Case managers find that outreach and trust can reduce rates of new HIV/AIDS infections in minority men in Texas and help them accept substance use treatment.
Corpus Christi, Texas—“Body of Christ”—is a tough town. It is ringed by 15 miles of chemical processing plants and sits on the Gulf Coast just above the Mexican border. Whether these plants process petroleum or corn products is irrelevant to their aggressive ugliness. Corpus Christi is a workingman’s town, and a sense of resilience is probably required to survive long, hot, loud days of industrial work right up to the moment you drop from exhaustion. It turns out knowing this is important to understand the work of the Coastal Bend Wellness Foundation and the grant they received from SAMHSA for substance misuse treatment for at-risk minority men.
“The grant targets gay, bisexual, and ‘on the down-low’ men with a history of substance use. Often they have difficulty accepting their own sexual orientation. They are HIV positive or at risk for it. Some have a co-occurring disorder such as schizophrenia, borderline personality, or a mood disorder. They have little or no support,” explained Roger Vazquez, Director of Behavioral Health Services for Coastal Bend. “They have a lack of coping skills and stresses get magnified, and depression has become a large part of their life. Their first coping mechanism is drugs and or alcohol.”
“Our goal is to reduce the number of unhealthy decisions by clients and to decrease the rate of HIV transmission and the pattern of substance abuse,” Vazquez said. “We served 45 clients this year, with a six-month follow and will serve 60 clients per year for the next four years. We get referrals from other agencies that deal with men who have sex with men [MSM]. We offer confidential testing to get them in the door, recruit at bars, and on social media. We give presentations to other agencies about MSM best practices and cultural awareness issues. The clients we recruit are vulnerable and want to change and get educated.”
Case managers Ruth Luna and Jason Dodd talked about how gaining trust is the key to success with clients.
“Trust is a big issue,” Dodd said. “We do outreach in bars, go to drag shows, show them we are willing to walk the talk, give them support right at the club.”
Ruth Luna described what change looks like for their clients.
“The majority of clients complete the five core sessions we offer, and those that do complete the sessions have a very positive reaction and are willing to recommend us to their peers, which is important. They see an improvement in themselves—more sobriety, better coping skills, a positive impact on their performance at jobs and schools. We explain to them they need a good weekly goal, something that is important to them, something realistic and clearly stated that is easy to determine if it has been accomplished.”
We asked the case managers what worked, and they emphasized the need to be persistent and to provide nonjudgmental support to clients. “They have good days and bad days,” Dodd said. “Depression and lack of support is a huge issue for the MSM community. They can’t get that kind of support from Texas Mental Health and Mental Retardation (MHMR) case managers—we have 20 people on our caseload and MHMR case managers have 100. We emphasize that it is a team effort with the counselor and the client, and we try to schedule appointments and other sessions according to client needs.”
“In a lot of ways, clients recognize that it is amazing this is available in South Texas. This is a very underserved population, and for many of them it is significant that the government is acknowledging that they exist. Just that feeling increases trust and word of mouth,” Luna said.
This article was originally published to highlight the April 2014 theme of Alcohol Awareness.
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