New York City HIV Prevention Planning Group (PPG)

New York City HIV Prevention Planning Group (PPG)

General Membership Meeting

Tuesday August 18, 2009, 1:00PM-5:00PM

NYSDOH

90 Church Street, CRA & CRB

New York, NY10013

Attendance

PPG Members Present: Karen Baird,Cinthia Tejada (Alt. for Fay Barrett), Victor Benadava, Michael Camacho, Jennifer Carmona, Anthony Case, Calvin Cleveland, Norman Davis, Ken DeJesus (Community Co-Chair Elect), J. Marshall Evans (Community Co-Chair), Karen Ford (Secretary), Terrance Gardet (Governmental Co-Chair), Christian Grov, Sonia Gonzalez, Jacoby Johnson, Mary Johnson, Katherine Marx, Hilda Mateo, Claudia Molina (Alt), Aman Nakagawa, Donald Powell, Joe Mancino (Alt. for Joel Rivera), Manuel Rivera,Betty Rothbart, Nathaly Rubio-Torio, Audria Russell,Marcella Tillett, Lyndel Joel Urbano, Kim Watson.

PPG Members Absent: Sallie Adams,Nina Aledort,Nurah Amat’ullah, Evans Kwame Asumang, Michelle Bacon,Bimbla Felix, Terry Hamilton, Daphne Hazel, Carla S. Lewis, Rafael Madrid, Dore Mann, Tiffanie Patterson,Lundgren Peters, Raul Plasencia, Dena Quinones, Joel Rivera, Wendy Shotsky, Erika Tullberg.

DOHMH Staff Present: Marilyn John, Linda Battle,Andrea Barkman,Robert Zielony, Kimbirly Mack.

Other Guests Present: Soraya Elcock, Jorge Benitez, John Bonelli, Beryl Koblin, Jessica Adams, Tokes Osubu, Lester Cook, Denise Garanegan, Susan Mabney, Michelle Cummings, Luis Hernandez, Marie Novis, Emma Roberts, Mallory Marcus, DK Calkins, James Lister.

Moment of Reflection

The moment of reflection was led by Norman Davis.

Introduction

All who were present introduced themselves.

Rules of Respectful Engagement

The rules of respectful engagement were reviewed by Ken DeJesus.

Approval of Minutes-April 21, 2009

The minutes from the May 19th meeting were reviewed and accepted.

Review of Open Items List

Item #86: Christian Grov, reporting on behalf of the MSM workgroup stated that Part II of the MSM Workgroup presentation to the full PPG, the MSM research synthesis, will be presented at the November General PPG meeting.

Item #108: Karen Baird reported for IBSE. The committee has finalized the facilitators training and provided training to the Women and Children workgroup. Katherine Marx also contributed that the Adolescent Workgroup received a presentation from Sonia Gonzalez. Kim Watson added that the Transgender Advisory Committee received a presentation by Carla Lewis.

Public Comment

Lester Cook of Dreamweavers Peer Support, Inc. provided public comment. Mr. Cook emphasized the need for transgender individuals to be involved in HIV prevention community planning for representational purposes and to help achieve the goal of enhanced data identification for transgender populations in New York City. Mr. Cook also elaborated on Common Ground Technology suggesting DOHMH get in touch with Office of Minority Health (OHM). He offered his perspective about Common Ground Technology stating that it allows all things related to mental health to be adapted to other things and meet real community needs.

Coordinating Committee Business Report

Blue Document-Letter of Concurrence Draft

J. Marshall Evans announced that the 2008 Letter of Concurrence is being provided so that members can take a look at it. He asked that there be an Adhoc Committee to look at the letter and add to it. If any members have questions or feedback to share they should funnel it to Linda Battle.

