Safe spaces play important role in community-based HIV prevention, research finds

November 16, 2015

CORVALLIS, Ore. - The creation and sustainment of "safe spaces" may play a critical role in community-based HIV prevention efforts by providing social support and reducing environmental barriers for vulnerable populations, a new study from an Oregon State University researcher has found.

Safe spaces often are run by community-based organizations working with vulnerable populations. They can be used to provide social support and services such job and education assistance and health testing and treatment. Such spaces appear to be an important but under-used public health tool for prevention and treatment of HIV, said Jonathan Garcia, lead author of the study and an assistant professor in OSU's College of Public Health and Human Sciences.

"These safe spaces serve as surrogate homes, creating an environment with a brotherhood or family undertone for men who have often been marginalized by their families and communities and do not trust public institutions such as churches, schools or law enforcement agencies," he said. "Often they have no other place to go."

Garcia studies how social experiences influence health, with a focus on developing new public health approaches to address needs of vulnerable populations and communities. His latest research was published recently in the journal PLOS ONE.

Co-authors of the paper are Caroline Parker, Richard G. Parker and Patrick A. Wilson and Jennifer S. Hirsch of Columbia University and Morgan M. Philbin of the HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute. The research was supported by a grant from the National Institute of Mental Health.

For the study, researchers spent nearly a year conducting observations and in-depth interviews with 31 black men who were gay or bisexual, or who may not have identified as such but who had sex with other men. They also interviewed 17 others with knowledge of the men and the safe spaces they frequented in the New York City area.

They focused on black men who have sex with other men because that population is considered particularly vulnerable to HIV, Garcia said. While these men make up just 2 percent of the U.S. population, they accounted for about 75 percent of new HIV infections between 2008 and 2010.

About half of the men interviewed were homeless or were living in unstable housing situations and nearly half were unemployed. About two-thirds of the men had some kind of health insurance, with 17 receiving federal Medicaid.

The researchers found that these men were using safe spaces as places to hang out and connect, but they also served to address vulnerabilities, including exposure to violence; lack of social support; feelings of fear or mistrust against institutions or law enforcement; and limited employment opportunities.

Addressing those issues and providing a safe, community environment provides a better basis for which men are open and amenable to seeking HIV testing and treatment, Garcia said.

"The meaning of safety is different for people who don't feel like they are safe at home, or that the police are on their side," Garcia said. "Safe spaces help create that feeling of security not found elsewhere."

The findings are already being used to help shape a clinical trial that is now under way. Men who are at substantial risk of exposure to HIV are given daily HIV medication even though they have not contracted the disease. The goal of this pre-exposure prophylaxis, or PREP, is to prevent HIV infection from taking hold if the person is exposed. The trial incorporates the use of safe spaces, both in person and in online settings, for the men receiving the treatment, Garcia said.

Safe spaces also could be used in prevention and treatment of other diseases that carry a stigma, including sexually-transmitted infections and Hepatitis C, which is common among intravenous drug users, he said.

One problem facing organizations that operate safe spaces is funding, Garcia said. The safe spaces often are the first thing eliminated when a group or organization experiences a funding shortfall. The rationale is to use funds first on treatment or prevention services.

"Safe spaces are recognized as something important but are more unofficial," he said. But the spaces can play such a critical role in educating and providing health services to the affected men that eliminating the spaces could reduce the effectiveness of health programs, Garcia said.

"If that support is what they are lacking, then providing it is likely to help them continue to seek treatment and services," he said.
-end-


Oregon State University

Related HIV Articles from Brightsurf:

BEAT-HIV Delaney collaboratory issues recommendations measuring persistent HIV reservoirs
Spearheaded by Wistar scientists, top worldwide HIV researchers from the BEAT-HIV Martin Delaney Collaboratory to Cure HIV-1 Infection by Combination Immunotherapy (BEAT-HIV Collaboratory) compiled the first comprehensive set of recommendations on how to best measure the size of persistent HIV reservoirs during cure-directed clinical studies.

The Lancet HIV: Study suggests a second patient has been cured of HIV
A study of the second HIV patient to undergo successful stem cell transplantation from donors with a HIV-resistant gene, finds that there was no active viral infection in the patient's blood 30 months after they stopped anti-retroviral therapy, according to a case report published in The Lancet HIV journal and presented at CROI (Conference on Retroviruses and Opportunistic Infections).

Children with HIV score below HIV-negative peers in cognitive, motor function tests
Children who acquired HIV in utero or during birth or breastfeeding did not perform as well as their peers who do not have HIV on tests measuring cognitive ability, motor function and attention, according to a report published online today in Clinical Infectious Diseases.

Efforts to end the HIV epidemic must not ignore people already living with HIV
Efforts to prevent new HIV transmissions in the US must be accompanied by addressing HIV-associated comorbidities to improve the health of people already living with HIV, NIH experts assert in the third of a series of JAMA commentaries.

The Lancet HIV: Severe anti-LGBT legislations associated with lower testing and awareness of HIV in African countries
This first systematic review to investigate HIV testing, treatment and viral suppression in men who have sex with men in Africa finds that among the most recent studies (conducted after 2011) only half of men have been tested for HIV in the past 12 months.

The Lancet HIV: Tenfold increase in number of adolescents on HIV treatment in South Africa since 2010, but many still untreated
A new study of more than 700,000 one to 19-year olds being treated for HIV infection suggests a ten-fold increase in the number of adolescents aged 15 to 19 receiving HIV treatment in South Africa, according to results published in The Lancet HIV journal.

Starting HIV treatment in ERs may be key to ending HIV spread worldwide
In a follow-up study conducted in South Africa, Johns Hopkins Medicine researchers say they have evidence that hospital emergency departments (EDs) worldwide may be key strategic settings for curbing the spread of HIV infections in hard-to-reach populations if the EDs jump-start treatment and case management as well as diagnosis of the disease.

NIH HIV experts prioritize research to achieve sustained ART-free HIV remission
Achieving sustained remission of HIV without life-long antiretroviral therapy (ART) is a top HIV research priority, according to a new commentary in JAMA by experts at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

The Lancet HIV: PrEP implementation is associated with a rapid decline in new HIV infections
Study from Australia is the first to evaluate a population-level roll-out of pre-exposure prophylaxis (PrEP) in men who have sex with men.

Researchers date 'hibernating' HIV strains, advancing BC's leadership in HIV cure research
Researchers have developed a novel way for dating 'hibernating' HIV strains, in an advancement for HIV cure research.

Read More: HIV News and HIV Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.