Many Men, Many Voices (3MV)

What is the Program?

Many Men, Many Voices, more commonly known as 3MV, is a three-day retreat-style workshop designed to build community and enhance self-esteem related to racial and sexual identity among young Black men in Toronto ages 16-29 who identify as gay, bisexual and/or transgender (GBT). The program aims to address factors that may contribute to HIV and STI risk, including:

Cultural, social and religious norms
Interactions between HIV and other STIs
Sexual relationship dynamics
The influences of racism and homophobia on sexual risk behaviour

3MV is delivered by Black Coalition for AIDS Prevention (Black CAP)—a Toronto-based organization that works to reduce HIV/AIDS in Toronto’s Black, African and Caribbean communities and to enhance the quality of life of Black people living with HIV/AIDS. It is based on an evidence-based HIV prevention intervention disseminated across the United States through the Diffusion of Effective Behavioral Interventions project (DEBI).

The Black CAP version of 3MV builds on the core elements of the original program and has included new features that offer tools to help address the social, emotional and psychological drivers for unsafe sex (e.g. depression, stress, anxiety and internalized homophobia), such as “self-actualization” techniques and a non-denominational spiritually-themed closure ceremony.

Further, the program engages older Black GBT as mentors and provides participants with opportunities to connect with clinical counsellors who are experienced in working with Black GBT youth. The resulting enhanced program focuses on reinforcing participants’ knowledge, attitudes, beliefs and behaviours to make them more resilient.

Who is DEBI?

For more information on the Diffusion of Effective Behavioral Interventions project, (DEBI) and its core elements as well as how Black CAP expanded upon a DEBI program to adapt it to a specific local context in Canada, please read Let the Adaptation Begin in CATIE’s Prevention In Focus. For more information on the original version of the 3MV intervention as delivered in several cities in the United States, please see Other Useful Resources.

Why Was the Program Developed?

Black CAP strives to find innovative ways to educate and empower members of the diverse community it serves. Particularly at risk for HIV infection within Toronto’s Black community are young GBT men, many of whom are marginalized by issues such as homophobia, anti-Black racism, immigration, HIV-related stigma and discrimination, and poverty. 3MV was adapted by Black CAP specifically to address this community.

In 2007, Black CAP became aware of innovative work being done with Black youth in New York City through a literature search and a review of current programs for Black MSM in Canada, the U.S. and UK. In particular, research-based prevention programs for Black MSM were being adapted across the U.S. by dozens of organizations through the DEBI Project. 3MV was one such program being implemented by People of Color in Crisis (POCC).

In 2008, Black CAP staff visited POCC in New York, and received initial training related to the delivery of 3MV. Black CAP staff then attended a second follow-up training with the Gay Men’s Health Crisis (GMHC) in New York City.

Following this, Black CAP adapted the intervention to address the specific needs of young GBT men in Toronto, delivering it as a pilot program in 2009 to 15 youth over three days and two nights. Based on feedback from the pilot, 3MV was further adapted and a second pilot was held later in 2009.

Major adaptations from the original DEBI model of 3MV

Three-day retreat-style format

The original 3MV program was delivered in a series of seven three-hour sessions, each one delivered on a weekly or bi-weekly basis. While this strategy worked in cities like New York, which has long-established services readily accessed by their African American GLBT communities, the Black GLBT population in Toronto is composed largely of recently arrived African and Caribbean people who have a limited history of accessing such services. A three-day retreat was developed to retain the interest of a community that might have been difficult to recruit for seven separate sessions. The three-day format also facilitates the construction of lasting networks among facilitators, mentors and participants.

Participants of mixed serostatus

While the original program was developed and tested among men of HIV-negative or unknown serostatus, Black CAP opened up participation to HIV-positive men. It was determined that this would offer more opportunities for community building. To date, about one-third of all participants have been HIV positive.

Supplementary “Mindtraining”

To help enhance participants’ self-esteem, Black CAP added activities that help participants to identify their own potential and determine what might motivate them to reach this potential. These techniques are inspired by hypnosis therapy and the Human Potential Movement, which favours the cultivation of the extraordinary potential that exists in all people through techniques such as self-reflection, positive affirmations, visualization and guided imagery. 3MV does not follow any institutional practice but rather draws on the general principles of the Human Potential Movement to encourage participants to “train their own minds” to maximize their inherent potential.

