Project Vogue provided community-based care coordination, HIV care, and behavioral health services to Black men who have sex with men (MSM) within New York City’s House & Ball community. Supported by funding from the Ryan White HIV/AIDS Program (RWHAP) Part F Special Projects of National Significance (SPNS) Evidence-Informed Behavioral Health Models to Improve HIV Health Outcomes for Black MSM initiative, Gay Men’s Health Crisis (GMHC) developed and implemented Project Vogue from August 2019 through November 2021 to address the unique cultural barriers that Black MSM experience when trying to access care. Project Vogue participants were linked to behavioral health services as well as to non-clinical supportive services, such as food and housing assistance.
New York City, NY
Black MSM in New York City (NYC) have higher rates of HIV infection and experience worse health outcomes than the general population with HIV.1 Discrimination and stigma due to racism and homophobia, poverty, joblessness, untreated mental health disorders, and substance use are all contributing factors. Project Vogue addressed these issues by creating a nonjudgmental, client-centered environment where Black MSM could receive care and support.
For every client, Project Vogue staff completed a comprehensive intake process that identified needs and assessed barriers to care, using motivational interviewing techniques to gather information regarding past and current HIV treatment and medical care, substance use and mental health history, and access to supportive services. Staff also confirmed whether a client was connected to an HIV provider and the timing of their last appointment.
Project Vogue focused on helping Black MSM who were struggling to manage their behavioral health conditions. GMHC staff members used a psychosocial assessment to gather information on each client’s recent substance use history and mental health conditions, and then clients were referred to behavioral health services (mental health and substance use treatment services) within GMHC or to one of its external partners. GMHC staff also created an individualized action plan that guided the utilization of these services.
Peer Navigation Ambassadors (PNAs) provided linkage and reengagement navigation services based on action plans developed through the intake process. Navigation activities included regular check-ins, appointment reminders via phone or text, and accompanying clients to their mental health or supportive service appointments. The PNA also helped clients address barriers to care and linked them to GMHC’s Health Navigation team for enrollment into Medicaid.
PNAs also discussed treatment adherence issues and provided counseling, sharing their own life experiences to build emotional connections with clients. Project Vogue included three counseling sessions. In the first counseling session, the PNA and client developed a rapport and reviewed the comprehensive client assessment they completed during the enrollment process. The second (six-month) and third (12-month) counseling sessions focused on reviewing the progress on the client’s action plans, conducting reassessments, and developing an exit strategy for when the client graduated from the intervention.
GMHC created a safe space called “the Clubhouse” where members of the House & Ball community could access services like WiFi, discuss harm reduction strategies with GMHC staff, relax, and engage with others through artistic expressions like voguing and dance practices. Biweekly empowerment group sessions promoted engagement with GMHC services, and MetroCards helped clients get to events.
GMHC used the GET! Mobile app to share educational materials and facilitate virtual support group sessions and appointment scheduling. GMHC staff members sent secure individualized messages to their clients through the app, regarding key milestones, medically-sensitive data, and upcoming appointments. GMHC acquired the app through its partnership with the New York State Department of Health AIDS Institute.
GMHC enrolled 80 people in Project Vogue from September 2019 to December 2020. To be eligible, participants were considered ‘out of care’ based on RWHAP criteria, or were at risk of falling out of care because of housing instability, recent incarceration, history of substance use or ongoing mental health issues, and/or poor experiences with health care services. The evaluation found that 4 out of 5 clients received one or more supportive services during the intervention. About two-thirds of participants used behavioral health services after enrollment in Project Vogue.
Source: GMHC. Project Vogue Implementation Manual. Implementation of Evidence-Informed Behavioral Health Models to Improve HIV Health Outcomes for Black Men who have Sex with Men Project. 2022.
Framework for intervention. Project Vogue was modeled after His Health’s Project Silk,2 a recreation-based intervention that provided health services to Black LGBT individuals in a stigma-free environment. Among many of the intervention’s key components, Project Vogue adapted Project Silk’s model of community-based participation, peer navigation, behavioral health intervention, and offering a nonjudgmental space for people in the House & Ball community.
Internal promotion. Discussions were held with GMHC’s internal stakeholders and management team to promote Project Vogue. The program coordinator held individual meetings with colleagues and with mental health and substance use services at GMHC to integrate behavioral health services into the program plan. A one-page program summary was shared with GMHC staff.
Clinical and community partnerships. Project Vogue had four clinical partners who committed to the intervention via a memorandum of understanding (MOU). GMHC staff held meetings with these clinical partners to discuss how to facilitate referrals. Project Vogue also had informal referral agreements with hundreds of community providers, including New York City’s PlaySure Network, an initiative developed by the NYC Department of Health and Mental Hygiene with 50 community partners.
Staffing. Staffing for Project Vogue included a program director who provided leadership and oversight, a program evaluator who promoted continuous quality improvement, and a program coordinator who was responsible for the day-to-day management and PNA support.
Staff training. GMHC staff members received annual training on trauma-informed care and the impact of trauma on individuals they serve. Staff members also received anti-racism training that focused on approaching HIV care provision with cultural humility.
Promotion and client recruitment. To promote Project Vogue, GMHC developed palm cards and tear-off flyers based on input from GMHC’s communications team and clients. These promotional materials were distributed internally and through local partners. The palm cards were also posted on social media sites and on paid digital advertisements.
This intervention, as part of the Evidence-Informed Behavioral Health Models to Improve HIV Health Outcomes for Black MSM initiative, was funded by SPNS. Project Vogue also used existing programs and funding at GMHC to support the intervention. This included a workforce development services program designed for those who receive NYC HIV/AIDS Services Administration benefits, a RWHAP-funded legal services department, and housing assistance programs funded by the Centers for Disease Control and Prevention, Housing Opportunities for Persons with AIDS, and the New York State Department of Health AIDS Institute.
- Project Vogue staff found that HIV and mental health stigma negatively impacted participation in behavioral health services. Few clients followed through on their referrals, noting that they did not need services. Communication and tracking tools can be used to improve information sharing across behavioral health and other staff and to better monitor referral status and appointment attendance.
- After moving so many services to virtual provision during the early months of the COVID-19 pandemic, challenges with technology resulted in high cancellation rates, limited participation in virtual sessions, and longer times to engage the client in care. Providers should assess clients’ access to technology as a part of the enrollment process and explore ways to meet clients’ technological needs.
- Project Vogue experienced turnover among PNAs due to job stress and personal challenges. As a result, the remaining PNAs experienced high caseloads. Providers should create a path for professional growth within the agency for PNAs, hire PNAs on a full-time basis, and provide clinical supervision for them.
- Project Vogue was implemented during the COVID-19 pandemic, and virtual services allowed GMHC to expand its capacity to deliver services remotely. As a result, GMHC was able to plan for collaboration between clinical and non-clinical providers to provide clients with co-located virtual services.