Healing Conversations for Men Who Have Sex with Men

David Pantalone is the Director of the Clinical Psychology Doctoral Program and Professor of Psychology at the University of Massachusetts in Boston. His areas of expertise include Clinical health psychology; HIV/AIDS prevention and treatment; substance abuse; LGBT health and mental health. David joins the show today to talk about the statistics between men who are HIV positive, and men that use meth. He discusses why meth is back and easier to get, the correspondence that adverse childhood experiences have in health risks, and what is behind the program called Project Impact.   TAKEAWAYS: [2:07] David had a winding path into Psychology from the Public Health arena. He combines his passion for education and advocacy by teaching Human Sexuality to undergraduates and working with doctoral students on how to be therapists. David is also very involved in professional organizations such as Division 44, and ABCT. [4:40] Meth use is more common among MSM, and men who are HIV positive and use meth are more likely to miss their dosage to keep them safe and undetectable. David also shares a statistic that men who reported having used meth were 18x more likely to contract HIV than men who had not. [5:56] The supply and demand issue made meth go away, but now it is back and easier to get. However, the forms people are getting are tainted worse than ever, and no one can be too sure about the exact substances they are taking. [7:20] Working with men on healing from their adverse childhood experiences has a strong impact both on the ground and in practice. The more traumatic childhood, the more it may correspond with health risks, mental health, abuse, and healthcare engagement. [11:23] Project Impact was born from treating both depression and working to reduce substance abuse. They use effective and proven strategies including behavioral activation, and the participant has coached along in a 10-Week program. [16:01] In behavioral activation, the client gains success by getting their own behavior under control, and not having their actions be dependent upon their moods. [19:25] There has been some improvement in awareness regarding the meth epidemic, but communities can still do more. We must realize that the version of the drug out there today is worse than ever, we must focus on harm reduction, and also help young men develop better skills on how to cope with painful emotions and situations. [21:37] A large part of treatment in the digital age is helping the individual use apps appropriately, or to help them not use them at all if that is what’s best. [28:50] David has many new projects coming down the pipeline including ones for opioid use, children on the autism spectrum, and men of color. These are all fascinating and important studies that help intersectional stigmas and provide resources that are presently hard to come by.   RESOURCES: David.Pantalone@UMB.edu UMB HIV Explore Study Project Impact Division 44 ABCT University of Washington   QUOTES: ● “Some of the younger guys didn’t see the devastation meth caused in gay male communities.” ● “I want to develop interventions that get rolled out that are as easy as possible for community-based providers to use.” ● “We need lots of different options. It’s clear at this moment there is no end in sight in this wave in the meth epidemic.”  

Nelson Vergel is an author, speaker, men’s health coach, and former chemical engineer. He also has done and continues to do amazing work in the field of HIV and advocacy. As a Long-Term Survivor, Nelson stepped up out of the dark and shared his findings on how testosterone treatment helped prevent Wasting Syndrome, reversed fragility and got the body healthier overall. Nelson discusses how he got into advocacy work, the stigma around body image and confidence that he has shifted to be a source of motivation, and resources where people can go to learn everything from affordable labs to a guide for proper testosterone treatment.   TAKEAWAYS: [1:30] Nelson is a Long-Term HIV Survivor, and found in 1985 that he had the virus. He became very focused on how to not die from Wasting Syndrome, a leading cause of HIV related death that he saw many of his friends and loved ones pass away from. He left his career as an engineer to devote himself to the cause. [3:33] Nelson’s techniques helped him gain 35 lbs of muscle, which changed his outlook and gave him hope for both himself and others. This bought him time and prevented Wasting until they came out with drugs in 1996. [5:22] Those with HIV typically have low testosterone, and Nelson noticed that treatment with testosterone helped prevent and reverse fragility when combined with exercise and proper nutrition. It also helped support lean body mass, which is a key to survival and overall health and energy. Since women also have testosterone, it is a treatment that can help all genders, even those that identify as trans or another identity. [7:57] Wasting is defined as 10% more weight loss from your base weight. [9:39] Once treatment for HIV was more underway, Nelson then saw a need to cross over and help people all around the world who had low testosterone, but not HIV. He continues to work with men and women to teach them how to understand symptoms of low testosterone, possible treatments, how to talk to their doctor, and some of the benefits they can expect once they are more in hormonal balance. [24:11] Body image and confidence is already a complicated issue, and there is more pressure than ever before to look great and fit into our cultural definition of strong and sexy. Nelson was able to turn his body image issues into fuel that made him healthy, but often is the cause of much anxiety and stress to look a certain way. People must remember there is no quick fix, but instead health and wellness is a lifetime commitment.   RESOURCES: Built to Survive Testosterone: A Man’s Guide Program for Wellness Restoration Nelson Vergel Testosterone Replacement POZHealth Excel Male Discounted Labs U=U   QUOTES: ● “I think I survived because of all the knowledge I was able to gather.” ● “I got this message out at the right time. Doctors were desperate.” ● “It is time for some of us to cross over and help the entire population.” ● “I have been able to shift my body image anxiety into something that makes me healthier and hopefully live a little longer.” ● “I’m a product of my own advocacy.”

