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HIV infection among Somalis is increasing in Minnesota. Many Somalis living in Minnesota do not know they are infected and are not getting the medical treatment they need.

In 2009 the University of Minnesota and Midwest Community Development, Inc. launched a project to explore HIV risk and sexual behaviors in Somali women titled "Somali Women's Initiative for Sexual Health (SWISH)." On April 13, 2013, researchers shared their study results with the community.

This study is the first to examine HIV-related knowledge, attitudes, and behaviors of Somali women with the ultimate goal of meeting the critical need to reduce HIV and STD transmission among African-born Americans in Minnesota (and the US) as African-born Americans have the highest HIV/AIDS rates of any ethnic group. Participants were recruited through personal contacts as well as from Somali gathering places. Researchers interviewed 30 Somali women aged 18-40 from the Twin Cities area. Interviews were conducted in English (8) or Somali (22) by the project's bilingual Somali staff.

Key findings of the study include:

•    HIV testing was done at high rates, primarily due to immigration requirements. It is unknown how that may differ for those who were born in US.

•    Condoms are used, primarily for pregnancy prevention rather than disease prevention.  This may be due to a perceived low risk for disease.

•    Despite frequent mentions of prohibitions of many sexual behaviors, women also reported an encouragement within their religious tradition towards sexual pleasure within marriage.

•    Women often spoke of a culture of privacy in which discussions of sexuality are saved for one's spouse.

•    Vaginal intercourse seen as the only permissible form of sexual expression between spouses.

•    The more severe circumcision correlated with reported vaginal pain with intercourse.

•    This population reports a higher rate of pain with vaginal intercourse than the average US population (40% vs. 13%).

•    Generally, women had negative attitudes towards circumcision and would not choose to circumcise their daughters, despite high rates of personal circumcision.

The principal investigator of SWISH, Bean Robinson, PhD, said, "For this project, it was essential that we had strong, engaged community partners. Due to language barriers, we were challenged to develop interview questions that made sense and really got to the heart of what we were asking. For example, there is no Somali word for female or male 'orgasm' and our attempt at a description of an orgasm ended up being 59 words long and few participants understood what we were asking. We were not able to use that data."

The community presentation event was part of the Community Dialogue Series co-hosted by the University of Minnesota's Program in Health Disparities Research and the Center for Health Equity. The research project was funded by the Program in Health Disparities Research, the University's IDEA Multicultural Research Award, and the UCare Fund. The information gathered during this pilot study will be used to secure a larger grant to further study the knowledge, attitudes, and behaviors related to HIV/STD transmission and prevention within the Somali community. Ultimately the group will translate this knowledge to develop interventions for Somali women.

The research team included Bean Robinson, PhD, principal-investigator; Amira Ahmed, BA, co-investigator, founder and executive director at Midwest Community Development Inc.; Jennifer Connor, PhD, co-investigator, St. Cloud State University; Shanda Hunt, BA, project coordinator; Fatah Ahmed, BA, interviewer and recruiter; Amanda Ciesinski, MS, volunteer, Megan Finsaas, BA, volunteer; Fatima Noor, volunteer translator, and Professional Interpreting Inc.. The project's Community Advisory Board assisted and advised the research team in study development, recruitment, and data analysis and interpretation.

Community report in English

Community report in Somali

If you would like printed copies of the community report, please contact phsresearch@umn.edu

Photo: Bean Robinson, PhD, presenting; seated left to right: Amira Ahmed, BA; Shanda Hunt, MPH; Amanda Ciesinski, MS; Megan Finsaas, BA; Jennifer Connor, PhD


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I am writing this letter from the XIX International AIDS Conference in Washington, D.C. It has been 22 years since the International AIDS conference was held in the United States (mainly due to the unwillingness on the part of the United States to grant visas for HIV-infected individuals- only recently lifted).

Here 25,000 scientists, policy makers, health and education ministry officials, advocates, and activists from around the world are gathered with a renewed determination to stem the tide of this epidemic. Medical advances, improved access to care, prevention initiatives, and our nation's revived determination are all good signs, but as a culture we will need to shift our perspective to stop the spread of HIV.

Recent news of pre-exposure and post-exposure prophylaxis treatment has been encouraging. Last week, the Food and Drug Administration (FDA) approved Truvada (emtricitabine and tenofovir disoproxil fumarate) for Pre-Exposure Prophylaxis (PrEP) to prevent the spread of HIV to high-risk, healthy individuals. Other similar preparations are under investigation and HIV therapeutic drugs are being developed for prophylactic use. These drugs are very costly and require individuals to adhere to rigid compliance in order to be effective.

Also, last week, Health and Human Services (HHS) Secretary Kathleen Sebelius announced nearly $80 million in grants to increase access to HIV/AIDS care across the United States. The funding will ensure that low-income people living with HIV/AIDS continue to have access to life-saving health care and medications. This effort stemmed from President Obama's determination to create an AIDS-free generation.

