one HIV Education
60.0%
Talked to an HIV Prevention Worker at a 57.1%
community event
Got a condom from an Outreach Worker 56.8%
Talked to an HIV Prevention Worker online55.0%
Attended a small educational or support
group about HIV
Talked to an HIV Prevention Worker in a
health van
Talked to an HIV Prevention Worker in a
bar
Received pamphlets, booklets, newsletters
or other written material
Attended a social event where information
about HIV was handed out
Saw a media campaign (billboard, radio,
television)
52.8%
45.5%
37.8%
36.4%
33.9%
28.6%
The online survey indicates respondents are engaged in a wide variety of harm reduction
activities. While some MSM (24%) indicate they use condoms “100% of the time,” a
larger group of men (38%) indicates they are using condoms “most of the time” and yet
another group (18%) says they are using condoms “some of the times. Additionally some
MSM (27%) report engaging in serosorting, defined as “only having sex with people of
the same HIV status” and another group of MSM (24%) indicate they are utilizing harm
reduction methods, defined as reducing exposure to semen by “pulling out,” reducing the
number of partners, etc. (See Chart 2.)
HIV/AIDS Prevention Assessment among Gay, Bisexual
and Other Men who Have Sex with Men (MSM)
John Snow, Inc.
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Other methods utilized to reduce exposure to HIV transmission include monogamy,
abstinence, avoiding anal sex, testing with a monogamous partner prior to sex, and using
condoms with all “but my primary partner.”
Chart 2. Strategies to Reduce Exposure to HIV Infection
by HIV Negative/HIV Positive Serostatus
ii. HIV Counseling and Testing
HIV Counseling and Testing programs were seen as professional and helpful in terms of
using the testing setting as a teachable moment. Most who participated in this
assessment’s primary data collection activities, either through the survey or through focus
groups had been tested. 7
The public health counseling and testing sites were viewed as accessible and the services
were considered high quality and respectful of the confidentiality of clients. Based on the
focus group findings, men look for cues from providers to indicate they will be welcomed
7
These findings are not population-based and therefore may not reflect the actual population of gay,
bisexual, transgender males and other MSM in Minnesota.
18
as gay, bisexual or transgender males and competency to work with differences such as
race, gender or language.
While not significant enough to interfere with widespread use of these sites, there is a
sense of stigma about being seen using a public counseling and testing site. These
feelings were based on perceptions that others might be judging their sexual activities.
They were expressed in a particularly strong way by Latino/Hispanic focus group
participants. Concerns about being judged unfairly or having to face unfounded
assumptions about their reasons for seeking an HIV test were also expressed by
transgender males who participated in focus groups.
There was a lower degree of comfort with community-based testing activities. Men felt
less comfortable testing in places with smaller crowds and where they might stand out if
they participated in a testing activity (e.g. outreach vans, health fairs or bars.) A notable
exception, was community-based testing offered annually at the GLBT Pride Festival
where there was a sense of comfort in numbers and testing was supported as a cultural
norm. While community-based testing is an important activity to continue, it seems there
is a need for it to be approached with some degree of cultural knowledge and
sophistication.
Over 90% of survey respondents had seen a doctor, nurse or other health care provider in
the past 12 months. Among HIV negative men who were seen for care, 71.3% were
offered an HIV test. This is reflected in the actual number of individuals (44.0%) who
were last tested in a doctor’s office. Other locations survey respondents indicated they
received counseling and testing included STD clinics (14.5%), HIV counseling and
testing sites (9.3%), public health clinic (6.2%), street outreach program (bar or mobile
unit) (4.7%), community health center (4.1%), community event or fair (3.1%), or
HIV/AIDS service organization (2.1%).
Overall, most survey respondents had been tested for HIV in the past 5 years. Only 4%
had never been tested for HIV. Among the reasons given for NOT getting tested, “too
low risk” (7.0%) was the most common reason followed by “Afraid to find out I have
HIV” (6.0%), “Didn’t know where to go” (4.0%), “Worried the government would
know” (3.0%), “Worried other people would find out” (2.5%), and “Afraid I’d lose my
job insurance or housing (2.5%), and worried my family would find out (2.0%).
The focus group responses amplified these survey findings. Participants generally did
not talk about their aspirations for good health only in terms of HIV/AIDS, but defined
good health as a lifestyle and access to health care that supported their over-all wellness.
It is notable we saw access to regular health care linked with a high rate of routine testing
among the participants in this assessment. While public testing sites or community-based
clinics or services were the preferred HIV-testing sites, we did hear from focus group
participants that once they had an established and trusting relationship with a doctor, they
were willing to test in their doctor’s office.
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John Snow, Inc.
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We also learned about a high capacity to self-assess risk and act on it by getting tested.
iii. Partner Services
Partner services were seen as useful and helpful. However, many individuals don’t know
what is meant by “Partner Services” unless the term is explained. The service has a
relatively low profile. In focus group settings, when asked about Partner Services it was
common for participants to offer blank expressions and to say they had never heard of the
service. Those who were not familiar with the service, after it was explained to them,
thought it sounded like a reasonable thing to do. However, we tended to hear stronger
opinions and concerns about Partner Services from focus group participants who were
already familiar with the service and especially from key informant interviewees.
In interviews conducted by an MDH staff person with Partner Services clients indicated
that the Disease Intervention Specialists (DIS) were clear on the purpose of their call and
of Partner Services and all DIS identified themselves to clients clearly.
In general, many of these clients had an attitude toward partner services that one
respondent summed up as, “Partner Services was hard to accept” and that it was good that
MDH “put it out there.” In other words, despite some of the challenges (see next section)
of how partner services are offered, most people understand why the service is offered
and the potential benefit to identifying potential cases of HIV.
c. HIV/AIDS Prevention Challenges
i. Prevention Programs (HERR)
There are a wide variety of challenges facing the broad array of prevention programs for
gay, bisexual, transgender males and other MSM in Minnesota.
As described above, gay and bisexual men are engaged in a wide variety of behaviors to
reduce HIV risk and transmission, including many harm reduction activities. The
challenge for providers of HIV/AIDS prevention services is that harm reduction
approaches are often viewed with anger by members of the gay and bisexual male
community who view this as being too permissive of unacceptable risk. It is sometimes
difficult for those not in the field to understand that clients don’t necessarily change their
behavior from high risk to no risk in one step.
Similarly, MDH is often in a position where it can not support some harm reduction
strategies, even though they may be evidence-based or considered by providers to be
promising based upon their knowledge and experience delivering services. As with
providers, MDH sometimes refrains from encouraging or supporting some harm
reduction strategies because of backlash from gay and bisexual men’s communities.
Providers express frustration that MDH’s embrace of certain harm reduction activities is
20
constrained by the potential political difficulty if the State is perceived as supportive in
any way of activity that some might consider to be unsafe behavior.
As an additional concern, providers identified a need for more information about research
into effective HIV prevention. It was observed that for many who experience HIV
infection risk, the situations in which they experience risk can be chaotic or impulse
driven; something that can especially be true for younger men. A need was expressed for
information, reflective dialogue, research and training to promote use of interventions
that recognize and respond to this reality.
In the online survey, men identified a wide range of barriers to receiving prevention
services. The top reason was that they “already know all they need to know about HIV.”
Chart 3. Barriers to HIV Prevention
Additional barriers to receiving prevention services are identified in Chart 3.
Key community informants identified a range of challenges facing HIV prevention
programs for gay and bisexual men’s communities in Minnesota.
Administration of HIV/AIDS Prevention Programs
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With respect to the overall administration of HIV prevention programs, community
leaders view the politicization of HIV/AIDS prevention as limiting the ability of state and
other public officials to visibly address the health needs of the gay and bisexual men’s
communities. This results in public statements and reports that often minimized the
impact of the HIV/AIDS epidemic in these communities. The community perceives this
as being an “invisible” part of the public and consequently of being of lesser value.
Younger gay and bisexual men who have more recently experienced the public school
system found a lack of any comprehensive health education that addressed the sexual
health of gay or bisexual or other MSM. This was true both of their school experiences,
as well as the information intended for young people offered through public health and
community-based programs.
Further, administrative limits such as program caps or budget adjustments when
programs successfully obtain private funds combine to limit the ability of community
agencies to provide comprehensive evidence-based programs. As indicated in the
community survey and in the focus groups, services that utilize peer models and one-onone counseling among the most effective programs. By effectively limiting the size of
programs serving gay and bisexual men’s communities, it is more difficult to develop
services that are in proportion to the scale of HIV’s impact in the gay and bisexual
community and to sustain the services so they can have the desired effect over time.
Providers feel these limits on the ability of providers to scale-up their services impair
their ability to achieve the outcomes presumed to come from evidence-based, researchsupported intervention, or to independently assess results from an intervention.
Biological methods of HIV Prevention
In interviews with key informants, no one thought that biological means of preventing
HIV infections were being used. The specific methods discussed included Post-Exposure
Prophylaxis (PEP) and Pre-Exposure Prophylaxis (PREP.) However, when asked about
these methods through the online survey 3.1% of respondents indicated they had used
PREP and 4.6% indicated they had used PEP. While these are small numbers and may
not be reflective of any trend, the questions used in the survey had been validated in a
previous survey and are likely to reflect real findings. Further, there will be results from
several PREP studies in the coming year or two which will further raise awareness of the
possibility of using HIV treatment medications to prevention infection.
Use of Internet to meet sexual partners and make social connections
When asked where people meet sexual partners, 57.8% of survey respondents indicated
that they met partners at “online/internet – hook up sites” and 48.5% indicated that they
met partners at “online/internet – social networking sites.” Finding ways to partner
effectively with these sites to provide reminders and support about safer sex behavior is
necessary to reach men where and when they are sexual active.
22
ii. Counseling and Testing
Expansion of counseling and testing to additional community sites may pose several
challenges. According to the survey there is higher comfort receiving services at a private
doctor’s office (89%), HIV/AIDS service organization (89%) or community health center
(79%) compared with a mobile van (52%) or a community event (41%) (see Chart 4.)
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Chart 4: Comfort receiving an HIV test at various locations (n = 203)
Respondents indicated that testing at community events (with the exception of GLBT
Pride Festival) and testing at bars was problematic because these were events that people
attended with their peers and would therefore were perceived not to be confidential.
Having “testing nights” at such locations is useful for promoting the idea of testing and
disseminating prevention information, but shouldn’t be expected to generate substantial
numbers of testing clients. It is especially unlikely that individuals with concerns related
to the potential disclosure of their status would test at such sites.
Successful CTR sites tended to send cues through their marketing and the health literacy
activities within their facilities that suggested welcoming attitudes toward serving gay
and bisexual men’s communities. When these sites also became know for diverse
cultural competencies and diversity on their staff, including language skills, they became
known as trusted providers within gay and bisexual men’s commuinities. Sites seeking to
improve their HIV testing services or efforts to expand services would be wise to learn
from the experiences of these more successful CTR sites.
24
iii. Partner Services
While many of those who accepted Partner Services had a respect for the service and
understood its purpose, there were several challenges suggested in the interviews of
individuals who received or declined these services.
First, only about half of the individuals interviewed who received these indicated that
they received useful health education as part of those services. The other half either did
not remember receiving those services or felt they weren’t really useful. The reasons
information wasn’t useful included someone who felt they knew the information already,
someone who didn’t have any questions and someone who felt “it was all so new they
couldn’t take in any useful information.”
With respect to referrals, slightly more than half of those receiving partner services
indicated that they received useful referrals in the area of medical case management, legal
services and support services. Still, little less than half did not receive these referral
services. A few of these individuals were already linked into services and one wound up
finding services on his/her own.