Tez Anderson is an HIV Long-Term Survivor, Writer, Speaker, HIV Activist and Founder of the Let’s Kick ASS (Aids Survivor Syndrome) grassroots movement empowering HIV survivors. Tez joins the show today to discuss how he went from coming to terms with his own diagnosis and standing as a long-term survivor, to becoming an advocate and running groups to help connect and empower others. Tez talks about how Let’s Kick ASS came to be, where we have made strides in helping long-term survivors, and the issues we still face today. He shares the symptoms that long term survivors often face, and how he and his team help others cope with grief, anger, fear, and planning for the often unexpected future.   TAKEAWAYS: [2:28] Tez was diagnosed in 1986 with HIV, and lived through a several year period here he thought HIV had gotten into his brain. He felt angry, confused and was severely depressed, without feeling as though there was much reason to live. He thought he had 18 - 24 months to live, and prepared for death. [4:23] Tez was not prepared to live past his own expected 5 years either financially or emotionally and looked hard to find support and resources that would help him in the years to come. This experience served as a foundation for him to help others because he knows the isolation and doubt that comes with being a long-term survivor. [7:43]  Tez found that it was trauma causing his symptoms, not the actual disease. He began to meet with other long-term survivors and found they had similar experiences. They put on a town hall and the attendance was more than double what he expected. [9:10] Once HIV became a chronic manageable illness rather than a death sentence, the urgency dropped down and advocates had to make sure people knew it was still an extremely important issue to focus on. [11:46] The first town hall became a cultural touchpoint in San Francisco, and other organizations that dealt with HIV started to pay attention to long-time survivors. [12:30] The combination of side effects from early medications, along with the actual virus, makes the comments of “It’s just one pill a day” feel hurtful and dismissive. [15:54] There are still many people who don’t have access to support easily. They feel alone and through Let’s Kick ASS, Tez provides a way for people to chat about their experience without having to explain it or expose information they don’t feel comfortable sharing yet. [19:19] Lack of future orientation can be one of the biggest symptoms of long-time survivors. [21:53] Besides the in-person testimonials and people sharing their personal experiences, The Multicenter AIDS Cohort Study showed real scientific evidence of long-term survivor syndrome. [24:27] Tez works with other long-term survivors on their guilt about surviving when their loved ones or close friends may not have. Survivor guilt is valid, but much like shame, is useless for how it helps or benefits us now. [27:01] There is still a generation in need of attention, care, and support.   RESOURCES: Let’s Kick ASS Aids Survivor Syndrome @letskickass_hiv And the Band Played On Spencer Cox Bay Area Reporter HIV Long-Time Survivor League Act Up USCA Dr. Ron Stall Dr. Michael Gottlieb Multicenter Aids Cohort Study   QUOTES: ● “I aged into my job.” ● “Death is death. It’s messy and complicated, and it can be beautiful and awful at the same time.” ● “I had prepared to die. I had not prepared to live.” ● “Once it became chronic and manageable and no big deal, the urgency ran out.” ● “It’s about empathy. It’s about generating and cultivating empathy.” ● “It’s not about surviving the virus, it’s about surviving the epidemic.”