In addition, there is reduced stigma for HIV infected individuals. The CDC just launched "Let's Stop HIV Together" a new campaign that is part of the 5-year initiative started in 2009 to reduce stigma around HIV and advocate for more access to testing and treatment "Act Against AIDS."

The United States, through its National AIDS Strategy, has outlined a "prevention" strategy through early detection and early treatment, focusing on vulnerable populations.

These new strategies are overdue. In the United States, we continue to experience 50,000 new infections a year. And, there are serious health disparities. People of color, youth, and sexual minorities are much more likely to become infected than other groups.

Over the last 30 years, where have we failed? We know that HIV is still mostly spread by sexual behavior. Yet, the disease is rather easily preventable through the use of condoms. Condoms are reasonably inexpensive, potentially readily available, easy to use, and highly effective in preventing HIV and other sexually transmitted infections (and unintended pregnancy). What a bargain! So, why are they not used more?

Behavioral HIV prevention strategies and interventions have tried to get people to reduce risky sexual behavior and promote condom use. While reasonably effective, there needs to be continuous implementation of these interventions, and they are costly. Investment in prevention strategies has always been difficult. With the recently adopted National Prevention Strategy, National AIDS Strategy, and the Affordable Care Act, there is new hope that these investments will be made.

But a fundamental problem remains. We remain a sexually dysfunctional culture. We live in a culture that is still uncomfortable talking about sex and sexuality in a mature and honest fashion. We continue to debate and hold back on providing comprehensive sexuality education. It is very clear that what distinguishes the United States from other developed countries in sexual health indicators is the existence of (or lack thereof) early and sustained comprehensive sexuality education. When kids are educated early they grow up to be more comfortable with talking about sexuality, more likely to be sexually responsible, and have lower rates of sexually transmitted infections and unintended pregnancies. They contribute to a cultural climate that is sexually healthy. That climate then insists on comprehensive sexuality education and thereby creates a cycle of healthiness. In the United States, we are still caught up in a negative and unhealthy vicious cycle. The goal of the Joycelyn Elders Chair in Sexual Health Education is to reverse this negative cycle.

Both Walter Bockting and I, along with over 600 delegates from around the world attended the "Global Forum on Men who Have Sex with Men (MSM) and HIV" as part of the International AIDS Conference. While 60% of new infections around the world are found in gay and bisexual men, only 2% of the global prevention budget is directed at this group. Also, transgender individuals are an overlooked population at major risk for HIV, due in large part to continued stigma and discrimination. This disparity in funding efforts represents the institutionalized stigmatization, heterosexism, and homophobia that exist in our cultures as well as in our public health systems. If we do not attend to this population as well as other marginalized populations such as sex workers and drug users, we will fail in our efforts to stop the spread of infections.

Walter Bockting and I also attended two important meetings pertaining to transgender health and HIV. The first was called "The Great TRANSformation: Towards a Holistic Approach for Healthier and Happier Trans Communities in Latin America and the Caribbean." Walter Bockting talked about "Avenues for Action for the Provision of Care and the Promotion of Well-Being." This symposium represented some of our ongoing work with the Pan American Health Organization in developing and finalizing a "Blueprint for the Provision of Prevention and Care for Transgender Individuals through Latin American and the Caribbean." We also participated in a second special session on "Addressing Stigma in Transgender & Other HIV-Vulnerable Communities" sponsored by the Human Rights Campaign, the International Association of Physicians in AIDS Care, the International Treatment Preparedness Coalition, and the Pan American Health Organization.
 
As the current Chair in Sexual Health, I was happy to participate in this conference and push a sexual health agenda in HIV prevention. I was very pleased that the Program in Human Sexuality was a co-sponsor along with the Pan American Health Organization and the Centers for Disease Control and Prevention of a satellite session on "Addressing Sexual Health and Evidence-based Sexual Health Education: Evolving Opportunities." I spoke on "Towards a Broader Vision of Sexual Health in the New Millennium." I emphasized the need for a broad sexual health approach to stem the tide of the HIV epidemic, which emphasizes a positive and respectful approach to sexuality and sexual expression throughout the lifespan and that acknowledges sexuality as a basic and fundamental aspect of our humanness and that the pursuit of sexual pleasure is natural and desirable. A broad sexual health approach combats sexual coercion, shame, discrimination, and violence. But a sexual health approach must go beyond venereology and, on an individual level, promote positive sexual identity and esteem, honest communication and trust between partners, the possibility of having pleasurable, fulfilling and satisfying sexual experiences, taking responsibility of the consequences of one's sexual choices and their impact on others, and optimizing reproductive capacity and choice. At the community level, it is achieved through access to developmentally appropriate, comprehensive and scientifically accurate sexuality education, clinical and preventative sexual health services, and respect for individual differences and diversity and a lack of societal prejudice, stigma, and discrimination.

The Chair in Sexual Health will continue to work with our faculty at PHS and with partners around the world to promote a sexually healthier culture - not only to address the sexual problems in the world -- but to advance the opportunity for everyone to lead sexually healthier lives which are pleasurable and satisfying.

