Theo Braden, Ryan Westergaard , Erika Christenson, Kofi Short, Dan - PowerPoint Presentation

Theo Braden, Ryan Westergaard , Erika Christenson, Kofi Short, Dan Ruge

Objectives for Study Objective for Year 1: Explore attitudes, normative beliefs, and individual barriers that influence PrEP uptake and adherence among young(18-30) Black MSM and TGF Study Components: Community Readiness Assessment(CRA) June-October 2015 structured interviews with community stakeholders to identify structural barriers influencing uptake among target population. Individual interviews July 2015-Jan2016 Based on the integrated Behavioral Model, investigated attitudes, sense of self efficacy, norms around PrEP among target population .

PrEP CRA Answer the question: What is the Milwaukee community’s level of readiness to address the issue of the use of PrEP as a prevention tool for sexually active AAMSM?

PrEP CRA- Stakeholder Groups 6 Stakeholder groups/ 28 interviews

PrEP CRA- 5 Dimensions Community Knowledge of Efforts Leadership Community Climate Community Knowledge about the Issue Resources Related to the Issue

PrEP CRA- Quantitative Results PrEP CRA: Overall Dimension Scores   Community Knowledge of Efforts Leadership Community Climate Community Knowledge of the Issues Resources Stakeholder Group Total Dimension Total 2.27 4.63 3.95 2.34 3.38 Overall Community Readiness Score3.31(Vague Awareness) Readiness Score: 3* Vague Awareness- Recognizes the issue is of concern in the community and something should be done but immediate motivation is insufficient

Demographics of Interviewees 23 conducted interviews at DNR. Participants received $40. Median Age: 26

Primary Themes Internalized Mistrust and Historical Trauma Community Attitudes Stigma Knowledge/Awareness of PrEP & HIV Logistical Barriers Leadership & Outreach

Internalized Mistrust and Historical Trauma CRA Findings Main Idea: Blacks have not forgotten past wrong doings of the medical community and resultantly may not be receptive to outreach promoting PrEP. Interviews FindingsMain Idea: I like your PrEP but not your doctors. Interviews responded positively to and strongly believed in the effectiveness of PrEP . However, many appeared skeptical of the medical community. “people are suspicious of doctors and public health efforts-we all know Tuskegee ” “I have heard that this is something implemented by the government to kill us off faster…a lot of people have felt that its just a way to kill us off “ “I’d consider taking PrEP … Just because I know if it works, I guess, I know that it works, and anything that prevents me from getting sick I’m down for” “Don’t really want to be a test patient, you know what I mean?” “ PrEP is to, in my sense from what so far what you’ve given me is to make sure that we’re okay, and that’s not what the government does.”

Community Attitudes CRA Findings Main Idea: Community Attitudes around HIV/AIDS and homosexuality prevents some from supporting the use of PrEP: Do not think HIV is a big deal Bad choices cause HIV PrEP will perpetuate immoral risky sexual behaviors. Interview FindingsMain Idea: PrEP sounds good and all but its not really for me. Interviewees expressed fear of HIV and held empathetic but stigmatized attitudes towards people with HIV (. e.g blame, promiscuity, sero -sorted dating, irregular testing). Such attitudes may influence one’s perception risk and PrEP uptake. “They would say us approving this drug is saying its okay for you to do something immoral” “they don’t feel they will be impacted by it at all, they don’t view that as an important to them.” “I mean, it’s going to help you, you can be a nasty trifling asshole if you want to, fuck whoever you want to fuck, you ain’t got to worry about all that.”“No…… Because I’m safe… And my, and I haven’t messed with a lot of different people within five years, they’ve been the same five people I’ve been messing with and we always use protection…

Stigma CRA Findings Main Idea: stigma and fear of stigmatization prevents both homosexuality, HIV and PrEP from being discussed. Fear of publically endorsing PrEP Fear of being outted as HIV+ or as someone engaging in unprotected sex Interview Findings Main Idea: Disclose but with reservations. Most said they would share with friends however mentioned being concerned about: Judgment from the greater community. B eing outted on social media B eing ridiculed as someone having HIV, P ersonal safe ty. “There is still a lot of bias against AAMSM, especially in the Black community. There is not a feeling of desire to be supportive of this group.” “there is so much stigma around HIV that how do we expect them to get this info. They say that it’s a HIV pill so why would I want to take that. The community memebers don’t have the knowledge to defend or explain it.”“people are so malicious these days if they see it, they might think that, you know, might use that against you. I’ve seen people posting medication on Facebook and ousting people and it’s not right and I can see that being used against people.”“It’s just, if it works and so I bring it to the subject, that’s a story that has to be told. That’s something that has to be, you know, broadcasted to me, but mainly to my friends”

Knowledge and Awareness of PrEP & HIV CRA Findings Main Idea: Lack of knowledge around HIV and PrEP may influence community support of PrEP. Lack of information about HIV and PrEP within the community. Misconceptions about PrEP among people who know about PrEP (e.g. magic pill) “For people who aren’t in the field, HIV isn’t on your radar” “People think it’s a magic pill and if you take it you don’t have to worry. That probably the main one and that you can still have unprotected sex if you take PrEP. “ Interview Findings Main Idea: HIV is real. However, what exactly is PrEP? Close personal experience and above average understanding of HIV. While most had heard of PrEP, many held misconceptions around: side effects, it’s use, appropriateness. “I feel it’s scary. I don’t want to take it, but if I have to, I will because I don’t want to be sweating when I sleep, I don’t want to have so many mood swings and like outbursts from taking medication”“From what I gather from that meeting, because we only talked about it once, was that it helps, like it’s kind of like the Plan B pill, kind of like the day-after pill”

Leadership & Outreach CRA Findings Main Idea: Milwaukee leadership is not talking about PrEP and there are a lack of effective outreach campaigns promoting PrEP. General apathy towards HIV/STI prevention; especially from those in power (e.g. elected officials) Community meetings—leaving confused Lack of advocacy from people representative of the community “From my alderman to my local assemblyman to the mayor to my congressman, I’ve not heard any feedback to anything relating to STD programs treatment. None whatsoever!” “The people delivering the information don’t really reflect the population that they are speaking to…it could be more effective if delivered by someone from the same demographic” Interview Findings Main Idea: Direct community outreach and engaging leaders within the Black MSM/TGF community are critical to promoting successful PrEP uptake. Decline in HIV/STI community outreach programs Show me you care—come to me. “Mm-hmm. I think if you get like the right role models, it’d be successful… Yeah, it definitely has to be relatable. It’s got to be relatable, got to be hip. It got to be cool…… The only thing that’s going to get these black kids here to do anything”

Recommendations

Integrate PrEP within Current Outreach Efforts Recruit a group of existing opinion leaders within the black MSM community to be advocates for PrEP Integrate the topic of PrEP within ongoing conversations on HIV/STI prevention with Black MSM communityDevelop clear and consistent guidelines and standardized information about how and where to get PrEP specifically in Milwaukee

Increase the knowledge of the general Community Conduct individual outreach and one-on-one meetings with community and religious leaders to educate on HIV/STIs and PrEP Visit existing and unrelated groups to increase awareness about HIV/STI’s impact on the community.Create a PrEP fact sheet with guidelines for medical providers and the general public Provide cultural competency trainings to medical professionals, community and religious leaders, and elected officials.

Acknowledgements Thank you for all of the instrumental and emotional support during the first phase of PrEP -Net. Ronnie GraceKofi Short Shawnika Hull Erika ChristensonSHEBA Diverse and Resilient Dane County Department of Health Services