Key informant interviewees and focus group participants also reminded us that, in the
past, many gay, bisexual and trangender communities have been prosecuted as criminals.
They continue to feel public policies are discriminatory or foster stigma. This contibutes
to feelings of suspicion or distrust of government, or a sense of having been abandoned
by their government. These experiences and feelings influence how some view a public
health’s delivery of Partner Services. Overcoming this visceral sense of resentment may
require sustained training and accommodation, as would be similarly appropriate to shape
and deliver services in a culturally-relevant manner to reach any other target population.
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d. Moving Forward with HIV/AIDS Prevention for Gay and Bisexual
Men and other Men who Have Sex with Men (MSM)
i.Prevention Programs
A new framework for HIV prevention programs is needed that recognizes the fact that
HIV is endemic in gay and bisexual men’s communities. With this population,
HIV/AIDS is no longer an epidemic that is emerging in impact, but has become more of a
permanent reality that affects at all ages, social and economic groups and across all racial
and ethnic groups. This new framework should include policies meant to combat
homophobia in all of its expressions. It is homophobia which reinforces stigma and social
isolation and limits the ability to provide comprehensive sex education inclusive of maleto-male sex and responsive health care and services.
MDH should review HIV prevention funding to ensure that it allocates resources in a
fashion proportionate to the burden of the epidemic on the gay and bisexual male
community. Any administrative barriers to achieving proportionate funding should be
reviewed and reconsidered.
The Internet, and new media in general, is now a primary source for both online
information about HIV/AIDS for meeting sexual partners and for making and sustaining
supportive social connections and networks. It is increasingly important that both MDH
and community organizations work to increase their presence on the Internet, improve the
accuracy and accessibility of information about HIV prevention and utilize new outreach
strategies on sites for gay and bisexual men’s communities as well as new media sites.
Traditional media still has an important role. More aggressive social marketing
campaigns are needed to raise the visibility of HIV/AIDS awareness and prevention
targeting the gay and bisexual men’s communities. These may include media campaigns
on television, radio or the Internet. It can also include posters, billboards, flyers as well as
organized meetings that demonstrate renewed commitment to fighting the epidemic in
this community. The Young MSM Summit held early in 2010 is a good step in this
direction. However, it should be emphasized that because HIV is endemic in all MSM
communities (adult, older, African-American, Latino/Hispanic, White), that ALL MSM
communities need added attention and strategic thinking.
Collaboration among HIV/AIDS service providers can help provide services in ways that
respond to the diversity of Minnesota’s gay and bisexual men’s communities. This was
most clearly described in the focus group with transgender males, who said they were not
necessarily expecting HIV/AIDS providers to meet all of their needs or a program or
organization designed specifically to serve their community, but they at least wanted to
see indications that providers were aware of their needs, and more importantly, that
HIV/AIDS providers and those with expertise in the health needs of transgender males
26
were collaborating with each other to develop strategies for making sure they got useful
HIV prevention services. The same could be said for any unique community of gay,
bisexual or other men who have sex with men (e.g. men in rural communities, younger
men or men of color, such as African Americans, Latino/Hispanics, Asian/Pacific
Islanders or Native Americans.)
Initial planning and discussion should take place over the next year with respect to state
policy with respect to both PEP and PREP. As more information becomes available on
the efficacy of these practices, the state must take a leadership role in providing guidance
to both providers and consumers with respect to whether and how to utilize these
practices in an ethical and effective fashion.
With respect to Community Planning, there should be ongoing efforts to expand
engagement of gay and bisexual men and to build capacity through member selection,
training and education. Community planning and public health leaders should also
consider how to foster an environment among HIV service providers that supports more
reflective learning about HIV prevention in general, as well as the unique challenges of
reaching gay, bisexual and transgender male communities.
ii. Counseling and Testing
MDH should work with gay and bisexual men’s communities to expand access to HIV
counseling, testing and referral [CTR]. Bolder efforts to normalize HIV counseling,
testing and referral in routine medical care and increase access and use of emerging HIV
screening and testing technologies to create more options for individual to learn their
status, while retaining standards of confidentiality are needed. Emphasis should be
placed on directing CTR resources in ways that follow the course of the epidemic and
increase access to services in venues where those at highest risk are most likely to seek
CTR services.
MDH should ensure that clinicians in private physician’s office receive adequate training
in the provision of counseling and referral services related to HIV testing. The increasing
push for routine testing in medical settings is logical since these are trusted providers of
care. Such trusting relationships are built through routine, regular access to a provider,
which means access to health care. Additionally, if such providers or their staff are
unable to speak with confidence about issues related to transmission, prevention and, if
needed, living with HIV as a gay or bisexual man and connecting to services to manage
HIV as a chronic disease, these sites will not be seen as safe places for testing.
iii.Partner Services
The Partner Services program should continue to work to increase cultural sensitivity
towards gay and bisexual men’s communities including having staff with experience
working in or who are from these communities. It should actively work to explore how
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and Other Men who Have Sex with Men (MSM)
John Snow, Inc.
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ideas around privacy and confidentiality with respect to their sexual contact in these
communities are different from the heterosexual community due to stigma, perceived
discrimination and suspicion of government intrusion.
Clear information about Partner Services, using laymen’s terms, should be used to
explain the purpose and scope of Partner Services and ensure that recipients of the
services understand that Partner Services are part of a comprehensive HIV prevention
services program.
MDH should recognize that increased attention to the provision of referrals and linkage
to services to people newly diagnosed with HIV helps support the notion that there is
concern for the quality of their lives and that the focus on them is not simply as
transmitters of disease.
It is clear from the findings that men in gay and bisexual men’s communities, as is the
case for many who are newly diagnosed with HIV/AIDS, do not adjust to a diagnosis
according to a time frame that corresponds to when disease intervention staff (DIS) staff
are likely to contact them. Due to this, some individuals may find the services intrusive
and “painful” when they are not yet ready to face their illness. The program should
understanding this and adopt strategies that may minimize discomfort, such as use of
email or snail mail rather than in-person or telephone contacts.
28
VI. Acknowledgments
The Minnesota Department of Health STD/HIV Section within the Infectious Disease
Epidemiology, Prevention and Control (IDEPC) Division provided support for this study,
utilizing funds from the federal Centers for Disease Control. Numerous individuals
within the STD/HIV Section provided assistance in completing the work. Amy Meier, an
intern with the Division, conducted interviews with clients or potential clients of the
Partner Services Program.
Stewart Landers from John Snow, Inc. (JSI) conducted this project with assistance from
Arman Lorz. Bob Tracy, a Minnesota-based consultant, was an essential partner and
collaborator throughout the project.
Throughout the Minnesota HIV/AIDS community, program leadership and staff were
open to being interviewed and accessible throughout this process. Many in the
community provided assistance in helping us identify focus group members and in
soliciting respondents to the online survey.
We are extremely grateful to the many gay, bisexual and other men who have sex with
men (MSM) in Minnesota who took our survey or participated in a focus group. This
report is for them.
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Appendix A – Key Informant Interview Summary
Key informant interviewees included leadership or staff at community-based
organizations, AIDS services organizations, County and State health departments,
academia and the Minnesota Legislature. Key informants selections were made to assure
the experiences of the diverse array of HIV among gay, bisexual, transgender and other
men who have sex with men in Minnesota were addressed in the interviews. Fourteen
interviews were conducted with individual representing the following organizations:
Pillsbury House – HIV/Health Education Project
Hennepin County Public Health Clinic – Red Door Clinic
University of Minnesota – School of Public Health
University of Minnesota – School of Public Health/Man2Man Program
University of Minnesota – Program in Human Sexuality
West Side Community Health Service / La Clinica
Rural AIDS Action Network
Minnesota AIDS Project
Minnesota AIDS Project – Pride Alive
Minnesota AIDS Project – Positive Link
Minnesota AIDS Project – Allan Spear Forum
Minnesota Department of Education – Coordinated School Health
Minnesota State Senator Scott Dibble
The City, Inc
Kevin Sitter
A copy of the interview tool is presented below, followed by the findings of a content
analysis of the interview results.
30
MDH MSM Prevention Assessment
Key Informant Interview Tool
Institutions: ______________________________________________
Interviewee (Title and Name): __________________________________
Interviewer(s): __________________________________
Where: ____________________________________
Date and Time: ________________________________
Survey Section Used:
___ A: Interview Background
___ B: Field Notes (incorporated)
Other Topics Discussed:_____________________________________
Documents Obtained: ___________________________________
________________________________________________________________
Introductory Protocol
Bob will be taking notes today. Your responses will be used to help shape the activities
that will comprise this assessment of HIV Prevention Programs for MSM in Minnesota.
Additionally, all notes associated with this interview will be retained by the study team,
Bob and myself, Stewart Landers, Senior Consultant at JSI, and will remain private.
Essentially, this document states that: (1) all information will be held confidential, (2)
your participation is voluntary and (3) any information put into a public report will be
presented in a way that does not necessarily identify the source. Thank you for your
agreeing to participate.
We have planned this interview to last no longer than 60 minutes. During this time, we
have various questions that we would like to cover. If time begins to run short, it may be
necessary to interrupt you in order to push ahead and complete this line of questioning.
Introduction
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You have been selected to speak with us today because you have been identified as a key
opinion leader with respect to HIV/AIDS prevention interventions specifically aimed at
MSM populations. Our research project as a whole focuses on understanding current
practices, with particular interest in the direction of how MDH might support
interventions going forward that may better serve MSM in Minnesota. We are trying to
learn about current or past programs, community concerns, and hear your ideas with
respect to the needs of MSM at risk for, or already living with HIV/AIDS.
A. Interviewee Background
How long have you been in your present position? _at this institution? ________
1. Briefly describe your role (office, committee, classroom, etc.) as it relates to
HIV/AIDS interventional programs and, where possible, those specifically involving
MSM:
Probes:
How did you get involved?
B. Questions
1. Can you describe the nature of HIV/AIDS work at _________, and specifically
regarding MSM?
2. Can you describe programs/initiatives related to HIV prevention in the MSM
community? What was the program? Your role? How would you rate its efficacy?
Probe:
1. What community assessments, if any, have been used to guide program
activities?
2. What, if anything, could be done differently in order to improve results?
32
3. 3. What do you consider to be the biggest challenges involved regarding the
delivery of HIV/AIDS prevention interventions geared towards MSM
populations?
Probe:
1. Where do you look for guidance in the development of HIV prevention
programming?
2. How are programs evaluated?
4. Do you believe certain populations under the MSM umbrella are at greater risk? If so,
which ones, and for what reasons?
Probe: Describe any particular efforts and barriers to reaching particular
populations.
5. Do you know of any previous or current interventions with which you were not directly
associated, but that you believe to be successful? What do you believe contributed to
their success?
6. With whom would you suggest we speak with respect to understanding how HIV
prevention efforts around MSM can best be enhanced?
Probe: How would you suggest reaching MSM to obtain additional feedback on HIV
prevention activities (media, forums, surveys, etc.)
