Final action plan N= approx. 239
Community Forum N= approx 45
Researcher Interviews N=6
Interviews w/ Latino MSM N=157
Dialouge w/ Providers N=31
Finding 1: San Francisco is a magnet for migration of young Latino men looking for sexual freedom and gender self-expression; they are treated as sexual objects and land in high risk contexts that put them at risk for substance abuse and HIV.
Recommendation 1: A guiding structure (perhaps a website online) that orients new waves of young Latino gay men who are newcomers to San Francisco; "landing pads" would be healthy and supportive contexts rather than situations of risk where Latino gay men are sexually objectified.
Finding 2: In San Francisco, it is very easy to find sex, but extremely difficult to find meaningful relationships. "Hot Sex" is the most valued commodity and men feel socially pressured to give up expectations of partnerships where they can integrate emotional and sexual satisfaction.
Recommendation 2: Programs that provide relevant and tailored education on the interconnection of sexuality, relationships, substances and HIV. Community building in context that emphasize a sense of familia.
Finding 3: Main reason for UAI (unprotected anal intercourse): perceived seroconcordance. Men are approaching HIV prevention by making assessments of HIV risk within particular sexual encounters - pursue risk reduction strategies other than condom use.
Recommendation 3: Programs that help men make sound and accurate assessments of HIV risk in different sexual contexts and situations, including knowledge of HIV status of self and sexual partners.
Finding 4: Stimulant use and participation in "Party and Play" (PNP) contexts are strong correlates of HIV risk. Sex under the influence is forced underground by stigmatizing attitudes and by health providers who do not address the issue.
Recommendation 4: Culturally relevant programs that address the functional use and impact of substances - emphasis on connection between stimulants and HIV. Need anti drug-stigma campaign and increased provider training.
Life Concerns and Priorities
Participants completed a brief survey listing 23 life concerns. They were asked to list and rank-order their 10 most important concerns:
Financial Well being 39%
Finding a good job 38%
Physical Health 34%
Depression/anxiety 24%
HIV/AIDS 21%
Having good friends 15%
Paying bills/debts 14%
Finding good housing 13%
Finishing school 13%
Emotional well-being 11%
Finding 5: Content of HIV prevention does not address the most pressing concerns of Latino gay men: Financial well being (#1) employment (#2) physical (#3) and mental (#4) health. Desire for improved physical and mental health is beyond issues related to HIV/AIDS (#5)
Recommendation 5: Programs need to address Latino gay men's concerns for job stability and financial well being; that is, connect HIV prevention with the existing with the strong motivation towards "Superacion" (improve one's situation - financial, educational, physical and emotional).
Finding 6: Latino English-speaking gay men have substantially lower rates of participation in Latino-identified HIV programs in the city - no HIV prevention programs specifically targeted to monolingual English-speaking Latino gay men.
Recommendation 6: Programs that welcome and target Latino English-speaking gay men need to be developed. However, this should not be done at the expense of existing programming designed for immigrant, Spanish-speaking men.
Finding 7: Riskiest group: older (over 35), English-speaking, unemployed, drug-using, HIV-positive, marginally housed, Latino gay men. Their risk is connected to poverty, social alienation, and social situation of vulnerability.
Recommendation 7: Create a program that targets the particular issues of older English-speaking Latino gay men of lower socioeconomic status who are marginally housed (mostly in SROs or shelters). The program should address issues of life stability, as well as access to culturally appropriate mental health and substance abuse services.
Finding 8: HIV positive men are reporting higher rates of risky sexual activity than HIV negetive men (59% v. 44%). Meanwhile, high rates of HIV stigma discourage disclosure.
Recommendation 8: Culturally tailored Prevention for Positives that addresses sexual behavior, HIV disclosure, and assessments of risk for HIV transmission among positive Latino men in a way that is non-stigmatizing. Campaigns aimed at reducing HIV stigmatization in the Latino gay community.
Finding 9: Non-gay identified men found in the social context that Latino gay men participate in: all (100%) straight-identified men interviewed were classified at HIV risk: these individuals unlikely to visit agencies or attend groups.
Recommendation 9: Programs tailored to MSM who identify as heterosexual should be developed, with targeted individual assessment and counseling by culturally trained prevention workers.
Finding 10: Many HIV prevention providers - often themselves members of the Latino gay community - are accomplishing very hard work under difficult circumstances.
Recommendation 10: Programs that address high burnout rates of HIV service providers. Existing Latino programs should be funded to carry out activites that prevent burnout and sustain the long-term, enthusiastic work of their front-line staff.
Whew! I know that was long, but it's good stuff. After some discussion on budget (pretty tall order for a city that just got it's state HIV prevention funds cut from 2.9 million to $500,000!) the HPPC voted unanimously to support the LAP recommendations.
The LAP team will be presenting they're more thorough data in a few months.
