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ATTC Messenger April 2015: The YMSM+LGBT Center of Excellence

April 2015

The Young Men Who Have Sex with Men and Lesbian, Gay, Bisexual, and Transgender Center of Excellence (YMSM + LGBT CoE)

Brandy T. Oeser, MPH
Project Director

Recently, SAMHSA awarded funding under the Addiction Technology Transfer Centers (ATTCs) to establish a Young Men Who Have Sex with Men and Lesbian, Gay, Bisexual, and Transgender Center of Excellence (YMSM+LGBT CoE). The primary goals of this new CoE are to provide:

  • Training and technical assistance to decrease the rate of substance abuse and new HIV infections among racial/ethnic minority YMSM (ages 18-26), and
  • Culturally responsive prevention and treatment services for the LGBT population dealing with co-occurring substance use and mental health disorders.

Please join us for the next YMSM + LGBT CoE Webinar!
April 24, 2015, 2:00 ET
"Not Because our Bodies are Different: A Look at the Causes of LGBT Health Disparities"

The LGBT people experience significant health disparities: why? After a short untangling of LGBT terminology and subpopulations, this webinar will address the diverse factors that impact LGBT health.

Register now

For more information contact Brandy Oeser: [email protected]

A collaborative team from the Pacific Southwest ATTC (PSATTC; HHS Region 9), Northeast and Caribbean ATTC (NeC-ATTC; HHS Region 2), and the National American Indian and Alaska Native ATTC (NAI & AN ATTC) lead CoE activities.
Two curricula are being developed during the first year of the project. The first curriculum will be an extensive revision to the SAMHSA manual, The Provider’s Introduction to Substance Abuse Treatment of Lesbian, Gay, Bisexual and Transgender Individuals (2001). It will help providers to develop skills in delivering culturally responsive prevention and treatment services for the LGBT population, especially those dealing with co-occurring substance use, mental health disorders (COD), and/or physical health disorders. The second curriculum will provide training and technical assistance to service providers designed to help them decrease the rate of substance abuse and new HIV infections among racial/ethnic minority YMSM clients. 

Additionally, a YMSM+LGBT Information Clearinghouse, which will reside on the project website, will be developed. On this website, providers will be able to access additional training curricula, evidence-based practice manuals, research article abstracts, and links to organizations that provide services to the target populations. The goal is for available curricula, services, and information to enhance the CoE’s organizational capacity to provide culturally responsive services.

In January 2015, the CoE launched a series of webinars, which are held on the fourth Friday of every month at 11:00am PT. The first webinar on January 23 featured an introduction to the CoE and plans for the three-year project. It was followed by “Gender & Sexual Orientation: Are they related?” (February 27), and “YMSM: The People Behind the Epidemiological Term” (March 27). All webinars will be archived and available for future reference on the project website.

This month's CoE webinar will be held on April 24, 2015 at 11:00 am PT (12:00 MT, 1:00 CT, 2:00 ET) and is entitled “Not Because Our Bodies Are Different: A Look at the Causes of LGBT Health Disparities."

Importance of Serving the Target Populations

In 2011, YMSM accounted for 77% of new HIV infections among 13-24 year olds in the U.S., and HIV incidence increased by 34% among YMSM from 2006-2009 (CDC, 2013; Prejean et al., 2011). YMSM represent approximately 90% of new HIV cases among 13-19 year olds (CDC, 2014). Sixty-three percent (63%) of HIV-seropositive YMSM in 2009 were African-American. YMSM are disproportionately affected by mental health difficulties, substance use, and risky sexual behaviors (Holloway et al., 2014). Mental illness and substance use among YMSM occurs in the context of population-specific risk factors including poverty, racism, homophobia, limited health insurance, lack of transportation, homelessness, unemployment, limited education, and low health literacy (Traube et al., 2013). YMSM of color often face discrimination from both their racial/ethnic communities (homophobia) and from the LGBT community (racism). These experiences lead to shame, depression, suicide attempts, substance use, and risky sexual behaviors. Homeless or marginally housed YMSM of color are at particular risk for substance use and HIV transmission (Tucker et al., 2012).

Given the very high incidence and prevalence rates of HIV among YMSM of color, there is a pressing public health need to develop and disseminate effective prevention and treatment approaches specific to this population. Primary HIV prevention efforts must be targeted to physical venues, and delivered via electronic means appropriate to racial/ethnic minority YMSM (i.e.; use of social networking websites and applications like Grindr and Scruff). A great need exists to include material specific to YMSM of color in school-based sexual education and HIV prevention efforts. Prevention and treatment interventions must be designed and delivered in the context of the developmental period of adolescence and young adults (e.g., making greater use of peer and social networks). They must also recognize cultural distinctions between subgroups of YMSM in the delivery of all services designed to address mental health, substance use, and HIV.

Numerous recommendations and demonstration projects for increasing the efficacy of HIV prevention/treatment efforts in this population have been published, including the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN); the Healthy Young Men’s Study; the Ryan White SPNS/YMSM of Color Initiative; and the CDC-funded American Psychological Association Healthy Lesbian, Gay, and Bisexual Students Project. However, like many research findings, many have not been widely adopted in healthcare or education settings. In addition, a recently released guide Addressing Stigma (Wilson, 2014) provides concrete recommendations for reducing HIV-related stigma in healthcare settings for Black & Latino MSM. Reviewing, tailoring, and disseminating the recommendations of these projects and reports as best practices would be one of the primary goals of the YMSM+LGBT CoE.

LGBT individuals continue to experience stigma and discriminatory attitudes from both clinicians and the community. In order to guide the selection of effective, culturally responsive services, it is critical that service providers understand the complexity and context of high-risk behaviors for HIV, sexually transmitted diseases (STDs), and hepatitis C (HCV). LGBT individuals describe a variety of reasons for using substances, including to cope prior to coming out, to self-medicate due to family and other social conflicts, to deal with social alienation, to decrease anxiety in social and sexual situations, and/or to reduce sexual inhibitions and enhance sexual experiences. “At the intersection of substance use, addiction, and related conditions that affect the health of LGBT individuals, clinicians are challenged to understand the meanings of behaviors in clinical contexts…this requires cultural competence on the part of the clinician to understand the [ways in which] substances occupy historically and currently in the lives of LGBT clients.” (Hall, Reback, & Shoptaw, In Press).

For more information about the YMSM + LGBT CoE or to register for the April 2015 webinar, please email Brandy Oeser at [email protected].

About the author:
Brandy.pngBrandy Oeser began her career in the field of substance abuse and addiction in 1997. She is currently Project Director of the SAMHSA funded project Young Men Who Have Sex with Men and Lesbian, Gay, Bisexual, and Transgender Center of Excellence (YMSM+LGBT CoE). Ms. Oeser has been with the UCLA Integrated Substance Abuse Programs (UCLA-ISAP) since 2004 and previously worked on the Evaluation, Training, and Technical Assistance (ETTA) for Substance Use Service Activities within the Health Care System project which focuses on both qualitative and quantitative research/evaluation efforts as well as training and technical assistance focused on SUD service delivery and integration activities. She has a background in substance use disorder treatment research, and training and technical assistance activities aimed at educating and further developing the substance use disorder treatment workforce.