Bruce Richman is the founding Executive Director of the Prevention Access Campaign and tireless advocate of the Undetectable Equals Untransmittable (U=U) campaign. He joins the show to talk about what exactly the U=U campaign does, and how it pairs with activists and researchers to make sure the correct science reaches the people that would benefit from it the most. He also talks about what breakthroughs took place in the movement, why the United States is one of the most challenging countries so far, and how changing the stigma surrounding HIV and transmission is changing many lives for the better.   TAKEAWAYS: [2:28] A person living with HIV who is on treatment and has undectable viral load can’t transmit HIV through sex partners. An undetectable viral load means less than 200 copies/ml. [3:35] In the late 1990’s, any findings on HIV transmission were widely criticized, with many skeptics finding not enough evidence to trust the research. After 2010, new studies provided breakthrough results: these studies featured 150,000 couples who had sex without condoms, providing a solid evidence base and a staggering amount of scientific evidence. [6:16] Bruce’s background in philanthropy and social justice gave him a foundation on how to use his platform to help inform and educate those who needed it. He was depressed and felt isolated about his own HIV diagnosis, and knew the feeling of hopelessness and not knowing where to turn. When Bruce learned the information from the study, he started taking medication and knew he needed to share the information and focused his energy on putting the groundbreaking science to light to create community awareness and a coalition for others to feel a sense of belonging. [11:12] Many advocates paved the way for others, using their own courage and bravery, and took the risk to go public with their diagnosis. [12:57] There have been 98 countries and 1000 partners that have signed on from different organizations. England and France are leading the pack with their creative and innovative campaigns. Hopefully the US will pick up more and find a way beyond the scarcity of resources and inner policy blockages. [19:16] When advocates get together with policy makers and move things forward, it can help thousands of people overcome the stigma that leads to shame, violence, isolation and possibly even suicide and murder. [29:31] The U=U campaign serves as a hub for resources, research and solidarity with the vast partners that are pioneering.   RESOURCES: Prevention Access Campaign @UequalsU Bruce Richman @preventionac CDC U.S. Health Department @DrDemetre   QUOTES: ● “We really did it together.” ● “It is surreal how fast this has expanded in such a short period of time.” ● “We are seeing a lot of really brilliant national efforts.” ● “This gives people one less thing to worry about. This gives them hope.” ● “The impact on stigma can’t be underscored enough.”

Regina McCarthy, LCSW, is a clinical social worker, Holistic Psychotherapist, and author of Courageous Gilbert the Groundhog. Everyone, but especially gay, bisexual and transgender men, will find that both Gilbert's experiences and the solutions he discovers are directly applicable to their lives. Regina joins the show to discuss why she decided to write Courageous Gilbert, and the impact it has been having on both her own life and the lives of children and adults that read it and put the practical tips into use. Regina discusses why the book features a groundhog star, and how it serves to help people of all ages identify, observe, and process their emotions in a healthy and positive way.   TAKEAWAYS: [2:28] Regina works with her clients from a holistic perspective, which means she works in the mental, physical, emotional and spiritual all in one. [4:41] Regina never thought of herself as an author, but the idea came to her in a dream and she knew she needed to put it out there. She saw a groundhog in her yard and found it to be a symbol of digging up her truth so others can do the same. Courageous Gilbert may have won 14 awards, but the biggest thrill for Regina is the way it has resonated and helped others. [5:51] Gilbert is a shy groundhog who gets bullied and is afraid of public speaking. He finds an oak tree mentor who teaches about emotions, and that it’s okay to feel and express them. [8:00] Activity that releases stuck energy helps us get out of our head and into our body, and in turn will let us respond calmly and thoughtfully instead of reacting. [9:42] Many of us walk around with a shame that we aren’t enough, or that there is something wrong with us. As a result we play small and don’t ask others for help. [11:28] Building self confidence and self worth takes time, and it’s not a perfect path at every moment. It’s important to realize that there is no rush, and even small wins are worth celebrating. [13:09] Breathing for relaxation is free, available to us at any time, and has profound effects. Regina walks us through a 4:7:8 breath pattern. [15:39] In the book, Gilbert learns to deep breathe, and locate where emotions are stuck in the body such as fear, sadness and anger. [19:29] In times of great stress and trauma, our brain will send us into fight, flight, or freeze. When we freeze it is common to go into shock, and on a small scale dissociate using numbing or negative habits. [27:02] Regina’s next book will be focused on how the character Peter Possum got to be a bully, and will feature some grounding techniques to feel calmer and more in control.   RESOURCES: National Association of Social Workers Conference 8 Weeks to Optimum Health Courageous Gilbert the Groundhog Bluestone Healing Center   QUOTES: ● “I only have control over me, and I’m the only person I can change.” ● “We have to practice expressing our feelings.” ● “Practice makes permanent, not perfect.” ● “We are incredible human beings, just the way we are.”  