September General PPG Meeting

Terrance Gardet reported that September 15th was the original date of the September General PPG meeting but because of delays in the CDC release of the 2010 cooperative agreement guidance, the meeting has to be rescheduled for Tuesday, September 29th. The meeting will probably be at the LGBTCommunity Center. Two Coop review special sessions will be organized to take place on 9/23 and/or 9/24. Mr. Gardet emphasized the importance of PPG members attending one of the two Coop special sessions so that adequate time and attention can be given to their review of the application and responses to their questions. J. Marshall Evans and Terrance Gardet will review the proposed budget at the Coop special sessions.

HIV Prevention Conference

J. Marshall Evans read the names of PPG members who will be attending the National HIV Prevention Conference through the support of the PPG and the names of PPG members and DOHMH staff who will comprise the PPG’s delegation to the UCHAPS meeting. Members will report back on both the conference and UCHAPS meeting.

Finally, Mr. Marshall announced that several members of the PPG will make presentations at the HIV Prevention Conference.

New Business and Members Announcements

Kim Watson made an acknowledgement that in remembering the Stonewall Riots, people remember Marsha P. Johnson and Sybol Rivera. Ms. Watson commented that no one remembers the name of the third person in that riot. Kim Watson further noted that her best female friend, Ms. Majors was actually in the Stonewall Riots and she is not mentioned in much of the literature about the riot. Ms. Majors has a foundation for transgenders in the prison system in San Francisco.

Prevention Policy Pt. II

Jennifer Carmona introduced Soraya Elcock, Vice President of Policy and Governmental Affairs at Harlem United.Ms. Carmona noted that Ms. Elcock’s last presentation to the PPG was in 2008 during which time she provided an update about the state of HIV/AIDS policy in New YorkState and around the county. Jennifer Carmona stated that when she spoke to Soraya, she expressed a preference that the PPG move beyond the conversations that have occurred in the last few years about written informed consent and the Federal ban on syringe exchange. She also expressed an interest in having Ms. Elcock review and discuss the role of community planning with respect to an increased emphasis on other types of interventions such as bio-medical and structural interventions. Soraya offered some guidance to the PPG about these items. The following is a summary of Ms. Elcock’s comments and remarks:

• The prevention field has become really complex, hard to maneuver. Prevention and treatment is not changing well with the epidemic. The field is not processing new things coming into the epidemic. What does HIV prevention look like in 2009 when we have this level of treatment available? A paradigm shift has to be made.
• In the past, prevention was about ILI’s, GLI’s and CLI’s. The CDC introduced “Advancing HIV Prevention”,which focused on prevention with positives. DEBI’s were everywhere. The big problem is that DEBI’s that work cannot be scaled up. It needs to be clear that they are part of an overall bigger approach. HIV will not be ended in this way.
• Pre-exposure prophylaxis (PrEP) is medicine for prevention and treatment. The outcomes have been staggering. Incredible research has occurred over the past five years. High risk groups before they are infected get anti-retroviral medication so that even if they have sex, it lowers the odds of them being infected. There should be a focus on keeping people alive. How will PrEP impact prevention work? It will really challenge how we think of HIV prevention. How do we use an intervention like PrEP? What should prevention, care and treatment look like? What policies don’t make sense anymore?
• In the earlier years when we talked about prevention we were speaking of civil rights. Ageism, sexism, racism, societal ills; how do you marry these? Housing is prevention but you can’t do that for everyone. How do prevention experts balance these elements? The HIV prevention and treatment funds are never going to be enough to end homophobia. If clients get healthy, are alive and empowered they will be there to fight racism, sexism and homophobia. Have a clear position on PrEP, identifying, treating and getting into care because that’s prevention.
• Sometimes advocacy gets the policy and gets the legislation. Use data, prevention facts to drive advocacy and change policy. The big things are status, treatment and PrEP. How do you prevent a disease using biomedical interventions with limited resources. Prevention and treatment people often buck heads. Don’t fight the language, add to it and expand it within the discussion. This doesn’t mean stop doing GLI’s, ILI’s, CLI’s; but do it understanding that those alone are not how we are going to end the epidemic.

