Leadership Link & Learn Webinar Series Empowering and Promoting HIV Leaders in MSM of Color Communities Presenters: Dr. Valerie Earnshaw, Harvard Medical School & Boston Children s Hospital Corey Yarbrough, ED and Co-Founder of Hispanic Black Gay Coalition
HealthHIV Core Capabilities Capacity Building Health Services Research & Evaluation Advocacy Education & Training Diverse staff of professionals with HIV, HCV, and LGBT clinical, global, cultural competency, prevention, and other experience particularly within LGBT and other underserved communities Numerous strategic partnerships with national and local organizations (non-profit, clinical, behavioral, political, and technological)
HealthHIV CBA Programs ASO/CBO Capacity Building HIV Prevention Technical Assistance Health Department Capacity Building Health Center Capacity Building Workforce Capacity Building Retention in Care Institute PatientCentered HIV Care Model Municipal Leadership Capacity Building
Approach of Three D HIV Prevention Program Facilitate community infrastructure development and systems coordination to ensure sustainability along the HIV care continuum Expand care team integration through partnership development to include nonclinical HIV prevention partners Demonstrate cost effectiveness and outcomes monitoring of programs to maximize strengths and efficiencies and impact of health outcomes Promote workforce development, including training the next generation of leaders in HIV prevention
HealthHIV s ASO/CBO Leadership Initiative ASO/CBO Leadership Training & Certificate Program Leadership Link & Learn monthly webinar series Mentor/ mentee program Online portal that links ASO & CBO leaders around the country to engage with one another, share information and best practices, and participate in online education and training
Become a Certified ASO Leader! HealthHIV s ASO/CBO Leadership Training and Certificate Program TM http://tinyurl.com/pa5jo6t
Certified ASO Leaders Across the US HIV Prevalence-Certified ASO Leaders Key HIV Prevalence 2812.4 481.8-782.0 269.5-391.0 149.4-237.0 34.6-119.0 Certified Leaders within County 1 2 3-4 5-6 Prevalence Rates are per 100,000 population Data source: CDC HIV Surveillance Report 2013 Total Number of Certified Leaders = 94
Available for Download Guide to HealthHIV s ASO/CBO Leadership Training & Certificate Program: http://tinyurl.com/pbbl4c2 Also available for download following the webinar today: Slide Deck Webinar Recording Q&A www.healthhiv.org
Leadership Among MSM of Color
Social Determinants of HIV: Focus on Stigma Valerie A. Earnshaw, Ph.D. Boston Children s Hospital, Harvard Medical School
Social Determinants of Health World Health Organization Definition: the conditions in which people are born, grow, live, work and age (which are) shaped by the distribution of money, power and resources at global, national and local levels
Key Determinants: HealthyPeople 2020 1. Economic Stability Poverty Food + housing security Employment 2. Education High school + beyond Language + literacy 3. Social and Community Context Social cohesion Incarceration + institutionalization Stigma 4. Health and Health Care Access to health care Health literacy 5. Neighborhood and Built Environment Access to healthy foods Housing quality Violence and crime Environmental conditions
Social Determinants of Health World Health Organization Definition: the conditions in which people are born, grow, live, work and age (which are) shaped by the distribution of money, power and resources at global, national and local levels mostly responsible for health inequities the unfair and avoidable differences in health status seen within and between countries
studies, regions and demographics reported comparable UAI, fewer sex partners, less substance use, but greater undiagnosed HIV infection and less access to ART [59]. A more recent meta-analysis of 176 US studies affirmed the results of the first meta-analysis and also found that black MSM have a 40% greater odds than other MSM of engaging in any behavior protective of HIV transmission[9]. Scientific opinion explaining low income, to be uninsured or to attend clinical visits. A separate analysis of HIV surveillance data found that an additional 38,920 black MSM would need to be placed on treatment to raise viral suppression to a comparable level as white MSM [62], which may be difficult to achieve since some black MSM in high prevalence jurisdictions remain undiagnosed even when engaged in health care and informing their physicians about their homosexual behavior [63]. HIV Inequities: Black MSM Disparities persist between black and other MSM throughout treatment cascade (24 comparative studies) Undiagnosed HIV OR, 6.38 (4.33 9.39) Lower income (<$20k) OR, 3.42 (1.94 6.01) HIV detection Diagnosed HIV+ OR, 3.00 (2.06 4.40) ART utilization/ access OR, 0.56 (0.41 0.76) >200 CD4 cells/mm 3 before ART initiation OR, 0.40 (0.26 0.62) Health insurance OR, 0.47 (0.29 0.77) Healthcare visits OR, 0.61 (0.42 0.90) ART adherence OR, 0.50 (0.33 0.76) HIV suppression OR, 0.51 (0.31 0.83) Viral suppression (Millett, 2012) Fig. 3. Disparities persist between black and other MSM throughout treatment cascade (24 comparative studies). Beyrer et al (2013)
