Introduction
This blog summarizes the adaptations that UCSF’s Center for AIDS Prevention Studies, along with our community partners, have made to the original Mpowerment Project model to ensure that it addresses the needs of young gay, bisexual, and other MSM living with HIV, and continues to be a dynamic and effective community-level HIV prevention program for the entire young gay men’s community. The National Institute of Mental Health is supporting this work.
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| Join us. Attend the Mpowerment Project Training. |
Background
The Mpowerment Project (MP) has been enhanced to help young gay, bisexual, and other MSM (YMSM) living with HIV to engage in the HIV care continuum. The Mpowerment Project+ (MP+) builds on the Mpowerment Project “model” to mobilize YMSM in the community to decrease psychosocial barriers (e.g., reducing HIV stigma) and increase psychosocial facilitators (e.g., increasing social support for engaging in care, increasing literacy about HIV treatment) to support YMSM living with HIV in order to increase their engagement in care. The MP model involves implementing the program’s original core elements for all YMSM regardless of HIV status, but for MP+ all the core elements have been adapted to also support engagement in care. In addition, three new core elements have been developed: the Positive Living Group and the Support Networks Group (both described below). Finally, we encourage the use of a Peer Navigator in the program.
The overarching goal of the project is to build an empowered, cohesive, and mobilized YMSM community that supports each other about HIV prevention. MP+ does not solely focus on YMSM living with HIV for four reasons:
First, the social networks of YMSM who are living with HIV include both HIV-negative men as well as men living with HIV. Therefore, to maximize social support for engagement in HIV care and to reduce HIV stigma, it is necessary to mobilize peers, regardless of their HIV status.
Second, concerns about HIV stigma dissuade many YMSM who are living with HIV from participating in a program if it is perceived as being solely for men who are living with HIV. Therefore, MP+ weaves in information specific to men who are living with HIV throughout all of the intervention’s core elements and also targets the entire community of YMSM to support engagement in the HIV treatment cascade.
Third, for YMSM men who are unaware of their HIV infection, or who are HIV-negative, HIV prevention messages are diffused throughout the community to create positive social norms and increase social support to promote regular HIV testing, reduce unprotected sex, and increase awareness of pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). Diagnosis of HIV infection is the first step of the HIV treatment cascade.
The fourth reason is that the project space is a social environment for YMSM living with HIV to disclose their status to others and receive emotional, informational, and practical support from other YMSM regardless of their HIV status.
RELATED: What is the Mpowerment Project? Download Module 1: Overview.
RELATED: What is the Mpowerment Project? Download Module 1: Overview.
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| Holatinos, Mpowerment New York City NY |
The MP+ is
- Focused on social change (e.g., changes social norms, increases social support), interpersonal change (e.g., addresses couples’ dynamics), structural change (e.g., provides a community center for men to gather and builds a supportive community, addresses the environment in which men live, provides condoms and lube at the project site and throughout the community through outreach), and increasing personal and community empowerment.
- A combination prevention strategy – it focuses on individual, interpersonal, social, and structural issues, and links both a social/behavioral intervention approach with biomedical methods.
- A community mobilization strategy, using community organizing methods.A social marketing approach.
- An approach that addresses social determinants of health (e.g., heterosexism, racism, low education levels, low SES, internalized oppression).
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| Join us. Attend the Mpowerment Project Training. |
Adaptations to Existing MP Core Elements
The following sections describe how MP’s existing core elements have been adapted to focus on men living with HIV in order to support them to engage in care. Examples are provided. All of the core elements are adapted to focus on prevention with positives (PwP), internalized and externally expressed HIV stigma reduction, social support to engage in the HIV care continuum, social norms about engaging in the HIV care continuum, HIV treatment literacy, and critical analysis regarding reducing transmission risk.
There are some activities that are exclusively for men living with HIV (the new groups and some social activities). It may be challenging to recruit men living with HIV to these activities early on in the project, until they begin to feel openly accepted at the project space, see the emphasis on confidentiality, and observe the anti-HIV stigma messaging that will be diffused in the community. But as trust is built, men living with HIV are more willing to attend project-sponsored activities designed specifically for them.
Coordinators. Coordinators are trained in care, treatment, and adherence issues, as well as available local HIV-related resources. Besides having at minimum 1.5 FTE for MP (two or more FTE is far better), the additional components require an additional Coordinator. It is important to have a Coordinator who is living with HIV, is “out” about his HIV status, and is able to discuss issues about living with HIV from his own experience.
The Core Group (CG). The CG is the decision making body for MP+. It mobilizes men from the entire YMSM community and actively recruits YMSM from diverse social networks. In addition, priority is placed on recruiting some CG participants who are open about living with HIV and are comfortable discussing HIV-related issues. The CG analyzes the root causes for why some YMSM living with HIV do not fully engage in HIV care, and from those discussions they derive project-based solutions and carry out activities specifically about engaging in HIV care, why it is important to take HIV medications regularly if living with HIV, and the importance of getting tested regularly for HIV for persons who may be at risk. They also discuss how to reduce HIV stigma in the YMSM community, and the CG will enact the solutions they generate.