Post Interview Comments and/or Observations:
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SUMMARY OF
Total
COMMUNITY KEY INFORMANT INTERVIEWS
Responses
1. PERCEPTION OF PUBLIC HEALTH AS CONCERNED ABOUT GAY/BI MEN'S HEALTH IS LOW
Gay, bisexual, transgender and other men who have sex with men need to perceive that public health leaders are genuinely concerned about
their health. They are unwilling to trust information or respond to services provided by public health for a variety of reasons. There is a
perception t that public health officials are too willing to sacrifice the health needs of gay, bisexual and transgender men under the threat of
political pressure. Further, language used in describing the epidemic, organizational and program structures and how funds are solicited and
allocated reinforce a perception that public health leaders are unprepared or unwilling to address the impact HIV is having in communities of
gay, bisexual, transgender and other men who have sex with men.
a. MDH [state] is politically squeamish when it comes to gay/bi; we perform to the lowest/safest common denominator
Can't count on MDH to back up sound public health practice in face of controversy. Tell us to be "edgy" but don't have
our backs; fearful; MDH is hampered by institutionalized homophobia
5
b. Community needs to perceive public health values them and wants to serve them
5
c. Publc health politicized in MN
5
d. Unwilling to use gay/bi label -- MSM "degays"
4
e. Public health professionals throughout the state need training in gay/bi issues [so go gay/bi men]
4
f. Have not tried to get resources for gay/bi prevention; state funding has been "locked in time"
4
g. Public [County/state/schools] support gay/bi services when "couched & hidden" within other programs
2
h. Epi data reported in ways that minimizes public [and gay/bi communities'] awareness of gay/bi nature of epidemic
2
i. MDH provides services for gay/bi, but only because it is mandated
1
j. Mixed message from MDH; some staff supportive & competent/some resist and resent
1
k. Need to acknowledge a/the domestic HIV problem
1
l. Health disparities in gay/bi/GLBT community not recognized in Office of Minoity Health
1
m. Need staff who have actual, sexual experience within gay/bi communities
1
n. Lots of fear about criminalization & distrust of govt; carried over from application of sodomy laws
1
2. MDH ADMINISTRATION OF RESOURCES FOR HIV PREVENTION VIEWED AS POSING BARRIERS TO MEETING NEEDS
There is a perception that guidelines developed to distributed state HIV prevention resources were designed to respond to political pressures
to de-emphasize HIV prevention targeting gay, bisexual, transgender and other men who have sex with men, and highly visible providers that
target these communities. The sense is these political pressures, combined with administrative decisions, have made it impossible to
implement effective, evidence-based interventions designed for these communities.
a. Data collection onerous [we are here to serve the govt - serve CDC reporting]
MDH/CDC reporting requirements do not match up with DEBIs; Focus more on reporting than effective program
6
b. Do not use epi to direct funding; succumb to political pressures to redirect resources from gay/bi
3
c. Inadequate resources to support implementation
2
d. Funding formula is irrational and creates barrier to delivering needed or effective services
2
e. Studies come and go; we don't get results or hear/see what's done with findings; need product community can use.
2
f. Unwilling/unalbe to solve problems when they get identified [e.g. partner services issues]
1
g. Concerned that division does not have structure, support and/or right leadership to be effective
1
h. Too internally focused. Do not know how to have partnership with community providers.
1
i. Lots of reporting [very duplicative and inefficiently organized] and we get no feedback
1
34
SUMMARY OF
Total
COMMUNITY KEY INFORMANT INTERVIEWS
Responses
j. Best reporting experience was Pride Study -- we actually partnered.
1
3. COMMUNITY PLANNING COULD BE MADE MORE RELEVANT
The confidence in the community planning process is low. There is a perception the process is not organized in a way to effectively engage
community resources and to openly address needs and effective use of available resources.
a. Members lack knowledge, right/needed expertise and come with special interests
5
b. Hard to do primary prevention [e.g. funding to address youth and developmental issues]
4
c. CCCHAP has minimal impact.
1
d. Lack of MDH transparency. Not up front about budget. Does not include all programs [e.g. omits DIS]
1
4. POLICIES HINDER MAXIMUM EFFECT OF HERR FUNDING AND COMMUNITY GRANTS
Policies for allocating resources to support community-based prevention are perceived to limit the effectiveness of HIV prevention services
targeting gay, bisexual, transgender and other men who have sex with men. Funding caps, policies that discourage private fund-raising, and
allocation procedures that give preferential treatment to state-directed services are perceived to be barriers to scaling up prevention services
to so they can be effective and large enough respond to the size of the HIV epidemic in these communities.
a. Can't fund whole programs [e.g. multiple contracts to create 1 program - very high administrative/reporting cost]
6
Never fully fund a service; never increase funding [real funding goes down over time]
b. Funding restrictions prohibit implementation of DEBI, evidence-based and/or multi-level interventions
Spend millions developing evidence-based interventions; but don't fund agencies in ways to support implementation;
5
we should concentrate resources to really have a strategic impact and test what works
c. Competitive nature of funding does not facilitate collaboration between providers
Funding goes to ASO, race-based or U programs; do not encourage connections between efforts.
4
d. Get penalized if you find other stream of dollars; they ignore there really are no other streams of dollars.
4
e. Funding restrictions prohibit scaling-up programs to reach larger gay/bi community; invest in a community and do it well
3
f. Funding caps are irrational [e.g. $130K per program; 2 staff @ $50K each]
3
g. No CDC dollars go into community; all goes to MDH programs -- community only gets [political] state $; not growing
2
h. Tend to put dollars into starting up new programs/agencies; rather than build capacity among est. HIV providers.
2
i. Funding is behaviorally-based; not community-based -- can't address interrelated factors [e.g. race & homophobia]
1
j. Will integrate funding to meet admin needs [e.g. add STI, Hep C to HIV], but not to allow community [see H above]
1
k. Uneven contract management; varied knowledge/comfort with gay/bi needs
1
l.Fear or low priority given to using incentives to get people involved
1
m. Not enough money in contracts for condoms or testing
1
5. BENEFITS OF PARTNER SERVICES FOR GAY/BI MEN COULD BE IMPROVED
There is room for improvement of state partner services to be more reflective of and responsive to gay, bisexual, transgender and other men
who have sex with men. Poor experiences with the service seem to reverberate within the community and create misperceptions and restrict
openness to using the service. There are concerns the limited reach of the services also limits its potential impact.
a. Varies; but people I've talked to who went through process felt it was helpful
3
b. Gay/bi men say "I wasn't contacted" or "didn't know what the call was about" or "felt pathologized"
2
c. Staff are not sensitive to gay/bi men
1
d. Community views reporting by diagnosis sites as being "ratted out"
1
e. One bad experience reverberates; this perception problem is not taken seriously
1
HIV/AIDS Prevention Assessment among Gay, Bisexual
and Other Men who Have Sex with Men (MSM)
John Snow, Inc.
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SUMMARY OF
Total
COMMUNITY KEY INFORMANT INTERVIEWS
Responses
f. Poor impressions of partner services creates resistance to testing
1
g. Low rate of reaching people; especially compared to cost and effort
1
h. Resistant/slow to incorporate changes or improvements; Unwilling/unalbe to solve problems
1
i. Issues about disclosure to partners of married bi men
1
j. Need staff who have actual, sexual experience within gay/bi communities
1
k. Changed approach to meeting with Latino men; only meet at clinic, stopped going to homes; us same staff
1
6. THERE IS OPENNESS TO CHANGE AND INNOVATION IN HIV TESTING
There is an openness to exploring options for expanding access and environments for testing , recognizing that the process creates not only an opportunity
to provide access to care for those who are positive, but also moments of serious assessment and reflection on HIV transmission risk.
a. Need to normalize and destigmatize testing for gay/bi men; but also address their apprehensions
3
b.Testing TA offered through MDH is tailored; helpful
2
c.Need resources to test in more enviornments and communities [statewide, over-the-counter]
2
d. Not sure if only goal of testing is identifying positives; also supports intensive prevention counseling
1
e. Inappropriate use of testing a prevention tool -- lack of understanding of value of routine testing
1
f. Takes a long time to understand and trust results among Latinos; coordinated with clinic early intervention
1
7. EPI AND SURVEILLANCE SERVICES CAN INCREASE AWARENESS WITH CHANGES IN HOW DATA IS REPORTED
There is a sense that epidemiological data about the impact of HIV is reported in ways that limit awareness and understanding about the real
impact of HIV in communities of gay, bisexual, transgender and other men who have sex with men. A more straight-forward and pronounced
description of how these communities are affected, as well as a deeper sharing of information with providers and affected communities were
considered to be of potential value.
a. Institutional Homophobia; Epi data reported in ways that minimizes public [and gay/bi communities'] of epidemic
awareness of gay/bi nature ambiguous and vague when it comes to gay/bi [esp in print]; left open to misinterpretation;
2% nat'l pop but 68% prevl. wouldn't know this is only group with increasing infections nationally [Do not collect population data about gay/bi
men]
[Do not collect population data about gay/bi men]
5
b. Focus on incidence in how data is reported and used; ignores how prevalence drives epidemics
2
c. Failure to use gay/bi language and to describe epidemic forth-rightly is stimgatizing to gay/bi men/GLBT community
1
d. Do not share detailed epi with community/providers in ways to help develop responses.
1
e. Use more interactive video to report; so numbers can be explained
1
f. Could use to tease out more info collected from DI to understand trends/risk situations
1
g. Be clear we have two epidemics -- Blacks and everyone else
1
h. We really don't know what works; interventions have been poorly researched and evaluated
1
8. GENERAL AWARENESS CAN HELP INCREASE PERCEPTION OF RISK IN COMMUNITY
The perception exists that more aggressive social marketing that is specifically-designed to reach communities of gay, bisexual, transgender
and other men would promote community engagement with responding to the impact of HIV.
a. Need to learn from and apply experience with tobacco and "Target Market"
6
b. Dependent upon local capacity, skill, knowledge or willingness to do work [e.g. schools, public health]
3
c. Department does little to promote awareness and understanding [e.g promotes "AIDS" days]
3
36
SUMMARY OF
Total
COMMUNITY KEY INFORMANT INTERVIEWS
Responses
d. Good information on MDH Web site; but hard to find and use --too technical [due to politics]
1
e. ABC Model -- gay is in third place; need social marketing initiatives
1
f. Gen sex ed is important; but needs to extend outside reach of schools, PSAs, etc.
1
9. MAJOR SHIFTS ARE NEEDED TO ADDRESS STRATEGIC CHALLENGES
There is a need to recognize the endemic presence of HIV in communities of gay, bisexual, transgender and other men who have sex with men; the fact that
continued, high rates of infection have had a sustained, high presence in all parts of the community. Support is need to help develop deeper understanding
and greater willingness and capacity to respond to the (a) impact of social factors [such as homophobia,] (b) changing and diverse attitudes about sex and
sexuality in these communities, (c) inter-relatedness of these communities – racial, age, socio-economics, (d) health care needs beyond just HIV risk, and (e)
the realities of incorporating the impact of HIV into individual and community life for a long-term are among the significant changes creating the context for
new approaches to responding to HIV.
a. Divided GLBTQ movement; diverse movement; marriage versus the "sex pigs"; where is place for youth/trans;
Need to develop community-oriented concept and capacity to "policy ourselves" - redefine norms in positive way
4
b. Can't/don't collect health behavior, needs & disparities data [e.g. ed survey, minority health.]
4
c. Need to address social homophobia
4
d. Need to challenge the notion that we can "treat" our way out of this problem [Faucci]
3
e. Resistence to harm reduction; both from outside and inside gay/bi communities
3
f. Need shift policies and strategies to view HIV as endemic in gay/bi communities
2
g. Need health care; this is a population that does not have routine access to health care
2
h. Closeted and stigmatized; esp issue for younger gay/bi; they don't get education; significant issue for African Amer
2
i. "I did it for love" -- Need to recognized gay/bi sexuality as real and legitimate; overcome loneliness
2
j. Slow to look at new prevention strategies [e.g. PrEP, internet, ]
k. Affirm its not just knowledge/skills about sex - mental health, substance use, personal violence, social stigma, safer sex
2
info presented in ways that is disconnect from real life experiences; risk assessment is based on trust not transmission facts
1
l. Need to recognize men change behaviors over time; different needs at various stages of life; no single strategy for
all or for always; no population in world where condoms have been used deliberately & consistently over long times
1
Conceptualize what does it mean/what does it take to be "negative for life"; reconceptualize gay sexuality
m. The reality is we don't know what works -- we've researched short term impact, but don't have good research
to guide efforts to achieve goal of making long term changes
1
10. A SHIFT IN EMPHASIS CAN IMPROVE HIV PREVENTIONS SERVICES FOR GAY/BI MEN
HIV prevention services targeting communities of gay, bisexual, transgender and other men who have sex with men need to shift toward a
focus on mobilizing communities and on responding to the realities of the increase role of Web-based supports for social networking.
a. Can do individualized work effectively on Web; tailor messages; opens up use of wider range of prevention messages
Lots of factors go into risk calculation and reasoning not to use condoms -- messages need to vary to address this.
