Program Details

Practice Type:	Promising
Program Name:	Community-Based STD Clinic for LGBT Youth (13 – 23): A Collaborative Approach That Finds High Rates of Positivity
Organization:	Jacksonville Area Sexual Minority Youth Network, Inc. (JASMYN)
Web site:
Overview:	Lesbian, gay, bisexual, and transgender (LGBT) young people, especially young men who have sex with men (YMSM) in Duval County, Florida, have unique health needs not easily addressed by the public health or the medical community. In Duval, at least one in 13 Black MSM have HIV. Young males make up 33% of the HIV cases among men. Duval County ranked first in Florida in the number of Gonorrhea cases reported in 2007, second in Chlamydia, and sixth in Syphilis and HIV. The Duval County Health Department (DCHD) and the Jacksonville Area Sexual Minority Youth Network, (JASMYN), the LGBT youth center, developed an innovative collaboration to provide services to LGBT youth through an on-site STD clinic. Community-Based STD Clinic Goal: To increase STD/HIV testing and access to healthcare for LGBT youth Methods: The Duval County Health Department (DCHD) and the Jacksonville Area Sexual Minority Youth Network, (JASMYN), a community-based LGBT youth center, have developed an innovative collaboration to provide health services to LGBT youth through the establishment of an onsite STD clinic. JASMYN supports and empowers LGBTQ youth, ages 13–23, by creating safe space, providing youth development services, and bringing people and resources together to promote diversity and human rights. The Duval County Health Department Field Operations Division has a long history of seeking testing venues in neighborhoods and community settings where HIV and STD rates are high. This collaboration provides a first-time opportunity to bring STD testing and treatment services to a youth center that specializes in reaching high risk sexual minority youth in Duval County. Results: A total of 112 clients received 149 clinical services during 46 clinic sessions. Of these, 13.4% tested positive for HIV, Chlamydia, Gonorrhea, and/or Syphilis. For Black gay, bisexual and other YMSM, 16.3% tested positive for at least one STD. A total of 71 HIV tests were administered, with a 7% positivity rate; all of which occurred in Black YMSM.
Year Submitted:	2010
Responsiveness and Innovation:	• Over half (55%) of new HIV cases in 2007 were African American MSM. In Duval County, at least one in 13 Black MSM are living with HIV. Young males/adolescents (ages 13–29) make up 33% of the HIV cases among men. These reflect high rates of HIV cases among predominantly African American YMSM. (The Partnership 4 Comprehensive HIV/AIDS Prevention Plan 2007–2009, revised June 2008) • The June 27, 2008, MMWR, Trends in HIV/AIDS Diagnosis Among MSM reports from 2001–2006 statistically significant increases in diagnoses were observed in nearly all racial/ethnic populations of MSM ages 13–24, with an increase of 93% observed among young Black MSM, twice as many as their white counterparts. • In a study in the CDC Fact Sheet: HIV/AIDs among MSM of young MSM, 77% of those HIV positive believed they were not infected. Young Black MSM were more likely to be unaware of their infection, 9 out of 10 young black MSM compared with six out of 10 young white MSM. Of these YMSM who tested HIV positive, 74% had previously tested negative for HIV and 59% believed they were at low or very low risk. • Duval County ranked first of Florida in the number of Gonorrhea cases reported in 2007, second in Chlamydia, and sixth in Syphilis cases. The high rate of STD infection creates an added risk factor, especially African American YMSM. According to Out in the Open, in the presence of most STDs, the likelihood of acquiring or transmitting HIV increases 3–5 fold. • “Fear of discrimination and stigma keep many in the GLBT community from seeking care for themselves or their families or from disclosing relevant personal information once in care.” The GLBT Health Access Project, described in the American Journal of Public Health (June 2001). • The special needs of GLBT youth are also discussed in the Healthy People 2010 Companion Document for LGBT Health, by the Gay and Lesbian Medical Association: “Among all age groups, adolescents are the most uninsured and underinsured group and are the least likely to receive office-based medical care or to use primary care services. Despite having poorer overall health status, ethnic and racial minority youth are less likely than white peers to receive needed health or mental healthcare. Minority youth are at higher risk for serious health problems and poor outcomes, and are less likely to have health insurance or a routine source of care for health maintenance or acute care needs.” (Ryan and Futterman, Lesbian and Gay Youth: Care and Counseling, P.208, 209) • There are multiple conditions that work together to magnify the opportunity for the risk behaviors that lead to exposure and infection from HIV. These include STD infections, mental health and substance abuse issues. Combined with the community’s stigma around HIV and homophobia, the lack of access to safe, supportive, and affordable healthcare, and the developmental challenges of adolescents, these conditions create a variety of institutional barriers and individual and community challenges.Review of local data regarding the high rates of STD and HIV infection within the target population by health officials, and the identification of JASMYN's successful venue and youth-friendly approach resulted in the creation of this collaboration. Attracting foundation funding to support the ancillary services provided by JASMYN was also a critical element that affirmed the issue's relevancy to the