Mentor participation

Some of the 3MV participants have not had the opportunity to meet and interact with positive role models from the Black community who are also gay, bi or transgendered. Role models (including community leaders, successful professionals and men who have previously completed the 3MV program) are invited to participate in 3MV as guest speakers and facilitators to further strengthen participants’ self-perception as GBT black youth. Black CAP is working on providing opportunities for participants to maintain relationships with mentors following the completion of the 3MV program.

Non-denominational spiritually themed activity

Many 3MV participants come from backgrounds with strong religious and spiritual ties yet many are often rejected by their families and spiritual leaders because of their sexual orientation or gender identity. Black CAP identified the need for youth from a diversity of backgrounds and cultures (Muslim, Animist, Catholic, Fundamentalist) to have meaningful experiences with a non-denominational spiritual theme. 3MV therefore incorporates a non-denominational closing ceremony led by a spiritual leader from the community. The ceremony provides closure by reinforcing the importance of believing in one’s inherent inner strength.

For more information on the original 3MV, see the “Original 3MV Fact Sheet” in Program Materials.

How Does the Program Work?

The 3MV program takes place over three days and two nights with 15 GBT youth, seven mentors and three facilitators. Mentors often stay on for various aspects of the weekend.

The bonding process established by the intimate dynamic of the three-day retreat begins at the very first meeting. The program delves directly into exercises and discussions that promote the exploration of emotions and feelings, facilitating community connection and sharing.

Location

A private, comfortable space capable of accommodating 15 to 20 people over the course of three days. The event has been delivered in private homes and at a university where Black CAP rented an entire floor of a dormitory. While Black CAP prefers to run the program in a private home for the intimate atmosphere afforded by such a location, either option is acceptable.

During the entire duration of the retreat, participants are asked to abstain from the use of substances (including alcohol) as well as from sexual activity. This policy is designed to help ensure a safe environment for all participants with a shared focus on retreat objectives.

Recruitment and engagement

Facilitators

Facilitators must be trained in guiding self-actualizing exercises in a group setting. Aside from the Program Coordinator who first adapted the program for Black CAP’s use, all facilitators of 3MV at Black CAP have been past participants in the program who have gone on to receive training in delivering self-actualization-style exercises in a group setting.

Mentors

The program involves the participation of a number of volunteer mentors 26 years of age or older. Mentors may be past participants in the 3MV program, community leaders or any Black GMT man who has successfully overcome obstacles and is willing to share his story with the group. Mentors from a range of professions, ages and cultural backgrounds were selected to represent a variety of issues and experiences; mentors included both HIV-positive and HIV-negative men. Recruitment typically takes place through word-of-mouth.

Participants

Black CAP recruits participants by speaking about 3MV to community leaders, by spreading the word through social networking sites and by talking about the program at events catering to community service organizations.

The majority of recruitment, however, is done through two peer research assistants (RAs) who are former participants in the 3MV program and who encourage participation by reaching out to men in their social networks. RAs speak about how they enjoyed the program themselves and how it has increased their self-esteem, helped them make new friends and created an ongoing sense of community among Black GBT youth. In addition to recruitment, RAs conduct intake and exit interviews with participants (see Human Resources).

Because 3MV is evaluated as a part of a community-academic research project (see the Evaluation section), participants are offered an honorarium (currently $150) for their participation. This can serve as further incentive.

When people express interest in participating, they are asked to fill out an application form and survey. These documents serve primarily to ensure that participants identify as Black GBT youth and that they are interested in participating in a program of this duration. Facilitators are also able to assess participants’ knowledge of HIV at this stage, which can help in planning sessions during the event. While participants are primarily young gay men, the program is also open to transgender individuals (both male to female and female to male). Each participant under 18 years of age must have a parent or legal guardian fill out a consent form granting permission to participate.

Workshop

The workshop takes place over three days and two nights, taking participants through a specific set of activities and presentations, which can be grouped according to four broad categories: meals with mentors, educational presentations, mind training exercises and special activities. For a complete session-by-session breakdown of the entire three-day weekend, see the “Course Outline” in Program Materials.

