Adapting Popular Opinion Leader to Meet the Growing Needs of the MSM of Color Online Community Georg

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Adapting Popular Opinion Leader to Meet the
Growing Needs of the MSM of Color Online
CommunityGeorge Bouldin Gates
Managing Director of Education Training
Harlem United Community AIDS Center Rashi
Rohatgi, MPH Senior Director of Evaluation
Harlem United Community AIDS Center
Special thanks to MHRA/HIV Care Services
Coiel Ricks, Contract Manager
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Integrated Care Model
Supportive Housing Programs
HRA Housing
FROSTD at Harlem United
Womens Housing
Education Training
PREVENTION DIVISION
HOUSING DIVISION
HUD Housing
Testing Services
Transitional Housing
Emergency Congregate Housing Foundation House
North and South
HEALTHCARE DIVISION
Vocational Education
Primary Care
Dental Clinic
COBRA Case Management
Mental Health Services
Evening Food Nutrition
Adult Day Health Center East El Faro Fully
Bi-Lingual (Spanish/English)
Adult Day Health Center West
Federally Qualified Healthcare Center Healthcare
services for the Homeless in Central and East
Harlem
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HIV/AIDS in East Central Harlem and the South
Bronx

• Central and East Harlem have the second and third
  highest rates of HIV diagnosis per 100,000
  population in NYC (132.4 and 108.2, respectively)
  after Chelsea (135.0).  This compares with a
  city-wide rate of 47.5.
• Crotona/Tremont, High Bridge/Morrisania, and
  Hunts Point/Mott Haven in the Bronx and Central
  and East Harlem all show rates of HIV/AIDS
  surpassing 2.0, with Central and East Harlem
  with 2.6 of their populations living with
  HIV/AIDS. This is second only to Chelsea (4.3).
• Central and East Harlem also have some of the
  highest death rates in NYC at 31.9 and 32.6 per
  1,000 people living with HIV/AIDS, compared with
  11.4 per 1,000 in Chelsea.

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New HIV Diagnoses Rising in NYC Among Young
MSMYoung Blacks and Hispanics Hit Hardest

• New HIV diagnoses among MSM under age 30
  increased by 33 (2001 2006)
• Among all MSM, blacks received twice as many HIV
  diagnoses as whites in 2006 (232 vs. 101)
• Hispanics received 55 more than whites (157 vs.
  101)
• Among adolescents more than 90 of the MSM under
  age 20 diagnosed with HIV in 2006 were black and
  Hispanic (81 out of 87)
• Largest increases occurred in
• Queens (49)
• Manhattan (57)
• East and Central Harlem (up 115, from 26 to 56)
• Chelsea and Clinton (up 56, from 25 to 39)

Data courtesy of the NYC Department of Health
Mental Hygiene
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Prevention Division
Testing Services Rapid HIV testing Innovative
Recruitment Strategies Evaluation of Testing
Strategies Connection to Primary Care
Services Access to HIV Care Through ADAP
Enrollment
FROSTD _at_ Harlem United Intravenous Drug
Users Healthcare Harm Reduction Syringe
Exchange HIV Counseling Testing Linkage to
Healthcare
PREVENTION DIVISION
Education Training Community Education African
Services Black Mens Initiative (BMI) Delivery of
CDC-sponsored effective behavioral interventions
Community PROMISE Healthy Relationships Many
Men, Many Voices Popular Opinion
Leader VOICES/VOCES
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What is Popular Opinion Leader (POL)?

• POL is a community-level HIV prevention
  intervention designed to identify, enlist, and
  train opinion leaders to encourage safer sexual
  norms and behaviors within their social networks
  of friends and acquaintances through risk
  reduction conversations.
• POL is part of the Center for Disease Control and
  Preventions (CDC) Diffusion of Effective
  Behavioral Interventions (DEBI) project. The DEBI
  project was designed to bring science-based,
  community-and group-level HIV prevention
  interventions to community-based service
  providers and state and local health departments.
• The goal is to enhance the capacity to implement
  effective interventions at the state and local
  levels, to reduce the spread of HIV and STDs, and
  to promote healthy behaviors.

