Implementing the Youth Action Research Model: An innovative approach utilizing youth peers to study HIV risk among YMSM of Color in urban settings Presenters: Mario de la Cruz Prevention Department Prevention Department Bronx AIDS Services National HIV Prevention Conference Tuesday, December 4th, 2007

Overview Project Context Collaboration Youth Action Research Principles TrainingImplementationChallenges

Organizational History  BAS is a non-profit, AIDS Community Service Program founded in 1986 in response to the overwhelming need for HIV/AIDS related services in the Bronx.  We provide a spectrum of culturally sensitive prevention and social supportive services for PLWHA as well as family and friends who are affected by HIV/AIDS.  Services include but are not limited to: Prevention Case Management, Confidential Rapid HIV Testing, Legal Advocacy, Food Pantry, Risk Reduction Counseling, Outreach and Support Groups.  Specific populations targeted for services include: Women of Color, Young Men of Color who have Sex with Men, adolescent girls, HIV+ Men who have Sex with Men, and IDUs.  Multiple funding sources and a demonstrated history of collaborating with other CBO’s, Social Service Providers, and NYCDOHMH.

 In 2001, BAS was awarded a federal grant to provide HIV Prevention Services specifically to Young Men of Color who have Sex with Men. In 2006 refunded in two categories to continue work with this community. Reaching Out to the YMSM Community  Created a coalition of service providers sensitive to YMCSM’s needs.  Increase Bronx YMSM’s access to CTR Services.  Sponsor events that empower YMCSM and MSM in the Bronx  Provide Support Groups and GLIs to High Risk YMCSM.

Project Context In 2003, More than 50% of all PLWHA in the Bronx who are males between the ages of indicated they were infected with HIV through unprotected sex with another male (MSM). In 2005, New York City had one of the highest reported AIDS rates (45.2 per 100,000 population) among MSAs in the country. Analysis at the borough level showed that HIV diagnosis rates were highest in the poorest neighborhoods of NYC (South Bronx, Central Brooklyn, and Harlem) New HIV diagnoses among MSM under age 30 have increased by 33% during the past six years, according to NYCDOH data, from 374 in 2001 to almost 500 in New diagnoses have doubled among MSM ages 13 to 19, while declining by 22% among older MSM. The under-30 group now accounts for 44% of all new diagnoses among MSM in New York City, up from 31% in The exploding epidemic among Young Men of Color who have Sex with Men (YMCSM) and low level of access to MSM-friendly, culturally competent prevention services and primary care, demands the implementation of innovative research techniques to aid in the development of new prevention strategies. The exploding epidemic among Young Men of Color who have Sex with Men (YMCSM) and low level of access to MSM-friendly, culturally competent prevention services and primary care, demands the implementation of innovative research techniques to aid in the development of new prevention strategies.

Center for Gender, Sexuality and Health Bronx Boggie Down Program Human Subjects Protocol: NEIRB Grant No.: SPNS 1 H97 HA

Youth Action Research Principles

TRAINING I. Consciousness-raising objectives II. Skill objectives III. Career development objectives IV. Community development objectives

Example of training tool… BESA

IMPLEMENTATION Identification of Venues Field Activities Street Survey – Pocket PCs Adult-Youth Teams

CEO Trainee Data Demographics Cycle I: (March 2005 – November 2005) Cycle I: (March 2005 – November 2005) Recruited (n = 22) : Retention (n = 19) : Average Age (17.6) Jan (n = 114 street surveys) Cycle II: (April 2006 – December 2006) Cycle II: (April 2006 – December 2006) Recruited (n = 19) : Retention (n = 17) : Average Age (19.8) Jan (n= 213 street surveys) Cycle III: (April 2007 – December 2007) Cycle III: (April 2007 – December 2007) Recruited (n = 17) : Retention (n = 15) : Average Age (18.8) Dec (n= 251 street surveys)

Youth Street Survey Data Waves 1 - 3

Comparing Cycles – Street Survey Race/ethnicity (cycle 1%-- cycle 2%--cycle 3%) Black/African-American (40%--28%--19%) Hispanic/Latino (30%--45%--54%) “More than one” (20%--20%--18%) Black/Non-American (5%--2%--3%) White (2%--3%--6%) Asian/Pacific Islander (0%--1%--0%) Sexual Activity Cycle n Age First Sex___Age First Partner Cycle 1: Cycle 2: Cycle 3:

Sexual Identity (cycle 1%-- cycle 2%--cycle 3%) Gay (61%--64%--60%) Bisexual (21%--25%--32%) Straight (9%--7%--5%) Other (6%--4%--2%) Birthplace: US (82%--81%--66%) Puerto Rico (5%--7%--10%) Jamaica (3%--1%--2%) DR (2%--4%--8%) Other (7%--7%--6%)

Examples of findings (cycle 1): HIV perceptions and socialization spaces Respondents who identified the “street” as their “hang out” space were more likely to agree with the statement that “I will get HIV sooner or later”. Respondents who identified the “street” as their “hang out” space were more likely to agree with the statement that “I will get HIV sooner or later”. HIV testing privacy and socialization spaces Respondents who found partners in “sex clubs/parties” were more likely to agree with the following statement. “I don’t believe that my privacy will be protected” Risk behavior and socialization spaces Having unprotected receptive anal sex in the last six months was associated with hanging out on the internet and finding partners in parks or the street. Having unprotected receptive anal sex in the last six months was associated with hanging out on the internet and finding partners in parks or the street.

Examples of findings (Cycle 2): Self Reported Sexual Risk behavior 32% of respondents reported having intercourse without a condom. Of those reported having unprotected receptive anal intercourse (n=62), 61% reported their partner ejaculated during anal intercourse Finding partners very close to ones own neighborhood and Finding partners very close to ones own neighborhood and finding partners with a small group of people independently finding partners with a small group of people independently decreased the likelihood of having had unprotected receptive decreased the likelihood of having had unprotected receptive anal sex in the last six months. anal sex in the last six months. Sexual Partnering and Sexual Risk behavior Attitudes Towards Testing and HIV Vulnerability Approximately 62% of the respondents disagreed with the statement that “Young men who have sex with men rarely have HIV”.

Challenges CommunicationsIRB HIV Testing Link to Care

Lessons Learned/Recommendations By training youth peers connected to YMCSM networks to facilitate self- administered surveys and provide referrals: 1) Engagement to participate in survey activities is increased, and 2) Respondents are more enabled to disclose personal information, ask questions about HIV risks and ask questions about HIV risks and 3) Are more encouraged to access additional prevention services. Continued research of these networks and the level of access of services by both HIV+ and high risk HIV- YMCSM will yield best practices for retaining these populations in care and services and effectively addressing their prevention needs. Prevention efforts geared toward young MSM of color need to address structural problems that this population faces in society. Racial tensions, unemployment, and housing problems, among other structural factors intersect with homophobia, stigma and discrimination. Any intervention that targets YMCSM populations needs to understand the nature of these men’s social networks, their social interactions and desire to seek identity and intimacy in the community.

Acknowledgements Collaborators: BAS Program Staff Adolescent AIDS Program Staff Miguel Munoz-Laboy, DrPH Blandon Casenave Ernesto Vasquez del Aguila,PhD Pamela Valera, PhD Sonya Romanoff, MPH Alea Holman, MPH The Venue Owners, Managers And Youth Respondents COMMUNITY ETHNOGRAPHER ORGANIZERS