Abstract
In Chicago, Black men who have sex with men (MSM) and transgender and gender nonconforming (TGNC) individuals experience higher rates of HIV diagnoses. The Southside of Chicago has a thriving house ball culture powered by MSM and TGNC individuals who are disproportionately impacted by HIV. While this community has a history of facilitating health promotion at their events, gaps exist in community-empowered education specific to this community. Through partnership between nursing students from University of Illinois Chicago (UIC) and leaders from the Southside Health Advocacy Resource Partnership (SHARP) and the University of Chicago Center for HIV Elimination (CCHE), we aimed to reduce health disparities experienced by the Black MSM/TGNC community in Chicago. We promoted COVID-19 vaccinations and obtained funding for a community-led project to reduce HIV-related stigma. Our team consisted of two community leaders, seven students, and two professors. We met weekly during the development stages and detailed notes were maintained by students and updated with next steps. Four months of collaboration demonstrated how nursing coursework can facilitate community–academic partnership and yielded a COVID-19 viral vaccination promotion video, community administration of vaccines, and SHARP’s procurement of funding to implement a project to reduce HIV-related stigma. Students learned the importance of community leaders’ presence when bringing health care to communities. Community leaders learned to communicate population needs and best utilize students as a resource. Enriching nursing curriculum using an integrated service-learning format offers the opportunity for student development while simultaneously serving the community.
Keywords
Assessment of Need
Systemic racism and ensuing medical mistrust have exacerbated health disadvantages for Black men who have sex with men (MSM) and transgender and gender nonconforming (TGNC) communities (Bogart et al., 2021). In 2019, Black MSM and TGNC individuals in Chicago experienced 4.3 times more new HIV diagnoses than Black and heterosexual or cisgender individuals (Chicago Department of Public Health [CDPH], 2022). COVID-19 has further harmed the Black community in Chicago; in the first year of the pandemic, Black non-Hispanic Chicagoans had the highest cumulative rates of hospitalization and death (CDPH, 2021). Notably, while 74.2% of residents have received at least one vaccine dose, this includes only 58.1% of Black Chicagoans (CDPH, 2022).
To advance health equity, University of Illinois Chicago (UIC) nursing students and leaders of the Black MSM and TGNC communities partnered. Leaders from the University of Chicago Center for HIV Elimination (CCHE) and the Southside Health Advocacy Resource Partnership (SHARP) collaborated to provide clinical services and advocacy related to COVID-19 vaccines and HIV prevention, testing, and care. Many in this partnership are also involved in house ball culture. With roots in the 1980s AIDS epidemic, house ball is a subculture which highlights artistic talents through events that foster community (Livingston, 1990). The community has a long-standing history of facilitating health promotion, including HIV testing at balls (Lemos et al., 2015; Livingston, 1990). Despite health disparities within Black MSM and TGNC communities, there remains a lack of health education specific to their needs. House balls can serve as a venue for health promotion, drawing on their leaders’ connections to organizations that work to improve health outcomes (Lemos et al., 2015).
Objectives
As UIC nursing students and community leaders from CCHE and SHARP, our objective was to reduce health disparities experienced by Black MSM and TGNC persons. Over the course of a semester, we fostered relationships and supported sustainable, community-empowered health interventions. We share our perspectives on our collaboration and its outcomes.
Method
Partnering with community members to develop, adapt, and deliver health promotion activities promoted sustainability. Community goals included COVID-19 vaccination promotion and HIV prevention for Black MSM and TGNC community members. Furthermore, community leaders wanted to draw on their visual art, musical abilities, and social media skills for these initiatives.
COVID-19 Vaccination Promotion
Increasing uptake of COVID-19 vaccinations was identified as a community goal. Students and faculty worked with artists to create palm cards featuring influential house ball community leaders promoting vaccination. These cards were distributed at the ball by a prominent house parent. Attendees were informed by a house ball legend that they would receive free admission with on-site vaccination. Alongside supervising faculty, students administered vaccines and spoke with ball-goers about COVID-19 vaccinations and other health concerns. As COVID-19 cases rose in fall 2021, students hosted an outdoor vaccine clinic at #jamoutsavelives, a family-friendly event and concert to raise awareness about COVID-19 testing and vaccination. Our partners produced a 2-minute music video that was shared on social media and, to date, has more than 2.4 million impressions (Stamps, 2021).
HIV Prevention
Together we applied for an HIV Challenge grant through the Department of Health and Human Services, Office of Minority Health (HHS-OMH) to support the growth of an SHARP’s outreach initiative. Yuck or Yum is an innovative, community-led project aimed at reducing stigma related to HIV care and pre-exposure prophylaxis (PrEP) use. Our team proposed expanding this social media–based talk show to provide culturally informed, community-driven health education around HIV and direct linkages to care. Featuring influencers and health care professionals, the show will reduce stigma related to PrEP and antiretroviral therapy (ART) utilization, foster connection among viewers, and offer real-time referral to testing and treatment. Our work on the proposal resulted in SHARP being selected, out of 80+ applicants, to receive $20,000.
Outcomes
Efforts have yielded grant funding, a viral video, vaccinations, and increased community awareness. Most importantly, these efforts have shown how nursing coursework can be utilized in service to community work, if community leaders are willing to integrate the diverse skills and constraints of students and trusted faculty mentors are available to serve as guides. We gained insights from one another and learned new ways of operating in the community and in academia. In addition, we leveraged our resources as nursing students to further the community’s work in fostering resilience through identity-affirming social norms and the establishment of physical and virtual spaces to share health information and ultimately improve access to health care.
Community leaders took a leap of faith to incorporate nursing students into an existing partnership providing an exceptional learning experience. Inviting nursing students into this partnership required that community partners invest time and energy. Community leaders met virtually with the students to share their goals and how the students could contribute. All participated in these planning meetings with open minds, curiosity, and patience. Over time, we developed a sense of mutual trust, appreciation, and motivation to work together to innovatively address health disparities experienced by Black MSM and TGNC individuals.
As students and future health care professionals, we learned that community-based work requires flexibility, trust, and humility—especially when entering spaces which were created by and for a particular group. We learned to think creatively when considering methods of community engagement. As community leaders, we learned how to work in the context of students’ clinical coursework, navigating what each person brings to the table and balancing varying desired outcomes in a finite time frame. It required the ability to step back and acknowledge team members’ experience, knowledge, and passion. Trusting one another was both a risk and a reward of this process; all involved were able to allow trust to germinate over the course of a semester.
Conclusion
Clinical placements for nursing programs have typically served the needs of students with lesser emphasis on the impact on the community. This partnership moved beyond the traditional modes of teaching and encouraged students to be change agents within the community. It resulted in deliverables that met a need identified by stakeholders at a time when circumstances called for creative and agile partnerships. This creative partnership demonstrated the collective power of committed individuals working toward a common purpose.
