MSM Syphilis Prevention: Sexual Identity and Intersecting Social Networks FR Bloom, A Goodfellow, M...
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Transcript of MSM Syphilis Prevention: Sexual Identity and Intersecting Social Networks FR Bloom, A Goodfellow, M...
MSM Syphilis Prevention: Sexual Identity and Intersecting Social
Networks
FR Bloom, A Goodfellow, M Berry, and MM Hayes
Centers for Disease Control and Prevention
BackgroundMSM Syphilis in Los Angeles
• Initial reemergence of MSM syphilis in 2000• Recurrent MSM syphilis increases since 2002
through present• Common characteristics of syphilis increases
– Drug use– HIV positive – LA County Gay Men’s Lock-Up (K-11 Unit)– Transgender MTF
Background IITransgender MTF and STDs in LA
• Social Stress– Stigma and unemployment– Cost of hormone therapy and surgery– Unstable residence patterns– Depression
• Drug use
– Sex trade
Technical Assistance IRapid Ethnographic Assessment
• Conversation and Observation: June 2005– Public Health Investigators (PHI) & Staff (n=10)– K-11 Deputies (n=2)– MSM street intercept (n=12)
» STD mobile testing van
• Revisit: February 2006– Public Health Investigators (PHI) and
STD Program staff (n=12)
Technical Assistance II Syphilis Case Reports: Preliminary
Review• 47 Syphilis cases with history of incarceration
– January – June, 2005– 41 (88%) male cases– 31-38 (66% - 81%) MSM
– 15 (32%) HIV+ MSM
• 5 (11%)Transgender MTF identified by PHI narrative– 2 (4%) Transgender HIV +
• 1 heterosexual-identified male with Transgender partner
Findings IRapid Ethnographic Assessment
• Continuity of Services– LA County Health Department and County Jail– Service referrals (Medical, mental health, social)
• Determining Sexual Identity– PHI observation versus self identity– Biological determinates versus social
determinates
• Chasing Syphilis versus Syphilis prevention– Keeping up with technology– Staffing needs, time, effort, and results
Findings II: Syphilis Case ReportsThe Context of Incarceration
• 83% Drug use and addiction • 15% Homelessness or unstable residence• 68% Anonymous partners• 89% Unprotected penetrative sex• 34% Sexual risk while in jail• 6% Travel out of area• 35% Trading sex for drugs/money• -- Referral issues• -- Casewatch system deficits
» transgender or other MSM identity
Findings IIIIntersecting Social Networks
• MSM as an artificial category with limited use• Diversity and conflict: gender identity for
MSM• K-11 as milieu of intersecting social networks
– Gay-identified men– Bisexual-identified men– Transgender
• Bridging and intersecting networks– Place versus population
Recommendations IGender and Public Health
• Increase public health capacity to capture transgender and other MSM identities– Focus on identity beyond biology in interview– Enhance open-ended approach to data collection
• Increase capacity to capture field note data
• Improve understanding of gap between observer categories and client gender-identity– Gender identity is key to disclosing behaviors
and social networks
Recommendations IIResponse and Implementation
• Casewatch capacity and gender-identity– Transgender and other identities added to
program• Referral list distributed and referrals
increased• One of four open field FTEs filled
– 2 additional PHI temporarily added• Continued collaboration at LA County Jail
– STD testing and treatment
Implications ISyphilis Prevention for Transgender
MTF• Biological Facts versus Social Identities
– Social identities reveal networks– Social identities add context to behaviors– Social contexts
• Venues• Access to care• Communities• Cofactors (homelessness, unemployment)
Implications IISyphilis Prevention Sustainability
• Sustainable prevention for MSM – Based on gender identity
• Cross-cutting or targeted
– Recognition of instability of behavior change– Target social and health services to improve
sustainability• Change in services over change in end-user
– Use of collaboration to improve service access, treatment, and prevention