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POL Core Elements

• POL is directed to an identifiable target
  population in well-defined community venues where
  the populations size can be estimated.
• Ethnographic techniques are systematically used
  to identify segments of the target population and
  to identify those persons who are most popular,
  well-liked, and trusted by others in the each
  population segment.
• Over the life of the program, 15 of the target
  population size found in the intervention venue
  are trained as POLs.
• The program teaches POLs skills for initiating
  risk reduction messages to friends and
  acquaintances in everyday conversations.
• The training program teaches POLs characteristics
  of effective behavior change communication
  messages targeting risk related attitudes, norms,
  intentions, and self efficacy. In conversations,
  POLs personally endorse the benefits of safer
  behavior and recommend practical steps needed to
  implement change.

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POL Core Elements

• Groups of POLs meet together weekly in sessions
  that use instruction, facilitation modeling, and
  extensive role play exercises to help POLs refine
  their skills and gain confidence in delivering
  effective HIV prevention messages to others.
  Groups are small enough to provide extensive
  practice opportunities for all POLs to shape
  their communication skills and create comfort in
  delivering conversational messages.
• POLs set goals to engage in risk reduction
  conversations with friends and acquaintances in
  the target population between weekly sessions.
• POLs conversational outcomes are reviewed,
  discussed, and reinforced at subsequent training
  sessions.
• Logos, symbols, or other devices are used as
  conversation starters between POLs and others.

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POL Key Characteristics

• Pre-Implementation
• Elicit the involvement, support and cooperation
  of key gatekeepers in the community.
• Recruit opinion leaders by emphasizing their
  potential positive role as a popular AIDS
  prevention resource to others.
• Implementation Training POLs
• Emphasize the role of opinion leaders in changing
  peer group norms through HIV/AIDS prevention
  messages.
• Model examples of effective peer risk reduction
  conversations, including how to spontaneously
  initiate risk reduction conversations.
• Facilitate group problem-solving centered around
  how each opinion leader will have their peer
  conversations, allowing each person ample time to
  discuss issues particularly relevant to him or
  her.
• Maintenance Evaluation
• Organize reunion meetings with all opinion
  leaders and key community gatekeepers to discuss
  maintenance of POL.

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Harlem Uniteds Commitment to Evaluation

• Commitment to building internal infrastructure
  around evaluation versus hiring external
  consultants as needed.
• Recently formed Evaluation Unit (8 FTEs).
• Variety of evaluation-based contractual
  deliverables, including 3 CDC-funded research
  projects and Technical Assistance Initiative.
• Heart of our work is helping staff use evaluation
  as a management tool.

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Goals of POL Evaluation Initiative

• Formally adapt, implement, and evaluate POL to
  the online community of MSM of color.
• Increase the number of effective evidence-based
  behavioral HIV prevention interventions for men
  of color who seek sex online with other men.

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Goals of the Formative Evaluation

• Identify growing needs of a potential hidden
  MSM community who seek sex online.
• Ways of adapting POL to the virtual community
  (e.g., best approaches, times/days/sites, etc.).

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CDC Draft of Adaptation Guidelines
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Formative Evaluation

• Design of the Formative Evaluation
• Comprehensive literature review
• 3 Focus Groups (2 online and 1 offline) with
  online community members (e.g., 18 29 year old
  MSM of color)
• Brief online survey for those interested in
  participating in FGD (demographic and risk
  profile)
• 3 5 semi-structured interviews with owners of
  selected websites (e.g., Manhunt)
• Online community survey (assess community norms
  at baseline and every 6 months after)

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Prep for Formative Evaluation

• Identify Consultant
• Connected Health Solutions, Oscar Raul Lopez
• Instrument Design
• Consent to Participate
• Online survey via Survey Monkey
• FG Interview Guides
• Recruitment
• ALL online (Manhunt banner ad Craigs List
  posting)
• 2 online/1 offline FGDs
• Conduct 3 5 gatekeeper interviews with website
  owners/managers
• Incentives
• Survey FGD
• iTunes Gift Cards

