Transcript Slide 1

A strengths-based risk reduction
intervention for highly vulnerable
urban gay men
Steven P. Kurtz, Ronald D. Stall and Hilary L. Surratt
Nova Southeastern University
Center for Research on Substance Use and Health Disparities
Resilience in American Gay and Bisexual Men:
A New Perspective on HIV Prevention Research and Programs
Fenway Health
•
June 23-24, 2011
•
Boston
This research was supported by DHHS Grant
R01 DA024579 from the
National Institute on Drug Abuse.
The content is solely the responsibility of the
authors and does not necessarily represent the
official views of the National Institute on Drug
Abuse or the National Institutes of Health.
There are no relationships to disclose.
Conceptual Model of
MSM Health Risks
CONCEPTUAL MODEL
OF
MSM HEALTH RISKS
AND
THEORIZED PSYCHOLOGICAL EMPOWERMENT INTERVENTION EFFECTS
Migration
considerations:
Early life
experiences in
a homophobic
environment:
Perceived Costs
Urban Gay
Subcultures:
Cultural alienation:
 Lost social norms
 Family
rejection
 Escapist /
fantastic /
spectacular
 Lost relationships
 Homophobic
 Sense of sexual
violation
 Not fitting
in with
peers
 Competitive
 Depression/anxiety
Perceived Benefits
 Temporary
 Freedom
 Secrecy
 Mental health
 Verbal and
physical
abuse
 Attraction / desire
 Normative drug
use and
hypersexuality
 Reinforced
homophobia
 Shame
 Lost social capital
 Safety
 Friendships
 Limited social
networks and
opportunities
 Self-protective
"attitude"
 STI / HIV infections
 Substance use
 Sensation seeking
P
E
I
N
T
E
R
V
E
N
T
I
O
N
Mediators:
 Increased social
networks
 Increased perceived
control
 Active vs. escape
coping
 Increased social
diagnostic skills
 Reduced anxiety and
depression
Behavioral
Health
Outcomes:
 Reduced
sensation
seeking
 Reduced
sexual risks
 Reduced
substance
use
Psychological empowerment theory
Marc Zimmerman (1995)
Group Intervention
Approach
The 4 group sessions employ a motivational
interviewing approach to emphasize :
 A safe space to talk, building trust;
 Open dialogue across age, ethnic,
serostatus boundaries;
 Critical awareness of others’ behavior
norms, beliefs and motivations
………...
………….
 Increasing sexual and friendship
intimacy
 Accessing broader social networks
 Strengths-based repositioning of the
fast lane scene
 Making life changes; goal setting
 Overcoming barriers
Demographics (N=517)
Age (median; range:18 - 55)
38 years
Education (median)
14 years
Income (median)
$15,000
Race/Ethnicity
Anglo
Hispanic or Latino
African American
Other
HIV+
N
250
133
110
24
%
48.4
25.7
21.3
4.6
241 46.6
Current Substance Use
(Past 90 days)
100%
80%
60%
71.9%
65.8%
53.6%
45.6%
40%
34.4%
25.9% 24.9%
20.5% 18.0%
20%
0%
DSM Abuse: 74.2%
DSM Dependence: 62.3%
29.4%
13.9%
Sexual behaviors
(Past 90 days)
# male anal sex partners
# anal sex times
# times no condom
Sex with women – 12 mos.
Using sex to cope
Means
13
33
23
N
86
397
%
16.6
76.8
Resiliency measures with
variation and change
Measures of Activities / States
Brief COPE:
How often have you been …..
Satisf. w/ relationships:
How satisfied are you with….
Access to Social Capital:
# people I can count on to …
Social Activity:
# times in the past 90 days…
Resiliency measures with
low variation (social acceptability?)
Measures of Attitudes / Opinions
Coping Self Efficacy:
How confident are you ….
Personal Mastery:
Agree/disagree
Resiliency:
Agree/disagree
Social support scales, generally
Limitations:

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substance-using sample
psychological empowerment theory
based
limited social capital measures
there are many other measures
available
what else should we measure?