The three NIMHD-funded investigators presented their ongoing research and outreach to improve the health of men from racial/ethnic minorities, as well as from gay, bisexual and transgendered communities.
“There’s nothing like an NIH presentation to test your masculinity,” quipped Muñoz-Laboy.
Since the globalization of the 1990s, he said, the world has shifted from industrial to informational. Economic polarization and isolation increase as more people work part-time where “there is no factory; it moved away.” Meanwhile, the rise of the global drug market creates “a workforce traffickers can tap into,” and “racialized hyper-incarceration.”
There are studies that show that loneliness increases risk to cardiac health, but as for HIV exposure, “we don’t know causal relations between social isolation, loneliness and situational risk.” Factors that increase risk occur in clusters; for example, Mexican immigrant men go to places where they can pay for a dance and drink alcohol, which may up their risk. We know that isolation and depression correlate with an increased risk of HIV transmission. Now longitudinal studies are needed, he said.
|The panel at the men’s health disparities workshop included (from l) Rivers, Dr. Scott D. Rhodes, Dr. Miguel Muñoz-Laboy and moderator Terrance Afer-Anderson.
Muñoz-Laboy quipped, “There’s nothing like an NIH presentation to test your masculinity.”
Photos: Ernie Branson
Muñoz-Laboy has also examined drug use and sexual risk behavior among formerly incarcerated Latino men (FILM). Depression is a major problem among FILM, he said, and treating it must be a public health priority.
And to combat the high transmission rate of HIV among bisexual Latino men, Muñoz-Laboy launched the Latino BiCultural Project, a web site to reach out and “demystify” bisexuality in the Hispanic community.
Next, Rivers discussed men’s health with a focus on prostate cancer disparities.
“This is the magnitude,” he said. “Black men have a shorter life-span than anybody else in the U.S.; cancer and heart disease are the leading causes of death. In the context of prostate cancer, black men have the highest incidence rate in the U.S., and are more than twice as likely to die of this disease when compared to men of other racial and ethnic groups.
“The magnitude of these disparities differs across states in the U.S. due to the demographic composition,” he continued. “In some instances, the severity increases three-fold at the state level over the national level.”
To address these disparities, the African-American Men’s Health Forum, a community-based health promotion and health education event, was implemented with a host of community partners in the Tampa Bay area. In 2009, the title of the event was changed to Men’s Health Forum (MHF) in response to outcomes of an assessment conducted by the local health department highlighting the health needs of the burgeoning population of Hispanics and Haitians in the Tampa Bay area. The primary findings of the assessment included a gap in outcomes, awareness and access among men, particularly medically underserved men.
The MHF helps men understand their health status, offers free care and addresses some of the social determinants of health. It features ongoing workshops, language services and screenings, as well as community-based research and data collection. Realizing the need for standardized, evidenced-based prostate cancer information, Rivers is currently testing the impact of an application, PHIN or Personalized Health Information Navigator, delivered via iPads by patient navigators (someone to accompany, teach and advocate).
Rhodes discusses a community-based research partnership he developed to reduce HIV risk among especially vulnerable populations.
“Information is essential to improving informed or shared decision-making in the context of prostate cancer, but information-seeking is not uniform across social groups with lower socioeconomic status,” he said. “These individuals commonly encounter major barriers in seeking prostate cancer information outside the medical encounter.” Future plans include conducting a longitudinal men’s health study to assess the determinants of health care-seeking and utilization and effective strategies for community education.
Wake Forest’s Rhodes studies HIV among Latinos and sexual minorities, “vulnerable populations who are disproportionately affected in the southeastern U.S.,” he said.
In North Carolina, HIV has a 40 percent higher incidence than it does nationally, with the rate among Latino men 3 to 4 times higher than among other men. Many of them may not understand immigration policies, eligibility for services or the U.S. system of health care, Rhodes said.
He developed a community-based research partnership to reduce HIV risk among an especially vulnerable group: immigrant Latino men who have sex with men (MSM). Currently he is testing a revised version of an educational HIV prevention program that he originally developed and is now being disseminated by the CDC, known as HoMBReS. The program is conducted in partnership with local adult Latino soccer teams. One representative from each team is trained as a navigante (health advisor and advocate).
The navigante prepares teammates to approach the health care system and works to counter masculine stoicism (“I’m a man; I can’t ask for help”) with companionship, education, referrals and events such as condom distribution. The program had an 85 percent retention rate and was found to be effective to reduce men’s sexual risk.
Rhodes and his team have adapted the program for Latino gay and bisexual men, MSM and transgendered people. He noted that outreach efforts tend to be successful when they both dovetail with community assets and harness community strengths.
During the discussion, all three speakers called for an overarching approach.
Social determinants of health disparities include: health policy; the construction (or decline) of communities; access to health care and education; poverty; racism; homophobia; acculturation; and even something as basic as the location of grocery stores.
“The problem is that funding is disease-specific,” said Muñoz-Laboy. “Stop this silo mentality. And to lead to sustainable change, we have to deal with the criminal justice system.
“The frustrating part is that we know enough, we know a lot, about what men need to do,” he continued, “but very few people have come up with solutions to mobilize men. Women tend to mobilize for children’s benefit. How do we mobilize men?”
“We need more effectiveness studies that will allow for the examination of social determinants and health outcomes among men,” said Rivers. Via the Men’s Health Forum, “more than 10,000 men have been reached. It’s not true that men don’t care. The tides are turning and we must change our messaging.”
“We need to challenge racism and homophobia,” said Rhodes. “Compounded with the lack of jobs, poverty, lack of education—all are related to many health outcomes.”