Name of Innovative Program:
Dorothy Mann Center - The SWEAT Project (Sexuality with Education and Truth)
Dorothy Mann Center - St. Christopher's Hospital for Children/Drexel University College of Medicine
Name of Innovative Program Lead:
Noel Ramirez, MSW, MPH
E-mail Address of Innovative Program Lead:
The issues of mental health, HIV stigma, homophobia and poverty hinder young gay and bisexual men’s (YGBM) engagement in HIV medical care as well as their overall wellbeing. There are challenges in forming relationships and being future focused given prevalent negative messages around same sex relationships. Public health messages designed to prevent HIV further add to fear and isolation. SWEAT (Sexuality with Education and Truth) is a locally developed, psychoeducational group intervention for YGBM to learn the necessary tools to untangle these very issues that interfere with their own productive futures and drive the HIV epidemic. Through a series of workshops and peer engagement sessions, participants learn to manage HIV and improve wellness, cope with HIV stigma, and improve relationships (both interpersonal and with the community). The Dorothy Mann Center ‘s (DMC) successful implementation (described below) of the pilot group in 2011 showed impressive outcomes.
Creativity and Innovation:
Alternatives to SWEAT for are few. Available interventions focus on health education for medical content, but do not address the underlying depression, stigma, and difficulty in negotiating relationships in YGBM. This is partially related to years of federal focus on abstinence before marriage as a public health strategy , butalso poor of understanding of the trauma of being young, minority, gay, and HIV positive. The need to normalize and model living with HIV for YGBM is core to SWEAT. SWEAT’sinnovation lies in its empowerment framework, particularly its focus on the strengths of both the participants and their communities. While being conducted within the walls of medical facilities, they start as small group peer driven and then expand to a larger planning body in the City of Philadelphia. Through socialization with peers, social support and civic engagement the SWEAT Project strengthens both patients and organizations ability to confront HIV stigma.
Typically, development of similar interventions costs $500,000+, but SWEAT has been implemented with minimal funding. Development and pilot support combined resources and staff from other projects within the DMC, which is part of Drexel University College of Medicine (DUCOM) and the support of St. Christopher’s Hospital for Children (SCHC) under the Center for the Urban Child. The Philadelphia Health Department based on pilot data funded SWEAT as the only locally developed intervention in a recent competition with a small grant. SWEAT, while initially only at SCHC has been implemented at the adult partner (DUCOM’s pediatric and adult HIV initiatives combined represent one of the largest medical homes for HIV in Philadelphia). Beyond DUCOM without any additional payments to partners, SWEAT has expanded to two other community and five university hospital sites. SWEAT participants and graduates have been generous in their time and effort in providing ongoing feedback on the program.
The concept of SWEAT originated from repeated patient report of the fear of being discovered when entering the waiting room of an HIV clinic. SWEAT’s curriculum is based on social cognitive and empowerment approaches to re-program this isolation and fear. It also informs medical staff about how present stigma is as a barrier, with SWEAT participation facilitating improved communication. Key to the intervention is provider participation in recruitment of patients, but also in providers co-facilitating one of the sessions, and in ongoing discussions with project staff about progress. Providers give concrete feedback about improvements in attendance at visits and medical markers, but also see and comment on the activation of patients such that patients become partners in their care, reduce risky behaviors, and have improved wellbeing. This contributes to sustainability as providers and patients contribute to ongoing recruitment for new patients and providers and provide evaluation data to increase funding.
SWEAT has completed the pilot year. Existing partners plan to continue to provide SWEAT and new organizations hope to join the project. We have have secured through collaboration with an existing partner, a community location to host a quarterly SWEAT Series in the AIDS Library, to reach out to participants who may not be affiliated with a primary HIV care provider. Through the engagement of the SWEAT Steering Committee, SWEAT has created trainings and provided technical assistance to community based organizations and soon the AIDS Activities Coordinating Office regarding stigma reduction. Curriculum and presentations for both service providers and patients have been standardized through a rigorous process evaluation. When the evaluation is completed, the project will be submitted to a peer reviewed journal and a tool kit developed such that it can be delivered in any program serving HIV positive YGBM in the US.
The SWEAT project has serviced seven different HIV care sites and initiated three different Stigma reduction workshops in community based organizations in Philadelphia. The SWEAT Project has served approximately 55 participants and saw increased engagement in medical care (attendance in medical appointments) among its participants. Data is under analysis from psychological instruments delivered pre- and post- the intervention to participants as well as chart reviews for medical outcomes. The SWEAT project continues to grow in size and depth. We have standardized our training for student interns in the fields of social work and public health and have formed an Ad-HOC sub-committee of the Ryan White Planning Council in partnership with the Office of HIV planning, a critical coalition in shaping policy on HIV practices affecting the lives of YGBM in the greater Philadelphia area.