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Service Projects
Adopting an Evidence-based Motivation Interviewing Intervention for Field-based Application with Substance-using MSM
| Principal Investigator: | Cathy J. Reback, Ph.D. |
| Program Coordinator: | Dahlia Ferlito |
| Funded by: | Los Angeles County, Department of Public Health, Office of AIDS Programs and Policy |
| Contract Number: | PH-001039 |
| and | |
| Funded by: | UCLA Center for HIV Identification, Prevention and Treatment Services |
| Grant Number: | 5P30MH58107 |
| Total Project Period: | 4/11 – 1/13 |
Researchers have called for HIV prevention interventions that occur in real-world settings where risk behaviors occur. The field-based motivational interviewing (MI) project targets high-risk substance-using gay, bisexual, and other MSM, in the field such as cruising areas of parks, street corners, bars, bathhouses, and sex clubs. The purpose of this pilot program is to assess the feasibility and utility of a field-based MI intervention aimed at reducing HIV acquisition and transmission among high-risk, out-of-treatment, substance-using, MSM. Grounded in the Transtheoretical (i.e., “Stages of Change”) model (Prochaska & DiClemente, 1984), Motivational Interviewing (MI) (Miller & Rollnick, 2002), participants will receive a client-centered, semi-directive counseling session. The field-based MI session will focus on building rapport, patterns of substance use, the role of substance use in one’s lifestyle, patterns of sexual risk behaviors, the role of sexual risk behaviors in one’s lifestyle, identifying potential change behaviors, assessing motivation to change substance use and sexual risk behaviors, enhancing motivation to change behavior, planning and developing a change plan. A 90-day follow-up assessment evaluates change or movement toward behavior change in areas identified during the MI sessions. Additional referrals, resources and linkages are offered.
A.S.K. (Assisting with Services and Knowledge)
| Principal Investigator: | Cathy J. Reback, Ph.D. |
| Program Coordinator: | Dahlia Ferlito |
| Funded by: | Los Angeles County, Department of Public Health, Office of AIDS Programs and Policy |
| Contract Number: | PH-001053 |
| Total Project Period: | 10/1/09 – 12/31/12 |
The A.S.K. Program provides culturally appropriate, HIV prevention case management (PCM) services that combine drug and sexual risk reduction. The A.S.K. Program recruits high-risk men who have sex with men (MSM) and male-to-female (MTF) transgender women from The G.U.Y.S. Program and The TransAction Program. PCM is an evidenced-based intervention that was originally designed to target HIV-seropositive individuals. However, this intervention has also been beneficial to those who belong to communities with high HIV seroprevalence rates, are at particularly high risk and/or are underserved by less intensive prevention interventions. PCM is a tool that combines the intensive, individualized and well-rounded approach of individual case management, with the specific goal of reducing risky behaviors related to the transmission or acquisition of HIV. PCM, based on a client-centered philosophy, works to change those behaviors that put a participant at increased risk for HIV transmission and acquisition, focusing particularly on those participants that present with multiple and complex risk behaviors, and who have been unable to initiate or sustain changes in those behaviors with traditional prevention interventions. PCM focuses specifically on those services that are related to or influence HIV risk behaviors. The A.S.K. Program assesses HIV risk behaviors, other physical and mental health needs, as well as psychosocial needs. The A.S.K. Program provides multiple, one-on-one counseling sessions to help the participant assess their own personal risk, and create an individualized plan to initiate and maintain behavior change. By understanding the vast and complex factors that can impact HIV risk behaviors, the prevention case manager works with the participant to choose realistic and attainable behavior change goals.