Andrew Susskind is a Licensed Clinical Social Work, Somatic Experiencing Practitioner, and Certified Group Psychotherapist based out of Los Angeles. Andrew specializes in relationships, mid-life transitions, sexual recovery, trauma, and addictions. He is the author of the new book, It’s Not About The Sex, where he takes a deeper look at compulsive sexual behaviors, brokenheartedness, and a sustainable way to become emotionally sober. In today’s discussion, Andrew shares why he shies away from the term ‘sex addict’, the connection between childhood trauma and addiction, and some of the benefits of positive psychology.   TAKEAWAYS: [1:35] Andrew shares a little bit about his background and why his focus has been on trauma and addiction. [2:30] In his book, It’s Not About The Sex, Andrew states that sexual compulsivity is not about the sex, it’s about broken-heartedness. What does he mean by this? [6:45] Andrew doesn’t personally see sexual compulsivity as a disease. The reason why someone becomes addicted is a lot deeper than you might think. It begins from birth and when there are no role models for intimacy in this young child’s life, they’re left to figure things out on their own. [11:35] Andrew doesn’t agree with the term ‘sex addict’ as a way to address or define someone. The word in itself can produce shame or make someone feel like there’s something inherently wrong with this behavior. At the end of the day, it is how the person perceives these behaviors to be. If the person is being affected negatively by them, then it should be addressed. [12:35] When someone stops these negative behaviors, that’s unfortunately just the beginning. The long term solution is to look deeper into childhood trauma and brokenheartedness that lead to these behaviours, and the end-goal would be to strive for emotional sobriety. [18:30] During the therapy process, one of the things Andrew looks for is when the client has an ‘okay day’. It might just be okay, but Andrew wants to hone in on those feelings, those emotions, and harness them so that their brain can develop new pathways for enjoyment and love. [24:00] From what Andrew has seen, early childhood trauma in general makes it much more likely that someone is going to develop compulsive sexual behaviors. The good news is that there’s a lot of effective treatments out there that can help an individual toward recovery. [27:15] Andrew is excited about the new possibilities that have opened up for his clients when it comes to using positive psychology methods. By expressing gratitude, having forgiveness, recognition of personal strengths, and taking a look at purpose and core values, an individual can be transformed with a completely better outlook on life.    RESOURCES: West Side Therapist   QUOTES: ● “I really see the two as inseparable. Trauma and addiction really go hand-in-hand.” ● “I don’t use the term sex addict as often. There’s an implication that there’s an apology or it falls under the disease model somehow, or there’s something inherently wrong.” ● “A lot of folks think if you cut off the behaviors, you’re all better. And, actually, I tell my clients you are at the starting gate once you stop the behaviors.” ● “The simple way of thinking about emotional sobriety is when somebody’s more comfortable in their skin, when they really feel like they are not anxious all the time.”  

Damon Jacobs, New York-based MFT, advocate and HIV prevention educator, author, and expert in the field of PrEP joins the show today. He and David discuss what PrEP is, where people can get it, and the major changes it is making in the field of HIV and harm reduction. Damon discusses the changes PrEP has made since it’s come out, who could benefit from using it, and the amazing avenues he and his team are providing for intelligent and meaningful conversations on the subject.   