Meals with Mentors

The entire three-day workshop is punctuated by meals that are shared together as a group. At each meal, a mentor speaks to participants about his unique experiences as a Black GMT man and helps with the preparation and clean-up of the meal. The active participatory presence of mentors throughout the weekend promotes a heightened sense of community and contributes to smooth logistics at meal times. Each mentor brings a unique story and set of strengths to the group while contributing to the sharing of food and conversation.

Over the course of the three-days, participants are exposed to a number of different stories of resilience in this community context. Each mentor is asked to address some common topics in his presentation to the group (see “Mentor Talking Points” in Program Materials); however, each is also able to focus on what makes his story unique. For example, one man might speak of coming to terms with living with HIV, while another may speak of his experience overcoming addiction. Collectively, the combined experiences of five to eight mentors over the course of the weekend have a powerful impact on participants by painting a collective portrait of resilience through self-empowerment.

Educational Presentations and Exercises

Presentations and exercises carried over from the original 3MV program are woven through the workshop. These sessions introduce participants to content that is central to the core elements of the program. For more information on workshops, see the DEBI materials in Other Useful Resources. Examples of workshops offered include:

Black MSM and Dual Identity: Participants are asked to consider internal and external factors that influence behaviour change.

Spokes and Wheels Brainstorming: Participants are led to recognize the role that homophobia and racism play in their own perceptions of themselves and other Black and gay men.

HIV and STI 101: An overview of STIs and HIV and the risk factors for contracting or transmitting them. The session concludes with participants assessing their own risk for STIs and HIV.

Intentions to Act and Capacity for Change Exercises: Facilitators generate discussion on making changes to risky behaviours, engaging participants in establishing concrete goals as well as steps for achieving them.

Addiction Workshop: An overview of substance use and substance abuse with strategies for harm reduction presented.

Mind Training Exercises

Black CAP encourages participants to “train their own minds” using a series of “scripts” to help them realize their own potential and increase their self-esteem. These scripts are woven among the other exercises over the course of the event so that participants have a continuous opportunity to build resiliency by practicing seeing themselves as good, capable individuals. Each day starts out with a reminder of the positive affirmations from the previous day and ends with a “going to bed affirmation” that asks participants to visualize themselves in a positive light as they go to sleep.

Following are summaries of a few of the specific mind-training scripts used over the course of the weekend to train participants to truly believe in themselves. All scripts used in 3MV can be found in the resources section below.

The Lemon Test: The facilitator demonstrates how easy it is for a person to create a scenario in their mind, such as eating a lemon, and for the body to respond to it – even though the scenario is only visualized in their mind (its not real!). Participants are invited to consider what kinds of scenarios they have in their subconscious minds that are informing their conscious behaviours and actions.

High Road, Low Road: Participants envision their future with continued risk behaviours and adopt strategies for changing them.

Power Circle and Anchors: Participants practice claiming for themselves the qualities and characteristics they admire in others.

Community of Choice: Each participant draws an image of himself. The images are connected into a circle, and participants are asked to sign their images as a contract to themselves and to one another for continued growth.

Special Activities

Educational Community Outing: About halfway through the weekend, participants visit an HIV/STI testing clinic for a question-and-answer period with clinic staff. During the visit, participants observe a mock Point Of Care HIV test. The visit helps reduce any anxiety participants may have about being tested for the first time.

Spiritual Affirmation: The facilitators lead the group in a closing ceremony with a non-denominational spiritual theme. The session aims to connect participants with whatever resonates for them spiritually in their own lives, whether it is their faith of choice, a traditional spiritual teaching or a personal reference or resource.

Required Resources

Human resources

Program Coordinator and Facilitators

Black CAP runs its 3MV workshop with three facilitators who are representative of the Black GBT community. One of the three facilitators is a dedicated Program Coordinator. At any given time during the workshop at least two facilitators are present.

All facilitators are members of the Black GBT community and must be:

Knowledgeable about STIs and HIV
Experienced in using principles of self-actualization techniques to empower youth
Comfortable facilitating highly personal discussions of social and cultural factors affecting behaviours related to sexual health

Mentors

There is one mentor per meal to assist with meal preparation and clean-up and to facilitate discussion. Mentors must be:

Comfortable sharing their life experiences as Black GBT men
Committed to participating in the preparation of meals

Research Assistants

For evaluation purposes, two research assistants (RAs) are required to conduct intake and exit interviews and take field notes during the weekend. The RAs have also doubled as recruiters during Black CAP’s 3MV pilot. RAs must approach all of their tasks with a non-judgmental, inclusive approach. To date, Black CAP has recruited all of its RAs from 3MV workshops.

