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Community-Based HIV Prevention Interventions that Combat Anti-Gay Stigma for Men Who Have Sex with Men and for Transgender Women, Sean Cahill, Robert Valadéz, and Sabina Ibarrola, Journal of Public Health Policy (2012)
Research and Journal Articles
This article identifies the specific components of community-level and structural-level HIV prevention interventions targeting men who have sex with men that have proven effective in reducing homophobia and affirming the healthy formation of gay and transgender identities. These interventions include school-based interventions, community-based social marketing campaigns, community connectedness and social support interventions targeted at older gay men, and interventions addressing vulnerability and HIV prevention among transgender women. The CDC defines Community-level interventions (CLIs) re defined by the CDC as interventions "intended to reduce the HIV risk of an entire community" and structural-level interventions (SLIs) are those that "address barriers beyond the individual . . . designed to address external factors that impact personal risk for HIV."
The authors reviewed a number of of domestic and international interventions in both national and institutional settings. While a number of CLIs were effective in increasing condom use, reducing STI infections and reducing sexual risk behaviors, most focused only on heterosexuals. The authors cite gay-affirming school-based interventions, such as Gay Straight Alliances, non-discrimination policies, and anti-bullying curricula, as effective means to help young people affirm their gay identity and reduce HIV risk behaviors. Social marketing campaigns premised on strength-based rather than fear-based messaging have been similarly effective. A community connectedness intervention targeting older gay and bisexual men yielded positive results, with participants reporting a significant decrease in depressive symptoms and condom use self-efficacy. The authors briefly mention a 2008 campaign in New York City addressing transgender women's access to health care, homeless shelters, employment, and self-advocacy. Until 2011, the CDC had included HIV rates among transgender women within the men who have sex with men category; now that national data on HIV and transgender women is emerging, the need for culturally competent, effective HIV prevention interventions for this population is more apparent.
The authors conclude by recommending that health departments and other institutions design and implement HIV prevention interventions premised on anti-gay bias as a public heath threat. LGBT-affirming CLIs and SLIs – such as those the authors describe – should be prioritized in order to reach these underserved populations.