Social Determinants of HIV Economic Stability Transactional sex Afford prevention + treatment options Education Understanding of HIV prevention Navigation of health care system Health and Healthcare STIs, comorbidities Neighborhood and Built Environment Social networks Risk environments Social and Community Context Stigma
Figure 1 Stigma and HIV Disparities Model Earnshaw et al (2013)
Stigma à HIV Risk Inequity? Risk behaviors (sex, substance use) of Black and Latino MSM aren t greater than other groups Black and Latino MSM (especially young!) à highest incidence Structural Level Racial residential segregation à risk environments Medical mistrust à lower condom use Individual Level: Perceiver Racial stereotypes among Dr.s à lower PrEP prescription (Calabrese et al., 2014) Individual Level: Target Perceived, internalized stigma à greater substance misuse Perceived stigma à less condom use
Stigma à HIV Treatment Structural Level Racial residential segregation à quality of care Historical trauma / medical mistrust à access to care Individual Level: Perceiver Stereotypes among Dr.s à delays in prescribing medication Prejudice among Dr.s à worse care provided Individual Level: Target Internalized stigma à lower access, less medication adherence Perceived (anticipated?) stigma à lower engagement
Stigma à HIV Survival Structural Level Racial residential segregation, historical trauma à chronic stressors à faster disease progression Individual Level: Target Perceived + anticipated stigma à chronic stressors à faster disease progression
Resources World Health Organization on Social Determinants of Health Healthy People 2020 on Social Determinants of Health Pellowski JA, Kalichman SC, Matthews KA, Adler NA. A pandemic of the poor: social disadvantage and the US HIV epidemic. Amer Psychol 2013;68:197-209. Earnshaw VA, Bogart LM, Dovidio JF, Williams DR. Stigma and racial/ethnic HIV disparities: moving toward resilience. Amer Psychol 2013;68:225-236. Review of stigma à HIV cascade disparities Beyrer C, et al. The global HIV epidemics in men who have sex with men (MSM): time to act. AIDS 2013;27. Millett GA, et al. Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: a meta-analysis. Lancet 2012;380:341-348. Calabrese SK, Earnshaw VA, Underhill K, Hansen NB, Dovidio JF. The impact of patient race on clinical decisions related to prescribing HIV pre-exposure prophylaxis (PrEP): assumptions about sexual risk compensation and implications for access. AIDS Behav 2014;18:226-240.
Acknowledgments I have no known conflicts of interest in relation to this presentation. AHRQ Career Development Award: K12HS022986
Empowering Leaders in MSM Communities of Color Corey Yarbrough Executive Director / Co-Founder Hispanic Black Gay Coalition
Webinar Objectives To explore the current need for cultivating leaders of color in MSM/LGBTQ communities and how the lack of leaders of color contribute to social disparities To review the barriers that prevent the cultivation and retention of leaders of color in MSM/LGBTQ communities To explore best practices, program models, and organizational structures for developing and maintaining leaders of color in MSM/LGBTQ communities of color To identify alternative strategies for HIV prevention program implementation To share resources and opportunities for engaging and developing leaders of color in MSM/LGBTQ communities
Webinar Objectives Personal experience and journey as a leader of color Passion and connection to MSM leadership development Leadership as a form of survival and empowerment
The Urgency of Now Source: Movement Advancement Project (2007). Issues of Racial Justice and Inclusion: A Primer for LGBT Movement-Funders.
The Urgency of Now
Barriers to Developing Leaders Institutional Firm social arrangements and practices through which information is disseminated, services are provided, and support is accessed. (i.e. legal, educational, health care, social service, government, media). Societal Social, geographic and demographic factors that impacts one s ability to access information, education, services, and support. (i.e. race, class, immigration status, sexual orientation, gender identity). Behavioral Psychological conditions that impact one s behavioral patterns and ability to make healthy decisions (i.e. substance abuse, mental health). Attitudinal Personal attitudes, feelings, and/or beliefs that impact one s outlook on life, culture, community and health (i.e. religion, cultural norms).