Eli Coleman, PhD
Professor and Director
Academic Chair in Sexual Health

PHOTO: Omar Banos (Impacto at AIDS Project Los Angeles), Rafael Mazin (Pan American Health Organization), and Eli Coleman

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PHS joined Exposed Brick Theatre to create the new play based on the stories, experiences, and perspectives of transgender and gender non-conforming youth. Nearly 180 people attended the premiere performance of Trans/formation: Addressing Gender Issues in School at the Pillsbury House Theatre. After the production, the audience enjoyed a lively discussion with the cast, writers, and director about the themes of the play and their experience working on the project.

The aims of the project are to validate transgender and gender non-conforming youth experiences through performance, to educate peers, parents, families, friends, and educators about the experiences of transgender and gender non-conforming youth, and to encourage dialogues around gender issues, advocacy, and ally support for adolescents.

The performance on May 4, 2012, was the first step in a larger process. The next steps will be for the playwrights Anton Jones, Suzy Messerole, and Aamera Siddiqui to make final edits to the script and for PHS psychologists Katie Spencer, PhD, and Dianne Berg, PhD, to finalize the educational materials on the themes of the play. The play script and educational materials will then be made available for high school groups to download and perform at their schools, amplifying the impact of this project.

PHS and Exposed Brick would like to thank Stacey Mills and Sam Heins for their donation that made this project possible. We would also like to thank all of the people that helped to create this piece including the youth we interviewed, the advisory board whose thoughtful and creative feedback lifted the play to a whole new level, the youth who read the early drafts and whose honest feedback led us in the right direction. The youth performers are outstanding and their commitment to the piece has been amazing.

PHOTO: credit David Hannigan

 

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PHS has joined Exposed Brick Theatre to create a new play Trans/formation: Addressing Gender Issues in School based on the stories, experiences, and perspectives of transgender and gender non-conforming youth.  Dianne Berg, PhD, and Katie Spencer, PhD, are working with playwrights Anton Jones, Suzy Messerole, Aamera Siddiqui, and a community advisory group to develop the production and educational materials.  The aims of the project are to validate transgender youth experiences through performance, to educate peers, parents, families, friends, and educators about the experiences of transgender youth, and to encourage dialogues around gender issues, advocacy, and ally support for adolescents.
"In working with trans youth, it is integral to reach them in the settings they are in daily, it is not enough to intervene in the therapy office, but you also have to reach out to the classroom, to families, and to the community," said Spencer.  "This is a big step for PHS to put funding behind a community educative initiative like this, and I can tell you, from the community work I have been doing, people are really responding to it and they see it as a positive thing!"

The play production will be premiered on May 4, 2012, at the Pillsbury House Theatre in Minneapolis.  The play will also be performed at a Twin Cities high school.  Ultimately the play script and educational materials will be available for high school groups to download and perform at their schools. 

Messerole said that one of the individuals interviewed for the play shared that during his junior year of high school the gay straight alliance at his school brought in a speaker who was transgender.  The student shared with Messerole that it was the first time he had ever seen another transgender person and it was a very powerful experience.  Messerole added, "We all need to know that we are not alone, we all need to know that there are others who have similar stories. One of the most powerful things about theatre is its ability to hold up a mirror and see one's self reflected on stage. It's very validating to see someone one stage who 'gets you' in a way that is complex and nuanced."

Exposed Brick has worked extensively with area schools, creating over 30 Stand In It with Me performances since 2006.  Stand In It With Me performances are custom created for each school, based on interviews with students and teachers.  The performances fuel dialogue on issues of racism, gender discrimination, sexual orientation, classism, immigration, and more.

PHS and Exposed Brick are grateful to Stacey Mills and Sam Heins for their donation that made this project possible.  We would also like to thank all of the people that helped to create this piece including the youth we interviewed, the advisory board whose thoughtful and creative feedback lifted the play to a whole new level, the youth who read the early drafts and whose honest feedback led us in the right direction.  The youth performers are outstanding and their commitment to the piece has been amazing.

Community Advisory Board Members
Claire Avitable, director, 20% Theater Company
Katie Burgess, director, Trans Youth Support Network
Andrea Jenkins, trans activist, performer, poet
Moe Lionel, performer, Naked Stages Performer
Anthony Neumann, performer, director, Naked Eye
Ethan Turcotte, arts administrator, Kulture Klub Collaborative

Trans/formation: Addressing Gender Issues in School
By Anton Jones, Suzy Messerole, and Aamera Siddiqui

Friday, May 4, 2012 at 7 PM
Pillsbury House Theatre, 3501 Chicago Avenue South, Minneapolis, MN 55407

Parking: Free parking is available in the Pillsbury House lot next to Full Cycle, just south of 35th on the east side of the street.  Free street parking is also available on 35th and all other surrounding neighborhood streets.

Free and open to the public.  To reserve a seat, please RSVP to Jenae Batt at jenae@umn.edu or 612-625-1331.

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