NAESM Conference, Los Angeles, CA January 18, 2013 California STD/HIV Prevention Training Center Tim Vincent, Deborah Wyatt-O Neal, Duran Rutledge
DISPARITIES FOR AFRICAN AMERICAN MSM LINKING TO HIV CARE
AFRICAN AMERICAN MSM African-American MSM shared a disproportionate percentage of HIV incidence. New infections among young black MSM have shown a statistically significant increase nationally. Anti-gay stigma and discrimination increase African- American MSM s vulnerability to HIV in numerous ways. In response to NHAS, efforts are needed to increase timely knowledge of HIV serostatus, and link people to care.
DISCUSSION What factors may influence African-American MSM with HIV from seeking care?
FACTORS INFLUENCING THE DISPARITY OF AFRICAN AMERICAN MSM WITH HIV Undiagnosed HIV infection Provider discrimination (homophobia) Patient Mistrust of Providers/ Medical systems and antiretroviral therapy Lack of access to care Provider withholding ART (racial /ethnic) Social/Economic Insurance Linkage/ Retention to medical care
SUMMARY ON DISPARITIES the plurality of HIV-related disparities in US black MSM relative to other MSM are disparities in HIV clinical care access and use, structural issues (e.g., low income, unemployment, incarceration, low education), and sex partner characteristics, rather than disparities in sexual and substance-use risk behaviours. Millett, et al, Lancet 2012
RECOMMENDATIONS: Interventions that support early initiation of antiretroviral therapy (ART), adherence, and clinical visits for HIV- positive black MSM might have a greater effect in the reduction of HIV infection rates than do those that focus on sexual or drug use risks. Millett, et al., Lancet 2012
RECOMMENDATIONS FROM SFDPH Referral systems will need to be proactive rather than passive and could be modeled on systems such as those developed by Craw et al. [18] that feature strengths based case management. Using Social Networks to Reach Black MSM for HIV Testing and Linkage to Care- Fuqua, et. al 2012, AIDS and Behavior
ARTAS Linkage to Care
STRATEGY FOR LINKAGE TO CARE ARTAS Anti-Retroviral Treatment and Access to Services (ARTAS) is an individual-level timelimited intervention to link individuals who have been recently diagnosed with HIV to medical care.
BASIC ARTAS SUMMARY Time and session limited Goal-link newly diagnosed individuals to medical care Benefits- better health outcomes-reduced transmission More people linked to medical care
BASIC ARTAS SUMMARY Clients identify strengths and overcome barriers Session Plan includes goals and tracks progress Location, time, and day of the client s choice Transfers clients to other needed services
STRENGTHS BASED PERSPECTIVE
STRENGTH BASED PERSPECTIVE Individuals have abilities and inner capacities These allow them to successfully cope with challenges, and perceived and existing barriers, to meeting their goals.
1. Every individual, group, family and community has strengths 2. Trauma and abuse, illness and struggle may be injurious, but may also be sources of challenge and opportunity 3. Assume that you do not know the upper limits of the capacity to grow and change and take individuals, groups, and community aspirations seriously. 4. We best serve clients by collaborating with them 5. Every environment is full of resources 6. Caring, caretaking and context. Saleebey, Strengths Perspective in Social Work
THE LEXICON OF STRENGTHS: Competence Capacities Courage Resilience Reserves Resources Resourcefulness Strengths Promise Possibility Positive expectations Potential Adapted from: Saleebey, D. (2009). Introduction. In: D., Saleebey (Ed.), The Strengths Perspective in Social Work Practice (1-23). Boston, MA: Pearson.
STRENGTHS PERSPECTIVE: W H AT I T I S : Being strength-based means: Figuring out ways to recognize and utilize genuine individual strengths to allow building onto existing competencies and effectively addressing concerns. Five Step Process W H AT I T I S N ' T: Being strength-based does not mean: Simply focusing on positive aspects and ignoring concerns. Fabricating strengths that do not exist.
MY STRENGTHS Three of my most important roles Some strengths that I bring to each role
STRENGTH PERSPECTIVE There is a core to this five step Process of Strengths
4. Enhancing Strengths
CASE SCENARIO An HIV positive client is telling you that he had gonorrhea for the third time in the past six months. He was really stressed out because of financial reasons, and having sex was the way he was able to deal with the stress. He feels guilty and ashamed.
POSSIBLE COUNSELOR S RESPONSES: You shouldn t feel guilty or ashamed! You always come to your appointments on time and you are so responsible. Tell me about a time when you had a good sexual experience and were able to take care of yourself. I am glad to hear that you have had gonorrhea only three times and not 5 or 6 times! Do you remember a time in your life when you felt stressed and dealt with the stress in a way that you did not feel guilty afterwards?
DEMONSTRATION
CASE SCENARIOS
CASE SCENARIO A recently diagnosed, HIV positive client who had been clean and sober for the last three months has fallen off the wagon. He missed his last two HIV medical appointments; because he didn t want to face his medical providers. He has managed to keep his employment and currently is (4) days clean and sober coming to see you today to begin the ARTAS program. He feels ashamed seek medical care because this is the third time in two years he has relapsed.
APPLICATION Step One: Identify Strengths Step Two: Elicit Strengths Step Three: Transferring Strengths Step Four: Enhancing Strengths Step Five: Reassessing Goals
RESOURCES Training: ARTAS New Foundations ( for providers working with MSM) Strength Based Approach Positive Strengths (PwP) Technical Assistance: Evidence Based Interventions Public Health Strategies ( i.e. linkage to care) Implementing High Impact Prevention ARTAS webinar
CAPTC CONTACT INFORMATION Tim Vincent, CBA Manager Deborah Wyatt-O Neal, CBA Specialist tim.vincent@ucsf.edu deborah.wyatt-oneal@ucsf.edu 510.625.6015 510.625.6055 Duran Rutledge, CBA Specialist duran.rutledge@ucsf.edu 510.625.6001 Like us on Facebook www.facebook.com/californiaptc Visit our website www.stdhivtraining.org 300 Frank Ogawa Plaza, Suite 520 Oakland, CA 94612