RELATED: How to run a Core Group.
M-groups. These are one-time, 3-hour skills building sessions for 10-12 YMSM that address the issue of HIV related stigma and emphasize that HIV treatment is highly effective in keeping people living with HIV healthy and virally suppressed. Myths about medications are dispelled (e.g., that they change the way a person looks, that they cannot be taken if the person is drinking alcohol or using recreational drugs). M-groups also discuss the importance of regular testing for HIV if sexually active, and information about the availability of PrEP and PEP for men who are HIV negative. In addition, participants in M-groups learn about and are motivated to conduct Informal Outreach with their friends, specifically about engaging in care if living with HIV and getting tested at least every 6 months if HIV negative.
Informal outreach. This core element is about spreading messages to and supporting friends about HIV prevention, in which YMSM support their HIV-negative friends to get tested for HIV at least every six months, reduce their sexual risk behavior, consider using PrEP, and attend an M-group. Informal outreach to YMSM’s friends who are living with HIV, involves encouraging them to take their medications every day, see their healthcare provider at least twice per year, attend an M-group, and attend the Positive Living Group and the Support Network Group.
Project space. The space is a comfortable hang-out or drop-in location that is welcoming to all YMSM. It is a place where YMSM can relax and be themselves, easily obtain condoms and lube, obtain referrals including culturally sensitive HIV testing and treatment sites, and for local mental health (e.g., depression) services. YMSM can also receive materials about how to talk with healthcare providers in order to get their needs met. Posters are on display concerning tips for remembering to take medications every day, to remember not to make assumptions about others’ HIV status, and that the space is a “gossip-free” environment pertaining to others’ HIV status. There is also information about PrEP and PEP and where to obtain them. All such materials need to be created so that they are visually compelling, culturally appropriate, and appropriate for participants’ reading levels.
Project sponsored social events. Project sponsored events are meant to attract diverse YMSM to the project. The events target a range of issues that are important to all YMSM, and they also include content with an explicit focus on issues critical for those living with HIV. For example, weekly discussion groups can sometimes focus on coming out as gay and living with HIV, HIV stigma in the YMSM community, or on dating and relationships when someone is living with HIV. Community forums can focus on issues such as how to support friends living with HIV, spirituality, churches’ acceptance of YMSM in general and those living with HIV in particular, or treatment updates by HIV care providers. Some social events will be exclusively for men living with HIV, whereas other social events target all YMSM.
Outreach materials. Outreach materials distributed at project sponsored events and at community venues contain information about HIV prevention, the importance of engaging in HIV care, how to support friends living with HIV to engage in healthcare, and messages to decrease HIV stigma (e.g., reducing gossip about others’ HIV infection).
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| The Q Austin, Mpowerment Texas |
Three Additional Core Elements for MP+
In addition to the previous core elements, in MP+ there are three new core elements that have been specifically created for YMSM living with HIV.
Positive Living Groups. Since young men living with HIV want to talk with and get support from other men who are also living with HIV, one-time, 3-hour meetings of 8 – 12 men living with HIV were created. The groups are semi-structured and incorporate discussion, games, and fun educational content to help facilitate information sharing and encourage social support. The group addresses literacy about why medications are important to take and the importance of seeing your healthcare provider at least twice a year, feelings about living with HIV and taking medications, how to obtain emotional, informational and practical support about fully engaging in HIV care (including referral and retention in care and adherence to HIV medications), dating and disclosure of HIV status to others, relationships and sex, and how to prepare for and get the most from visits with a medical provider. Confidentiality is stressed.
Support Network Groups. These groups bring together YMSM living with HIV and 1-3 of their close friends or family members for the purpose of building support for men living with HIV. The meetings are 2-hours long and, through a mix of role play and discussion, increase awareness around what it means to be virally suppressed, how to become virally suppressed (adherence to medications), and ways to support the men living with HIV to remain in care.
MP+ Navigator (MPN). When MP+ Coordinators learn that participants who are living with HIV are not actively linked into care, the Coordinators will refer them to the MPN who, along with the Project Coordinator(s), will connect them with HIV treatment facilities and other services and help them develop ways to remind themselves to take their daily medications. MPN is not case management but does provide support, information, and referrals to case managers. MPN closely supports YMSM living with HIV to ensure that they link to and stay in care. Project sponsored activities encourage YMSM throughout the community to support their friends living with HIV to talk with a Coordinator or the MPN so that they receive services that will support them to link to, stay in, or re-engage in HIV healthcare and treatment, and to take their medications.
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