When Gerardo L. Angulo sits down to write up a prevention plan, which he does with each incoming client in Track Change, he strives to tailor the multiple-session, goal-oriented one-on-one counseling to each individual’s needs. Yet, often, he finds that his clients—young men of color ages fourteen to twenty-four who may or may not identify as gay or bisexual but who have sex with other males and also are at risk for HIV/STDs—confront similar issues. Misinformation about sexual health and safe sex practices, limited perceptions about self and community, and a dearth of skills necessary to navigate sexual and social situations are some of the issues that pop up time and again. And time and again, by the end of the program, Angulo has seen many clients walk away with a newfound sense of awareness and worth interlinked to an empowered approach to their sexual health.
As a part of the youth empowerment program at Native Health, a Phoenix, Arizona, nonprofit that provides medical, dental, and behavioral health services, Track Change is a CDC-funded HIV/STD prevention program. Angulo, the counselor for the program, says its primary focus is maintaining and improving sexual health.
“The Youth Empowerment Project provides counseling services to youth—basically those who need services outside of participating in social events or having a place to hang out. Track Change, however, was designed with the intention of having youth participating in what we call comprehensive risk counseling and services, or CRCS,” explains Angulo, whose credentials include a Master’s in counseling and almost twelve years of professional counseling experience. He is also a licensed substance abuse technician in the state of Arizona and a board certified professional counselor through the American Psychotherapy Association. Additionally, he is bilingual in Spanish and English, which is helpful in a state whose Spanish-speaking Hispanic population is significant.
CRCS was initially set up to provide case management services to gay youth in need of food, transportation, or housing, but has since expanded to include, via Track Change, free, voluntary, and confidential HIV testing and prevention counseling in order to provide support, guidance, and education to this population. In particular, the program is responding to high rates of HIV prevalence among ethnic minorities, among them African Americans, Latinos, Native Americans, and Asian Americans. Though the program targets young men of color, it will not turn away those who identify as white.
All clients are at risk for HIV and STD infections, and the reasons are varied and different for each of them. Lack of education, low socioeconomic status, being part of an underserved population, or living as an undocumented immigrant who does not qualify for benefits are some of the barriers to health that create a context of risk. And this context of risk is not only shaped by “everyday temptations” like raves, house parties, and underage drinking, says Angulo, but also by having sex with men they barely know whom they meet at bars or on-line. He has helped clients who have turned to sex work in order to survive, who are homeless, victims of domestic violence, or in need of material resources, mental health services, or even just relationship advice.
Whatever situation the client is in, says Angulo, “we go back to the question: What does [sexual health] mean for them?”
In other words, clients cannot begin to change the potentially harmful perceptions and practices that put them at risk if they do not understand why they are making the choices they are making and what other options are available to them.
“Some of our youth suffer from low self-esteem due to a lot of the social stigma that is still out there, even in 2010—[they are often affected by] the discrimination they have faced as an ethnic and sexual minority, and the coming out process and how difficult that can be for most youth. Now that kids are coming out younger than before, this type of resource is so needed because they have someone they can come to who is neutral and will not be judgmental, who will listen to them with a fresh, open ear,” says Angulo. “They have a chance to express their frustration, their pain, and their needs. And they can have someone they can come to to address those needs, whether they be emotional or mental health issues. Often they use substances, which can easily lead to unsafe sexual choices.”
Counseling also includes discussing their negative serostatus in relation to sexual health. A lot of times, youth will believe that oral sex is not real sex and not even think about safe sex practices, for example. They may at times be submissive to a partner’s demand to not use a condom because pleasurable feelings are reduced, or convince themselves that condoms are the enemies of erections.
“We try to help them understand that sex is an act of love and intimacy but it’s also a state of mind as well. When they start to change their frame of reference to believe that, although they may have an issue wearing a condom, they can see the benefit of wearing a condom.
“I ask all my clients the same question: How much do you value your health? You were just told you’re HIV-negative as per the last HIV test you had administered, so how much do you like to wake up every day knowing you’re HIV-negative?” says Angulo. “Do you want to wake up every day and say, ‘Oh my god, I’m HIV-positive and living with HIV for the rest of my life?’ They stop and they pause and say, ‘Well, I never really thought about it that way,’ or, ‘I may have taken my health for granted all this time.’”