community.Conclusions: Locating an STD clinic at the LGBT youth center increased testing and STD services to underserved high-risk youth, and yielded high rates of positivity for both STD and HIV. Implications for Programs, Policy, or Research: Collaborations between public health programs and specialized youth-oriented community organizations are extremely positive in terms of the opportunity to provide core STD services to disenfranchised high-risk populations. In a time when clinical outcomes (i.e., positivity rates) are critical measures of program effectiveness, the partnership described here represents a viable low-cost and extremely effective public health intervention. Innovative partnerships such as the DCHD/JASMYN project should be fostered and expanded because of the significant potential for disease control, prevention education, and risk reduction in underserved LGBT youth. Such programs are especially relevant in urban centers with high STD/HIV rates. Program expansions that would broaden the impact of non-traditional clinics could include immunizations, expanded reproductive health care, including care for transgender youth, mental health and substance abuse referrals, and primary medical care. Locating STD clinics within high risk community settings is not new, and an internet search pointed to several health clinics being offered in major cities in the US, many targetting adult MSM, gay, and bisexual men and some youth. However, this practice is not widely available in the southeast, where STD and HIV rates are among the highest in the country. Further, it is rare to find an STD clinic located within an LGBT youth center, where the approach combines health education and prevention interventions using a youth development focus with public health STD testing and treatment. The DCHD, Field Operations Divsition, under Lloyd Seaman, Area 4 STD Program Manager, is an exhuberant promoter of the successes of this clinic collaboration, and takes every opportunity to foster the collaboration and bring new stakeholders in through his leadership role within the Duval County Health Department and the community.The keys to successful collaboration include a willingness to share resources, strengthen partnerships, and grow. The leaders from DCHD and JASMYN in this collaboration have the goal of providing access to health care and STD treatment and care to high risk LGBT youth, and every effort to support and expand the collaboration centers on this shared goal, and consequently promotes its success.
Agency and Community Roles:	The local health department has be instrumental in the Community -Based Health Clinic Collaboration The STD Field Operations Division and the AIDS Program Office have both been engaged to provide support and resources to this project. Collaborations between public health programs and specialized youth-oriented community organizations are extremely positive in terms of the opportunity to provide core STD services to disenfranchised high-risk populations. In a time when clinical outcomes (i.e., positivity rates) are critical measures of program effectiveness, the partnership described here represents a viable low-cost and extremely effective public health intervention. Innovative partnerships such as the DCHD/JASMYN project should be fostered and expanded because of the significant potential for disease control, prevention education, and risk reduction in underserved LGBT youth. Such programs are especially relevant in urban centers with high STD/HIV rates. Program expansions that would broaden the impact of non-traditional clinics could include immunizations, expanded reproductive healthcare, including care for transgender youth, mental health and substance abuse referrals, and primary medical care. . Stakeholders are engaged through regular meetings between the collaboration's partners to discuss the clinic progress and make recommendations for improvement. Feedback is also obtained through client surveys and community input.
Costs and Expenditures:	The clinic, offered twice monthly at the JASMYN House, provides STD screening and treatment, HIV rapid testing, referrals, and linkages to further care. DCHD provides an ARNP with a specialty in STD treatment, medications, and medical supplies. JASMYN provides the facility and educational outreach to young LGBTQ clients in a friendly venue with peers and culturally appropriate staff and medical volunteers. JASMYN staff provide the overall coordination and follow-up for the clinic. The clinic is also complemented by JASMYN’s other youth development programs, including leadership development, evidence-based HIV prevention models such as D-UP! Defend Yourself and Street Smart, health education, comprehensive sex education, and case management for high risk youth. Since the clinic opened in May 2007, first with medical support from the University of Florida Department of Pediatrics, it has had over 100 visits from LGBTQ teens and young adults, and has identified at least one pregnancy and over 25 STDs, including Gonorrhea, Chlamydia, Syphilis, Herpes, and HIV. The clinic is supported by a variety of funding sources. The Duval County Health Department provides medical supplies, equipment, medications, lab services, and personnel through the STD Field Operations Department. JASMYN provides the youth-friendly facility, supportive staff who coordinate, provide outreach, intake and follow-up services and HIV rapid testing. These resources for the clinics first three years have been provided through grants from the Florida Department of Health Closing the Gap initiative, The Blue Foundation for a Healthy Florida, and the Jacksonville Jaguars Foundation. Ongoing funding is currently being sought.
