"Is Silk open tonight?": Lessons learned from Project Silk, an HIV prevention demonstration project for young African American MSM and transgender people

BACKGROUND: Project Silk is a CDC-funded HIV prevention services demonstration project targeting African-American young MSM and transgender people, ages 13-29, in Pittsburgh.  Utilizing a community-based participatory practice model, Project Silk combines structural and behavioral high-impact prevention to provide a safe recreational space, open four evenings/week; HIV CTRS on- and off-site; nested HIV care linkage/re-engagement; and ancillary social services across 19 domains.

METHODS: Quantitative data for safe space utilization, HIV CTRS, linkage to care, and ancillary service provision outcomes were collected via CDC reporting mechanisms in year 1 (2013).  Qualitative data assessing barriers/challenges were collected by an independent process evaluator who recorded 32 meetings and interviews with staff, stakeholders, and participants, and coded these data for themes.

RESULTS: 323 unique participants utilized the Project Silk safe space (median age=17).  28.4% (n=213) of total estimated County target population accessed the space (mid-year mean=8.0 visits/person), achieving community-level diffusion.  55.7% of participants reported ancillary service needs, with employment (29.7%) and housing (25.1%) most requested.  6.3% of target population members receiving HIV CTRS (n=64) were newly diagnosed as HIV-positive; 20.3% reported previously testing HIV-positive.  93.8% of HIV-positive participants were linked/re-engaged in HIV care services.  Three key programmatic challenges emerged: violence between participants; peer worker difficulties managing personal and professional spheres; and HIV-related stigma among participants.

CONCLUSION: Targeted HIV prevention, testing, and linkage/re-engagement in high-prevalence populations can be effectively provided in dedicated recreational safe spaces offering comprehensive social services.  We will discuss strategies addressing interpersonal violence, peer worker boundary-setting, and HIV-related stigma to maximize programmatic effectiveness.