7
b. Need community-level interventions to keep community engaged; motivated it's what worked at the outset
MAP is doing some work to keep profile in community; but the effort is under-resourced and stressed
Need funding to do basic community awareness to keep community's focus on issue; gay/bi & allies
6
c. Need training for informal peer/network leaders; esp. Greater MN; annual "summit"
4
d. Funding is behaviorally-based; not community-based -- can't address interrelated factors [e.g. race & homophobia,
intergenerational work]
2
e. Not just for Greater MN; summit of cross-industry professionals to mobilize on gay/bi health
2
HIV/AIDS Prevention Assessment among Gay, Bisexual
and Other Men who Have Sex with Men (MSM)
John Snow, Inc.
37
SUMMARY OF
Total
COMMUNITY KEY INFORMANT INTERVIEWS
Responses
f. Unwilling to really engage with prevention at locations where high risk activity is likely
2
g. Changing attitudes about being positive [e.g. more comfortable with being positive; more willing to disclose]
2
h. Develop capacity and skill to do good service assessment [e.g. quality improvement]
1
i. Gay community infrastructure is changing/deteriorating with emergence of internet social structure
1
j. Unrealistic to expect non-HIV agencies to offer effective pevention services; it takes knowledge and skill
1
11. HIV PRVENTION SERVICES GAPS CALL FOR A SHIFT IN FOCUS
Services are needed to support sexual development of gay, bisexual, transgender and other men who have sex with men. Sexual health
education for young people is not comprehensive or inclusive, a problem that is bad enough for all young men, and even more so for those
living outside of metropolitan areas. HIV prevention is hampered when the general health gay and bisexual men go unaddressed, including
the impact of mental health, substance abuse, or lack of access to routine health care. There is also a gap in meeting the prevention needs of
men who are living with HIV.
a. Sex ed for youth is not comprehensive and does not address needs of gay/bi/Q youth; seeing effect of ab only ed
8
b. Interventions for young MSM are underfunded, prohibited and/or not available [comm, public health or schools]
5
c. Need a fully-service, integrated GLBT health service [e.g. prevention, clinical, MH, policy, etc.]
Need general health education and support for gay/bi men; little focus on relationship med providers
4
d. Need services that address inter-connections between diversity of gay/bi communities [e.g. racial, age networks]
2
e. Need comprehensive plan to reach gay/bi; just as we had with IDU [e.g social marketing, policy, intervention, etc]
Need to change policies that stigmatize [e.g. marriage]
4
f. Need real commitment to prevention with positives/address the issue of prevalence
4
g. Emerging resistence to condoms; how do you do harm reduction for "resisters" without undermining condom users
Same problem with harm reduction for users. Parts of gay/bi communities object to harm reduction
Can't educate about sero-sorting.
6
h. Closeted and stigmatized; esp issue for younger gay/bi; they don't get education; youth development/leadership
Latino Men; African American youth face unusual barriers due to stigma
4
i. Men coming from rural communities to metro; to live and or to hook up [similar for Latino mingrants]
5
j. Not really addressing trans [e.g. changes in sexual norms, roles in "macho-based" culture of Latinos[
5
k. Mental Health: Rational behavior is not always the option given mental health concerns
4
l. Bi: Get needs met through clandestine means; safety not the priority. Either asexual or take risks. Down low
is misunderstood -- it's a gay stigma thing that's not racially specific; lots of gender fluidity with youth
4
m. Latino Men: New for MN -- culture, social norms, language
4
n. Need community supports for positives [e.g. connect with each other; connect with HIV-; newly diagnosed]
4
o. Behavior Challenges: droppoing condoms quickly with serial partners; little time for negotiation in internet hook-up
Avoid testing/don't want to know; most sex is impulsive -- we don't do much to apply safer sex in this context
3
p. Need education on SM/BD behaviors
2
q. Stigma: Can talk about drugs, prostitution, etc. -- but homosexuality only talked about in negative sense [esp. AA, Latino]
2
12. COMMUNITY HIV PREVENTION WORKERS SEEK PROFESSIONAL DEVELOPMENT
Community prevention workers desire opportunities to improve their skills and capacities to deliver services with the potential for greater
impact, but feel hampered and unsupported in their efforts to pursue continued professional development.
a. Funding restrictions make it hard to attract/keep trained and/or experienced staff
3
38
SUMMARY OF
Total
COMMUNITY KEY INFORMANT INTERVIEWS
Responses
b. Do not bring together high level staff to develop strategic focus/effective collaboration
Outreach workers network helped coordinate schedules; but that's about it; no new ideas
5
c. UM gets resources to do gay/bi prevention work; but little to transfer knowledge/tech to community
2
d. TA from CDC-funding programs hard to get; funding barriers
1
e. None to limited funding for national conference attendance/networking
5
f. MDH-provided training is very basic; not appropriate for building advanced programs/services; not practical
3
g. Limited staff training/capacity to manage boundaries; need support services for professionals who work in field; skill
working both as peer and professional [e.g. professional friend]
2
h. Web service delivery is not free and takes skill; training is not there
4
i. Limited opportunities to link community with research; doesn't happen at national/international conferences
1
j. Need a more reflective approach to professional development and support
1
HIV/AIDS Prevention Assessment among Gay, Bisexual
and Other Men who Have Sex with Men (MSM)
John Snow, Inc.
39
Appendix B – Focus Group Summary
Group Discussions Summary
Minnesota AIDS Project
Nov, 2009
Healthy means:
· Not being ill and function well in society, not having long term health issues, not
being in medications and being conscious about other issues.
· Being in non-stressful situation
· Keeping spirits up
· Not having the “doomed” attitude
· Keeping hope alive
· Staying active
· Seeing a physician
· Eating well
· Abstinence from drugs
· Having the right medication
· Exercising
· Aging well
HIV discussions among friends involve the following:
· Pride Alive provides great support for young men; they participate in the events
and get more involved every time
- Generation Gap
· Some people in younger generations have the “I don’t care” attitude about HIV;
they say, “If it happens to me, it happens”; many see HIV as a chronic condition.
Being positive is not a big deal since there are a lot of medications out there to
treat the infection. HIV is being seen as something not bad after all
· HIV has been normalized in this era and there is no sense of what it means to live
without HIV around. New generations almost see and hear messages that people
do not die of AIDS anymore; HIV is manageable, therefore it has lowered it
relevance and priority as a health concern; people are taking HIV les serious
· The gay community is not taking advantage of the information and services
accessible to them and younger generations see themselves as invincible;
· the current generation is full of passion and all about following it, taking risks,
and making decisions
· Nowadays people are more accepting of living with HIV. At the same time, it was
suggested that the LGBT community is aware of the HIV issues and that it is the
non-LGBT communities who live in stigma about sexuality and HIV
40
- Stigma
· The same stigma issues that were lived in the 80s are being presented among
minority populations
· Some people are not comfortable with honesty and rather not find out about HIV
status
· There is still some attitude about “don’t ask, don’t tell”
· The gay community is frustrated with being targeted in an isolation tone
· Participants mentioned that people are interacting less and less every time. There
is no sense of community and interactions at bars or any other events; now people
go online to find sexual partners but they do not talk about safe sex.
- HIV and Routine Medical Care
· There is a great need of icons and figures associated with activism on the HIV
arena as well as more education in the medical field to stop ignorance among
providers
· HIV Specialists have a wealth of information about the subject but in many
situations doctors do not have the basic information about the infection; there is
need of more training at hospitals and clinics
· PLWH/As are noticing this and are afraid to go to a doctor who has only half of
the information about their patient’s situation
- “Same Old Prevention”
· Some partnering business and bars started to not allowing the outreach at their
locations because people do not want to see that anymore. It was suggested for
organizations and volunteers to find non-bar venues to reach the people who have
not been reached yet
· The bar scene brings the same people and all have been “outreached” in one way
or another; people do not want to be approached any more and they believe they
have all the knowledge they need about sex and HIV. Prevention is seen as a
default activity and it has lessened its value/relevance; it has gotten old
- Role of Peers
· “Friends tell friends what they do and lean on them for ‘unsafe’ things”
· People who look like me make me feel safe”
· Instead, people are actually learning more about HIV once they get infected
because they have to at this point
- Misinformation
· There is an misconception between undetectable and un-transmissible
· There is a great need of a message of hope and family education
- Connection between Community and Services
· Need more inspirational role models
· HIV positive people are active in community building
· Some people are still afraid of HIV positive people
- Prevention challenges
· Depression for being gay, positive or both and a great need of discussion of topics
like disclosure, relationships, rejection, and safe sex
· Safe sex in not common in long term relationships
HIV/AIDS Prevention Assessment among Gay, Bisexual
and Other Men who Have Sex with Men (MSM)
John Snow, Inc.
41
·
·
·
There is an attitude about not using condoms and taking risk
Participants wander if the state health department know what is happening among
the community
People do not own the responsibility and consequences and HIV is seen and a
treatable disease
Trusted resources of information:
· The Internet; people see it and want more of this with some evidence and
resources to back-up the information
· The Circle of Love provides s sense of hopefulness
· The Red Door has a great presence in the gay community
· Doctors and providers are well trusted in the community and they should talk to
their clients more
· Minnesota AIDS Project has an incredible prevention program (Pride Alive), staff
is helpful and have a program for newly diagnosed (the positive Link)
· Spiritual leaders and faith based organizations are well trusted and not often used
as an entry to the down low at risk population
· Between Men
· Brother’s Circle/Pillsbury House
· AIDSLine
· Participants also mentioned that many receive their information form their friends
from social networks; people trust the information coming from peers. Friends tell
their friends what they do and what they don’t do and this has a great impact on
others either for good or bad; Peer pressure is still a good market to tap on to
influence others
· However, many people have incorrect information and they are misinforming
others (including the message of “it’s safe to be negative, a top and not using a
condom”)
HIV testing:
· Virtually everyone in our focus groups had been tested
· Some participants mentioned that few doctors are offering testing at their clinics,
some of those providers are GLBT friendly and their services needed to be
promoted among this population
· There is a need of promotion of HIV testing and services outside the twin cities.
The Red door offers testing and it is probably most well known facility for this
service yet it has stigma associated that promiscuous people go there to get tested
· There is also HIV testing occurring at the Saloon hotel, Pride Alive also offers it.
Participants suggested top be very appropriate to promote testing during Pride
events but not at bars; people go there with their friends to have a good time, not
to get tested
· When participants talked about their experience receiving a positive result it was
described as harsh and in a sense of isolation
42
·
·
The Red door has the connotation that people get tested for HIV and only
promiscuous people get tested there; The Pillsbury house is a beautiful place,
clean, respectful and participants feel more comfortable getting tested there
People getting tested at pride feel comfortable and they expect it every year but
not on other community events
Partner Services
· In general, people (even those that have received this service) does not recognize
the name “partner services” or “partner notification services” as a service; no one
mentioned this as a prevention service until they were asked specifically about it
· In one group, two participants received a call about the possibility of risk of
infection. One said, “It was scary, but I was glad for the service.”