Friends Getting Off
| Principal Investigator: | Cathy J. Reback, Ph.D. |
| Program Coordinator: | Dahlia Ferlito |
| Funded by: | Los Angeles County, Department of Public Health, Office of AIDS Programs and Policy |
| Contract Number: | PH-001039 |
| Total Project Period: | 10/1/09 – 12/31/12 |
| and | |
| Funded by: | City of West Hollywood |
| Contract Number: | 5364 |
| Total Project Period: | 10/1/09 – 9/30/13 |
Methamphetamine use is significantly associated with HIV infection among gay, bisexual and MSM populations, predominantly through high-risk sexual behaviors that are facilitated by use of the drug. Despite a decade-long trend of declining sero-conversions among MSM, this population continues to be at the core of the AIDS epidemic. In the last decade, researchers have been credited with developing, testing, and refining a number of noteworthy HIV-prevention interventions as well as substance abuse treatment interventions. Community programs have been encouraged to implement or adopt empirically validated interventions; however, disseminating these interventions into non-research settings has been challenging. This HIV prevention program transfers and implements a methamphetamine abuse treatment/HIV risk reduction intervention into a community setting. The intervention consists of an 8-week, 24 session gay-specific cognitive behavioral therapy (GCBT) intervention (“Getting Off: A Behavioral Treatment Intervention for Gay and Bisexual Male Methamphetamine Users” authored by Drs. Steve Shoptaw and Cathy J. Reback, in collaboration with colleagues, available for download at www.friendscommunitycenter.org), combined with a low cost contingency management (CM) behavioral intervention. The CM intervention involves providing vouchers redeemable for goods or services that promote a healthy methamphetamine-free lifestyle in exchange for urine samples that are methamphetamine metabolite-free. Phase I, weeks one through eight, couples the evidenced-based, manual-driven, GCBT intervention (i.e., “Getting Off” manual) with a CM intervention. Phase II, weeks nine and ongoing, consists of open-ended, support groups. Assessments are conducted at baseline and 3-months post admission.
Also see www.friendslabrea.org
Human Immunodeficiency Virus (HIV) Prevention Projections for Community-based Organization (TranSafety Counts)
| Principal Investigator: | Cathy J. Reback, Ph.D. |
| Program Coordinator: | Kimberly Kisler, M.P.H. |
| Funded by: | Centers for Disease Control and Prevention |
| Contract Number: | PS002439 |
| Total Project Period: | 8/10 – 6/15 |
Transgender women and substance-using MSM have a disproportionately high risk of HIV and viral hepatitis through drug use, sexual risk behaviors and, for transgender women, hormone misuse. Several co-factors contribute to HIV transmission risks among transgender women and substance-using MSM, including exchange sex, poverty, homelessness, incarceration, mental health issues, unemployment, STIs, stigma, homophobia and transphobia, racism, immigration status, language barriers, low educational attainment, violence and sexual assault. These co-factors increase HIV/hepatitis risks by diminishing their options for health-promoting behaviors. The TranSafety Counts program has adapted the evidence-based intervention (EBI) Safety Counts for high-risk transgender women in conjunction with Comprehensive Risk Counseling Services (CRCS) and Counseling, Testing and Referral (CTR) services to both transgender women and substance-using MSM. The TranSafety Counts program works with transgender women to reduce their risk of getting infected with or transmitting HIV and/or hepatitis. The program offers both one-on-one and group sessions in a warm and supportive setting. In the groups, participants learn about their risk of getting infected and/or transmitting HIV and hepatitis. Participants learn ways to protected themselves and the people they care about. TranSafety Counts offers two group sessions, one-on-one counseling, and a monthly social event. The objectives of the program are to: 1) decrease the acquisition and transmission of HIV and viral hepatitis; 2) increase the use of EBIs for HIV prevention; 3) increase outreach and education efforts for persons at high risk of acquiring or transmitting HIV and viral hepatitis; and 4) increase linkage to care, treatment, prevention, and other supportive services for persons living with HIV and persons at high risk of acquiring or transmitting HIV and viral hepatitis.
Social Network HIV Counseling and Testing Program
| Principal Investigator: | Cathy J. Reback, Ph.D. |
| Program Coordinator: | Dahlia Ferlito |
| Funded by: | Los Angeles County, Department of Public Health, Office of AIDS Programs and Policy |
| Contract Number: | PH-000831 |
| Total Project Period: | 10/10 – 12/12 |
The Social Network HIV Counseling and Texting (HCT) program utilizes a social networks testing methodology, specifically designed to work with HIV infected and high-risk gay and bisexual men and transgender women. HIV infected or high-risk negative participants who either come to the Friends Community Center site for services or are contacted through street outreach and meet eligibility are invited to serve as recruiters. The engagement of new recruiters is an active and ongoing part of the program. Potential recruiters attend a group orientation, which explains the social network methodology and informs potential recruiters that they will be requested to recruit individuals from their social, sexual or drug-using networks whom they believe to be at high-risk of HIV infection. Following the training period, the recruiter begins to locate network associates to be referred to our testing site. Confirmatory HIV tests are also available at the Friends Community Center site. Participants (both those who test HIV negative and positive) are then linked to appropriate medical, social, psychological, CRCS and other needed services. Network associates who then wish to become recruiters are assessed for eligibility and appropriateness.