Says Angulo: “Now when I write up a prevention plan, I have them outline for me what they want to accomplish as a result of being in the program.” Then Track Change helps the youth achieve that goal, whether it is learning about STDs in general or how to please a partner so that anal sex is not the only option.
As part of the education about safe sexual practices to prevent HIV and STD infection, Track Change also covers condom handling and use, as well as latex and lubricant information.
Even though Track Change focuses on helping HIV-negative youth stay negative, Angulo does not turn away someone who is positive or becomes positive during the course of counseling. Often, he says, positive youth will interpret their serostatus as “not needing to be healthy anymore or using protection. I always try to educate them around choices and free will, and also let them know the objective information about unsafe sex.”
From time to time, Angulo goes out into the Phoenix area to give presentations to mental health agencies, behavioral health agencies, health departments, and agencies that provide substance abuse treatment, among others. One of his goals is to help educate the community about the importance of referring youth to a program like Track Change if they self-identify as an individual who is having sex with other men. But, he adds, it’s important for them to also understand that HIV/AIDS is not a “gay disease” but rather a global concern. He aims “to help the community to understand that it’s not any one person’s or any one group’s problem. It’s everybody’s problem and everyone can contribute in their own way. Some can contribute just by self-educating themselves or taking an HIV 101 workshop,” he says, adding that workshops like these are offered in the community on a monthly basis.
“I’ve been asked by other people about why I’m so passionate about this position and program as a professional and I tell them that as an openly gay man I come from a world where growing up in the eighties in a small border town like Nogales, Arizona, and going to a private Catholic high school and living the conservative way of life, per se, is not the easiest thing. Especially being a Latino man and growing up Catholic—what does that do to your own self-perception? I have my own story of growing up without any of these resources that a lot of gay youth have nowadays. It’s beautiful to see the evolution of services in place for our youth and appreciate the funding that’s out there right now in order to enhance things like education and communication in the community to really try to stop the stigma and stop the discrimination and the prejudice and the thinking that you can get HIV just by touching somebody.”
Angulo also takes pride in being a model to youth. “I’m HIV-negative and that’s something I openly share, too,” he says. He also counters cultural messages that impart to youth that being gay automatically means circuit parties, raves, drugs, and multiple sexual partners. “No, you just have to be yourself,” he advises them, “build on your own individuality and give and share what you can to other people based on that individuality.” Angulo helps youth build healthy relationships as clients often believe the only way to meet sexual partners is by going to bars, bathhouses, or on-line. Or they often believe being gay is the only lens through which to see themselves.
Angulo believes sexual health is directly related to one’s own sense of self.
“I have found that a lot of our youth have been disempowered by society to believe that there is something wrong with them, to believe they are incapable of living and leading healthy lives, so I even try to help them to deviate from that idea and form new perceptions about themselves. A lot of times they don’t get that nurturing and validation at home.”
Track Change encourages youth to see that “they have so much to offer to their community, their society, and that they can definitely grow to be those strong individuals and thrive, be successful, be giving, and definitely have a feel for being alive, and not just have to be under some alias or belong to a specific group of people in order to survive. They know that they can get out there and be part of the mix, be part of the diversity. Teach about other things. Be open to new people and new ideas.”
Track Change has seen positive outcomes. “Usually I’ve come to find that there has been a lot of personal growth taking place with the people I see,” says Angulo, who notes that he always provides constructive feedback when he sees youth begin to evolve into more empowered human beings who have taken ownership of their health and the health of others. “[The program] has been effective because there’s been a lot of increased self-awareness, where they have been able to say, ‘Wow I never really looked at my health as an asset. I never appreciated being negative as much as I do now. And even though I’ve been sexually active and not using protection some of the time, here I am, having learned about myself, about STDs in general, how easy it is [to be infected], how it only takes that one person or one time to contract a disease.”
But perhaps one of the most significant effects is that the clients in turn become agents of change, sharing what they have learned with friends or peers or conducting more formal outreach.