· Partner notification services need to know cultural aspects to contact partner to
not violate confidentiality in the sense of a phone call or visit might not be
appropriate
· Language was too clinical
· “This is a very effective way to get people into treatment; one of the most
powerful prevention services”
· “There seems to be a lot of secrecy about services available”
· “Be human, use everyday perspective. It will make it more real to me”
Improving HIV services in Minnesota
- Using Media Including New Media
· More media involvement for outreach, like billboards, online, magazines, bus
stops, etc.
· Participants suggested finding new ways to approach communities with HIV
prevention and awareness like creating phone-applications and including HIV and
STI testing as the routing annual physical exam
· To access the young crowds look for social media methods such as Facebook
events
· Participants want to see more facts, FAQ and figures to back up the prevention
messages distributed, ideally in an accessible online website
- Support Peer Programs
· Peer to peer education should be used the most and should include education and
training opportunities; participants want to see more non-focused exclusively on
HIV social activities, but inclusive of HIV; not just sitting around to learn, but to
meet others in similar situations as participants
· People need to find finding mentoring opportunities and peer led programs
· The men’s center also provides discussion opportunities of anonymous
discussions
· “I need information from people who’ve been where I’ve been”
- More Community Involvement
· Reaching others from non-typical organizations like football leagues, soft ball,
rugby, hockey teams, etc.
HIV/AIDS Prevention Assessment among Gay, Bisexual
and Other Men who Have Sex with Men (MSM)
John Snow, Inc.
43
·
There is a lack of collaborations between organization and the community needs
to see this caring partnership for the benefit of the community
· The future of prevention relies on education for youth
- Comprehensive Sex Education
· Participants mentioned to want to hear more about dealing with serodiscordant
relationships
· More information on oral sex
· Need to learn about the “nuts and bolts” of gay sex
· Sexuality is still a taboo, stop beating around the bush; provide direct specific
information
· more information about being bisexual
· a great need of more support groups about identity
· “We need a more aggressive approach on prevention”
· There is need to approach the “I hate condoms” attitude
- Address Mental Health Issues including substance use, stigma and disclosure
· “If people don’t feel worthy of being safe, they won’t be safe” the idea of being
worthy of self protection needs to me implanted in the community
· There is a need to hand out more condoms, targeting self-control, self
responsibility of making decisions, and the status disclosure issue to stop the
“don’t ask, don’t tell” attitude
· There should be more emphasis on disclosure and then safe sex
· People need to know how to disclose safely
· Prejudice is still there and it needs to be addressed
· Due to the “I don’t care” attitude many people are will rely on the use of
substances including drugs and alcohol which leads to a “my life is not worth that
much” and “to hell with prevention messages overload” this issues should be
addressed as well.
· We need to “build people from the inside” by focusing on self-esteem
· “Men are creatures of habit; teach new habits and you will change men”
- Other
· There should be an effective way to utilize medical settings to provide HIV
information, services and testing
· There is a great need of receiving more information about living with HIV, how
to be HIV-positive, how lo live life being positive
44
Group Discussions Summary – Latino/Hispanic Men
Minnesota AIDS Project
Aug, 2010 – Latino/Hispanic Men
Session held in English & Spanish with interpreter support
Healthy means:
- A Normal Life
· Live a normal life and do what everyone else does
· Being conscious about my health, good nutrition; be alert
· Play safely; I want to know the right way to use condoms; I want to be well
- Access to Health Care
· Have a good medical person around
- Living Well with HIV
· I want to fight for my life and be well
· Help to keep on my medications and to lower the effects of side effects
HIV discussions among friends involve the following:
- Misperceptions about HIV
· My daughter was talking with a friend about HIV; they do not have much
information; they said if you have AIDS you are dead
· Basically, we need to have much more information about HIV and informing
people that it is not a mortal disease
· There is concern about getting infected, but they don’t have the right information
· We live in a society in which appearance is very important, so when we see
someone who looks healthy, then it is assumed there is no risk; we need to change
the notion that you can tell if a person has HIV based on how they look
- Values and Family
· Values make it hard to hear information – they get in the way
· When we talk about HIV there is not enough support in the community; the
community is not supportive of people living with HIV and their families
· Values and family are not different things, they are the same, they are connected
- General Awareness
· There is a need to provide more general information
· We need more of the Latino/Hispanic community out there and seen to be talking
about HIV
- Legal Fears
· There is not a good understanding about how seeking medical care might affect
immigration status
· Some people think they can be sent to jail if they are HIV positive
Trusted resources of information:
- Turning to Media
HIV/AIDS Prevention Assessment among Gay, Bisexual
and Other Men who Have Sex with Men (MSM)
John Snow, Inc.
45
·
·
·
·
A lot of people get information from the Web and internet, but we need more
information in Spanish
TV is important; right now there are three commercials talking about HIV
treatments and only one talking about prevention running on local TV – only one
addressing prevention
People watch Spanish-speaking commercial TV; TPT is good, but not that many
people watch it
The general public in the Latino/Hispanic community get information from TV,
but the gay community is more connected with internet—right now it’s really hot
HIV testing:
- Trusted Providers; Easy to Access
· I am comfortable going to LaClinica to get tested; they know about HIV and they
provide a lot of services
· I live in Minneapolis, it is easy to go to Red Door to get tested and they have
people there who speak Spanish
Use of Prevention Services:
- Community Health Resource Hub
· LaClinica is a primary place for getting services
· It helps to have a lot of services conveniently located in one place, like at
LaClinica or Red Door
- An Openness to HIV Service Providers
· I went to the AIDS Walk and I came to realize there are many other services; I
have not used them, but I know they are there
· Sometimes I go to Aliveness, but the hours are strange, they close early so it
doesn’t work well for people who work
- Stigma as a Barrier
· There is concern about confidentiality and stigma, people don’t want to be seen
going into places that provide HIV services, that’s why it is easier to go to
LaClinica – they provide a lot of services
· If I come to MAP I am afraid people will see me and think I have HIV
· The Positive Care Clinic at HCMC was better when it was not a stand alone clinic
- Language Support is Important
· I go to LaClinica or the Red Door because there are people there who speak
Spanish; people feel comfortable with LaClinica because it’s a Spanish name
· It makes a difference to know if there is someone who can speak Spanish; more
than language is the culture; can they understand people and our differences as
Spanish-speaking people
· It’s not just about speaking Spanish, it’s about understanding what people are
really saying and what they need
Partner Services
46
- Mixed Experiences
· I have had no experience with partner services.
· I have had a bad experience with partner services; we tell people when they are
tested the information will be confidential; then someone from MDH shows up
unannounced at their house
· When someone just comes to the door that is not the right way, it undercuts
confidentiality and privacy and trust – people need to know we are there to help
Improving HIV services in Minnesota
- Barriers to Providing Useful Information
· We work to try to educate the community, but it is difficult to do it in the right
way; we face a lot of restrictions and we do not feel we get 100% support from
the health department
· It is a problem when a trusted resource like the Red Door Clinic has to close their
Web site because of concerns about what is proper; this is what happens when the
community doesn’t get to be in charge of the message
- Create Leadership and Role Models
· We need more leaders on this issue; we need leaders in the Latino/Hispanic
community who represent us
· We need to have people in organizations who have the power to say what is right
for the gay community
· When I saw Antonio do the TPE commercial and disclose his HIV status that had
an impact; that’s the kind of person we need; he’s not my leader – he’s my hero
· We need more people out there who are out of the closet; we need gay/bi
Latino/Hispanics out there as leaders who are connected with HIV but are also
independent from HIV
· I don’t see a presence of gay Latino/Hispanics at events such as health fairs or
PrideFest; we need that
- Social Opportunities to Build Connections and Self-identity
· We need ways to come together; we can fight this as a community if we have
ways to come together
· The Saloon’s Latino/Hispanic night brought guys together
· We need places to come together and where we can meet – not just to dance – but
to talk about things
· We need to know that being gay is not about drama, but can be celebrated;
something like Man 2 Man for Latino/Hispanics would be good
HIV/AIDS Prevention Assessment among Gay, Bisexual
and Other Men who Have Sex with Men (MSM)
John Snow, Inc.
47
Group Discussions Summary – Transgender Men
Minnesota AIDS Project
Aug/Sep 23, 2010
Healthy means:
- Holistic Health and Balance
· Striving for holistic well-being. A sense of balance in my life
· Being physically healthy
· Tending to general health needs. Having access to health care and a provider who
understands my general and unique health concerns
- Social Connections and Support
· Building a connection with others; with friends, community and/or family
· Tending to the connection between individual well-being and the health of my
community
- Sexual Health
· Being sexually active and feeling sexually secure. Lack of understanding and
acceptance of queer issues by family or my community create a big strain
HIV discussions among friends involve the following:
- Disassociated Awareness
· Aware of safer sex but practice is different
· I know a lot of gay men and it’s an ever present topic, but it is under the surface.
I don’t hear it talked about a lot
· I’ve know lots of gay men and it used to be talked about a lot, but not now, it
seems people are aware, as if HIV information is pick up by osmosis
· Friends look at HIV as a chronic condition; manageable. Sense of acceptance and
inevitability
· I don’t hear it talked about in mixed LGBT communities.
· It’s talked about as it used to be, as if it only existed in the past.
- Real Conversations when it’s Close
· It’s talked about more in some crowds than in others
· There is awareness in my circle of friends
· Talked about more when I’m around others living with HIV
Trusted resources of information:
- Turning to Friends
· I get information from friends who work in HIV
· I go to a friend who is educated or works as a sexual health educator
· People turn to their friends to get suggestions for a doctor or a provider
· I’m lucky to be connected with friends who work in HIV and Trans health, so I
get information from them
48
- Turning to Providers
· Pamphlets in clinics help to raise awareness
· I trust the information I get from my doctor, but I’m lucky because I have
insurance and have routine access to a provider with whom I can develop a
trusting relationship.
- Walking their Talk
· I get information as part of my work in the community
- Turning to the Web
· I get a lot of information from Web sources, such as YouTube
· List Serv and other targeted internet networks
· Resource listings, especially those accessible through the Web
· There are resources out there, but they are sparse or not identified outside of the
Twin Cities
· I do my own research on line, but the information I find isn’t as inclusive as I’d
like
- Limited Resources
· There is very little information for trans men
· There is a lot of information that is not super straight-forward
· I can’t find information that is very specific in terms of risks for trans men [e.g.
oral sex, routine needle use, cervical cancer risk]
· Once you get outside of the Twin Cities, information is harder to get
· Trans men are not even brought up in most safer sex materials
· I’m comfortable with material that is not targeted to Trans men, as long as it is
inclusive. Though, there is a need for some specific information, too
HIV testing:
- Self-assessing Risk and Getting Tested
· I am routinely tested
· I know about risk. I get tested routinely because I have to use needles on a
regular basis and I know my sexual risks
· I get tested routinely, especially when I’m sexually active
· Even if I’m perceived as female, I would then be an African American woman
who is having sex with men and that puts me at high risk; don’t discount my
ability to understand my risk
- Poorly Treated by Test Providers
· It would be helpful if Trans men weren’t feeling negated when they walk into a
testing clinic
· I’ve had the experience of being pooh-poohed by my doctor because of
assumptions of monogamy or about what parts you’re using for what
· I have been reluctant to use queer-specific services; sometimes they can be more
“fixed” in their attitudes and expression of transphobia
· I get questioned about why test on a routine basis
- Searching for Responsive and Knowledgeable Providers
· I am comfortable going to my provider to get tested
HIV/AIDS Prevention Assessment among Gay, Bisexual
and Other Men who Have Sex with Men (MSM)
John Snow, Inc.