Barriers to Developing Leaders Institutional Societal Behavioral Attitudinal Qualifications for a job, program or leadership position. Disciplinary and intervention policies. Methods for disseminating opportunities and selecting candidates. Racial and ethnic makeup of agency staff and leadership. Ability to connect to program/environment culturally Travel, daycare, bilingual needs. Ability to take off of work for meetings Fear or harassment based on culture, religion, expression, immigration or HIV status. Substance Abuse Denial of sexual orientation/gender identity or need for support Fear of affiliation with community (Stigma) Mental health disorders Coping/defense mechanisms rooted in trauma Perceived cultural norms or beliefs Religious beliefs Distrust of administrators/agencies Prioritization of needs or identities Guilt and/or shame Inability (or perceived inability) to relate
MSM Stressors in the Social Context
MSM Stressors in Social Context Discrimination And Perceived Discrimination Education Level or Ability Income Accessibility Access To Health Care Internalized Racism Religious & Family Expectations Employment Status Language Time in the U.S. / Immigration Status Internalized Homo-Bi- Transphobia Substance Use & Unhealthy Coping Mechanism
Elements of Positive Leadership Development Building Self Esteem, Self Worth and Self Sufficiency Addressing Real and Immediate Needs Ensuring Inclusive Program Design and Implementation Lead By Target Population Building Positive Bonds With Entire Community Cultivating Safe and Supportive Relationships
Case Study: Hispanic Black Gay Coalition
Mission & Vision Mission: The Hispanic Black Gay Coalition (HBGC) works to inspire and empower Hispanic, Latin@, and Black LGBTQ individuals to improve their livelihood through activism, education, community outreach, and counseling. Vision: To create a world where LGBTQ individuals of color can comfortably and unapologetically incorporate themselves into their racial/ethnic community and the mainstream LGBTQ community simultaneously. We also envision a world where LGBTQ individuals of color can unite to support and empower each other. We believe by creating a coalition of LGBTQ Hispanic, Latin@ and Black individuals (with the support of our ethnic communities and the mainstream LGBT community) we can effectively serve and support our community in making our vision a reality.
Inclusive & Intentional Program Design
Addressing Real & Immediate Needs Coming Out / Peer Support HIV & STI Education & Prevention Spiritual Care & Growth Civic Engagement Community Building & Networking Youth Leadership Development
Program Spotlight: TOD@S Leadership Crew A bilingual program for LGBTQ individuals of color who are survivors of (or impacted by) partner abuse. Over 12 weeks participants engage in healing practices, learn about the dynamic of partner abuse, and receive community organizing and event planning trainings. Program culminates in the design and implementation of community projects aimed to raise awareness to partner abuse and increase access to support and services for LGBTQ people of color. A collaboration between HBGC, The Network/La Red, Fenway Health, and Renewal House. Replicated model for LGBTQ youth of color (New Leader s Institute)
Program Spotlight: LGBTQ Mentorship Program Pairs LGBTQ youth of color under 21 with LGBTQ professionals of color over 25. Mentees work towards personal, professional, social, and/or health goals over a 6 month period. Mentees attend bimonthly professional development days and social outings. Encourages positive, affirming intergenerational LGBTQ connections.
Program Spotlight: Gay-Straight Alliance Development Supports the creation of GSAs (or similar groups) in schools with a student of color population over 60% Develops leadership of GSA officers and support the creation of group work plans GSA implements school and community projects to raise awareness to LGBTQ issues and address school needs. Past events have included sexual heath fairs, school flashmobs, healthy relationship workshops, and fashion shows.
Program Spotlight: Community Forums & Action
Additional Resources Young Black Gay Men s Leadership Initiative (ybgli.org) 21st Century Pipeline Project (lgbtpipeline.org) National Black Justice Coalition Emerging Leaders (nbjc.org) Advocates for Youth (advocatesforyouth.org) National Resource Center for Youth Development (nrcyd.ou.edu) Latino Commission on HIV/AIDS (www.latinoaids.org) Black AIDS Institute (blackaids.org) Racial Equity Tools (racialequitytools.org) HealthHIV (healthhiv.org)
Questions? Discussion?
Available for Download Guide to HealthHIV s ASO/CBO Leadership Training & Certificate Program: http://tinyurl.com/pbbl4c2 Also Available for Download: Slide Deck Webinar Recording Q&A www.healthhiv.org/resources/webinars
Upcoming HealthHIV Webinars Leadership Link & Learn Series Transitioning from ICD-9 to ICD-10: Organization Prepared? Wednesday, May 28th, 2015 3:00 PM EST-4:30 PM EST Register: http://tinyurl.com/nx7h2sy
HealthHIV Capacity Building The webinar is presented as part of HealthHIV s Three D Program and it s National Center for Healthcare Capacity Building. For more information contact: Marissa Tonelli Senior Capacity Building Manager marissa@healthhiv.org 202-507-4726