HERE AS I AM A Listening Initiative with Latinx Gay and Bisexual Men Affected by HIV EN ESPAÑOL, HAGA CLIC AQUÍ HERE AS I AM // 1 The project is a key element of ViiV Healthcare’s Positive Study Implementation, Analysis and Action for Latinx Men initiative that supports Latinx-led Writing by TCC Group solutions, safe spaces and trusted networks for Latinx Key Contributions ViiV Healthcare, Memria, gay, bisexual and trans men to mobilize communities MPact Global Action for Gay Men’s Health and engage men in care. We would like to thank all and Rights and the Latino Commission on the men who opened their lives to generously share AIDS their stories. We also thank our community advisors Photographs by Christopher Gregory-Rivera who guided the design, collected data and stories and interpreted the key findings, many of whom are named Report design by Tania Lili Santamaría & at the end of this report. Gabrielle Merite TABLE OF CONTENTS 4 INTRODUCTION 8 METHODOLOGY 12 FINDINGS 14 Family and community are central to men’s lives and identities, shaping their health and wellness for better or worse. 19 Interruptions in care happen for many reasons beyond men’s control. Anti-immigrant sentiment and anti- 22 immigrant laws have a powerful effect on men’s health. 24 Men want diverse and responsive care that reflects their needs, identity and language. Resilience is activated through networks 28 and services by and for Latinx men, especially youth. 30 CONCLUSION 35 ACKNOWLEDGMENTS HERE AS I AM // 3 INTRODUCTION mid the dynamic forces of family, religion, culture, A sex, migration, economics, addiction and an increasingly hostile political environment, Latinx communities are experiencing a growing health crisis. HIV, AIDS and the fear and stigma that go with them directly impact more than 195,000 Hispanic/Latino men in the U.S. and its territories, including Puerto Rico.i While overall HIV diagnoses have decreased or plateaued in recent years, there have been trends of increasing diagnoses among Hispanic/Latino gay and bisexual men.ii The standard of care is not benefiting everyone equally.iii 4 introduction // HERE AS I AM Latinx community leaders and advocates are sounding the alarm, 1 Throughout this report, we use the term Latinx unless we calling for more community-led solutions that prioritize the specific are citing a data source, in which needs and concerns of Latinx men. In a resounding response, case we use the term from the original source. networks of Latinx-led organizations and communities are mobilizing Latinx is a gender to bring a new energy to programs and policies – with Latinx gay, neutral descriptor of the diverse bisexual, queer and trans men at the center. community of people of Latin American cultural or ethnic identity, including Latinx communities in the U.S. face many of the same challenges people who identify as Latino, Latina, Hispanic, Chicanx, as other communities of color, including poverty, poor access Xicanx, Latin@, Latine, or to education, poor housing and unreliable or unsafe public specific nationalities and indigenous groups that have transportation, all of which impact health outcomes.iv Local health called Latin America home in past or current generations. planning bodies often insufficiently engage Latinx men and fail to The term was first coined by prioritize modern HIV prevention approaches, such as pre-exposure Latinx LGBTQ communities. prophylaxis (PrEP).v Many HIV prevention and care resources are not available in Spanish. On top of this, anti-immigrant laws, ICE raids and changes to the public charge law2 spread fear and insecurity that keep Latinx communities from utilizing life-saving services including healthcare. When they do attempt to access care, many 2 See page 23 for more information about the public charge law report experiencing fear, discrimination and rejection from service and clinics. At the personal level, this results in Hispanics being among the least likely groups to have health insurance and be in care.vi Latinx1 community leaders and advocates are sounding the alarm, calling for more community- led solutions that prioritize the specific needs and concerns of Latinx men. Our Listening Initiative was designed to illuminate and inform programs and policies that help address the needs of Latinx men in the U.S. and Puerto Rico. We examined how social, political and economic forces affect the health and wellbeing of men, including their ability to access preventive care and HIV treatment. To learn from men’s experiences overcoming these forces and to tell the stories behind the statistics, we looked at men’s daily lives and the social networks that help fuel and sustain their resilience. Through iterative, community-guided listening, we heard stories of how men are