49
·
·
·
·
·
It all depends on how you are treated in the front office
I feel safe going to Pillsbury testing because I know the staff personally
Screening doesn’t tend to be very inclusive, through I’ve noticed that the Program
in Human Sexuality has done a good job of developing a more inclusive approach
to screening
My primary care provider was going to do an STD test, but once I explained to
her what my parts were like now, she seemed confused and we never did the test
Some providers think it is great that I’m getting screened, but it can be confusing,
even for someone with a lot of experience.
Use of Prevention Services:
- Hard to Organize Community
· There are two Trans communities, an academic community and others. The
academic community put on town hall and they get a low turnout, but when the
Boyz community does things the academic people don’t show up
- Condoms: Helpful and Complex
· I have received free condoms, it certainly helps promote awareness
· Condom distribute can raise controversy
· As a Trans man I needed a lot of information before I could go out and buy or use
a condom on my own
· You have to do a lot of communication to get to a point of having sex with
someone as a Trans person – there’s a lot more pre-work to finding a sex partner –
and then you get to the point where the person says he won’t use a condom, that
Partner Services
- An invisible service
· I have not heard of people who have experience with partner services
· I know a lot of HIV+ people and they don’t know about this service
· I have never heard of this service
Improving HIV services in Minnesota
- Need More Specific Safer Sex Information and Support
· Some of us have had experience with men prior to transitioning, it’s a completely
different experience, I find that for me there is so much more pressure not to use
condoms when I am having male-male sex rather than male-female sex – that is
really a new experience
· Most guys who respond to my ads are either bi-curious or sort of straight/bi guys
who are kind of curious or fascinated about having sex with someone who is
Trans, but they don’t bring the education that gay men have
- Raise Awareness and Capacity to Serve Trans Men
· Health professionals don’t know what to do – you are a medical professional –
why are you calling a mental health clinic when I come to seek care?
50
·
Educate the docs, have them sign something to say they are Trans-friendly and get
a list out so we can find them
· HIV organizations are there, but they don’t have information; they seem confused
when it comes to serving Trans men
- Collaboration
· We don’t necessarily expect stand alone services for Trans men, but it would help
to see collaboration between HIV providers and those who have experience
working with Trans men; no one entity can come in ad say “we are the experts”
need collaboration
· The community needs to see working partnerships and a consistent commitment
so they will trust turning to HIV providers for services
· Trans 101 and Trans-health education and HIV education need to be integrated,
Trans groups and HIV groups need to do this together and it needs to happen
more than once every ten years
- Statewide Reach
· The urban/rural split is real in this state; need to develop services that at least
address how to transfer what’s available in the Twin Cities to those of use living
in other parts of the state
HIV/AIDS Prevention Assessment among Gay, Bisexual
and Other Men who Have Sex with Men (MSM)
John Snow, Inc.
51
Appendix C – Partner Services Summary
MSM Assessment Data Report Draft
January 25, 2010
A total of 17 phone interviews were completed. The following table breaks down the
acceptance rate by contact.
Table 1: Frequency of those who either Accepted or Declined to be
interviewed for MSM Assessment
Participants
Accepted to
Declined
be
to be
Interviewed interviewed
Accepted Partner Services (Contact Type 1)
10
0
Declined Partner Services (Contact Type 2)
3
3
Partners of Index Cases (Contact Type 3)
4
1
17
4
Total
Insurance Status
Table 2: Insurance status by Contact Type at time of DIS
contact
Participants
Had
No
insurance insurance
Accepted Partner Services (Contact Type
1)
7
2
No
answer
1
Declined Partner Services (Contact Type
2)
3
0
0
Partners of Index Cases (Contact Type 3)
4
0
0
14
2
1
Total
Education
52
Participants
Accepted
Partner
Services
Declined
Partner
Services
Partners of
Index Cases
Total
Less
High
than
Some
school/G
high
college
ED
school
2 year
college
degree
BA/BS
Masters
PhD
0
3
1
2
4
0
0
0
1
0
1
0
1
0
0
0
1
0
3
0
0
0
4
2
3
7
1
0
Q: When you were contacted in (_/_) by Partner Services at MDH, did you decline
to be interviewed by the Disease Intervention Specialist (DIS)?
All participants were asked this question.
Of those who accepted Partner Services, all stated that they did not decline DIS
contact. Of those who declined Partner Services, two out of three stated that they
declined DIS contact while one participant stated that they did not decline. Upon
investigation, this person did have contact with someone other than a DIS for services
not directly associated with Partner Services. As such, this person was asked the same
questions of those who said they accepted Partner Services but their data is only
included with those who declined.
Q: What was your reason for declining Partner Services?
This question was only asked to the participants who stated that they declined Partner
Services.
One reason why Partner Services was declined was because the participant was too
busy at the time. Another reason given by a second participant was that they already
had a physician for resources.
Q: Was the person you spoke with clear about the purpose for contacting you?
All participants were asked this question.
All stated that the DIS was clear in their purpose for contacting them.
Q: Did the person you spoke with identify themselves to your satisfaction?
HIV/AIDS Prevention Assessment among Gay, Bisexual
and Other Men who Have Sex with Men (MSM)
John Snow, Inc.
53
All participants were asked this question.
All stated that the DIS identified themselves to their satisfaction.
Q: Did the person who contacted you give you their telephone number?
All participants were asked this question.
Of those who accepted Partner Services, 8 out of 10 stated that they were given
telephone number for the DIS. One stated that they didn’t remember if they received
a number. One respondent had no answer.
Of those who declined Partner Services, all stated that the DIS gave them a telephone
number.
Of those who were Partners of Index Cases, 3 out of 4 stated that the DIS gave them a
telephone number while one respondent did not remember if a number was given to
him or not.
Q: Did the person encourage you to call if you had any questions or need
additional information?
This question was only asked to those who accepted Partner Services and to those who
were Partners of Index Cases.
Of those who accepted Partner Services, 8 out of 10 stated that were encouraged to
call should they have any questions. One participant stated that they did not
remember. One participant had no answer.
Of those who were Partners of Index Cases, 3 out of 4 stated that the DIS encouraged
them to call while one respondent did not remember.
Q: Did you receive useful health education information from the person you spoke
with?
This question was only asked to those who accepted Partner Services and to those who
were Partners of Index Cases.
Of those who accepted Partner Services, half stated that they received useful health
education information. One participant stated that they ‘somewhat’ received useful
health education information. Two participants stated that they did not receive
useful health education information and two participants stated that they did not
remember if they did or not. Comments from those who stated that they either didn’t
54
receive any useful health education information or they ‘somewhat’ received useful
health education information were:
-Participant stated he already had M.D. for health education information.
-Participant stated that he did not have any questions in the first place.
-Participant stated that everything was so new - he was just trying to understand what
was happening.
Of those who were Partners of Index Cases, half stated that they did receive useful
health education information. One participant stated that they did not receive any
useful health education information. One participant did not remember if they did or
not. Comments included:
-Participant stated that he is in this field and because of that the information was not
new to him but exactly what he suspected would be given to him.
-Participant stated that he was only on the phone for a brief period of time and all
that was said was that he should be tested for HIV.
Q: Did you receive a referral or referrals for HIV services, such as medical case
management, legal assistance, support services?
This question was only asked to those who accepted Partner Services and to those who
were Partners of Index Cases.
Of those who accepted Partner Services, six stated that they did receive referrals from
the DIS. Four participants stated that they did not receive referrals. Comments from
those who stated they did not receive referrals were that they already had a physician
or social worker for referrals or services. One participant stated that he went about
looking for resources on his own.
Of those who were Partners of Index Cases, four stated that they did not receive any
referrals for HIV resources. All of these participants tested negative for HIV.
Q: (For partners) Did the person you spoke with recommend that you be tested
for HIV?
This question was only asked to Partners of Index Cases.
All were recommended by the DIS to be tested for HIV. Half were offered to be tested
by the DIS directly. Of those who were not offered to be tested by DIS, all were
referred to another provider. Of those referred to another provider, one used the DIS
referral for testing and another used a different provider not referred to by the DIS.
Q: What else would you like to share with us about your experience receiving
Partner Services?
HIV/AIDS Prevention Assessment among Gay, Bisexual
and Other Men who Have Sex with Men (MSM)
John Snow, Inc.
55
This question was only asked to those who accepted Partner Services and to those who
were Partners of Index Cases. The following are general comments – please see
attached document for a complete list of comments for each participant.
Of those who accepted Partner Services, eight had comments about their experience
and two did not have any comment. Some comments from this group include:
- Participant felt that he was being bombarded and that he was contacted too
soon after learning he was HIV positive.
- Participant felt that the DIS didn’t have good information about typical life
expectancy
- Participant stated that he was emotionally resistant and did not want help. DIS
contacting him was just another reminder and he hates knowing that his name
is on a government list.
- Participant stated that Partner Services was “good pressure”
- Participant stated that Partner Services was hard to accept and that it was
good that MDH “put it out there”.
- Participant stated that the process wasn’t as bad as he thought it was going to
be and that the services were helpful to him.
- Participant appreciated that the DIS did not show up in a state car in an effort
to protect his privacy.
- Participant felt that he knew 70% of the information given to him and 30% was
new information.
Of those who declined Partner Services, only one commented. Participant thought the
DIS was respectful and that he did not need help informing partners of exposure – he
did that himself.
Of those who were Partners of Index Cases, all had either good or neutral impressions
about Partner Services. One commented that he would still like to know who gave
MDH his name.
Q: Was there anything the person you spoke with could have done differently that
would have been more helpful to you?
This question was asked to all participants. The following are general comments –
please see attached document for a complete list of comments for each participant.
Of those who accepted Partner Services, six had feedback. Feedback included:
-
Participant wishes he would not get anymore calls about HIV as it is a painful
reminder.
Participant thought the DIS could have been more helpful in getting him
referrals.
Two participants thought that the DIS called too soon after learning they were
HIV positive.
56
-
-
Participant thought that having the option of an email or letter in which they
could fill out all the information about partners would be beneficial. He felt it
would give people time to reflect and obtain the most accurate information.
He also felt it would be more comfortable and easier to give the information in
the first place.
Participant thought that the materials about syphilis were old and outdated.
Participant felt that they could have met at a different location. They met in a
parking lot and he felt this was awkward. A more public setting would have
been appreciated.
Participant would have appreciated meeting in person at some point because it
is easier for him to speak about such personal matters in person.
Of those who declined Partner Services, none had feedback.
Of those who were Partners of Index Cases, one commented that the thought the DIS
took too long to get back to him. Participant had left a voice mail and it took “quite a
few days” to get back to him. No other feedback was given.
HIV/AIDS Prevention Assessment among Gay, Bisexual
and Other Men who Have Sex with Men (MSM)
John Snow, Inc.
