By Isaiah Webster III, Senior Manager, Health Equity/Prevention
Before there was AIDS, there was GRID or “gay-related immune deficiency.” Given the mystery and hysteria of 1982, GRID seemed like an appropriate moniker for an immune system “plague” that seemed to mostly afflict gay men. However, scientists quickly realized that GRID wasn’t a “gay plague” at all; rather it was a social disease capable of afflicting almost anyone. GRID became known as AIDS, caused by a retrovirus known as HIV – the human immunodeficiency virus.
Whatever the name, HIV/AIDS has always disproportionately impacted certain communities of people. What began as a disease of mostly White gay men is now a disease of many, but especially gay men/MSM of color. Among young Black gay men/MSM, the epidemic is as severe as it ever was among gay men in the 1980s. In 2010, the U.S. Centers for Disease Control and Prevention (CDC) released a landmark study of 21 cities, revealing that 28 percent of Black gay men/MSM were living with HIV. To put that into context, UNAIDS defines an “epidemic” as an HIV prevalence higher than 5 percent in any subpopulation that’s at higher risk of HIV infection.
HIV is no longer a mystery: we know what causes it; we know how to prevent it; and we know how to treat it to maintain a good quality of life. Given this, the current HIV/AIDS epidemic among young gay men/MSM of color is more a plague of health inequity. A plague fueled by stigma, classism and lack of access.
NASTAD is proud to re-release “CONCEPTS: A Health Department Response to the HIV, STD and Virus Hepatitis Epidemics Among Gay Men/MSM in the United States.” Assembled by NASTAD’s Gay Men’s Health Equity Work Group, “CONCEPTS” highlights how state and territorial health departments are addressing the health inequities facing gay men and other men who have sex with men (MSM). The document was designed as a way for health departments to share their efficacious strategies for addressing the needs of gay men of all races and ethnicities.
The Louisiana Department of Health shared the following CONCEPT:
The Louisiana Wellness Center (WC) Project was piloted in 2009 in Monroe, Louisiana. The project’s roots are based on a holistic health model that seeks to meet gay males, bisexual males, and transgender individuals where they are. Since research shows that there are many stigmatic barriers in the overall health of this target population, the project was developed to begin to break through these barriers.
The mission of the Louisiana Wellness Center Project is to actively engage and empower gay and bisexual men and transgender individuals in improving their health and wellness in communities across Louisiana. The project is a community-driven program that aims to decrease HIV/AIDS, STDs, and health disparities among the gay men and transgender communities. STD/HIV Program (SHP) defines “health” as a whole body, holistic concept, including mental/emotional, physical, sexual, and spiritual well-being. The Louisiana STD/HIV Program believes that the health of individuals is linked with the health of the community, and strengthening the gay men and transgender communities across Louisiana is a vital step in improving the health of gay men and transgender individuals.
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Since the implementation of the project in 2009, it has expanded statewide to six locations were risk is more prevalent: Monroe, Lafayette, New Orleans, Baton Rouge, Alexandria and Shreveport.
The three core components of the WCs are the following:
- Clinical Services - These services are aligned with the mission of the Louisiana WC Project. All sites provide free clinical services to community members. Services include HIV, Syphilis, Gonorrhea, and Chlamydia testing (oral, anal, urine), Treatment for Syphilis, Gonorrhea, and Chlamydia, HIV linkage to care, and Mental Health and Substance Abuse Assessments and referrals.
- Community Involvement – Community involvement can come in various ways when looking at the Louisiana WC Project. The cornerstone of this kind of involvement is the Community Advisory Board. This is a requirement for all wellness center locations. The board helps in the overall success of the center by guiding the project and assisting with community building. The advisory board acts as the voice of the community and aides in creating a true community center vibe for the project. It consists of MSM consumers to ensure the Centers are considered welcoming, affirming, and desirable by the target population. Other community involvement requirements consist of volunteers, focus groups, one on one interactions, etc. Implementation of the key pieces above helps to create a sense of ownership for community members.
- Health and Wellness Support Programming – These activities complement the clinical services and may or may not be offered at the physical WC site. These activities include programs addressing the core health and wellness issues of the target populations, as well as additional activities that are desirable to the local community (e.g. yoga, nutrition, movie nights, Pride etc.). The STD/HIV Program finds this to be a crucial part of the project as a whole. As public health employees, we know that factors exist in a community member’s life before the clinical services become a priority. Thus, all support activities are designed to bring the client back to the clinical aspect of the project.
The social marketing strategy for Louisiana’s Wellness Center Project focuses on producing relevant and inclusive messaging and images for the population. All materials ordered and produced contain information pertaining specifically to gay men’s wellness and health resources for gay men in their area. A customized wellness center brochure was created in order to include the most up-to-date health information for gay men in Louisiana. In addition to informational brochures, each wellness center has access to outreach materials including, but not limited to: t-shirts, wristbands, dog-tags and posters. These materials are distributed at outreach events, wellness center social events and large-scale testing events.
With the inclusion of all components above, the Louisiana Wellness Center Project is able to implement a true holistic model that has not existed in our state prior to 2009. For additional information about Louisiana’s Wellness Center Project, contact Chris Daunis.
NASTAD continues to build on the strategies outlined in “CONCEPTS,” and plans an annual re-release of the document to formally include this concept from Louisiana and others from jurisdictions across the country.
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The Gay Men’s Health Equity Work Group meets via conference call six times a year, and serves as a think tank for NASTAD on gay men/MSM. The group is exclusively for health department staff, and provides a forum for networking, sharing lessons learned and overcoming challenges in reaching gay men. If you are interested in joining the work group, please contact Isaiah Webster.
Samuel Burgess, prevention program manager for the Louisiana Office of Public Health – STD/HIV Program, contributed to this post.