We are writing to everyone who has expressed an interest in or has implemented the Mpowerment Project (MP) over the past few years. We want to alert you to interesting possibilities for funding MP if you or your agency plan to apply for funding under CDC’s FOA PS15-1502.
MP was identified in the FOA as being a “HIP Intervention” suitable both for High Risk HIV Negative (HRN) and HIV Positive Men Who Have Sex With Men (MSM).
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A. For High Risk Negative (HRN) Young (MSM). The MP retains its 8 core elements: Coordinators (staff), Core Group, Volunteers, M-groups, Formal Outreach, Informal Outreach, Publicity and Space. It reaches men regardless of HIV status. It focuses on both increasing HIV testing and on reducing sexual risk behavior. We think it is important that HIV testing be addressed in MP, but not only by providing HIV testing itself. Instead, MP methods can also be used to promote regular and frequent HIV testing (every 3 – 6 months) by using formal and informal outreach. You can develop HIV testing promotional materials and distribute them through social media, at project-sponsored events and at venues where young MSM congregate. You can discuss the importance of frequent testing at small, medium and large events. At M-groups, you can discuss the importance of regular and frequent HIV testing. Informal Outreach should focus both on encouraging friends to reduce their risks for acquiring and transmitting HIV, and on increasing HIV testing (e.g., by going with friends to get tested).
A.1. New Issues to Focus on for HRN MSM. There are 3 major changes that we suggest for HRN MSM. Click here for 10 steps that can be followed for MP to address the HIVCare Continuum.
(a) PrEP. The MP can be used to educate and inform young gay/bisexual men about PrEP (Pre-exposure Prophylaxis). Information about PrEP can be disseminated in the same ways that safer sex and HIV testing are promoted, i.e., through the use of the core elements, including creating materials on PrEP that are distributed in various ways, increasing formal and informal outreach focused on PrEP, and having materials about PrEP at the space, including where and how to obtain it.
(b) Condom Distribution. The MP can be used as a way to conduct condom distribution to young gay/bisexual men. The MP has always done this, but it can be formalized by following the guidelines for Condom Distribution provided by CDC. Condoms should be widely distributed via Formal Outreach, at all project-sponsored events and at venues where young MSM congregate. They should be freely available at the project space and given to young men to give to their friends.
(c) Collaboration with Health Care Organizations (HCOs). It is important for community-based organizations hosting MPs to have a strong collaboration with an HCO so that when a young man reveals to Coordinators that they have tested HIV-positive, he can be navigated into care at an HCO. Hence a strong partnership between the MP and an HCO is extremely important to ensure that all young men identified as HIV-positive are assisted to link to care, or if they have left care or are having challenges in taking medications, they can be referred to the HCO. In addition, the collaboration with the HCO is helpful in referring men to obtain PrEP, or if they need to be tested for STIs.
A.2. Staffing for HRN MP. As you know, it is difficult to make recommendations about staffing plans, because the staffing needs vary from organization to organization depending on factors such as community size, staff capacity, and other resources available to support MP programming. The recommendations below are just rough guidelines to keep in mind as you plan your specific work and staffing plans. Feel free to contact us for assistance in planning your specific proposals. It is vital to ensure that you have sufficient staffing to meet your program’s goals and objectives, and these will vary by each applicant. We state here the minimum that we suggest requesting in order to run the MP. The FOA states that after considering the amount of HIV testing the agency will do, 25% of the funding can be focused on HRN MSM. We would suggest that at least:
- 1.5 FTE (full-time equivalent) should be sought for MP
- .5 person who is funded through HIV Testing funding (who will both conduct testing and also promote it through MP methods).
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B. For HIV-Positive Young MSM. The MP team has been determining how to use MP methods to address the needs of HIV-positive young MSM – that is, to help them link into care once they have tested HIV-positive, to maintain or re-engage in care if they have left care, and to take their medications regularly. There are additional core elements to focus on HIV-positives that will be fully developed and ready for use by July 2015 that the CDC has accepted as evidence-based since they follow the logic and methods of MP. These additions are listed below. These are to be added to an MP for High Risk Negative MSM.