The following is a summary of the question/answer period that followed Ms. Elcock’s remarks:

J. Marshall Evans stated that he represented the PPG on a CDC conference call on PrEP. On Sunday in Atlanta UCLA is doing an eight hour crash course on the data surrounding PrEP. J. Marshall Evans will participate in the overview and share with the PPG body a condensed overview. Ms. Elcock emphasized that over the years there has been much discussion about the focus on the medical model of HIV; she reiterated that HIV is a disease, it’s about medical issues, but there are also social supports (i.e.for mental health issues, substance use, etc.) that are necessary. Ms. Elcock noted other questionsthat will have to be discussed; how you identify and ramp-up HIV testing, make sure ancillary and support services are in place, make sure the meds are not sold on the black market, ensure HIV negative persons, really are negative in regard to this technology. It is dangerous for seropositive individuals to receive PrEP. These will be important questions. The question of what role CBO’s will have in PrEP as well as the impact on the PPG in priority setting for populations and interventions are things to consider. In response to a question on how to inform administrators at non-HIV-specific agencies that their help is needed; Ms. Elcock suggested that they understand why their organization has an HIV program. Help them to understand how to integrate HIV. NYCAHN does a good job of this around housing. Ms. Elcock emphasized that in looking at PrEP as a strategy, all populations are being identified for the best way to work with those populations around the strategy. AIDS Vaccine Advocacy Coalition, , , and Community HIV/AIDS Mobilization Project were given as resources to find further information.

MSM Presentation Part I

Donald Powell began the presentation by explaining that three years ago the PPG declared a state of emergency among Black MSM in HIV prevention. The workgroup has tried to pull something together to support and sustain the need for a continued state of emergency. As such, the Coordinating Committee has allowed the workgroup to organize a two part presentation about MSM issues to the full PPG. The presentation today involves some cutting edge research done around black MSM and contextualizing some of their issues. In November the presentation will involve things that are being done locally around interventions, advocacy and next steps.

MSM workgroup member Michael Camacho introduced the first speaker, Beryl Koblin, PhD, who is a Principal Investigator at the Laboratory of Infectious Disease Prevention at the New YorkBloodCenter where she oversees Project Achieve. Project Achieve has two sites, one in Union Square and the other in South Bronx. Project Achieve is connected with the HIV Vaccine Trials Network and the HIV Prevention Trials Network. Recently Project Achieve has completed data gathering for the research study DISH. It was a homegrown intervention in NYC. Dr. Koblin spoke about DISH and an upcoming study called Brothers targeting Black MSM’s in NYC. Salient points made during the presentation are included below. Please refer to the Power Point handout for further details.

• The mission of Project Achieve is to advance the science of HIV epidemiology and prevention and to address these issues in NYC. The research agenda of Project Achieve consists of epidemiologic studies, Preventive HIV Vaccines, staff and community education, Behavioral Interventions.
• Project DISH a behavioral intervention for Black MSM focused on risk reduction strategies in the context of cooking and sharing meals. Group level sexual risk reduction intervention using the Social Cognitive Theory. Intervention participants were Black HIV infected and uninfected MSM.
• Intervention involved five, two-hour group cooking sessions. Attention focused on quick, delicious and healthy low-cost meals, smoothies, and desserts, utilizing inexpensive food preparation tools. Recipes are developed for limited budgets and meals appropriate for family, friends and romantic interests. Interactions around food are semi-structured and focused on fostering social integration, identity enhancement, improved self-esteem and worth. There will be a 3-month follow-up after the intervention. The intervention will be completed in October 2009.
• Brothers-HIV Prevention Trials Network (HPTN 061): Feasibility Study of a Community-Based, Multi- component HIV prevention intervention for Black MSM in preparation for a community-randomized efficacy trial. Looking at why HIV infection rates are highest among Black MSM’s. Sexual risk behaviors and substance use do not explain the differences in HIV incidence between Black and White MSM. In HIV infected MSM age 15-29 years, 91% of Black, 69% of Latinos and 60% of White were unaware of their HIV status.
• Feasibility study looks at likely causes of the high incidence of HIV among Black MSM and issues that may affect and may protect the Black MSM. Lowering the viral load across a community will lower HIV rates. The feasibility study asks many questions to aid the designing of a Community-level randomization research trial involving 12-30 cities with a minimum of 250 men at each site. A qualitative sub-study will seek to understand the impact and influence of stigma, discrimination and other emergent themes on HIV testing and access to care.