57
Appendix D – Online Survey with Results
58
HIV Prevention Assessment Survey for MSM in MN
1. How old are you
Response
Count
214
answered question
214
skipped question
0
Response
Response
Percent
Count
2. What is your sex or gender?
Male
97.7%
209
Female
2.3%
5
Transgendered, Male-to-Female
0.0%
0
Transgendered, Female-to-Male
0.0%
0
answered question
214
skipped question
0
1 of 29
3. How do you describe your racial or ethnic group?
Response
Response
Percent
Count
White/Caucasian
89.7%
192
Black/African American
2.8%
6
Hispanic/Latino
2.3%
5
Asian/Pacific Islander
1.4%
3
American Indian/Alaskan Native
3.3%
7
Other (please specify)
3.3%
7
answered question
214
skipped question
0
4. Were you born in the United States (includes U.S. territories such as Puerto Rico, Virgin Islands)?
Yes
No (please specify where you
were born)
2 of 29
Response
Response
Percent
Count
99.1%
212
0.9%
2
answered question
214
skipped question
0
5. What occupation do you have primarily?
Response
Response
Percent
Count
Unskilled labor
1.4%
3
Skilled labor
6.5%
14
Clerical/adminstrative
7.5%
16
Student
13.6%
29
Professional/white collar
54.7%
117
Unemployed
7.5%
16
Retired
3.7%
8
Disabled
4.7%
10
Other (please specify)
6.1%
13
answered question
214
skipped question
0
3 of 29
6. What is the HIGHEST level of school you have completed?
Response
Response
Percent
Count
Some elementary school
0.0%
0
Some high school
0.9%
2
High school graduate/GED
7.5%
16
Some college or technical school
23.8%
51
Technical school graduate
6.1%
13
College graduate
34.1%
73
Post-graduate
27.1%
58
Not Applicable
0.5%
1
answered question
214
skipped question
0
Response
Response
Percent
Count
7. Which of the following best describes you?
Gay/homosexual/same-gender
94.4%
202
Bisexual
4.2%
9
Straight/heterosexual
0.9%
2
Don't know/not sure
0.5%
1
answered question
214
skipped question
0
loving
4 of 29
8. Are you currently in a steady (primary or committed) relationship?
Yes, I'm in a steady relationship
with a member of the SAME sex
Yes, I'm in a steady relationship
with a member of ANOTHER sex
No, I'm not currently in a steady
relationship
Response
Response
Percent
Count
42.5%
91
2.8%
6
54.7%
117
answered question
214
skipped question
0
Response
Response
Percent
Count
9. With whom do you live? (Check all that apply)
I live alone
43.7%
93
I live with a partner or spouse
27.2%
58
I live with my partner(s)
5.6%
12
I live with my child(ren)
1.4%
3
I live with other relatives
4.2%
9
I live with one or more friends
17.4%
37
Other (please specify)
4.2%
9
answered question
213
skipped question
1
5 of 29
10. What is your current housing?
Response
Response
Percent
Count
I rent my house/apartment
43.7%
93
I own my house/condo
48.4%
103
5.2%
11
I live in a shelter
0.0%
0
I live in a half-way house
0.0%
0
I live on the street
0.5%
1
Other (please specify)
2.3%
5
answered question
213
skipped question
1
I am staying at someone else's
home
11. What is your zip code?
Response
Count
213
6 of 29
answered question
213
skipped question
1
12. What language do you speak? (Check all that apply)
Response
Response
Percent
Count
English
99.5%
212
Spanish
9.9%
21
Somali
0.0%
0
Sign Language
1.9%
4
Other language (please specify)
5.6%
12
answered question
213
skipped question
1
7 of 29
13. Think of all the people and/or places where you received information about HIV in the past 12 months. Fill in
the boxes next to the THREE people/places that helped you most in HIV/AIDS prevention:
Response
Response
Percent
Count
Television or radio
17.8%
38
Posters, flyers, or pamphlets
30.0%
64
Newsletter
20.2%
43
Case worker/manager
7.0%
15
43.2%
92
Friends and/or peers
47.4%
101
Support/educational group
15.5%
33
Internet
57.3%
122
Workplace
11.3%
24
33.3%
71
Counseling and testing staff
13.1%
28
Social event/party
11.7%
25
Bar or night club
22.1%
47
Drug treatment facility
1.9%
4
Needle exchange program
0.9%
2
Not Applicable
4.7%
10
Other (please specify)
9.9%
21
answered question
213
skipped question
1
Nurse, doctor, or other health
professional
HIV educator, peer educator, or
outreach worker
8 of 29
14. We are interested in your knowledge about HIV transmission. In terms of transmitting HIV, how risky do you
think each of the following behaviors is?
Low risk
Having oral sex without a condom
79.3%
if you are the insertive (top) partner
(165)
Medium
Not
Response
Applicable
Count
High risk
Not sure
15.4% (32)
4.3% (9)
1.0% (2)
0.0% (0)
208
42.8% (89)
12.5% (26)
2.4% (5)
0.0% (0)
208
38.5% (80)
0.0% (0)
0.0% (0)
208
risk
Having oral sex without a condom
if you are the receptive (bottom)
42.3% (88)
partner
Having anal sex without a condom
if you are the insertive (top) partner
9.6% (20)
51.9%
(108)
Having anal sex without a condom
if you are the receptive (bottom)
1.0% (2)
1.9% (4)
97.1% (202)
0.0% (0)
0.0% (0)
208
7.7% (16)
43.8% (91)
29.8% (62)
1.9% (4)
16.8% (35)
208
0.0% (0)
3.8% (8)
78.8% (164)
0.5% (1)
16.8% (35)
208
1.9% (4)
17.8% (37)
74.5% (155)
2.4% (5)
3.4% (7)
208
0.5% (1)
4.8% (10)
93.3% (194)
0.5% (1)
1.0% (2)
208
1.0% (2)
2.9% (6)
93.8% (195)
1.4% (3)
1.0% (2)
208
0.0% (0)
0.0% (0)
94.2% (196)
0.0% (0)
5.8% (12)
208
partner
Having vaginal sex without a
condom if you are the insertive
(top) partner
Having vaginal sex without a
condom if you are the receptive
(bottom) partner
Having sex when you and/or your
partner were high on alcohol and/or
drugs
Having anal sex without a condom
when you don't know your partner's
HIV status
Having anal sex without a condom
when you know your partner has
HIV infection or AIDS
Sharing needles/injection equipment
with another person whose HIV
status you don't know
9 of 29
answered question
208
skipped question
6
15. What things about HIV would you like to know more about? (check all that apply)
Response
Response
Percent
Count
Risks of oral sex
45.7%
95
Risks of anal sex
19.2%
40
Risks of vaginal sex
1.4%
3
Risks of other sexual behaviors
31.7%
66
How to use condoms effectively
7.2%
15
How to get clean needles
2.4%
5
New treatments for HIV/AIDS
40.9%
85
13.5%
28
19.2%
40
10.6%
22
16.8%
35
28.8%
60
4.3%
9
None of the above
21.6%
45
Other (please specify)
6.3%
13
answered question
208
skipped question
6
Where to go for more information
about HIV
Where to go for counseling and
testing services
Where to go for medical treatment
for HIV/AIDS
How to talk to a partner about using
a condom
How to talk with sex partners about
HIV
How to talk with drug-using partners
about HIV
10 of 29
16. Are you sexually active? (sexually active is defines as having oral, vaginal, or anal intercourse in the past five
years)
Response
Response
Percent
Count
Yes
95.2%
198
No
4.8%
10
answered question
208
skipped question
6
Response
Response
Percent
Count
17. In the past five years, have you been sexually active with:
Men
92.6%
188
Women
0.5%
1
Both Men and Women
5.9%
12
Transgendered Person (s)
0.5%
1
0.5%
1
answered question
203
skipped question
11
Transgendered Person (s) plus
either Men or Women
11 of 29
18. Where do you meet people who might be potential sexual partners? (check all that apply)
Response
Response
Percent
Count
Through friends
60.2%
124
Through social groups
47.1%
97
At work
13.1%
27
At school
11.2%
23
At bars/clubs
49.5%
102
48.5%
100
Online/Internet – “hook up” sites
57.8%
119
At community events
25.2%
52
15.5%
32
Where I practice my faith
6.8%
14
Cultural events
10.7%
22
Private parties
31.6%
65
19.4%
40
Not Applicable
10.7%
22
Other (please specify)
1.9%
4
answered question
206
skipped question
8
Online/Internet – social networking
sites
Through programs for gay, bi, trans
men
Public sex environments [e.g.
bookstores, parks, restrooms,
bathhouse]
12 of 29
19. To what extent, if any, have you used the following strategies to reduce your exposure to HIV infection? (mark
ALL that apply)
Response
Response
Percent
Count
Condoms 100% of the time
22.5%
46
Condoms most of the time
37.7%
77
Condoms some of the time
18.1%
37
27.9%
57
24.0%
49
18.1%
37
answered question
204
skipped question
10
Serosorting (only having sex with
people of the same HIV status
Harm reduction (i.e. reducing
exposure to semen by “pulling out”,
reducing the number of partners,
etc)
Other (please specify)
20. Of the following groups of people, how many of them would you say know about your sexual orientation?
Friends
Family
Sex Partner (s)
People at work/school
People where I practice my faith
None or
Less
almost
than
none
half
0.5% (1)
1.5% (3)
3.4% (7)
2.9% (6)
3.9% (8)
0.0% (0)
0.5% (1)
0.5% (1)
4.9%
6.4%
(10)
(13)
4.9%
(10)
5.4%
(11)
About
half
3.4% (7)
3.9% (8)
2.5% (5)
13 of 29
More
All or
than
almost
half
all
7.4%
87.3%
(15)
(178)
12.3%
76.0%
(25)
(155)
2.9% (6)
92.6%
(189)
15.2%
66.2%
(31)
(135)
1.5% (3)
Not
Response
Applicable
Count
0.0% (0)
204
0.0% (0)
204
3.4% (7)
204
3.9% (8)
204
31.4%
55.4%
(64)
(113)
204
answered question
204
skipped question
10
21. Have you seen a doctor, nurse, or other health care provider in the past 12 months?
Response
Response
Percent
Count
No
8.4%
17
Yes
91.6%
186
answered question
203
skipped question
11
22. At any of those times you were seen, were you offered an HIV test? (An HIV test checks whether someone has
the virus that causes AIDS)
Response
Response
Percent
Count
No
52.7%
107
Yes
47.3%
96
answered question
203
skipped question
11
Response
Response
Percent
Count
23. When was the last time you got tested for HIV?
Never
4.0%
8
More than 5 years ago
23.4%
47
2-5 years ago
15.4%
31
1-2 years ago
13.4%
27
Less than 1 year
17.4%
35
Less than 6 months
26.4%
53
answered question
201
skipped question
13
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24. When you last got tested for HIV, where did you get tested?
Response
Response
Percent
Count
HIV counseling and testing site
9.3%
18
STD clinic
14.5%
28
HIV/AIDS service organization
2.1%
4
Community health center
4.1%
8
Doctor’s office
44.0%
85
Hospital
6.2%
12
4.7%
9
0.5%
1
3.1%
6
Public health clinic
6.2%
12
Emergency room
0.0%
0
Other (please specify)
5.2%
10
answered question
193
skipped question
21
Response
Response
Percent
Count
Street outreach program [bar or
mobile unit]
Drug treatment program
Community event [health fair or
festival]
25. The last time you got tested for HIV, did you get those test results?
No
1.0%
2
Yes
99.0%
191
answered question
193
skipped question
21
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26. What was the reason for not getting the result of your last HIV test?
Response
Response
Percent
Count
Afraid of getting result
0.0%
0
Too busy to get result
50.0%
1
Didn’t care/didn’t want to know
0.0%
0
Lost appointment card, ID number
0.0%
0
0.0%
0
0.0%
0
0.0%
0
50.0%
1
answered question
2
skipped question
212
Response
Response
Percent
Count
Thought testing site would contact
me
Forgot to get result
Inconvenient (location hard to get
to, hours, etc.)
Other (please specify)
27. What was the result of the last HIV test that you received?
Negative
68.8%
132
Indeterminate
0.5%
1
Positive
27.6%
53
I prefer not to say
1.6%
3
Other (please specify)
1.6%
3
answered question
192
skipped question
22
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28. What are some of the reasons you did NOT get tested for HIV?