The G.U.Y.S. (Guys Understanding Your Situation) Program
| Principal Investigator: | Cathy J. Reback, Ph.D. |
| Program Coordinator: | Dahlia Ferlito |
| Funded by: | Los Angeles County, Department of Public Health, Office of AIDS Programs and Policy |
| Contract Number: | PH-001039 |
| Total Project Period: | 10/1/09 – 12/31/12 |
The G.U.Y.S. Program offers a multi-tier health education/risk reduction (HE/RR) intervention – utilizing both individual and group-level interventions – designed to reduce high-risk sexual and drug behaviors among homeless, substance-using men who have sex with men (MSM) and men who have sex with men and women (MSM/W). Most specifically the intervention targets sexual risk behaviors that are most likely to occur while using methamphetamine, particularly unprotected anal intercourse, as well as exchange sex risks and injection drug risks. The program consists of a comprehensive, culturally appropriate, continuum of services that includes outreach, individual-level interventions (ILI), and group-level interventions (GLI). Follow-up ILI assessments are conducted at 30, 60 and 90 days. Face-to-face street outreach is conducted in identified high-risk areas of Hollywood and West Hollywood and in the natural settings where homeless, substance-using MSM and MSM/W congregate. The program has successfully worked with MSM and MSM/W in highly charged sexual arenas and developed non-invasive outreach and intervention strategies for these venues, which vary based on the safety and atmosphere of each public or commercial sex environment. The GLI component of the intervention serves to increase knowledge and awareness of HIV risk behaviors, increase social support and self-esteem, and develop skills to decrease HIV risk behaviors. The GLI – working concomitantly with the outreach encounters and ILI – motivate ongoing and maintained HIV risk reductions and gear participants’ towards HIV testing to identify their HIV status and, finally, develop skills for disclosing HIV status.
TransAction
| Principal Investigator: | Cathy J. Reback, Ph.D. |
| Program Coordinator: | Dahlia Ferlito |
| Funded by: | Los Angeles County, Department of Public Health, Office of AIDS Programs and Policy |
| Contract Number: | PH-001039 |
| Total Project Period: | 10/1/09 – 12/31/12 |
Many male-to-female transgender women are at high-risk of HIV infection as a result of several socio-cultural conditions, such as low income, high unemployment, lower levels of education, and unstable housing. Economic necessity, as a result of severe unemployment and housing discrimination, results in a reliance on sex work to secure food, shelter, and money. The TransAction Program provides culturally appropriate, evidence-based HIV prevention services that address both individual and socio-cultural risk factors. The program offers a multi-tier health education and risk reduction intervention – utilizing both individual and group-level interventions – designed to reduce high-risk sexual and drug behaviors among transgender women. Most specifically the interventions will target risk behaviors that are specific to the socio-cultural circumstances of high-risk transgenders, particularly exchange sex, hormone misuse, injection and non-injection drug risks. The program consists of a comprehensive, culturally appropriate, continuum of services that includes outreach encounters, individual-level interventions (ILI), skills building group-level interventions (GLI)s and support GLIs. Follow-up ILI assessments will be conducted at 30, 60 and 90 days. Face-to-face street outreach is conducted in identified high-risk areas of Hollywood and West Hollywood and in the natural settings where high-risk transgender women congregate. The skills building GLI component of the intervention serves to increase knowledge and awareness of HIV risk behaviors and develop skills to decrease HIV risk behaviors. Concurrently, the support GLI component of the intervention serves to increase social support and self-esteem. Both the skills building GLI and support GLI – working concomitantly with the outreach encounters and ILI – motivate ongoing and maintained HIV risk reductions and gear participants’ towards HIV testing to identify their HIV status and, finally, develop skills for disclosing HIV status.
WeHo Streets
| Principal Investigator: | Cathy J. Reback, Ph.D. |
| Program Coordinator: | Dahlia Ferlito |
| Funded by: | City of West Hollywood |
| Contract Number: | 5363 |
| Total Project Period: | 10/1/10 – 9/30/13 |
The goals of the WeHo Streets service program is to reduce the risk of HIV acquisition or transmission among gay and bisexual males and male-to-female (MTF) transgender women who are substance users and sex workers, and to improve access to HIV-related services and other health care needs in the City of West Hollywood. These goals are being met through the provision of outreach contacts, new and unduplicated in-depth encounters, repeat in-depth encounters, and the distribution of risk reduction supplies. Non-invasive outreach is conducted on the streets in identified high-risk areas of West Hollywood where the target populations work and congregate such as street corners, bars, mini markets, fast food stands, and parks. Outreach workers maintain continuity and consistency in the time and location of their fieldwork, which encourages ongoing and sustained interventions within the natural setting.