New Program MFierce Aims to Reduce Sexually Transmitted Infections in Southeast Michigan

A young transgender woman goes to the front desk of her local clinic and is handed a blue intake form—blue for boys, pink for girls. She goes back to her seat to fill out her slip, already feeling misunderstood by her doctor. Young gay and bisexual men and transgender woman in the United States experience disproportionate rates of sexually transmitted infections, according to the Center for Disease Control and Prevention. This disparity is in part due to social factors such as prejudice and inadequate health care, said Triana Kazaleh Sirdenis, project director for a new program at the University of Michigan called MFierce. This is why MFierce is kicking off its second year in September of 2015 by training physicians and clinicians to be sensitive to gay, bisexual, and transgender health needs. The program aims reduce the rate of sexually transmitted infections in gay, bisexual, and transgender populations in Southeast Michigan—working with key partners such as the Detroit Department of Health and Wellness, the Michigan Department of Community Health, and regional health clinics—by building trust between physicians and the gay community.

Although the program is operated out of the University of Michigan, the target population is not just students. MFierce was enabled by a three-year, $1 million federal grant called “Community Approaches to Reducing Sexually Transmitted Diseases” from the Center for Disease Control and Prevention in September of 2014. Along with the University of Michigan, the grant was awarded to the AIDS Foundation of Chicago, Baltimore City Health Department, and the Public Health Management Corporation in Philadelphia. “Everybody’s working around the issue of STIs, but the community that they’re speaking to, that is most affected by it, changes by location,” said Sirdenis. AIDS Foundation of Chicago is focusing on young women of color. Baltimore City Health Department is focusing on Baltimore city youth. Public Health Management Corporation in Philadelphia is focusing on young African Americans and Latinos in North Philadelphia. And of course, the University of Michigan is focusing on gay and bisexual males and transgender females in Southeast Michigan.

Brooks Bock, an emergency medicine physician and former Founding Chair President of Harper University Hospital and Hutzel Women’s Hospital in Detroit, Michigan has seen the progression of the medical field’s culture of care toward gay, bisexual, and transgender patients over his 30 years of practice. As a medical student in Wayne State University’s School of Medicine in 1969, he received no special training on gay, bisexual, or transgender health needs. While there have been drastic changes since then in the health care industry regarding gay patients, he says it has not changed quickly enough. According to Bock’s experience, out of the hundreds of thousands of health care practitioners in the country, some of them still “assume that every gay man is sleeping with six gay men every night.”

The assumptions, prejudice, and discomfort are apparent to gay, bisexual, and transgender patients and contribute to worse health outcomes for this population: 72% of HIV cases in young people in the United States occur in young gay or bisexual men, and these numbers have increased by 22% between 2008 and 2010 according to a 2012 study by the Center for Disease Control and Prevention. Zach Crutchfield, who works on the Youth Advisory Board for MFierce and is a member of the gay and bisexual community in Southeast Michigan said, “I have friends who are trans who have had such bad experiences, they just don’t feel comfortable going to the doctor.” While Bock says that strides have been made in the medical field toward treating these patients better, Noel Gordon from the Human Rights Campaign said that today, lesbian, gay, and transgender health training is still not required in many medical schools. He has heard stories of providers who repeatedly misgender transgender patients throughout their consultation, doctors who make assumptions about the number of sexual partners their patients have had, the type of sexual partners gay and bisexual men have had, and he has even heard a doctor telling a gay man the sex he was having was “nasty” and “sinful.” He says these are the types of stigmatizing behaviors that patients sometimes receive when going to the doctor.

Both Sirdenis and Crutchfield think the approach to the MFierce project is one that could be a model for the rest of the country in its community-driven approach. According to Richard Lichtenstein, a professor at the University of Michigan School of Public Health and an expert in Community Based Participatory Research, projects did not always function in this community-driven way. He said in the past, researchers would come into a city like Detroit, collect their data, and leave. A project like MFierce, on the other hand, is more interactive. For the entire first year of the project, the team dove directly into the communities where this disparity is a problem. Sirdenis said they held dozens of town hall meetings asking gay and bisexual men and transgender women in these communities how they could be helped, and let ideas from those meetings dictate the program’s actions. Sirdenis says that because the leaders of the project are the ones who experience the problem, research shows the project will be more successful. However, she warns, “What works in Southeast Michigan might not work in Indiana or might not work in New York City.” The other unique aspect of the program is that it reaches broader social and economic factors such as quality of health care, prejudice, poverty, housing, and more, said Sirdenis. She says many programs exist that teach people how to use condoms and negotiate safe sex practices, but MFierce is working on the root causes.

Crutchfield, of the Youth Advisory Board for MFierce, says he “would like to see this grow into something bigger that could exist on its own, without having to rely on federal grant money.” He says, “Hopefully, if we do our job this will be around to stay.”

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About clarehudock

Student at the University of Michigan Aspiring public health innovator Public policy and economics

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