confronting internal and external challenges by holding up a mirror to their own lives, building strength and resilience and striving to create communities that help them feel whole and sustain them when they falter or feel vulnerable. From these stories, ViiV Healthcare is investing in community responses for Latinx gay, bisexual and trans men. HERE AS I AM // introduction 5 Key HIV data an estimated nearly about 186,900 80% 1 IN 3 Hispanic/Latino gay and of new diagnoses Hispanic/Latino gay bisexual men are living among Hispanics/ and bisexual men were with HIV in the U.S. Latinos were among not virally suppressed (2018)vii gay and bisexual men (2016)viii (2018)ix 6 introduction // HERE AS I AM nearly 7,996 2 OUT OF 3 1 IN 5 Hispanic/Latino gay Hispanic/Latino gay newly diagnosed and bisexual men newly and bisexual men were Hispanic/Latino gay diagnosed were aged newly diagnosed with and bisexual men were 13-34 (2018)xi HIV (2018)x diagnosed late, meaning with HIV and AIDS concurrently (2018)xii HERE AS I AM // introduction 7 METHODOLOGY iiV Healthcare’s approach centers listening V and elevating community voices to inform and inspire its community giving initiatives. For this work, we employed a two-pronged listening approach to better understand what helps Latinx men living with or affected by HIV achieve positive health outcomes. This included a six-month collaborative, community-based research study (“Mi Vida”) with the Latino Commission on AIDS and a 10-month Listening Initiative in eleven cities across the U.S. and Puerto Rico. 8 methodology // HERE AS I AM At the core of the Listening Initiative were group discussions, 6 Months interviews, observations, story collection and input from Latinx Research Study gay, bisexual and trans men, as well as advocates and service Mi Vida providers. Staff from local community organizations and national experts served as advisors to help design and implement an 10 Months adaptive, iterative listening approach, including selection of a diverse Listening Tour range of cities for listening activities. Advisors helped generate Listening Sessions key areas of inquiry to better illuminate how to support men and their communities in addressing the HIV epidemic. Community captains were selected in six cities across the U.S. and Puerto Rico Organization Meetings to recruit participants, tailor discussion activities and questions and facilitate listening sessions. Captains met each month to discuss lessons learned and share preliminary themes from the sessions. Storytelling Throughout the Listening Initiative, findings from theMi Vida study Archival were intentionally injected into the research and analysis process to create a synergized understanding of men’s lives and experiences. Community Through these combined methods, we heard from over 760 Mapping Latinx gay, bisexual and trans men. Once the data was collected, community captains and advisors reconvened to help interpret the findings and then group ideas, concepts or elements into categories or themes. This approach was informed by grounded theory, which provides a framework to develop categories of analysis based on the patterns in the data and through the voices of the men themselves.xiii Listening Initiatives Cities New York Chicago Los Angeles Riverside Houston Eagle Pass Miami McAllen Harlingen Puerto Rico San uan Mayagez HERE AS I AM // methodology 9 TCC Group served as the external facilitators of this community-guided exploration and the authors of this LISTENING INITIATIVE report. Additionally, we engaged organizational partners that infused specific ACTIVITIES methodologies or perspectives into the process: MPact Global Action for Gay Men’s • Listening Sessions Health and Rights, with expertise in global Local community advisors gathered groups advocacy research with Latinx gay and of 8-25 Latinx gay, bisexual and trans bisexual men, provided guidance in tool men for 2-3 hours to prompt communal design and methodology, attended each discussions. To encourage engagement listening session and drafted advocacy- and standardize areas of inquiry across focused findings reports; Memria, a cities, community advisors helped develop social enterprise specializing in audio a selection of engagement activities to story collection, provided storytelling customize for local sessions. Sessions were held in Spanish, English or a mix based on methodology, collection and analysis in attendee preference. a multi-lingual context; and the Latino Commission on AIDS helped integrate the Mi Vida Study findings into the Listening • Community Mapping Initiative analysis. External facilitators and community advisors conducted systematic It is important to acknowledge that all observation and documentation of the study designs have limitations.