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Manhunt Banner Ad
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Status of Formative Evaluation

• Completed 2 online focus groups, with each
  participating completing the online survey
• More community interest in participating in
  online than offline focus groups
• Expect to complete 3 5 interviews with website
  owners/ managers by mid-November
• Designing online community survey

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Preliminary Results from Online Survey(n 19)

• Age Ethnicity
• 100 18 29 year old men
• 72 Black/African American
• 39 Hispanic/Latino
• Residence
• 72 Manhattan
• 62 Harlem
• 18 Brooklyn
• 6 Queens
• Sexual Orientation
• 72 Homosexual/Gay, 17 Bisexual/Bi, 6 Straight,
  6 Questioning
• Education
• 50 College graduates, 39 Some college, 11 12th
  Grade
• Employment
• 83 Full time, 6 Part time, 11 Currently
  unemployed
• Living Arrangements
• 67 with a roommate, 22 alone, 6 with a
  partner, 6 with parents

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Preliminary Results from Online Survey(n 19)

• Risk History (Referring to the last 3 months)
• 43 reported unprotected sex
• 67 1 5 times, 33 6 10 times
• 36 did NOT know HIV status of last partner
• 57 reported having had sex while
  intoxicated/high
• 88 1 5 times, 13 6 10 times
• 78 reported meeting partners on the Internet
• Ranging from 1 to as many as 39 partners

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Preliminary Results from Online Survey(n 19)
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Preliminary Results from Online Survey(n 19)
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Preliminary Results from Online Survey(n 19)
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Key Themes Elicited from Formative
Evaluation(Preliminary Findings)

• Barebacking, particularly among HIV men, is
  prevalent among members of the online community
  and appears to coincide with a failure to
  disclose its practice to prospective partners.
• I dont know about talking about it but I know
  its happening, and maybe thats a part of the
  issue is that I dont know if people really do
  talk about what they do in the bedroom that
  much.
• Desire for online prevention messages that are
  closer to home and based on reality finding the
  balance between fear tactics and casualness.
• Taking 20 pills is no fun.
• Yeah, they might want to be more forthcoming
  with the actual side effects of the medications
  that show folks climbing mountains, etc.
• So anything that says abstinence is the only way
  to me is just unintelligent.

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Key Themes Elicited from Formative
Evaluation(Preliminary Findings)

• Preferred method of engaging men promote
  support in an informal manner.
• Something that is sex positive, non judgmental,
  not invested in body politics, uninterested in
  how fly you are, how big your d_ck is
• I think the best way is by casual conversation
• Use of humor and realness
• Messages that reflect social support You are
  not alone, with 2 men holding hands
• Dissemination of messages Combination of banner
  ads and online live outreach specialist whom
  specific questions could be directed to.
• Stirring-up interest 5 FG participants
  interested in being POLs and were willing to
  spread the word about this program to other
  community members.

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Next Steps Implementation

• Implementation of the On-line Community
  Assessment
• Adaptation of the POL Program (e.g., selection of
  popular websites, changing original curriculum
  and materials, name and logo development, adapt
  method of selecting POLs, etc.)
• Development of a Policy Procedures Manual
• Continued training and capacity building of staff
• Recruitment of online POLs
• Training of online POLs (to be completed
  off-line)
• Dissemination of messages through POLs (with
  routine supervision and coaching)
• Develop routine program monitoring systems (i.e.,
  CQI) to ensure POL is being implemented as it was
  intended
• Ellumination Web conferencing

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Successes Challenges

• Successes
• Internal evaluation staff to support formative
  activities
• Staff trained in POL
• Expertise of Connected Health Solutions
• Challenges
• Recruitment of community members into the offline
  focus group
• Resources/time
• Hiring appropriate and skilled staff

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QA
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Contact Info

• George Bouldin Gates
• Managing Director, Education Training
• ggates_at_harlemunited.org
• Rashi Rohatgi, MPH
• Senior Director of Evaluation
• rrohatgi_at_harlemunited.org
• Oscar Raul Lopez
• Chief Development Director
• Connected Health Solutions
• olopez_at_connectedhealthsolutions.com