Implementation:	• Over half (55%) of new HIV cases in 2007 were African American MSM. In Duval County, at least one in 13 Black MSM are living with HIV. Young males/adolescents (ages 13–29) make up 33% of the HIV cases among men. These reflect high rates of HIV cases among predominantly African American YMSM. (The Partnership 4 Comprehensive HIV/AIDS Prevention Plan 2007–2009, revised June 2008) • The June 27, 2008, MMWR, Trends in HIV/AIDS Diagnosis Among MSM reports from 2001–2006 statistically significant increases in diagnoses were observed in nearly all racial/ethnic populations of MSM ages 13–24, with an increase of 93% observed among young Black MSM, twice as many as their white counterparts. • In a study in the CDC Fact Sheet: HIV/AIDs among MSM of young MSM, 77% of those HIV positive believed they were not infected. Young Black MSM were more likely to be unaware of their infection, 9 out of 10 young black MSM compared with six out of 10 young white MSM. Of these YMSM who tested HIV positive, 74% had previously tested negative for HIV and 59% believed they were at low or very low risk. • Duval County ranked first of Florida in the number of Gonorrhea cases reported in 2007, second in Chlamydia, and sixth in Syphilis cases. The high rate of STD infection creates an added risk factor, especially African American YMSM. According to Out in the Open, in the presence of most STDs, the likelihood of acquiring or transmitting HIV increases 3–5 fold. • “Fear of discrimination and stigma keep many in the GLBT community from seeking care for themselves or their families or from disclosing relevant personal information once in care.” The GLBT Health Access Project, described in the American Journal of Public Health (June 2001). • The special needs of GLBT youth are also discussed in the Healthy People 2010 Companion Document for LGBT Health, by the Gay and Lesbian Medical Association: “Among all age groups, adolescents are the most uninsured and underinsured group and are the least likely to receive office-based medical care or to use primary care services. Despite having poorer overall health status, ethnic and racial minority youth are less likely than white peers to receive needed health or mental healthcare. Minority youth are at higher risk for serious health problems and poor outcomes, and are less likely to have health insurance or a routine source of care for health maintenance or acute care needs.” (Ryan and Futterman, Lesbian and Gay Youth: Care and Counseling, P.208, 209) • There are multiple conditions that work together to magnify the opportunity for the risk behaviors that lead to exposure and infection from HIV. These include STD infections, mental health and substance abuse issues. Combined with the community’s stigma around HIV and homophobia, the lack of access to safe, supportive, and affordable healthcare, and the developmental challenges of adolescents, these conditions create a variety of institutional barriers and individual and community challenges.Review of local data regarding the high rates of STD and HIV infection within the target population by health officials, and the identification of JASMYN's successful venue and youth-friendly approach resulted in the creation of this collaboration. Attracting foundation funding to support the ancillary services provided by JASMYN was also a critical element that affirmed the issue's relevancy to the community.Conclusions: Locating an STD clinic at the LGBT youth center increased testing and STD services to underserved high-risk youth, and yielded high rates of positivity for both STD and HIV. Implications for Programs, Policy, or Research: Collaborations between public health programs and specialized youth-oriented community organizations are extremely positive in terms of the opportunity to provide core STD services to disenfranchised high-risk populations. In a time when clinical outcomes (i.e., positivity rates) are critical measures of program effectiveness, the partnership described here represents a viable low-cost and extremely effective public health intervention. Innovative partnerships such as the DCHD/JASMYN project should be fostered and expanded because of the significant potential for disease control, prevention education, and risk reduction in underserved LGBT youth. Such programs are especially relevant in urban centers with high STD/HIV rates. Program expansions that would broaden the impact of non-traditional clinics could include immunizations, expanded reproductive health care, including care for transgender youth, mental health and substance abuse referrals, and primary medical care. Locating STD clinics within high risk community settings is not new, and an internet search pointed to several health clinics being offered in major cities in the US, many targetting adult MSM, gay, and bisexual men and some youth. However, this practice is not widely available in the southeast, where STD and HIV rates are among the highest in the country. Further, it is rare to find an STD clinic located within an LGBT youth center, where the approach combines health education and prevention interventions using a youth development focus with public health STD testing and treatment. The DCHD, Field Operations Divsition, under Lloyd Seaman, Area 4 STD Program Manager, is an exhuberant promoter of the successes of this clinic collaboration, and takes every opportunity to foster the collaboration and bring new stakeholders in through his leadership role within the Duval County Health Department and the community.The keys to successful collaboration include a willingness to share resources, strengthen partnerships, and grow. The leaders from DCHD and JASMYN in this collaboration have the goal of providing access to health care and STD treatment and care to high risk LGBT youth, and every effort to support and expand the collaboration centers on this shared goal, and consequently promotes its success.
Sustainability:	The DCHD has signed an MOU with JASMYN that is renewable annually for five years, indicating long-term committment by both partners. JASMYN has obtained significant partial funding to support the clinic for three years, and is continuing to seek further funding through private foundation support. JASMYN and DCHD are seeking opportunities to fund the clinic but also to promote this collaborative model and its successes through a variety of venues including national conferences and model practices websites.
Lessons Learned:

Back to main page.