Solutions for MSM
In addition to addressing the increased risk of blacks and Hispanics, the high rate of transmission through MSM, 41%, in Erie County must be managed. Although two current AIDS clinics offer counseling for gay and bisexual men with AIDS, the clinics can promote increased attendance through advertising on local television channels, radio, and billboards that are located in the downtown area. The AIDS clinics can also offer seminars for MSM, as a 2002 study by Rosser revealed an increase in condom use subsequent to 2 day human sexuality seminars. In this study, men attended an 18 hour seminar “designed to help participants clarify issues critical in their sexuality and to promote safer sex,” which included homosexual identity formation, comprehensive sexual health education to address challenges for MSM, research on cofactors of unsafe sex for MSM, and sexual decision making. In comparison to a control group that viewed a 3 hour session of 6 HIV prevention videos, men who attended the seminar evidenced an 8% increase in condom use for anal intercourse at a 12-month follow up, while the control group reported a 29% decrease in condom use. In addition, the seminar group displayed no change in unsafe sexual behaviors, defined as anal intercourse without a condom outside of monogamy, while the control group demonstrated approximately a 10% increase in unsafe sex. This study reveals that a “sexual health approach to long-term HIV risk reduction” is promising. Furthermore, this study is applicable to Erie County because it constituted men 60% of whom earned greater than $20,000 dollars per year. 39 out of 44 zipcodes in Erie County possess a median annual income greater than $20,000. The AIDS clinics in Buffalo can attempt to replicate the increase in condom use following seminars by holding MSM seminars that comprise large-group “multimedia presentations,” “panels,” “behavioral modeling,” and “small-group discussions,” facilitated by “MSM-identified health professionals,” as was done in this study. To address the high-risk population of MSM, AIDS clinics in Erie County should utilize “comprehensive sexuality education presented from a same-sex sensitive and normative perspective” and a “contextual approach to sexual health promotion” (Rosser 2002). Elford and Hart also expand on the benefits of group-level intervention, which possess the ability to “target men at highest risk,” including HIV negative men who engage in risky sexual behavior and also HIV positive individuals undergoing treatment (Elford and Hart 2003). Elford and Hart also report on studies which revealed sufficient evidence that cognitive behavioral therapy with a focus on risk decrease, sexual negotiation, and communication skills are effective. Similarly, community-level interventions provided significant evidence of effectiveness in influencing the sexual behaviors of MSM (Elford and Hart 2003). An additional study comprised of 6 group level and 3 community level interventions displays a 26% decrease in men reporting unprotected anal intercourse as compared to a control group (Elford and Hart 2003). AIDS clinics in Erie County must comprise small group therapy sessions as well as large group discussions comprised of a community-like MSM setting in order to decrease sexual risk. Large and small scale interventions possess a twofold advantage: they educate men about HIV/AIDS and provide a comfortable environment in which to discuss behavioral and emotional issues, such as sexual expression and responsibility. However, group level interventions and cognitive-behavioral work alone does not suffice for reducing the risk faced by MSM; randomized control trials must be conducted in Erie County in order to assess the effectiveness of behavioral interventions and the ability for experiments in one area to be reproduced in another. AIDS clinics can offer financial incentives for men to participate in experimental studies and conduct the studies at the AIDS clinics, therefore possibly both providing men with AIDS knowledge and encouraging them to return to the clinic after perceiving the social and emotional benefits.
Suggestions
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