A summary of salient points made during question and answer period is as follows:

Since the research is looking at protective factors, the question was asked,“What are they trying to find?” Dr. Koblin stated that there is a lack of data on protective factors available. They seek to be able to explain this through the findings in the study. Questions were asked about the recruitment of study participants. Dr. Koblin elaborated that they tried to identify men who weren’t diagnosed. They recruited from the community, not necessarily agency-specific based. Emphasis was placed on utilizing how the epidemiology plays out in the City. Dr. Koblin noted that recruitment will always be a challenge and elaborated on the emphasis that has been placed on developing relationships with existing agencies serving the Black MSM community and on nurturing and establishing linkages with members of the community.

MSM Workgroup member Christian Grov introduced the next speaker Jessica Adams-Skinner, MPH, Ed.D of the HIVCenter for Clinical and Behavioral Studies at NYS Psychiatric Institute. Dr. Skinner presented data on Caribbean MSM. Salient points made during the presentation are included below. Please refer to the Power Point handout for further details.

• Dr. Skinner’s research is Exploring the Social Space of English Speaking West Indian Men Who Have Sex with Men in New York City which is a HRSA-funded study that targets HIV + English-speaking Caribbeans. Recruitment challenges were the hidden populations marked by stigma, immigration issues, being undocumented and no access to care.
• The Caribbean region has an HIV prevalence of 2% the highest in the Americas. Thirty and under MSM account for 44% of new HIV diagnosis in NYC up from 31% in 2001. The study was qualitative. Eligibility criteria was 18 years of age and older, migrated to USA, self-identify as West Indian, report having anal sex with a man at least once in past two years. Self-report HIV + status and conversant in English.
• Overview of findings includes stigma and discrimination in the country of origin and how they contribute to, and influence, migration to the USA. Migration to the USA intensifies sexual risk taking because of the sexual liberation and freedom available to Caribbean MSM’s in NYC. In country of origin MSM’s experience severe discrimination, physical violence and harassment.
• Social spaces frequented by Caribbean MSM’s were identified. Emphasis was placed on identifying the activities that took place at the social spaces as well as the sense of community and social support. Emphasis was placed on the sexual behavior that occurred in the spaces. Group sex that involved infrequent or no condom use was common. HIV disclosure was almost non-existent.
• The next steps to come out of the study involve: designing an intervention for West Indian MSM’s specifically. Finding grant funding to implement intervention, community involvement and dissemination of findings.

A summary of salient points made during question and answer period is as follows:

Questions were asked about recruitment and the sample size. Dr. Skinner explained that men were recruited from the social spaces and many of the social spaces were frequented significantly from men from specific countries. The sample population was overwhelmingly Guyanese and Jamaican. A question was asked about the concept of sexual altruism. Dr. Skinner responded that the term was not coined by her and she extracted it from the research literature. The term reflects a person’s sense of knowing their status and not wanting to infect others. Within the study there were conflicting examples regarding sexual altruism. Whereas some men used this approach, others took a more cavalier attitude toward the idea of possibly infecting others. In response to a question about the sample size of twenty, Dr. Skinner explained that it was by design. The sample size was impacted by the time available to carry out the study. It was determined that for each of the five social spaces, input from four men would be sufficient for gathering information.