We do not recommend an MP solely for HIV-positive MSM because many men will feel wary about showing up for something that is only for positives out of concern about HIV stigma. HIV-positive men also do not just spend time with other HIV-positive friends. Therefore, in addition to the goal of reducing risk among HRNs, another MP goal is to mobilize the entire young MSM community to support positives about engaging in the continuum of care. Therefore, it is important to ask for funding for MP, as well as funding for what we are now calling “MP+” (see below). It is important to run an MP, and then add or adapt it to address HIV-positive men and their issues.
B.1. New Issues to Focus on and New Core Elements for HIV-positive Young MSM.
(a) Formal Outreach Events for HIV-Positive Men. It is key for HIV-positive men to get support from friends for linking into care, engaging in care or re-engaging, and taking medications as prescribed. There should be some project-sponsored formal outreach events specifically for HIV+ men in order to help build this support. Not all HIV-positive men will want to attend these, but many will and it may be that as these are held, more and more HIV-positive men will attend. These can be small or medium-sized events. Some can focus on issues about being HIV-positive, but also many HIV-positive men would like an opportunity to be with other guys like themselves (in other words, have a social focus to the events). Various issues of importance to HIV-positive men can be promoted at such events, such as sexual risk reduction, the need to stay in or re-engage in care, remembering to take medications as prescribed, how to work with one’s healthcare provider, how to advocate for yourself, and how to deal with structural issues (e.g., transportation). At formal outreach events that target both HIV-negative and HIV-positive men, activities can be included that give HIV-negative men ideas about and encouragement for supporting their HIV-positive friends to engage in care and take their medications as prescribed.
(b) HIV Stigma Reduction. Again, all of the MP core elements can be harnessed to address stigma reduction. Messages aimed at reducing HIV stigma can be created for use in the project space and can serve as a theme for materials disseminated throughout the community. . Themes can include HIV stigma-related gossip and not making assumptions about others’ HIV status. HIV stigma can also be discussed in project-sponsored formal outreach events and at Core Group meetings.
(c) Adapted M-group. By January 2015, we will be distributing a revised M-group curriculum that will address HIV-positive issues. It aims to increase literacy about treatments, build support for HIV-positives to engage in care and take medications as prescribed, reduce HIV stigma, and other related issues. The M-groups remain the first group than individuals participate in when coming into the project.
(d) Navigation into Care. Someone connected with the MP will need to help navigate HIV-positive men into care or help them re-engage in care and take medications as prescribed. The navigator can be employed by an HCO to work with the MP, or a staff person who works with MP can be employed to navigate individuals into care. This person should be especially savvy about issues facing young MSM.
(e) Positives Group. This is a group that totally focuses on the needs of HIV-positive MSM. It is delivered less often than M-groups. The Positives Groups focus on a myriad of issues, including dating and sex; disclosure to partners, friends and family; HIV and medication literacy; health promotion for positives. Individuals will participate in these groups once or twice. These are 2.5 hour-long groups. Guidance on these groups will be available by July 2015.
(f) Network Group. HIV-positive young men will identify 1-3 friends from their social networks who they want to bring to a Network group. They will discuss together how these “buddies” can support the young man regarding being HIV-positive and obtaining the best medical care. The HIV-positive individual identifies areas in which he could use support, how he wants support provided him by his friends, and how often he wants such support. Again, guidance on these Network Groups will be available by July 2015.
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B.2. Staffing for MP+. We state here the minimum that we suggest requesting in order to run MP+ (along with finding other sources of funding). These recommendations are for organizations doing both MP and MP+ (i.e., reaching both HIV positive and negative men). This is just a suggestion for one way to staff the entire program for positive and negative men.. Certainly there are many other possibilities. We suggest requesting:
- 1 FTE for HIV testing, and this position not only conducts testing, but also uses MP core elements to promote HIV testing, recruit men for testing and so forth (as was described earlier). This could come from HIV testing funding.
- 1 FTE for MP implementation, of which 75% will be for MP and 25% will be for conducting HIV testing. This could come from HRN funding.
- 1 FTE for MP+ implementation, of which 75% will be for the Positives Group, Triads, and MP core elements that are adapted to focus on HIV-positive men (e.g., events for HIV-positives), and 25% will be for Navigation.
In summary, we believe that it would take at least 3 total FTE to implement both MP and MP+ to reach HIV-positive and HIV-negative men together.
Please contact us if you have any questions about this. We can be contacted at:
Robert Williams Robert.Williams@ucsf.edu
John Hamiga John.Hamiga@ucsf.edu
Scott Tebbetts Scott.Tebbetts@ucsf.edu
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