NIMHD Workshop Aims to Prevent HIV Among Diverse Young Men Who Have Sex With Men
The National Institute on Minority Health and Health Disparities (NIMHD) hosted a workshop in February to discuss current research and challenges regarding behavioral interventions to prevent HIV infection in young men who have sex with men (MSM) from diverse backgrounds.
Held on the NIH campus, the Planning Workshop on Behavioral Interventions to Prevent HIV Among Diverse Young MSM featured speakers who discussed research gaps and opportunities in learning how to prevent HIV among diverse young MSM.
"An understanding of the cultural context is very critical," said speaker Venton C. Jones, Jr., events and operations manager, National Black Justice Coalition, which is a civil rights organization dedicated to empowering black lesbian, gay, bisexual and transgender people. "We now have an epidemic impacting an age group that’s younger than the HIV epidemic. … The main thing we need to figure out is how to take this conversation from the lab to the living room."
MSM bear a greater burden of HIV/AIDS than any other population group in the United States. They comprise only 2 percent of the population, but 56 percent of these individuals are living with HIV/AIDS. This burden is disproportionately experienced by African American and Hispanic MSM, who account for 36 percent and 22 percent respectively of new HIV infections. The increasing rate of HIV infection among MSM from health disparity populations is driven largely by young men between ages 13 and 24, who account for nearly one-third of new HIV infections. Despite a sizable portfolio of existing research on preventive HIV interventions for MSM, there remains a lack of evidence-based effective interventions for diverse young MSM which are available for broad implementation and dissemination in the U.S.
"We need interventions at all levels, we need to relieve some of the cultural barriers, and we need strategies that are sustainable," said speaker Dr. Scott D. Rhodes, professor and vice chair, Department of Social Sciences and Health Policy, Division of Public Health Sciences Wake Forest University School of Medicine.
The specific objectives of the forum included:
- Discussing the current best or promising practices regarding behavioral HIV prevention interventions for young MSM from diverse backgrounds;
- Identifying the research gaps in existing evidence-based behavioral HIV prevention interventions for young MSM belonging to various health disparity populations; and
- Identifying effective strategies to facilitate and increase collaboration among researchers and affected communities in developing behavioral interventions, implementation and dissemination of interventions for diverse young MSM.
The workshop was composed of two sessions—current research and future opportunities, and community participation and collaboration in research.
During the first session, speakers included Dr. Brian Mustanski, Northwestern University Feinberg School of Medicine; Dr. Patrick A. Wilson, Columbia University Mailman School of Public Health; Dr. Cynthia R. Pearson, University of Washington; and Dr. Frank Y. Wong, Emory University Rollins School of Public Health. These experts spoke about how researchers shy away from studies on adolescents who are less than 18 years old because of concerns regarding obtaining parental consent in some states. However, for researchers who do these studies, the speakers said it is necessary to target culturally-specific subgroups of MSM, and determine how they self-identity. To do this, they suggested including members of study teams who understand the culture and can communicate appropriately.
To reach young MSM and address evolving sexual development, panelists suggested starting sex education in elementary school and middle school, focusing on the diversity of sexuality. They also recommended collaborations with the Department of Education and schools to focus the curriculum on sexual health.
In the second session, speakers included Jones; Rhodes; Grazell R. Howard, The Black AIDS Institute; and Dr. Gregorio Millett, American Foundation for AIDS Research. They discussed community perspectives and the need for workforce training and certification for both medical and non-medical HIV service providers.
"People are listening, but we do have to give oxygen [to this issue] for mobility," said Howard. "I believe we can have an AIDS-free generation and it is up to us to empower our workforce."
If only one behavior could be the focus for community participation and collaboration in research, speakers agreed that it would be interventions reaching young MSM. Speakers made several recommendations including using networks of friends to encourage testing for HIV and partnering with known community members. They also believe that it is important to include spirituality, religion and culture because there are barriers to HIV prevention and treatment due to all of these factors. Social media was suggested as being a very useful tool in reaching young MSM. For example, Facebook groups can be created to target specific communities.
Speakers agreed that the most critical element of interventions is making sure they are reaching youth at the age of sexual debut as sexual and health habits are formed at this time. To do this, it is important to tap into their networks, such as friends, who can encourage each other to get tested for HIV. According to the Centers for Disease Control and Prevention (CDC), about 50 percent of youth aged 13 to 24 with HIV in the United States were unaware of their infection in 2010. CDC recommends that everyone between the ages of 13 and 64 get tested at least once and that high-risk groups get tested more often. Since testing increases when friends support it, speakers acknowledged the need to make sure the messenger is someone with whom they can relate.
"The messenger really matters," said Gregorio Millett. "We need to make sure the messenger is someone who really speaks to the population."