Response
Response
Percent
Count
I DID get tested for HIV
61.0%
122
Too low risk
7.0%
14
Worried other people would find out
2.5%
5
Afraid I’d lose my partner/spouse
0.0%
0
Didn’t know where to go
4.0%
8
Afraid to find out I have HIV
6.0%
12
3.0%
6
2.0%
4
2.5%
5
None of the above, I get tested
29.5%
59
Other (please specify)
7.0%
14
answered question
200
skipped question
14
Worried the government would
know
Worried my family would find out
Afraid I’d lose my job, insurance or
housing
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29. How comfortable would you feel getting an HIV test at each of the following locations:
Response
Comfortable
Uncomfortable
Mobile Van
51.3% (102)
48.7% (97)
199
Community Health Center
79.4% (158)
20.6% (41)
199
Private office (doctor)
88.9% (177)
11.1% (22)
199
HIV/AIDS service organization
88.4% (176)
11.6% (23)
199
Community Event (health fair, etc.)
41.2% (82)
58.8% (117)
199
Count
answered question
199
skipped question
15
30. Some people take HIV or AIDS medicines BEFORE engaging in activity that might put them at risk for HIV
transmission because they think it might reduce their chances of getting HIV. This is known as “Pre-exposure
prophylaxis” or “PREP.” We don't know, for sure, if this works. In the past 6 months, did you take any AIDS
medicines to reduce your chance of getting HIV? (AIDS medicines are also known as antireterovirals, HAART, or
the AIDS cocktail.)
Response
Response
Percent
Count
No
96.9%
190
Yes
3.1%
6
answered question
196
skipped question
18
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31. Some people take HIV or AIDS medicines AFTER engaging in activity that might put them at risk for HIV
transmission because they think it might reduce their chances of getting HIV. This is known as “Post-exposure
prophylaxis” or “PEP.” In the past 6 months, did you take any AIDS medicines to reduce your chance of getting
HIV? (AIDS medicines are also known as antireterovirals, HAART, or the AIDS cocktail.)
Response
Response
Percent
Count
No
95.4%
187
Yes
4.6%
9
answered question
196
skipped question
18
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32. What HIV information and services have you received in Minnesota in the past 12 months and were they
helpful?
This service was useful in
I received this Service
helping me change my
behavior to be less risky
Response
Count
Talked to an HIV
prevention/outreach worker at a
community event [health fair,
93.3% (56)
53.3% (32)
60
84.6% (11)
38.5% (5)
13
95.7% (45)
36.2% (17)
47
90.9% (20)
50.0% (11)
22
94.7% (36)
50.0% (19)
38
95.7% (45)
57.4% (27)
47
96.9% (62)
32.8% (21)
64
81.8% (9)
54.5% (6)
11
87.9% (29)
48.5% (16)
33
78.3% (18)
60.9% (14)
23
94.2% (49)
26.9% (14)
52
97.8% (88)
55.6% (50)
90
95.7% (66)
34.8% (24)
69
festival]
Talked to an HIV
prevention/outreach worker in a
health van
Talked to an HIV
prevention/outreach worker in a bar
Talked to an HIV
prevention/outreach online or in a
chat room
Attended a small educational or
support group about HIV
Received one-on-one HIV
education
Attended a social event where
people were giving out information
about HIV prevention
Called a hotline or talk to someone
on the phone to get HIV information
or counseling
Received information about HIV
prevention online (e.g. in an internet
chat room)
Trained to be a peer educator
Saw a media campaign (billboard,
radio, television)
Got a condom(s) from an outreach
worker or health professional
Received pamphlets, booklets,
newsletters, or other written
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materials about HIV
As far as I am concerned, I have
not received any HIV prevention
94.3% (33)
17.1% (6)
35
Other (please specify)
16
answered question
192
skipped question
22
services in Minnesota
33. Think about all the HIV prevention services you received in the past 12 months. Overall, do you strongly
agree, agree, disagree, or strongly disagree with the following statements:
Strongly
Strongly
Not
Response
disagree
applicable
Count
0.5% (1)
1.1% (2)
25.4% (48)
189
36.5% (69)
2.6% (5)
1.6% (3)
24.9% (47)
189
32.8% (62)
28.0% (53)
1.6% (3)
0.5% (1)
37.0% (70)
189
32.8% (62)
25.9% (49)
5.3% (10)
0.5% (1)
35.4% (67)
189
answered question
189
skipped question
25
Agree
Disagree
27.0% (51)
46.0% (87)
34.4% (65)
agree
Written materials [pamphlets,
flyers, posters, webpostings
emails) or video materials were
clear and easy to understand.
HIV prevention program services
were respectful of my culture,
language, lifestyle.
HIV prevention program staff
answered my questions and
addressed my concerns about HIV.
HIV prevention program staff made
me more confident about taking
steps to reduce HIV risk.
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34. Since you received these HIV prevention services, how often have you tried to do the following things to
prevent HIV:
Always
Used a condom more often during
anal sex
Asked sexual partners about their
risk for HIV
Lessened or not used alcohol or
drugs before sex
Asked a sexual partner if they’ve
had an HIV test
Disclosed your HIV status to a
sexual partner
Most of
the times
Sometimes
Never
Not
Response
applicable
Count
32.8% (62)
20.6% (39)
16.9% (32)
4.8% (9)
24.9% (47)
189
31.2% (59)
15.3% (29)
17.5% (33)
12.2% (23)
23.8% (45)
189
19.6% (37)
17.5% (33)
24.3% (46)
7.4% (14)
31.2% (59)
189
24.9% (47)
18.0% (34)
21.2% (40)
13.2% (25)
22.8% (43)
189
42.3% (80)
14.3% (27)
11.6% (22)
4.8% (9)
27.0% (51)
189
25.4% (48)
8.5% (16)
12.7% (24)
16.9% (32)
36.5% (69)
189
4.8% (9)
0.5% (1)
1.1% (2)
0.5% (1)
93.1% (176)
189
3.7% (7)
6.3% (12)
16.4% (31)
38.1% (72)
35.4% (67)
189
Decided only to have sex with
people who are of the same HIV
status as me
Stopped sharing used needles with
others
Abstain from sex
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Other (please specify)
1
answered question
189
skipped question
25
35. Overall, when it comes to HIV, would you say that your behaviors now are more risky, the same, or less risky
than they were 12 months ago?
Response
Response
Percent
Count
More risky now
5.3%
10
The same
62.2%
117
Less risky now
32.4%
61
answered question
188
skipped question
26
36. What is the approximate year when you FIRST had sex? (Type "N/A if you have never had sex)
Response
Count
188
answered question
188
skipped question
26
Response
Response
Percent
Count
37. Think about the FIRST time you had anal sex, Did you use a condom?
I have never had anal sex
I don't remember if I used a
condom (go to box below)
No, I did not use a condom (go
to box below)
Yes, I used a condom (go to box
below)
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3.2%
6
4.3%
8
51.1%
96
41.5%
78
answered question
188
skipped question
26
38. Which of the following things are barriers (things that get in the way) of you receiving HIV prevention
services? (mark ALL that apply)
Lack of transportation to sites
where services are offered
Having to wait too long for services
Response
Response
Percent
Count
5.3%
10
11.2%
21
12.8%
24
12.3%
23
2.7%
5
0.5%
1
3.7%
7
41.7%
78
13.9%
26
34.8%
65
answered question
187
skipped question
27
Afraid staff will make negative
judgments of me due to my culture
or lifestyle
Afraid others will think I have HIV
Afraid my sexual partner will get
upset or angry Afraid others will
find out I’m gay/Bi
Staff don’t speak my Language
I don’t have time to go to HIV
prevention events I don’t have
regular access to a computer
Already know everything I need
to know about HIV
Other things in my life are more
important right now than getting HIV
services
Other (please specify)
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39. Which of the following things do you think would help you change your behaviors to lower your risk for HIV?
(mark ALL that apply)
Having better access to condoms
Knowing how to use condoms
correctly
Having more information about HIV
Receiving more HIV prevention
services
Having access to clean needles
Response
Response
Percent
Count
23.1%
43
4.8%
9
16.1%
30
15.6%
29
4.3%
8
6.5%
12
27.4%
51
24.2%
45
23.7%
44
3.8%
7
12.9%
24
34.9%
65
answered question
186
skipped question
28
Having more access to drug
treatment services when I
want/need them
Knowing how to resist pressure to
engage in risky behaviors that may
lead to HIV
Learning how to talk to sexual
partners about condom use
Having more emotional support in
my life
Getting out of my current
relationship
Being able to be more open about
my sexual orientation
Other (please specify)
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40. Please indicate if you have been tested for each of the following Sexually Transmitted Diseases (STD).
I have never gotten
I got tested LESS
I got tested MORE
Response
tested for it
than 12 months ago
than 12 months ago
Count
Hepatitis B
23.1% (43)
28.0% (52)
49.5% (92)
186
Hepatitis C
26.9% (50)
29.0% (54)
44.6% (83)
186
Gonorrhea
22.0% (41)
41.9% (78)
37.1% (69)
186
Syphilis
19.9% (37)
44.1% (82)
36.6% (68)
186
Chlamydia
24.2% (45)
41.9% (78)
34.4% (64)
186
Herpes
37.6% (70)
28.0% (52)
34.9% (65)
186
answered question
186
skipped question
28
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41. What other kinds of services have you received in the past 12 months? (Mark ALL that apply)
Response
Response
Percent
Count
Primary care medical services
76.9%
143
Homeless shelter
0.5%
1
Welfare
5.9%
11
Domestic violence services
0.5%
1
Job counseling/training services
8.1%
15
Unemployment
8.6%
16
5.9%
11
Mental health services
23.7%
44
Drug/alcohol treatment services
4.3%
8
29.6%
55
3.2%
6
Student Counseling Services
3.8%
7
Faith-based counseling
2.7%
5
2.7%
5
None of these services
14.5%
27
Other (please specify)
1.6%
3
answered question
186
skipped question
28
Case management (not HIV
specific)
Sexually transmitted disease (STD)
Screening
Employee Assistance Programs
(EAP)
Corrections/prison/probation
services
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42. Think about the following situations, and whether or not there is someone in your life you could go to for
help in that situation.
Response
Yes
No
95.7% (178)
4.3% (8)
186
92.5% (172)
7.5% (14)
186
90.3% (168)
9.7% (18)
186
93.5% (174)
6.5% (12)
186
Count
Is there someone you could go to if
you needed information or advice
about HIV?
Is there someone you could go to if
you needed help in thinking about
your past behaviors and how they
might place you at risk for HIV?
If you were afraid you might have
HIV, is there someone you could
talk to if you were upset and
needed to talk about it?
If you wanted to go to a counseling
and testing center, is there
someone you could go to for help
getting you there?
answered question
186
skipped question
28
Response
Response
Percent
Count
43. What type of health insurance do you currently have?
I Do NOT have insurance
I have PRIVATE insurance (HMO,
employer health insurance, etc)
10.8%
20
73.7%
137
11.8%
22
3.8%
7
answered question
186
skipped question
28
I have PUBLIC insurance (Medical
Assistance, Medicare, Minnesota
Care, etc)
Other (please specify)
28 of 29
44. Please let us know if you are willing to be contacted to participate in a FOCUS GROUP; each participant will
receive a $20 gift card.
Response
Response
Percent
Count
Yes, I want to participate
41.9%
78
No, I do not want to participate
58.1%
108
answered question
186
skipped question
28
45. Please provide the following information; we will only contact you with information to participate in the
FOCUS GROUP. -Your name and contact information will NOT be linked to your survey responsesResponse
Response
Percent
Count
Name:
100.0%
79
Email Address:
100.0%
79
Phone Number:
100.0%
79
answered question
79
skipped question
135
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