TAKEAWAYS: [1:43] PrEP is the use of the antiretroviral drug Truvada, to prevent zero conversion of HIV, should someone be exposed. [2:05] Damon has been an HIV Prevention Educator since 1991, a time when communities were being decimated by the AIDS epidemic. Damon saw that to have integrity in the role, it meant he needed to get out and help communities learn about safe sex to the best of his own ability. He personally started using PrEP in 2011, and the FDA approved it in 2012. [5:53] PrEP is a daily pill that blocks the T cells of someone with HIV duplicating and replicating in the individual taking the pill Truvada, which is a combination of two drugs, tenofovir and emtricitabine. [9:30] Damon sees some of the positive “side effects” of PrEP being that people are getting more physicals, and getting regular STI checks. [12:07] The Magnet Clinic in San Francisco reported that 91% of people they start on PrEP come to their clinic because they already gave up using condoms, or they are inconsistent in their use. [14:53] Studies have shown that you may not need to take PrEP daily if you are able to predict and organize when you do have sex. You can double up on use, but it is something that should be discussed with an expert. [19:14] Damon’s Facebook group, PrEP Facts Rethinking HIV Prevention and Sex, has 21,200 international members and is a safe place for people to come and have intelligent and meaningful conversations about the subject. [22:17] The U.S. has seen a historical drop from 50,000 new cases a year to 38,000 new cases, and PrEP was partially attributed to that. There are also drops in new HIV diagnosis in cities where it is widely implemented and normalized like San Francisco and New York. [24:31] There are many avenues for people in the United States to get PrEP for a low cost or free because of existing financial support systems. [27:28] There are three documented cases where an individual was adhering to PrEP and they did acquire HIV. However, there is very little risk involved and the benefits are huge.   RESOURCES: Magnet Clinic Dr. Dave Glidden PrEP Facts CDC Patient Advocate Foundation U=U PrEPLocator.org PrEPforsex.org DamonLJacobs.com Rational Relating Absolutely Should-Less   QUOTES: ● “We can recall that knowing people with AIDS meant losing people to AIDS.” ● “PrEP will soon be an umbrella term, like the way we use birth control today, to describe different interventions.” ● “You don’t need an agency anymore, a WiFi connection will get the word out about PrEP.” ● “There is no more exciting time than now to be doing this work.”  

John-Manuel Andriote is an award-winning author, journalist, speaker, and communication consultant. Since 1983 he has written about health and medicine, LGBT issues and popular culture. He has reported on HIV-AIDS for more than 30 years. He joins the show to talk about reframing and rewriting the story of gay men, how we can improve our ability to be resilient, and his newest book Stonewall Strong: Gay Men's Heroic Fight for Resilience, Good Health, and a Strong Community.   TAKEAWAYS: [1:38] John identifies a hero and role model as someone that lives out their values to be the best they can be, and helps raise others up in the process. Through his own work he loves shining a spotlight on those in the LGBTQ movement that display these qualities of compassion, courage and awareness of belonging to a bigger community, such as Reverend Bean and Ginny Apuzzo. [5:29] John came to terms with his own HIV diagnosis in 2005 while he was living in Washington D.C. as a journalist. The experience became the catalyst for thinking about resilience. [9:02] While apps and online sites provide an opportunity to meet others, they have downsides like isolation and loneliness when we are reduced to superficial and shallow interactions. Part of a healthy life is having real connection with others. [13:18] in the mid 1990’s, John saw the crystal meth epidemic move eastward from the west coast. [16:18] People look to numb themselves and dissociate from uncomfortable feelings like trauma and shame. Often times the addictive behavior is driven from loneliness and a desire for true connection. [19:03] Cases of abuse are consistent in men that continue to engage in high risk sexual activities. When we focus on addressing people’s trauma rather than getting caught up in judging them, we can speak about things that matter and keep them safe. [23:36] Resilience is a skill, and we can learn to be more resilient. It’s how we frame our story, and how we tell ourselves what our traumatic experience means. [27:21] We can improve the experience of getting older as gay men by embracing resiliency.   RESOURCES: The Plague Victory Deferred Stonewall Strong Golden Men Out In Time National LGBTQ Task Force Meth Comes Out of the Closet   QUOTES: ● “We didn’t know we were a part of a movement, we were just living our lives.” — Ginny Apuzzo ● “Heroism is a matter of common decency.” — Albert Camus ● “If they learn to value themselves for who they really are, miracles occur.” ● “The way we learn to be resilient is by learning how to frame the story.” ● “Aging is a ripening.”

