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Black men who have sex with men (BMSM) are more affected by HIV than any other group in the United States. In spite of recent incremental progress to reduce the rate of increase in new HIV infections, Black men continue to account for the largest proportion of new HIV diagnoses among MSM. Not only are they disproportionately more likely to be living with HIV, BMSM also may face barriers that make it difficult to engage and remain in HIV care. These can include multiple or intersecting experiences with stigma or bias related to their race, sexual/gender identity, mental health needs, and/or HIV status. Given the ambitious goals of the Ending the HIV Epidemic Initiative, we are exploring innovative ways to reach this traditionally marginalized population to escalate HIV prevention and treatment efforts.
Stigma can have long-lasting impacts on physical and mental health. Once diagnosed with HIV, BMSM are at higher risk for poor health outcomes compared to their peers. Among BMSM with HIV, experiences of discrimination add to their cumulative burden of stress and can increase their vulnerability for depression, substance use, and other mental health issues.[1] People with untreated mental or behavioral health issues are also less likely to be retained in care or be virally suppressed.[2] These findings indicate the potential benefits of integrated clinical and behavioral health services to engage and retain BMSM in HIV care.
The HRSA Ryan White HIV/AIDS Program Part F: Special Projects of National Significance (SPNS) initiative, Implementation of Evidence-Informed Behavioral Health Models to Improve HIV Health Outcomes for Black Men who have Sex with Men, is a three-year initiative that funds eight demonstration sites across the country to implement evidence-informed behavioral health interventions and/or models of care (MOCs) to engage, link, and retain BMSM with HIV in medical care and supportive services. The interventions/MOCs focus on strategies to integrate behavioral health services with HIV care to specifically address the needs of BMSM with HIV and improve their health outcomes. Such interventions include a social marketing campaign, an intensive case management program, recreation-based peer supports, and motivational interviewing. Each site adapted one of the four MOCs to create interventions that integrate HIV clinical and behavioral health care for BMSM with HIV in their respective communities. Further, HRSA SPNS awarded a cooperative agreement to NORC at the University of Chicago to design and implement a culturally-responsive, sequential, transformative, mixed-method study to evaluate the impact of the Initiative for all eight recipients. This multisite evaluation will assess barriers and facilitators to implementation, the impact of HIV clinical and behavioral health outcomes, and the costs of adapting and implementing interventions.
As of October 15, 2020, all recipients completed adaptation of their interventions and are implementing interventions to integrate clinical and behavioral health care for BMSM with HIV. To date, recipients have recruited and enrolled 630 eligible BMSM into the multi-site evaluation.
From baseline data of 304 clients, a preliminary analysis determined 177 (58%) clients received HIV medical care in the 12 months preceding enrollment and 140 (46%) clients were screened for behavioral health needs. Of those screened, 97 (69%) reported they need behavioral health care. However, only 17 (18%) of those who screened positive received a referral to behavioral health care in the previous 12 months and only 9 (53%) clients received this type of care. These findings reveal gaps in care the SPNS BMSM Initiative seeks to address.
These early analyses of baseline data demonstrate clients’ need for behavioral health support. They also highlight an opportunity for the SPNS BMSM Initiative to fill this need by linking clinical and behavioral health/support service care for this vulnerable population. Ongoing data analysis will further explore relationships between clients’ self-reported characteristics, exposure to intervention components and clinically reported health outcomes across the HIV care continuum. Final results will inform implementation of culturally-responsive, patient-centered care to help BMSM with HIV obtain HIV medical care, behavioral health, and support services.
[1] Buttram ME, Kurtz SP, and Surratt HL. Substance Use and Sexual Risk Mediated by Social Support among Black Men. J Community Health. 2013 Feb; 38(1): 62–69.
[2] Zuniga JA. The Role of Depression in Retention in Care for Persons Living with HIV. AIDS Patient Care STDS. 2016 Jan 1: 30(1): 34-38.