Material resources

Food
Handouts
Location
Yoga mats, inflatable mattresses and other bedding for participants to sleep on

Financial resources

The program’s major expenses are:

Honourarium (currently $150 per participant, with an additional $25 for those completing a final post-workshop focus group conducted to evaluate the program)
Food (a minimum of eight meals for 20 people—15 participants plus 2-3 facilitators, 1 mentor and 1 RA per meal)
Fee for the use of location (which has varied from $500 as an honourarium given to an individual who donated the use of his private home to $2,000 for the rental of an entire floor in a university dorm for a weekend)
Subway tokens (for participants who require transportation)

Challenges

GBT youth from communities of colour might be initially reluctant to participate in a group of strangers.
Getting youth to devote themselves to an entire weekend retreat may be challenging, particularly the first time such a workshop is offered; sufficient recruitment time and effort must be factored into the planning.
Participants in the program may find the transition/adjustment back to their “regular lives” difficult after a positive experience during the retreat; follow-up programming may be required.

Evaluation

The original 3MV program was developed in the U.S. and evaluated through a randomized controlled trial prior to being disseminated by the CDC’s Diffusion of Effective Behavioral Interventions project (DEBI). For more information on this iteration of the program, please see links to the DEBI site in Other Useful Resources.

Black CAP has implemented its own systematic evaluation plan for its version of 3MV. Research assistants (RAs) are employed to carry out this evaluation, which includes a pre-intake interview, a pre-participation survey, an exit interview one week after the retreat, an online survey one month after the retreat, and another online survey three months after the retreat. The RAs are present at the retreat to document input and collect feedback from the participants, mentors and facilitators. Participants are made aware that their participation in the program will be documented by researchers for use in evaluating and improving the program.

The information collected from these surveys and observations has been used by Black CAP to make adjustments to the program in each of its five initial iterations. After the completion of five retreats, two participants from each retreat were invited back for a one-time focus group. The data from this group were being compiled into a final comprehensive evaluation of the program at the time of writing and will be posted in the Program Materials section when it becomes available.

Following are samples of participant testimonials collected at various stages of the evaluation process to date:

“We were able to come together as a Black gay community and discuss important issues surrounding us like AIDS and HIV. That topic brought us all together and made us a family.”

“The amount of strength I walked out with in the end [was impressive]. I was moved way beyond farther than I thought I would be. I had so many insecurities and self-doubt.”

“It was good to hear from and see older Black mentors that went through what we’re going through, to hear their experiences and ask questions to help us with our troubles right now. It’s hard to find people to look up to, especially when you’re a Black male."

“Even going into the retreat I was sceptical. A group of Black young males [isn’t] going to listen: we’re going to rant and rave; we’re not going to learn anything. [But] being there, a family was created, and I was surprised by that.”

Black CAP eventually plans to disseminate information collected during the delivery and evaluation of 3MV through theatre, which will be developed and presented through a partnership with a theatre company in Toronto.

Future plans for expanded evaluations of the program include seeking funding to conduct a structured, quantitative analysis of its impact on the behaviours, relationship and emotions of participants in Black CAP’s version of the program. Black CAP also recognizes the need going forward to more clearly identify programming needs as distinct from research and evaluation goals.

Lessons Learned

An overnight retreat setting can be a powerful tool for building an immediate community dynamic.
Peer recruitment is most effective in generating interest
Many Black youth find spiritually-themed exercises empowering
Providing a context to interact in a non-sexualized environment can help young Black gay guys to identify as valued members of a vibrant community.
A key component of the program is the inclusion of mentors who are willing to share their experiences growing up as Black GBT men.
An American-based HIV prevention intervention can be transferred into a Canadian context if the model has been carefully adapted it to the realities of the local culture.

Program Materials

Original 3MV Fact Sheet

Contact Information

For more information on the project, please contact:

Garfield Durrant
MSM Prevention Coordinator
Black CAP
416-977-9955 x248
g.durrant@black-cap.com

David Lewis-Peart, MES (cand.)
MSM Prevention Research Coordinator
Black CAP
416-977-9955 x229
mprevention@black-cap.com

www.blackcap.ca