Dr. Oni Blackstock joins the show to talk about her work as the Assistant Commissioner for the Bureau of HIV/AIDS Prevention and Control for the NYC Health Department. Dr. Blackstock oversees and supervises all programmatic and administrative activities for the Bureau of HIV/AIDS. She is also a primary care physician, HIV specialist and research. She and David discuss the programs she is involved in regarding treatment and prevention services, community engagement and advocacy. They also discuss the state of HIV in New York currently, and both her concerns and successes within the recent years. Finally, they talk about how drug use intersects with HIV, and what upcoming programs we can expect in the future.   TAKEAWAYS: [1:41] Dr. Blackstock oversees the Bureau of HIV and it’s 8 programs. She also helps immensely in strategies that reduce the number of new HIV infections, and also to improve the overall health and well being of those living with HIV. [2:40] They are also seeing 85% of people living with HIV medical care reported as virally suppressed compared to the 79% we saw in 2013. In New York there are 100,000 people living with HIV. Dr. Blackstock and her team take into account all the data reported and do their best to develop programs according to social determinants of health as well. [5:21] One of the goals is to help dismantle racism and stigma in the black and Latin communities, those that rank the highest of being disproportionately impacted. [7:52] The Bureau has also been working with agencies they contract with to gather data and drill down on more information on both HIV numbers and drug use. Here they can get a better idea about crystal meth use as it relates to HIV, and create campaigns and forums to help even more. [11:12] Dr. Blackstock discusses data captured from a CDC funded project, the National HIV Behavioral Surveillance Study. This showed them that crystal meth use seemed to be on a decline amongst white MSM, yet increasing in the black and latino community. [14L02] The Long Time Survivor Coalition in New York celebrates the lives of people living with HIV. It helps them be part of a community to engage in self care, and gives them a resource to help guide them into resources that provide social and health services. [15:08] Often times those affected with HIV are not able to come to meet in person, for many reasons. This is why there are programs that focus on telephone outreach so there is still care and social connection given. [20:41] There is also work to be done to make providers more comfortable discussing sexual history and PrEp with their patients. [26:02] There is more optimism and hope than ever, and people are now seeing HIV as a chronic manageable disease rather than a death sentence. Hopefully in 2020 and beyond there will be more tools and prevention accessible to all who need it.   RESOURCES: ParTy Boi HIV Health and Human Services LGBT New York HIV Surveillance Report   QUOTES: ● “We have a significant commitment to reducing the HIV related disparities and health inequalities we see as we work to end the epidemic.” ● “Person to person was so valuable, and it still is.” ● “Social support is so important.” ● “Social connection is really a healing force.”

Graham Harriman is a long term HIV survivor and Director of the Care and Treatment Program in the Bureau of HIV Prevention and Control at the New York City Department of Health and Mental Hygiene. Graham serves as the NY EMA Program Director, the largest EMA in the nation. Graham’s work in the field of HIV began over 29 years ago as a mental health therapist in an integrated medical clinic serving low-income people living with HIV and AIDS and has worked in public health for over 15 years. Graham describes his duties as a Director in the Bureau of HIV in NY, speaks about the efforts available in the Care and Treatment Program, and what he sees in the intersection of HIV and drug use in New York.   TAKEAWAYS: [2:12] Graham oversees the Ryan White Program, a status neutral program for those that want to access PrEP, or the Undetectables Program and programs for MSM or transgender individualswho use methamphetamines. [4:30] We have seen an increase of meth use in men of color and Latino men since 2014. [5:26] The program addresses the needs of MSM of color and transgender individuals through a combination of different services. These include health education, medical services including vaccinations and screenings, and social benefits and entitlements such as housing, food and health insurance. [8:31] The model is a status neutral harm reduction program that leverages the Ryan White funding to address the needs of people who are HIV positive and meth users. The goals of the program include promoting and providing easily accessible harm reduction based substance use treatment, medical care, and reducing negative health impacts through services. [10:02] They use a harm reduction approach to maximize engagement with persons who are using meth because they know only a portion of the users are ready or interested in engaging in substance use treatment. The harm reduction model helps us have a population based approach to prevent new infections and focuses on reducing negative harms associated with meth use. [12:53] They are a one-stop shop and judgement free zone for mental health, sexual health and substance abuse information. [13:42] It seems like they are reaching the right folks. Out of the 271 clients that are fully enrolled, 97% are male and 66% are under the age of 40. More than half the clients are MSM of color, and the majority are smoking meth and half of them are injecting meth. 40% of the people in the program are HIV negative and 60% are HIV negative. [15:13] Peer engagement makes all the difference in the world, and many people have stayed with the program to offer support and help others through education and outreach. [17:08] Over 25% of persons that have come into the program are on PrEP. [19:13] They expect to have a forum in the fall to address issues of chemsex and how they can help people understand the fusing and risks of sex and drug use.     RESOURCES: ParTy Boi Act Up HIV Health and Human Services Recharge LGBT New York   QUOTES: ● “There’s a number of issues going on here, power and control.” ● “We’ve created a program that embraces a model of care.” ● “When you get peer engagement, it makes all the difference in the world.”