The Importance of Safe Spaces in Community-Based HIV Prevention

Ethnographic study findings indicate that safe spaces represent a promising but so far under-utilized part of community-based HIV prevention infrastructure. Led by Jonathan Garcia, PhD, Assistant Professor for the School of Biological and Population Health Sciences in the College of Public Health and Human Sciences at Oregon State University, the study investigators suggested in the October 22, 2015 issue of PLOS One that safe spaces provide social support and reduce environmental barriers for vulnerable populations.

Safe spaces, often run by community-based organizations, work with vulnerable populations to provide social support and services such as job and education assistance, medical testing, and treatment. “These safe spaces serve as surrogate homes, creating an environment with a brotherhood or family undertone for men who have often been marginalized by their families and communities and do not trust public institutions such as churches, schools or law enforcement agencies,” said Garcia. “Often they have no other place to go.”

For the community-based ethnography, the study team sought to identify the structural and environmental factors that influence vulnerability to HIV among black men who have sex with men (BMSM) and their engagement with HIV prevention services. Participants were observed at community-based organizations in New York City, in-depth interviews were conducted with 31 BMSM, and interviews were also conducted with 17 key informants who knew about the men and the safe spaces they frequented. Approximately 50% of the participants were homeless or living in unstable housing situations, and another almost 50% were unemployed. About two-thirds had some sort of health insurance, 17 of whom received federal Medicaid.

Garcia explained that BMSM are considered particularly vulnerable to HIV. Although this population constitutes only 2% of the United States population, they accounted for 75% of new HIV infections from 2008 to 2010. In the study, these men were using safe spaces as spots to connect, but the spaces also aided in addressing vulnerabilities, including exposure to violence, lack of social support, limited employment opportunities, and feelings of mistrust against institutions or law enforcement.

The fear and mistrust that characterized BMSM’s relation to social and public institutions—like churches, schools, and the police—created HIV vulnerability by challenging engagement with services. To be successful, “HIV prevention efforts must address these structural and environmental vulnerabilities,” write the study authors. Garcia added that addressing these issues and provide a safe, community environment provides a better basis for which men are open and amenable to seeking HIV testing and treatment.

“The meaning of safety is different for people who don't feel like they are safe at home, or that the police are on their side,” Garcia said. “Safe spaces help create that feeling of security not found elsewhere.”

Looking ahead, the small study’s findings are helping shape a clinical trial that incorporates the use of safe spaces, both in person and online, for men who are receiving pre-exposure prophylaxis because of their high risk for exposure to HIV. Garcia said that safe spaces could also be used in the prevention and treatment of other stigma-carrying diseases, such as sexually transmitted infections and hepatitis C.

Unfortunately, funding is a key issue facing organizations that operate safe spaces, according to Garcia. He added that safe spaces are often eliminated first when groups or organizations experience a funding shortfall, in order to sustain treatment and prevention services. “Safe spaces are recognized as something important but are more unofficial,” said Garcia. “But the spaces can play such a critical role in educating and providing health services to the affected men that eliminating the spaces could reduce the effectiveness of health programs… If that support is what they are lacking, then providing it is likely to help them continue to seek treatment and services.”